Tomy Varghese

Elastography: Ultrasonic estimation and imaging of the elastic properties of tissues

Abstract The basic principles of using sonographic techniques for imaging the elastic properties of tissues are described, with particular emphasis on elastography. After some preliminaries that describe some basic tissue stiffness measurements and some contrast transfer limitations of strain images are presented, four types of elastograms are described, which include axial strain, lateral strain, modulus and Poissons ratio elastograms. The strain filter formalism and its utility in understanding the noise performance of the elastographic process is then given, as well as its use for various image improvements. After discussing some main classes of elastographic artefacts, the paper concludes with recent results of tissue elastography in vitro and in vivo.

A theoretical framework for performance characterization of elastography: the strain filter

This paper presents a theoretical framework for performance characterization in strain estimation, which includes the effect of signal decorrelation, quantization errors due to the finite temporal sampling rate, and electronic noise. An upper bound on the performance of the strain estimator in elastography is obtained from a strain filter constructed using these limits. The strain filter is a term used to describe the nonlinear filtering process in the strain domain (due to the ultrasound system and signal processing parameters) that allows the elastographic depiction of a limited range of strains from the compressed tissue. The strain filter predicts the elastogram quality by specifying the elastographic signal-to-noise ratio (SNR/sub e/), sensitivity, and the strain dynamic range at a given resolution. The dynamic range is limited by decorrelation errors for large tissue strain values, and electronic noise for low strain values. Tradeoffs between different techniques used to enhance elastogram image quality may also be analyzed using the strain filter.

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.

ELASTOGRAPHIC IMAGING OF THERMAL LESIONS IN THE LIVER IN VIVO FOLLOWING RADIOFREQUENCY ABLATION: PRELIMINARY RESULTS

Radiofrequency (RF) ablation is an interstitial focal ablative therapy that can be used in a percutaneous fashion. This modality provides in situ destruction of hepatic tumors. However, local recurrence rates after RF ablative therapy are as high as 34% to 55%, believed to be due in part to the inability to visualize accurately the zone of necrosis (thermal lesion). This can lead to the incomplete ablation of the tumor, generally in areas near the tumor edges. In this paper, we show that ultrasound (US)-based in vivo elastography can accurately depict thermal lesions after thermal therapy. However, elastography of the liver and other abdominal organs is challenging due to the difficulty in providing controlled and reproducible compression. The use of the RF ablation probe as the compressor/displacement device reduces lateral slippage or nonaxial motion that may occur with externally applied compressions or imaging during the respiratory cycle. This technique also provides controlled and reproducible compressions of the liver for in vivo elastographic imaging. Comparison of elastograms with histology of ablated tissue demonstrates a close relationship between elastographic image features and histopathology.

Tissue-mimicking agar/gelatin materials for use in heterogeneous elastography phantoms

Five 9 cm x 9 cm x 9 cm phantoms, each with a 2-cm-diameter cylindrical inclusion, were produced with various dry-weight concentrations of agar and gelatin. Elastic contrasts ranged from 1.5 to 4.6, and values of the storage modulus (real part of the complex Youngs modulus) were all in the soft tissue range. Additives assured immunity from bacterial invasion and can produce tissue-mimicking ultrasound and NMR properties. Monitoring of strain ratios over a 7 to 10 month period indicated that the mechanical properties of the phantoms were stable, allowing about 1 month for the phantom to reach chemical equilibrium. The only dependable method for determining the storage moduli of the inclusions is to make measurements on samples excised from the phantoms. If it is desired to produce and accurately characterize a phantom with small inclusions with other shapes, such as an array of small spheres, an auxiliary phantom with the geometry of the cylindrical inclusion phantoms or the equivalent should be made at the same time using the same materials. The elastic contrast can then be determined using samples excised from the auxiliary phantom. A small increase of about 10% in volume of the cylindrical inclusions occurred-a tolerable increase. Interestingly, the smallest increase (about 5%) occurred in the phantom with the largest elastic contrast.

Viscoelastic characterization of in vitro canine tissue

Mechanical properties of biological tissues are of interest for assessing the performance of elastographic methods that evaluate the stiffness characteristics of tissue. The mechanical properties of interest include the frequency-dependent complex moduli, storage and loss moduli of tissues. Determination of the mechanical properties of biological tissues is often limited by proper geometry of the sample, as well as homogeneity of the stress-strain relationship. Measurements were performed on in vitro canine liver tissue specimens, over a frequency range from 0.1 to 400 Hz. Tests were conducted using an EnduraTEC ELF 3200, a dynamic testing system for determining the mechanical properties of materials. Both normal tissues and thermal lesions prepared by radio frequency ablation were tested. Experiments were conducted by uniaxially compressing tissue samples using Plexiglas platens larger than the specimens and measuring the load response. The resulting moduli spectra were then fit to a modified Kelvin-Voigt model, called the Kelvin-Voigt fractional derivative model. The data agree well with the model and in comparing the results from the normal tissue with that of the thermal lesions, the concept of a complex modulus contrast is introduced and its applications to elastography are discussed.

