Breast vibro-acoustography: initial results show promise

INTRODUCTION: Vibro-acoustography (VA) is a recently developed imaging modality that is sensitive to the dynamic characteristics of tissue. It detects low-frequency harmonic vibrations in tissue that are induced by the radiation force of ultrasound. Here, we have investigated applications of VA for in vivo breast imaging. METHODS: A recently developed combined mammography-VA system for in vivo breast imaging was tested on female volunteers, aged 25 years or older, with suspected breast lesions on their clinical examination. After mammography, a set of VA scans was acquired by the experimental device. In a masked assessment, VA images were evaluated independently by 3 reviewers who identified mass lesions and calcifications. The diagnostic accuracy of this imaging method was determined by comparing the reviewers' responses with clinical data. RESULTS: We collected images from 57 participants: 7 were used for training and 48 for evaluation of diagnostic accuracy (images from 2 participants were excluded because of unexpected imaging artifacts). In total, 16 malignant and 32 benign lesions were examined. Specificity for diagnostic accuracy was 94% or higher for all 3 reviewers, but sensitivity varied (69% to 100%). All reviewers were able to detect 97% of masses, but sensitivity for detection of calcification was lower (≤ 72% for all reviewers). CONCLUSIONS: VA can be used to detect various breast abnormalities, including calcifications and benign and malignant masses, with relatively high specificity. VA technology may lead to a new clinical tool for breast imaging applications

Evaluation of Elastographic techniques generated by means of external vibration

Breast cancer is one of the greatest problems of national and international public health, whose incidence among women population shows an increasing trend. Nowadays there are several elastographic techniques, which seek to characterize the tissue, that is, to analyze the response produced by the application of a perturbation in the medium, to describe its mechanical properties. Among the modalities used are ultrasound, nuclear magnetic resonance and optical coherence tomography. On the other hand, among the types of disturbance used are low frequency mechanical waves, a uniform compression force or acoustic radiation force. In this thesis work, ultrasound was used due to its low economical cost in comparison to the other modalities. In addition, the type of perturbation selected was the external mechanical vibration, as it ensures the achievement of quantitative results, there is no risk of temperature rise in the analyzed area and allows the repeatability of the results obtained. Hence, two elastographic techniques were the axes of the present work: vibro-elastography and normal vibration holography. For the first, a calibrated phantom and a gelatin-based phantom were used, in order to characterize and validate the technique over a wide range of excitation frequencies. Posteriorly, 18 patients were analyzed prior biopsy exam, obtaining elastograms and contrasting them with the respective biopsy results. The results suggest that the technique is able to identify the presence of benign or malignant cancer, and the elasticity estimated agree with values reported in the literature. The second technique is proposed in the elastography field for the first time. Based on holography, its experimental scheme is established, and the mathematical expression for shear speed estimation is presented. Results from simulation and experiments performed on homogeneous and heterogeneous phantoms are presented, and the estimates are compared with previously obtained reference values. The results suggest that the estimates are close to the reference values for all media tested, and the technique must be studied in depth to revert artifacts formation.Tesi

Ultrasound elastographic techniques in focal liver lesions

Elastographic techniques are new ultrasound-based imaging techniques developed to estimate tissue deformability/stiffness. Several ultrasound elastographic approaches have been developed, such as static elastography, transient elastography and acoustic radiation force imaging methods, which include point shear wave and shear wave imaging elastography. The application of these methods in clinical practice aims at estimating the mechanical tissues properties. One of the main settings for the application of these tools has been liver stiffness assessment in chronic liver disease, which has been studied mainly using transient elastography. Another field of application for these techniques is the assessment of focal lesions, detected by ultrasound in organs such as pancreas, prostate, breast, thyroid, lymph nodes. Considering the frequency and importance of the detection of focal liver lesions through routine ultrasound, some studies have also aimed to assess the role that elestography can play in studying the stiffness of different types of liver lesions, in order to predict their nature and thus offer valuable non-invasive methods for the diagnosis of liver masses

New Technology and Techniques for Needle-Based Magnetic Resonance Image-Guided Prostate Focal Therapy

