Toward simultaneous flow and pressure assessment in large arteries using non-invasive ultrasound

Ultrageluid wordt in de kliniek vaak toegepast om op een niet-invasieve manier geometrische eigenschappen van grote vaten, zoals diameter en wanddikte en hemodynamische variabelen zoals bloedstroomsnelheid te bepalen. Om biomechanische parameters en hemodynamische variabelen die karakteristiek zijn voor de ontwikkeling van hart en vaatziekten, zoals compliantie en impedantie, te bepalen, is de bepaling van geometrie en bloedstroomsnelheid alleen onvoldoende. Daarvoor is een gelijktijdige en bij voorkeur niet invasieve meting van debiet en druk vereist. Met de huidige ultrageluidstechnieken is het onmogelijk om gelijktijdig debiet en druk nauwkeurig te bepalen. Debiet wordt vaak bepaald aan de hand van twee metingen: een diametermeting (geluidsbundel loodrecht op het vat) en een meting van de maximale axiale bloedstroomsnelheid met behulp van Doppler ultrageluid (geluidsbundel onder een hoek met het vat). Door een theoretische snelheidsverdeling aan te nemen, bijvoorbeeld een Poiseuille of Womersley profiel, wordt hieruit vervolgens het debiet berekend. In-vivo zijn vaten zelden recht: vaten zijn taps toelopend, gekromd en hebben vertakkingen. Dientengevolge zijn er secundaire snelheidscomponenten aanwezig die de axiale snelheidverdeling be¨invloeden. Dit resulteert in asymmetrische axiale snelheidsverdelingen. Omdat de aangenomen snelheidsverdelingen slechts geldig zijn voor rechte vaten, geeft een dusdanige bepaling een onnauwkeurige afschatting van het debiet. Verder is het onmogelijk om gelijktijdig met de snelheidsmeting nauwkeurig de wandbeweging te bepalen, waardoor de debietmeting nog verder verslechtert en het gelijktijdig bepalen van druk uit wandbeweging en debiet onmogelijk wordt. In dit onderzoek worden Particle Image Velocimetry (PIV) gebaseerde algoritmen toegepast op RF-data die verkregen zijn met behulp van een commercieel beschikbaar, voor klinische toepassing goedgekeurd ultrageluidssysteem. Dit maakt het mogelijk om snelheidscomponenten loodrecht op de ultrageluidbundel, en dus gelijktijdig wandpositie en axiale snelheid nauwkeurig te meten. Deze snelheidsmeettechniek is gevalideerd door metingen van het snelheidsprofiel in een experimentele opstelling te vergelijken met resultaten van computational fluid dynamics (CFD) berekeningen, voor stationaire en instationaire stromingen in een recht vat. Er werd een goede overeenstemming gevonden voor het axiale snelheidsprofiel. Integratie van het gemeten axiale snelheidsprofiel leverde een nauwkeurige afschatting van het debiet op. Omdat in de praktijk de meeste vaten gekromd zijn is de snelheids meetmethode vervolgens gevalideerd voor toepassing op stromingen in dit soort geometrieën. In de experimentele opstelling zijn axiale snelheidsprofielen gemeten voor stationaire en instationaire stroming in kromme buizen. Opnieuw zijn de gemeten profielen vergeleken met resultaten van CFD-berekeningen. Ook hier werd een goede overeenstemming gevonden tussen de gemeten profielen en de met behulp van CFD berekende snelheidsprofielen. Om nauwkeurig debiet te bepalen op basis van de gemeten asymmetrische axiale snelheidsprofielen, is een analytische en een op CFD gebaseerde studie gedaan naar stroming in kromme vaten. Deze studie heeft geresulteerd in de cos ¿-methode. Toepassing van de cos ¿-methode op de gemeten asymmetrische axiale profielen gaf een nauwkeurige afschatting van het debiet, voor stationaire en instationaire flow. Vergeleken met de huidig toegepaste afschattingsmethode voor het debiet werd een grote verbetering gevonden. Voor een fysiologisch relevant debiet gaf de cos ¿-methode een gemiddelde afwijking van 5% ten opzichte van het referentiedebiet terwijl deze voor de huidig toegepaste Poiseuille en Womersley benaderingen gelijk was aan 20%. Tenslotte is getracht om de lokale druk te bepalen uit enkel een niet-invasieve ultrageluidsmeting door een meting van de diameter te combineren met een gelijktijdige bepaling van de lokale compliantie. De lokale compliantie is bepaald door de lokale golfsnelheid (PWV) te meten. Verschillende methoden om lokaal de PWV te meten zijn getest in de experimentele opstelling. Hieruit bleek dat de QA-methode, een methode waarbij de lokale PWV bepaald wordt uit de verhouding tussen veranderingen in debiet en veranderingen in oppervlak van de dwarsdoorsnede van het vat, het mogelijk maakt om lokaal nauwkeurig PWV te meten. Door de PWV meting te combineren met een gelijktijdige meting van de diameter werd de lokale druk nauwkeurig afgeschat. Dit geeft aan dat het haalbaar is om op een niet-invasieve manier in-vivo druk te meten met behulp van ultrageluid. Hoewel de meettechnieken besproken in deze studie alleen getest zijn voor toepassing in een gecontroleerde experimentele omgeving, zijn de vooruitzichten voor klinische toepassing veelbelovend. De gepresenteerde methoden maken het mogelijk om de toestand van het vaatbed nauwkeuriger te bepalen, waardoor in de toekomst informatie verkregen kan worden over het effect van therapeutische ingrepen en factoren ge¨identificeerd kunnen worden die karakteristiek zijn voor de ontwikkeling van hart- en vaatziekten