An analysis of elastographic contrast-to-noise ratio

We present a theoretical formalism and simulation results that allow the incorporation of the elastic contrast properties of tissues with simple geometries into the elastographic noise models developed previously. This analysis results in the computation of the elastographic contrast-to-noise ratio (CNRe). The CNRe in elastography is an important quantity that is related to the detectability of a lesion or inhomogeneity. In this paper, the upper bound on the elastographic CNRe is derived for both a one-dimensional (1-D) and 2-D analytic plane-strain tissue model. The CNRe in the elastogram depends on the contrast-transfer efficiency (CTE) for both the 1-D and 2-D geometries discussed in this paper. The 1-D model is used to characterize layered structures and the 2-D model is derived for circular inclusion within a background of uniform elasticity. A previously derived classical analytic solution of the elasticity equations, for a circular inclusion embedded in an infinite medium and subjected to a uniaxial compression, is used to compute the upper bound of the CNRe. Monte Carlo simulations illustrate the close correspondence between the theoretical and simulation results.

Noise reduction in elastograms using temporal stretching with multicompression averaging

Elastography uses estimates of the time delay (obtained by cross-correlation) to compute strain estimates in tissue due to quasistatic compression. Because the time delay estimates do not generally occur at the sampling intervals, the location of the cross-correlation peak does not give an accurate estimate of the time delay. Sampling errors in the time-delay estimate are reduced using signal interpolation techniques to obtain subsample time-delay estimates. Distortions of the echo signals due to tissue compression introduce correlation artifacts in the elastogram. These artifacts are reduced by a combination of small compressions and temporal stretching of the postcompression signal. Random noise effects in the resulting elastograms are reduced by averaging several elastograms, obtained from successive small compressions (assuming that the errors are uncorrelated). Multicompression averaging with temporal stretching is shown to increase the signal-to-noise ratio in the elastogram by an order of magnitude, without sacrificing sensitivity, resolution or dynamic range. The strain filter concept is extended in this article to theoretically characterize the performance of multicompression averaging with temporal stretching.

Ultrasound monitoring of temperature change during radiofrequency ablation: preliminary in-vivo results.

Radiofrequency (RF) ablation is an interstitial focal ablative therapy that can be used in a percutaneous fashion and permits in situ destruction of hepatic tumors. However, local tumor recurrence rates after RF ablative therapy are as high as 34% to 55%, which may be due in part to the inability to monitor accurately temperature profiles in the tissue being ablated, and to visualize the subsequent zone of necrosis (thermal lesion) formed. The goal of the work described in this paper was to investigate methods for the real-time and in vivo monitoring of the spatial distribution of heating and temperature elevation to achieve better control of the degree of tissue damage during RF ablation therapy. Temperature estimates are obtained using a cross-correlation algorithm applied to RF ultrasound (US) echo signal data acquired at discrete intervals during heating. These temperature maps were used to display the initial temperature rise and to continuously update a thermal map of the treated region. Temperature monitoring is currently performed using thermosensors on the prongs (tines) of the RF ablation probe. However, monitoring the spatial distribution of heating is necessary to control the degree of tissue damage produced.

Temperature dependence of ultrasonic propagation speed and attenuation in excised canine liver tissue measured using transmitted and reflected pulses

Previous reported data from our laboratory demonstrated the temperature dependence of propagation speed and attenuation of canine tissue in vitro at discrete temperatures ranging from 25 to 95 degrees C. However, concerns were raised regarding heating the same tissue specimen over the entire temperature range, a process that may introduce irreversible and, presumably, cumulative tissue degradation. In this paper propagation speed and attenuation vs temperature are measured using multiple groups of samples, each group heated to a different temperature. Sample thicknesses are measured directly using a technique that uses both transmitted and reflected ultrasound pulses. Results obtained using 3 and 5 MHz center frequencies demonstrate a propagation speed elevation of around 20 m/s in the 22-60 degrees C range, and a decrease of 15 m/s in the 60-90 degrees C range, in agreement with previous results where the same specimens were subjected to the entire temperature range. However, sound speed results reported here are slightly higher than those reported previously, probably due to more accurate measurements of sample thickness in the present experiments. Results also demonstrate that while the propagation speed varies with temperature, it is not a function of tissue coagulation. In contrast, the attenuation coefficient depends on both tissue coagulation effects and temperature elevation.