The most common diagnosis of prostate cancer is that of localized disease, and unfortunately the optimal type of treatment for these men is not yet certain. Magnetic resonance image (MRI)-guided focal laser ablation (FLA) therapy is a promising potential treatment option for select men with localized prostate cancer, and may result in fewer side effects than whole-gland therapies, while still achieving oncologic control. The objective of this thesis was to develop methods of accurately guiding needles to the prostate within the bore of a clinical MRI scanner for MRI-guided FLA therapy. To achieve this goal, a mechatronic needle guidance system was developed. The system enables precise targeting of prostate tumours through angulated trajectories and insertion of needles with the patient in the bore of a clinical MRI scanner. After confirming sufficient accuracy in phantoms, and good MRI-compatibility, the system was used to guide needles for MRI-guided FLA therapy in eight patients. Results from this case series demonstrated an improvement in needle guidance time and ease of needle delivery compared to conventional approaches. Methods of more reliable treatment planning were sought, leading to the development of a systematic treatment planning method, and Monte Carlo simulations of needle placement uncertainty. The result was an estimate of the maximum size of focal target that can be confidently ablated using the mechatronic needle guidance system, leading to better guidelines for patient eligibility. These results also quantified the benefit that could be gained with improved techniques for needle guidance

Robust Displacement Estimation for Ultrasound Elastography and Thermal Imaging

Ultrasound imaging is becoming the modality of choice for many diagnostic and surgical procedures. Besides being inexpensive and safe, ultrasonography is emerging as a quantitative tool able to image tissue properties. In this dissertation we focus on elastography and thermal imaging, which both rely on the measurement of real or apparent motion in ultrasound image sequences. In ultrasound elastography, signal decorrelation is widely viewed as the major limiting factor for adoption of into clinical practice. In this dissertation we focus on improving the robustness of a displacement estimation method based on dynamic programming, addressing multiple weak points. We propose a set of tools which can improve its ability to overcome displacement discontinuities and regions of poorly correlated RF data. The method is further extended to three dimensional data. Phantom, animal and human studies are presented for experimental validation. The addition of robust tools results in an improved ability to achieve repeatable, artifact-free strain maps, without compromising computational speed. In thermal imaging, we focus on the estimation of real and apparent motion while the tissue temperature is increased in an ablation procedure. Estimating heat-induced echo shifts is a very difficult problem because of their very small amplitude, on the order of tens of microns. They can easily be masked by other sources of deformation/movement from the environment such as patient motion or hand tremor. In this dissertation, we build upon the robust displacement estimation method for elastography, with the additional deployment of an iterative motion compensation algorithm. The validation experiments are performed on laboratory induced ablation lesions, where the ultrasound probe is either held by the operator's hand or supported by a robotic arm. We demonstrate the ability to detect and remove non-heat induced tissue motion at every step of the ablation procedure. Our results exceed the state of the art in both the accuracy of temperature estimation as well as the length of time over which temperature estimation can be performed. Previous research in the area of motion compensation resulted in good results for experiments lasting less than 10 seconds. Our experiments lasted close to 20 minutes

Implementation and Algorithm Development of 3D ARFI and SWEI Imaging for in vivo Detection of Prostate Cancer