Arterial elasticity imaging: comparison of finite-element analysis models with high-resolution ultrasound speckle tracking

<p>Abstract</p> <p>Background</p> <p>The nonlinear mechanical properties of internal organs and tissues may be measured with unparalleled precision using ultrasound imaging with phase-sensitive speckle tracking. The many potential applications of this important noninvasive diagnostic approach include measurement of arterial stiffness, which is associated with numerous major disease processes. The accuracy of previous ultrasound measurements of arterial stiffness and vascular elasticity has been limited by the relatively low strain of nonlinear structures under normal physiologic pressure and the measurement assumption that the effect of the surrounding tissue modulus might be ignored in both physiologic and pressure equalized conditions.</p> <p>Methods</p> <p>This study performed high-resolution ultrasound imaging of the brachial artery in a healthy adult subject under normal physiologic pressure and the use of external pressure (pressure equalization) to increase strain. These ultrasound results were compared to measurements of arterial strain as determined by finite-element analysis models with and without a surrounding tissue, which was represented by homogenous material with fixed elastic modulus.</p> <p>Results</p> <p>Use of the pressure equalization technique during imaging resulted in average strain values of 26% and 18% at the top and sides, respectively, compared to 5% and 2%, at the top and sides, respectively, under physiologic pressure. In the artery model that included surrounding tissue, strain was 19% and 16% under pressure equalization versus 9% and 13% at the top and sides, respectively, under physiologic pressure. The model without surrounding tissue had slightly higher levels of strain under physiologic pressure compared to the other model, but the resulting strain values under pressure equalization were > 60% and did not correspond to experimental values.</p> <p>Conclusions</p> <p>Since pressure equalization may increase the dynamic range of strain imaging, the effect of the surrounding tissue on strain should be incorporated into models of arterial strain, particularly when the pressure equalization technique is used.</p

Characterization of carotid artery plaques using noninvasive vascular ultrasound elastography

