Raffaella Righetti

ELASTOGRAPHIC CHARACTERIZATION OF HIFU-INDUCED LESIONS IN CANINE LIVERS

The elastographic visualization and evaluation of high-intensity focused ultrasound (HIFU)-induced lesions were investigated. The lesions were induced in vitro in freshly excised canine livers. The use of different treatment intensity levels and exposure times resulted in lesions of different sizes. Each lesion was clearly depicted by the corresponding elastogram as being an area harder than the background. The strain contrast of the lesion/background was found to be dependent on the level of energy deposition. A lesion/background strain contrast between -2.5 dB and -3.5 dB was found to completely define the entire zone of tissue damage. The area of tissue damage was automatically estimated from the elastograms by evaluating the number of pixels enclosed inside the isointensity contour lines corresponding to a strain contrast of -2.5, -3 and -3.5 dB. The area of the lesion was measured from a tissue photograph obtained at approximately the same plane where elastographic data were collected. The estimated lesion areas ranged between approximately 10 mm2 and 110 mm2. A high correlation between the damaged areas as depicted by the elastograms and the corresponding areas as measured from the gross pathology photographs was found (r2 = 0.93, p value < 0.0004, n = 16). This statistically significant high correlation demonstrates that elastography has the potential to become a reliable and accurate modality for HIFU therapy monitoring.

Elastography : Imaging the Elastic Properties of Soft Tissues with Ultrasound

Elastography is a method that can ultimately generate several new kinds of images, called elastograms. As such, all the properties of elastograms are different from the familiar properties of sonograms. While sonograms convey information related to the local acoustic backscatter energy from tissue components, elastograms relate to its local strains, Youngs moduli or Poissons ratios. In general, these elasticity parameters are not directly correlated with sonographic parameters, i.e. elastography conveys new information about internal tissue structure and behavior under load that is not otherwise obtainable. In this paper we summarize our work in the field of elastography over the past decade. We present some relevant background material from the field of biomechanics. We then discuss the basic principles and limitations that are involved in the production of elastograms of biological tissues. Results from biological tissues in vitro and in vivo are shown to demonstrate this point. We conclude with some observations regarding the potential of elastography for medical diagnosis.

The feasibility of elastographic visualization of HIFU-induced thermal lesions in soft tissues

The potential for visualizing high-intensity focused ultrasound (HIFU)-induced thermal lesions in biological soft tissues in vitro using elastography was investigated. Thermal lesions were created in rabbit paraspinal skeletal muscle in vivo. The rabbits were sacrificed 60 h following the treatment and lesioned tissues were excised. The tissues were cast in a block of clear gel and elastographic images of the lesions were acquired. Gross pathology of the tissue samples confirmed the characteristics of the lesions.The potential for visualizing high-intensity focused ultrasound (HIFU)-induced thermal lesions in biological soft tissues in vitro using elastography was investigated. Thermal lesions were created in rabbit paraspinal skeletal muscle in vivo. The rabbits were sacrificed 60 h following the treatment and lesioned tissues were excised. The tissues were cast in a block of clear gel and elastographic images of the lesions were acquired. Gross pathology of the tissue samples confirmed the characteristics of the lesions.

Tradeoffs in elastographic imaging.

This paper presents the tradeoffs in elastographic imaging. Elastography is viewed as a new imaging modality and presented in terms of three fundamental concepts that constitute the basis for the elastographic imaging process. These are the tissue elastic deformation process, the statistical analysis of strain estimation and the image characterization. The first concept involves the use of the contrast transfer efficiency (CTE) that describes the mapping of a distribution of local tissue elastic moduli into a distribution of local longitudinal tissue strains. The second concept defines the elastographic system and the relationship between ultrasonic and signal processing parameters. This process is described in terms of a stochastic framework (the strain filter) that provides upper and practical performance bounds and their dependence on the various system parameters. Finally, the output image, the elastogram, is characterized by its image parameters, such as signal-to-noise ratio, contrast-to-noise ratio, dynamic range and resolution. Finite-element simulations are used to generate examples of elastograms that are confirmed by the theoretical prediction tools.

Axial resolution in elastography

The limits and trade-offs of the axial resolution in elastography were investigated using a controlled simulation study. The axial resolution in elastography was estimated as the distance between the full widths at half-maximum of the strain profiles of two equally stiff lesions embedded in a softer homogeneous background. The results show that the upper bound of the axial resolution in elastography is controlled by the physical wave parameters of the ultrasound (US) system used to acquire the data (transducer center frequency and band- width). However, an inappropriate choice of the parameters used to process the US data (cross-correlation window length and shift between consecutive windows) may compromise the best resolution attainable. The measured elastographic axial resolution was found to be on the order of the ultrasonic wavelength.

Trade-offs between the axial resolution and the signal-to-noise ratio in elastography.