<p>Prostate cancer (PCa) is the most common non-cutaneous cancer in men with an estimated almost 30,000 deaths occurring in the United States in 2014. Currently, the most widely utilized methods for screening men for prostate cancer include the digital rectal exam and prostate specific antigen analysis; however, these methods lack either high sensitivity or specificity, requiring needle biopsy to confirm the presence of cancer. The biopsies are conventionally performed with only B-mode ultrasound visualization of the organ and no targeting of specific regions of the prostate, although recently, multi-parametric magnetic resonance imaging has shown promise for targeting biopsies. Earlier work has demonstrated the feasibility of acoustic radiation force impulse (ARFI) imaging and shear wave elasticity imaging (SWEI) to visualize cancer in the prostate, however multiple challenges with both methods have been identified.</p><p>The aim of this thesis is to contribute to both the technical development and clinical applications of ARFI and SWEI imaging using the latest advancements in ultrasound imaging technology.</p><p>The introduction of the Siemens Acuson SC2000 provided multiple technological improvements over previous generations of ultrasound scanners, including: an improved power supply, arbitrary waveform generator, and additional parallel receive beamforming. In this thesis, these capabilities were utilized to improve both ARFI and SWEI imaging and reduce acoustic exposure and acquisition duration. However, the SC2000 did not originally have radiation force imaging capabilities; therefore, a new tool set for prototyping these sequences was developed along with rapid data processing and display code. These tools leveraged the increasing availability of general purpose computing on graphics processing units (GPUs) to significantly reduce the data processing time, facilitating real-time display for ultrasonic research systems.</p><p>These technical developments for both acquisition and processing were applied to investigate new methods for ARFI and SWEI imaging. Specifically, the power supply on the SC2000 allowed for a new type of multi-focal zone ARFI images to be acquired, which are shown to provide improved image quality over an extended depth of field. Additionally, a new algorithm for SWEI image processing was developed using an adaptive filter based on a maximum a posteriori estimator, demonstrating increases in the contrast to noise ratio of lesion targets upwards of 50%.</p><p>Finally, the optimized ARFI imaging methods were integrated with a transrectal ultrasound transducer to acquire volumetric in vivo data in patients undergoing robotic radical prostatectomy procedures in an ongoing study. When the study was initiated, it was recognized that the technological improvements of Siemens Acuson SC2000 allowed for the off-axis response to the radiation force excitation to be concurrently recorded without impacting ARFI image quality. This volumetric SWEI data was reconstructed retrospectively using the approaches developed in this thesis, but the images were low quality. A further investigation identified multiple challenges with the SWEI sequence, which should be addressed in future studies. The ARFI image volumes were very high quality and are currently being analyzed to assess the accuracy of ARFI to visualize prostate anatomy and clinically significant prostate cancer tumors. After a blinded evaluation of the ARFI image volumes for suspicion of prostate cancer, three readers correctly identified 63% of all clinically significant tumors and 74% of clinically significant tumors in the posterior region, showing great promise for using ARFI in the context of prostate cancer visualization for targeting biopsies, focal therapy, and watchful waiting.</p>Dissertatio

Development of a Harmonic Motion Imaging guided Focused Ultrasound system for breast tumor characterization and treatment monitoring

Breast cancer is the most common cancer and the second leading cause of cancer death among women. About 1 in 8 U.S. women (about 12%) will develop invasive breast cancer over the course of their lifetime. Existing methods of early detection of breast cancer include mammography and palpation, either by patient self-examination or clinical breast exam. Palpation is the manual detection of differences in tissue stiffness between breast tumors and normal breast tissue. The success of palpation relies on the fact that the stiffness of breast tumors is often an order of magnitude greater than that of normal breast tissue, i.e., breast lesions feel ''hard'' or ''lumpy'' as compared to normal breast tissue. A mammogram is an x-ray that allows a qualified specialist to examine the breast tissue for any suspicious areas. Mammography is less likely to reveal breast tumors in women younger than 50 years with denser breast than in older women. When a suspicious site is detected in the breast through a breast self-exam or on a screening mammogram, the doctor may request an ultrasound of the breast tissue. A breast ultrasound can provide evidence about whether the lump is a solid mass, a cyst filled with fluid, or a combination of the two. An invasive needle biopsy is the only diagnostic procedure that can definitely determine if the suspicious area is cancerous. In the clinic, 80% of women who have a breast biopsy do not have breast cancer. Most women with breast cancer diagnosed will have some type of surgery to remove the tumor. Depending on the type of breast cancer and how advanced it is, the patient might need other types of treatment as well, such as chemotherapy and radiation therapy. Image-guided minimally-invasive treatment of localized breast tumor as an alternative to traditional breast surgery, such as high intensity focused ultrasound (HIFU) treatment, has become a subject of intensive research. HIFU applies extreme high temperatures to induce irreversible cell injury, tumor apoptosis and coagulative necrosis. Compared with conventional surgical procedures the main advantages of HIFU ablation lie in the fact that it is non-invasive, less scarring and less painful, allowing for shorter recovery time. HIFU can be guided by MRI (MRgFUS) or by conventional diagnostic ultrasound (USgFUS). Worldwide, thousands of patients with uterine fibroids, liver cancer, breast cancer, pancreatic cancer, bone tumors, and renal cancer have been treated by USgFUS. In this dissertation, the objective is to develop an integrated Harmonic Motion Imaging guided Focused Ultrasound (HMIgFUS) system as a clinical monitoring technique for breast HIFU with the added capability of detecting tumors for treatment planning, evaluation of tissue stiffness changes during HIFU ablation for treatment monitoring in real time, and assessment of thermal lesion sizes after treatment evaluation. A new HIFU treatment planning method was described that used oscillatory radiation force induced displacement amplitude variations to detect the HIFU focal spot before lesioning. Using this method, we were able to visualize the HMIgFUS focal region at variable depths. By comparing the estimated displacement profiles with lesion locations in pathology, we demonstrated the feasibility of using this HMI-based technique to localize the HIFU focal spot and predict lesion location during the planning phase. For HIFU monitoring, a HIFU lesion detection and ablation monitoring method was first developed using oscillatory radiation force induced displacement amplitude variations in real time. Using this method, the HMIgFUS focal region and lesion formation were visualized in real time at a feedback rate of 2.4 Hz. By comparing the estimated lesion size against gross pathology, the feasibility of using HMIgFUS to monitor treatment and lesion formation without interruption is demonstrated. In order to reduce the imaging time, it is shown in this dissertation that using the steered FUS beam, HMI can be used to image a 2.3 times larger ROI without requiring physical movement of the transducer. Using steering for HMI can be used to shorten the total imaging duration without requiring physical movement of the transducer. For the application of breast tumor, HMI and HMIgFUS were optimized and applied to ex vivo breast tissue. The results showed that HMI is experimentally capable of mapping and differentiating stiffness in normal and abnormal breast tissues. HMIgFUS can also successfully generate thermal lesions on normal and pathological breast tissues. HMI has also been applied to post-surgical breast mastectomy specimens to mimic the in vivo environment. In the end, the first HMI clinical system has been built with added capability of GUP-based parallel beamforming. A clinical trial has been approved at Columbia University to image breast tumor on patient. The HMI clinical system has shown to be able to map fibroadenoma mass on two patients with valid HMI displacement. The study in this dissertation may yield an early-detection technique for breast cancer without any age discrimination and thus, increase the survival rate