L'athérosclérose est une maladie vasculaire complexe qui affecte la paroi des artères (par l'épaississement) et les lumières (par la formation de plaques). La rupture d'une plaque de l'artère carotide peut également provoquer un accident vasculaire cérébral ischémique et des complications. Bien que plusieurs modalités d'imagerie médicale soient actuellement utilisées pour évaluer la stabilité d'une plaque, elles présentent des limitations telles que l'irradiation, les propriétés invasives, une faible disponibilité clinique et un coût élevé. L'échographie est une méthode d'imagerie sûre qui permet une analyse en temps réel pour l'évaluation des tissus biologiques. Il est intéressant et prometteur d’appliquer une échographie vasculaire pour le dépistage et le diagnostic précoces des plaques d’artère carotide. Cependant, les ultrasons vasculaires actuels identifient uniquement la morphologie d'une plaque en termes de luminosité d'écho ou l’impact de cette plaque sur les caractéristiques de l’écoulement sanguin, ce qui peut ne pas être suffisant pour diagnostiquer l’importance de la plaque. La technique d’élastographie vasculaire non-intrusive (« noninvasive vascular elastography (NIVE) ») a montré le potentiel de détermination de la stabilité d'une plaque. NIVE peut déterminer le champ de déformation de la paroi vasculaire en mouvement d’une artère carotide provoqué par la pulsation cardiaque naturelle. En raison des différences de module de Young entre les différents tissus des vaisseaux, différents composants d’une plaque devraient présenter différentes déformations, caractérisant ainsi la stabilité de la plaque. Actuellement, les performances et l’efficacité numérique sous-optimales limitent l’acceptation clinique de NIVE en tant que méthode rapide et efficace pour le diagnostic précoce des plaques vulnérables. Par conséquent, il est nécessaire de développer NIVE en tant qu’outil d’imagerie non invasif, rapide et économique afin de mieux caractériser la vulnérabilité liée à la plaque. La procédure à suivre pour effectuer l’analyse NIVE consiste en des étapes de formation et de post-traitement d’images. Cette thèse vise à améliorer systématiquement la précision de ces deux aspects de NIVE afin de faciliter la prédiction de la vulnérabilité de la plaque carotidienne. Le premier effort de cette thèse a été dédié à la formation d'images (Chapitre 5). L'imagerie par oscillations transversales a été introduite dans NIVE. Les performances de l’imagerie par oscillations transversales couplées à deux estimateurs de contrainte fondés sur un modèle de déformation fine, soit l’ « affine phase-based estimator (APBE) » et le « Lagrangian speckle model estimator (LSME) », ont été évaluées. Pour toutes les études de simulation et in vitro de ce travail, le LSME sans imagerie par oscillation transversale a surperformé par rapport à l'APBE avec imagerie par oscillations transversales. Néanmoins, des estimations de contrainte principales comparables ou meilleures pourraient être obtenues avec le LSME en utilisant une imagerie par oscillations transversales dans le cas de structures tissulaires complexes et hétérogènes. Lors de l'acquisition de signaux ultrasonores pour la formation d'images, des mouvements hors du plan perpendiculaire au plan de balayage bidimensionnel (2-D) existent. Le deuxième objectif de cette thèse était d'évaluer l'influence des mouvements hors plan sur les performances du NIVE 2-D (Chapitre 6). À cette fin, nous avons conçu un dispositif expérimental in vitro permettant de simuler des mouvements hors plan de 1 mm, 2 mm et 3 mm. Les résultats in vitro ont montré plus d'artefacts d'estimation de contrainte pour le LSME avec des amplitudes croissantes de mouvements hors du plan principal de l’image. Malgré tout, nous avons néanmoins obtenu des estimations de déformations robustes avec un mouvement hors plan de 2.0 mm (coefficients de corrélation supérieurs à 0.85). Pour un jeu de données cliniques de 18 participants présentant une sténose de l'artère carotide, nous avons proposé d'utiliser deux jeux de données d'analyses sur la même plaque carotidienne, soit des images transversales et longitudinales, afin de déduire les mouvements hors plan (qui se sont avérés de 0.25 mm à 1.04 mm). Les résultats cliniques ont montré que les estimations de déformations restaient reproductibles pour toutes les amplitudes de mouvement, puisque les coefficients de corrélation inter-images étaient supérieurs à 0.70 et que les corrélations croisées normalisées entre les images radiofréquences étaient supérieures à 0.93, ce qui a permis de démontrer une plus grande confiance lors de l'analyse de jeu de données cliniques de plaques carotides à l'aide du LSME. Enfin, en ce qui concerne le post-traitement des images, les algorithmes NIVE doivent estimer les déformations des parois des vaisseaux à partir d’images reconstituées dans le but d’identifier les tissus mous et durs. Ainsi, le dernier objectif de cette thèse était de développer un algorithme d'estimation de contrainte avec une résolution de la taille d’un pixel ainsi qu'une efficacité de calcul élevée pour l'amélioration de la précision de NIVE (Chapitre 7). Nous avons proposé un estimateur de déformation de modèle fragmenté (SMSE) avec lequel le champ de déformation dense est paramétré avec des descriptions de transformées en cosinus discret, générant ainsi des