Elastography involves tracking the ultrasonic A-mode signals before and after mechanical compression of tissue to form a computed image of the local strains undergone by various tissue components. The quality of the strain estimates in elastography is typically quantified using factors such as the elastographic SNR (SNR(e)), contrast-to-noise ratio (CNR(e)), and the spatial resolution. These quality factors depend on the mechanical parameters (such as the applied strain and the boundary conditions), the acoustic parameters (such as the sonographic SNR, the center frequency, and the bandwidth), and the signal-processing parameters (such as the window length and the window separation). Theoretical developments in elastography have established functional relationships between the SNR(e) and CNR(e) and these parameters. Similarly, simulations have established empirical relationships between the axial resolution and the acoustic and signal-processing parameters. We find that a trade-off exists between the achievable SNR(e) (CNR(e)) and the axial resolution in elastography and that the trade-off occurs only with respect to the signal-processing parameters. Theoretical work on the spatial resolution accompanied with simulations and experiments were used to confirm such an observation. The trade-off between the SNR(e) (CNR(e)) and the resolution was found to be nonlinear, with large improvements in the SNR(e) being possible at the expense of small reductions in the axial resolution. All the quality factors improve with the acoustic parameters, which suggests the preferred use of transducers with high absolute bandwidths and center frequencies.

Lateral resolution in elastography

The factors that control the lateral resolution in elastography were investigated using a simulation study. The lateral resolution was estimated from the simulated axial strain elastograms as the smallest measurable distance between two equally stiff lesions embedded in a homogeneously softer background. The lesions were symmetrically positioned lateral to the center of the target, at the focus of the transducer. Ultrasound (US) systems with different transducer frequencies, bandwidths and f-numbers were simulated. The effects of the ultrasonic parameters, the lateral spacing between adjacent echo signals, the cross-correlation window length, the lesion/background elastic contrast and the lateral motion of scatterers on the estimated lateral resolution were investigated. The results show that the lateral resolution in elastography is proportional to the beam width of the US system used to acquire the data, and is on the same order as the sonographic lateral resolution.

The feasibility of using poroelastographic techniques for distinguishing between normal and lymphedematous tissues in vivo

Lymphedema is a common condition involving an abnormal accumulation of lymphatic fluid in the interstitial space that causes swelling, most often in the arm(s) and leg(s). Lymphedema is a significant lifelong concern that can be congenital or develop following cancer treatment or cancer metastasis. Common methods of evaluation of lymphedema are mostly qualitative making it difficult to reliably assess the severity of the disease, a key factor in choosing the appropriate treatment. In this paper, we investigate the feasibility of using novel elastographic techniques to differentiate between lymphedematous and normal tissues. This study represents the first step of a larger study aimed at investigating the combined use of elastographic and sonographic techniques for the detection and staging of lymphedema. In this preliminary study, poroelastographic images were generated from the leg (8) and arm (4) subcutis of five normal volunteers and seven volunteers having lymphedema, and the results were compared using statistical analyses. The preliminary results reported in this paper suggest that it may be feasible to perform poroelastography in different lymphedematous tissues in vivo and that poroelastography techniques may be of help in differentiating between normal and lymphedematous tissues.

The feasibility of estimating and imaging the mechanical behavior of poroelastic materials using axial strain elastography

In this paper, we have investigated the feasibility of imaging the mechanical behavior of poroelastic materials using axial strain elastography. Cylindrical samples obtained from poroelastic materials having different elastic and permeability properties were subjected to a constant compression force (a classical creep experiment), during which poroelastographic data were acquired. For comparison, we also tested a few gelatin phantoms and non-homogeneous poroelastic phantoms constructed by combining different poroelastic materials. From the acquired data, we generated time-dependent sequences of axial strain elastograms and effective Poissons ratio elastograms, which were then used for generating axial strain and effective Poissons ratio time-constant elastograms. Thereafter, the various poroelastographic images were analyzed to evaluate the presence of statistically significant differences among the two types of poroelastic samples and for image quality analysis. The results of this study demonstrate that it is technically feasible to use axial strain elastography to distinguish among homogeneous poroelastic materials characterized by different elastic and permeability properties. They also show that the use of axial strain elastography instead of effective Poissons ratio elastography results in objectively higher quality poroelastograms of the temporal behavior of the poroelastic materials under loading. However, the use of effective Poissons ratio elastography may in any case be required to verify that the temporal changes occurring in the axial strains of the homogeneous poroelastic samples are also accompanied by temporal changes of the effective Poissons ratios and are therefore due to poroelastic behavior.

Resolution of axial shear strain elastography

The technique of mapping the local axial component of the shear strain due to quasi-static axial compression is defined as axial shear strain elastography. In this paper, the spatial resolution of axial shear strain elastography is investigated through simulations, using an elastically stiff cylindrical lesion embedded in a homogeneously softer background. Resolution was defined as the smallest size of the inclusion for which the strain value at the inclusion/background interface was greater than the average of the axial shear strain values at the interface and inside the inclusion. The resolution was measured from the axial shear strain profile oriented at 45 degrees to the axis of beam propagation, due to the absence of axial shear strain along the normal directions. The effects of the ultrasound system parameters such as bandwidth, beamwidth and transducer element pitch along with signal processing parameters such as correlation window length (W) and axial shift (DeltaW) on the estimated resolution were investigated. The results show that the resolution (at 45 degrees orientation) is determined by the bandwidth and the beamwidth. However, the upper bound on the resolution is limited by the larger of the beamwidth and the window length, which is scaled inversely to the bandwidth. The results also show that the resolution is proportional to the pitch and not significantly affected by the axial window shift.