Evaluation of shear wave speed measurements using crawling waves sonoelastography and single tracking location acoustic radiation force impulse imaging

Many pathological conditions are closely related with an increase in tissue sti ness. For many years, experts performed manual palpation in order to measure elasticity changes, however, this method can only be applied on superficial areas of the human body and provides crude sti ness estimation. Elastography is a technique that attempts to characterize the elastic properties of tissue in order to provide additional and useful information for clinical diagnosis. For more than twenty years, di erent research groups have developed various elastography modalities with a strong interest for quantitative images during the last decade. Recently, comparative studies among di erent elastographic techniques have been performed in order to better characterize biomaterials, to cross-validate several shear wave elastographic modalities and to study the factors that influence their precision and accuracy. This comparison works may contribute to achieve standardization in quantitative elastography and their use in commercial equipment for their application in human patients. However, there is still a limited literature in the field of quantitative elastography modalities comparisons. This thesis focuses on the comparison between two elastographic techniques: crawling wave sonoelastography (CWS) and single tracking location-acoustic radiation force impulse (STL-ARFI). The comparison shows the estimation of the shear wave speed (SWS), lateral resolution, contrast and contrast-to-noise ratio (CNR) in homogeneous and inhomogeneous phantoms using both techniques. The SWS values obtained with both modalities are validated with mechanical measurements that are considered as ground truth. The SWS results for the three di erent homogeneous phantoms (10%, 13%, and 16% gelatin concentrations), show good agreement between CWS, STL-ARFI and mechanical measurements as a function of frequency. The maximum accuracy errors obtained with CWS were 2.52%, 1.63% and 2.26%. For STL-ARFI, the maximum errors were 6.22%, 5.63% and 4.08% for the 10%,13% and 16% gelatin phantom respectively. For lateral resolution, contrast and CNR estimated in the inhomogeneous phantoms, it can be seen that for vibration frequencies higher than 340 Hz, CWS presents better results than the obtained with STL-ARFI using distances between the push beams ( x) higher than 4 mm. However, using these vibration frequencies will not be feasible for in vivo tissues due to attenuation problems. It that sense, for lower vibration frequencies than 300 Hz and x among 3 mm and 6 mm, comparable lateral resolution, contrast and CNR was obtained. Finally, the results of this study contribute to the data currently available for comparing elastographic techniques. Moreover, the methodology implemented in this document may be helpful for future standardization for di erent elastographic modalities.Tesi