composantes de déformations affines (déformations axiales et latérales et en cisaillement) sans opération mathématique de dérivées. En comparant avec le LSME, le SMSE a réduit les erreurs d'estimation lors des tests de simulations, ainsi que pour les mesures in vitro et in vivo. De plus, la faible mise en oeuvre de la méthode SMSE réduit de 4 à 25 fois le temps de traitement par rapport à la méthode LSME pour les simulations, les études in vitro et in vivo, ce qui pourrait permettre une implémentation possible de NIVE en temps réel.Atherosclerosis is a complex vascular disease that affects artery walls (by thickening) and lumens (by plaque formation). The rupture of a carotid artery plaque may also induce ischemic stroke and complications. Despite the use of several medical imaging modalities to evaluate the stability of a plaque, they present limitations such as irradiation, invasive property, low clinical availability and high cost. Ultrasound is a safe imaging method with a real time capability for assessment of biological tissues. It is clinically used for early screening and diagnosis of carotid artery plaques. However, current vascular ultrasound technologies only identify the morphology of a plaque in terms of echo brightness or the impact of the vessel narrowing on flow properties, which may not be sufficient for optimum diagnosis. Noninvasive vascular elastography (NIVE) has been shown of interest for determining the stability of a plaque. Specifically, NIVE can determine the strain field of the moving vessel wall of a carotid artery caused by the natural cardiac pulsation. Due to Young’s modulus differences among different vessel tissues, different components of a plaque can be detected as they present different strains thereby potentially helping in characterizing the plaque stability. Currently, sub-optimum performance and computational efficiency limit the clinical acceptance of NIVE as a fast and efficient method for the early diagnosis of vulnerable plaques. Therefore, there is a need to further develop NIVE as a non-invasive, fast and low computational cost imaging tool to better characterize the plaque vulnerability. The procedure to perform NIVE analysis consists in image formation and image post-processing steps. This thesis aimed to systematically improve the accuracy of these two aspects of NIVE to facilitate predicting carotid plaque vulnerability. The first effort of this thesis has been targeted on improving the image formation (Chapter 5). Transverse oscillation beamforming was introduced into NIVE. The performance of transverse oscillation imaging coupled with two model-based strain estimators, the affine phase-based estimator (APBE) and the Lagrangian speckle model estimator (LSME), were evaluated. For all simulations and in vitro studies, the LSME without transverse oscillation imaging outperformed the APBE with transverse oscillation imaging. Nonetheless, comparable or better principal strain estimates could be obtained with the LSME using transverse oscillation imaging in the case of complex and heterogeneous tissue structures. During the acquisition of ultrasound signals for image formation, out-of-plane motions which are perpendicular to the two-dimensional (2-D) scan plane are existing. The second objective of this thesis was to evaluate the influence of out-of-plane motions on the performance of 2-D NIVE (Chapter 6). For this purpose, we designed an in vitro experimental setup to simulate out-of-plane motions of 1 mm, 2 mm and 3 mm. The in vitro results showed more strain estimation artifacts for the LSME with increasing magnitudes of out-of-plane motions. Even so, robust strain estimations were nevertheless obtained with 2.0 mm out-of-plane motion (correlation coefficients higher than 0.85). For a clinical dataset of 18 participants with carotid artery stenosis, we proposed to use two datasets of scans on the same carotid plaque, one cross-sectional and the other in a longitudinal view, to deduce the out-of-plane motions (estimated to be ranging from 0.25 mm to 1.04 mm). Clinical results showed that strain estimations remained reproducible for all motion magnitudes since inter-frame correlation coefficients were higher than 0.70, and normalized cross-correlations between radiofrequency images were above 0.93, which indicated that confident motion estimations can be obtained when analyzing clinical dataset of carotid plaques using the LSME. Finally, regarding the image post-processing component of NIVE algorithms to estimate strains of vessel walls from reconstructed images with the objective of identifying soft and hard tissues, we developed a strain estimation method with a pixel-wise resolution as well as a high computation efficiency for improving NIVE (Chapter 7). We proposed a sparse model strain estimator (SMSE) for which the dense strain field is parameterized with Discrete Cosine Transform descriptions, thereby deriving affine strain components (axial and lateral strains and shears) without mathematical derivative operations. Compared with the LSME, the SMSE reduced estimation errors in simulations, in vitro and in vivo tests. Moreover, the sparse implementation of the SMSE reduced the processing time by a factor of 4 to 25 compared with the LSME based on simulations, in vitro and in vivo results, which is suggesting a possible implementation of NIVE in real time

Quantification of Blood Velocity and Vascular Wall Shear Rate From Ultrasound Radio Frequency Signals and Its Relationship to Vascular Mechanical Properties and Potential Clinical Applications.

This study evaluates a novel measurement method of determining vascular wall strain and wall shear rate, which are interrelated physiologic parameters fundamentally important in vascular disease. Wall strains during vascular wall dilation were performed using ultrasound 2D speckle tracking; vascular wall edges and vascular wall shear rate were determined using decorrelation based velocity measurement method for in-vitro and in-vivo flow measurement. These experiments and measurements were performed to investigate both the novel measurement methods as well as the relationship between the vascular wall shear rate and vascular wall dilation. First, this study measures arterial wall strains using the ultrasound radio-frequency (RF) signals. Strains in the arterial wall during arterial dilation (from diastole to systole) were determined using a 2D speckle tracking algorithm. These ultrasound results were compared with measurements of arterial strain as determined by finite-element analysis (FEA) models with and without the effects from surrounding tissue, which was represented by homogenous material with fixed elastic modulus. Under pressure equalization, the strain levels predicted by FEA model without surrounding tissue were considerably greater than the strain levels measured by both ultrasound and the FEA model with surrounding tissue. Second, this research aims to measure wall edges and wall shear rate for in-vitro flow experiment using decorrelation ultrasound based velocity measurement. The flow velocity was obtained by multiplying the speckle movement in two consecutive frames by the acoustic frame rate. The wall edge was determined using B-mode images and 2nd order gradient of flow velocity profiles. The wall shear rate was measured at the wall edge and evaluated by comparison with velocity gradients from parabolic flow velocity profile based on Poiseuille theory. Third, this research measures the vascular wall shear rate in the brachial artery for healthy and renal disease subjects using the decorrelation based ultrasound velocity measurement. The vascular wall shear rate and vascular diameter pre-, during- and post-vascular occlusion with pressure cuffs were compared for the healthy and renal disease subjects at top and bottom wall edges. The mean vascular wall shear rate change between pre- and post-vascular occlusion was significantly different for the healthy versus renal disease subjects.Ph.D.Biomedical EngineeringUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/91610/1/bigrain_1.pd

Cyclic variation of the common carotid artery structure in relation to prior atherosclerotic burden and physical activity

Background and aims: Cardiovascular disease (CVD) accounts for the most deaths of non-communicable diseases worldwide. It begins with structural and functional changes of the arterial system commonly known as the atherosclerotic process, starting asymptomatically in early childhood, adapting arterial structure and function with advancing age depending on genetic and environmental exposures and finally resulting in CVD events such as myocardial infarction or stroke. CVD risk prediction today is generally based on risk scores, but substantial disadvantages occur since they account only for specific risk factors at one time point. Carotid structure and function (also called carotid stiffness) parameters measured by ultrasound may overcome this disadvantage, since they can provide information on structural and elastic carotid properties and reflect therefore vascular damage accumulated over time. Thus, the aims of this thesis were to summarize the state of the art of ultrasound measurements, to validate the new developed ultrasound analysis system, to assess the variability and reproducibility within the study sample and to investigate the long- and short-term associations of cardiovascular risk factors and carotid stiffness with main focus on physical activity in elderly participants of the SAPALDIA cohort. Methods: The SAPALDIA cohort study is an ongoing multicenter study with a population-based random sample of adults from eight rural and urban areas started in 1991 (SAPALDIA 1), with a first follow-up in 2001-2003 (SAPALDIA 2) and a second follow-up in 2010-2011 (SAPALDIA 3). In SAPALDIA 3, sequential B-mode ultrasound images of the common carotid artery were examined in 3489 participants (51% women) aged between 50-81 years at the time of examination. Expert readers analyzed these ultrasound images with a new analysis system called DYARA (DYnamic ARtery Analysis) according to the state of the art assessed in the review. Thereof, carotid structure parameters were measured and carotid stiffness indices were derived considering blood pressure at time of ultrasound assessment. Validation of the ultrasound analysis program DYARA and reproducibility of carotid parameters were performed in subgroup within the SAPALDIA 3 survey. The presented studies within this thesis comprise cardiovascular risk factor data from the first and second follow-up and therefore, long- and short-term associations with carotid stiffness could be investigated. Results: The intra- and inter-reader results of the validation study were highly consistent with slightly higher bias for analyses with manual interactions compared to the automatic detection. Among the carotid structure parameters, average values across heart cycle showed lower variability than single images in diastole and systole, whereby the relative difference was smaller in lumen diameter values compared to the carotid intima media thickness (CIMT). Based on different statistical approaches, reproducibility values within SAPALDIA 3 were consistently good to excellent for carotid structure and function indices. Findings additionally revealed that subjects itself were the greatest source of variability between two measurements. Multivariate regression analyses suggested that most single cardiovascular risk factors in SAPALDIA 2 were long-termly associated with increased carotid stiffness in SAPALDIA 3 except physical activity and high-density lipoprotein cholesterol (HDL-C). HDL-C was the only protective vascular determinant and no relation was observed for physical activity. Most carotid stiffness parameters were similar strong associated within each cardiovascular risk factor (except compliance showed main deviances among several risk factors). Estimating sex-specific associations of atherosclerotic risk factors and carotid stiffness indicated that increased heart rate was more strongly associated with stiffer arteries across all carotid stiffness parameters in men than in women. Low-density lipoprotein cholesterol (LDL-C) was significantly associated with carotid stiffness only in men and triglyceride only in women. Multifactorial pathway analyses of cardiovascular risk factors in SAPALDIA 3 showed that age was the strongest predictor of carotid stiffness, followed by mean arterial blood pressure and heart rate. Age strongly confounded the association of physical activity and carotid stiffness in multiple regression analyses and therefore, only an univariate association of physical activity and carotid stiffness could be observed. Conclusion: DYARA tackles the challenge of being able to analyze varying ultrasound image qualities with high precision. The high reproducibility and the feasible application in a large sample size suggest that this program can be recommended for epidemiological research, diagnostics and clinical practice. Long- and short-term cardiovascular exposures have added important information to the overall vascular damage assessed by carotid stiffness for both sexes. Although age was the strongest predictor, sex-differences in long-term associations may indicate a certain differentiated susceptibility to cardiovascular risk factors among men and women, which should be investigated in more detail. The presented studies within this thesis provide an important basis towards future investigations targeting the early and late consequences of atherosclerosis, its progression and possible implementations of preventive and/or personalized interventions

Ultrasound Imaging Innovations for Visualization and Quantification of Vascular Biomarkers

The existence of plaque in the carotid arteries, which provide circulation to the brain, is a known risk for stroke and dementia. Alas, this risk factor is present in 25% of the adult population. Proper assessment of carotid plaque may play a significant role in preventing and managing stroke and dementia. However, current plaque assessment routines have known limitations in assessing individual risk for future cardiovascular events. There is a practical need to derive new vascular biomarkers that are indicative of cardiovascular risk based on hemodynamic information. Nonetheless, the derivation of these biomarkers is not a trivial technical task because none of the existing clinical imaging modalities have adequate time resolution to track the spatiotemporal dynamics of arterial blood flow that is pulsatile in nature. The goal of this dissertation is to devise a new ultrasound imaging framework to measure vascular biomarkers related to turbulent flow, intra-plaque microvasculature, and blood flow rate. Central to the proposed framework is the use of high frame rate ultrasound (HiFRUS) imaging principles to track hemodynamic events at fine temporal resolution (through using frame rates of greater than 1000 frames per second). The existence of turbulent flow and intra-plaque microvessels, as well as anomalous blood flow rate, are all closely related to the formation and progression of carotid plaque. Therefore, quantifying these biomarkers can improve the identification of individuals with carotid plaque who are at risk for future cardiovascular events. To facilitate the testing and the implementation of the proposed imaging algorithms, this dissertation has included the development of new experimental models (in the form of flow phantoms) and a new HiFRUS imaging platform with live scanning and on-demand playback functionalities. Pilot studies were also carried out on rats and human volunteers. Results generally demonstrated the real-time performance and the practical efficacy of the proposed algorithms. The proposed ultrasound imaging framework is expected to improve carotid plaque risk classification and, in turn, facilitate timely identification of at-risk individuals. It may also be used to derive new insights on carotid plaque formation and progression to aid disease management and the development of personalized treatment strategies

Ultrafast Ultrasound Imaging

Among medical imaging modalities, such as computed tomography (CT) and magnetic resonance imaging (MRI), ultrasound imaging stands out due to its temporal resolution. Owing to the nature of medical ultrasound imaging, it has been used for not only observation of the morphology of living organs but also functional imaging, such as blood flow imaging and evaluation of the cardiac function. Ultrafast ultrasound imaging, which has recently become widely available, significantly increases the opportunities for medical functional imaging. Ultrafast ultrasound imaging typically enables imaging frame-rates of up to ten thousand frames per second (fps). Due to the extremely high temporal resolution, this enables visualization of rapid dynamic responses of biological tissues, which cannot be observed and analyzed by conventional ultrasound imaging. This Special Issue includes various studies of improvements to the performance of ultrafast ultrasoun

Investigation of the relationship between tensile viscoelasticity and unloaded ultrasound shear wave measurements in ex vivo tendon

Mechanical properties of biological tissues are of key importance for proper function and in situ methods for mechanical characterization are sought after in the context of both medical diagnosis as well as understanding of pathophysiological processes. Shear wave elastography (SWE) and accompanying physical modelling methods provide valid estimates of stiffness in quasi-linear viscoelastic, isotropic tissue but suffer from limitations in assessing non-linear viscoelastic or anisotropic material, such as tendon. Indeed, mathematical modelling predicts the longitudinal shear wave velocity to be unaffected by the tensile but rather the shear viscoelasticity. Here, we employ a heuristic experimental testing approach to the problem to assess the most important potential confounders, namely tendon mass density and diameter, and to investigate associations between tendon tensile viscoelasticity with shear wave descriptors. Small oscillatory testing of animal flexor tendons at two baseline stress levels over a large frequency range comprehensively characterized tensile viscoelastic behavior. A broad set of shear wave descriptors was retrieved on the unloaded tendon based on high frame-rate plane wave ultrasound after applying an acoustic deformation impulse. Tensile modulus and strain energy dissipation increased logarithmically and linearly, respectively, with the frequency of the applied strain. Shear wave descriptors were mostly unaffected by tendon diameter but were highly sensitive to tendon mass density. Shear wave group and phase velocity showed no association with tensile elasticity or strain rate-stiffening but did show an association with tensile strain energy dissipation. The longitudinal shear wave velocity may not characterize tensile elasticity but rather tensile viscous properties of transversely isotropic collagenous tissues

Echocardiography

The book "Echocardiography - New Techniques" brings worldwide contributions from highly acclaimed clinical and imaging science investigators, and representatives from academic medical centers. Each chapter is designed and written to be accessible to those with a basic knowledge of echocardiography. Additionally, the chapters are meant to be stimulating and educational to the experts and investigators in the field of echocardiography. This book is aimed primarily at cardiology fellows on their basic echocardiography rotation, fellows in general internal medicine, radiology and emergency medicine, and experts in the arena of echocardiography. Over the last few decades, the rate of technological advancements has developed dramatically, resulting in new techniques and improved echocardiographic imaging. The authors of this book focused on presenting the most advanced techniques useful in today's research and in daily clinical practice. These advanced techniques are utilized in the detection of different cardiac pathologies in patients, in contributing to their clinical decision, as well as follow-up and outcome predictions. In addition to the advanced techniques covered, this book expounds upon several special pathologies with respect to the functions of echocardiography