352 research outputs found

    Why Are Viscosity and Nonlinearity Bound to Make an Impact in Clinical Elastographic Diagnosis?

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    The contributions by Antonio Gomez, Monica Contreras and Francisca S. Molina are gratefully acknowledged.The adoption of multiscale approaches by the biomechanical community has caused a major improvement in quality in the mechanical characterization of soft tissues. The recent developments in elastography techniques are enabling in vivo and non-invasive quantification of tissues’ mechanical properties. Elastic changes in a tissue are associated with a broad spectrum of pathologies, which stems from the tissue microstructure, histology and biochemistry. This knowledge is combined with research evidence to provide a powerful diagnostic range of highly prevalent pathologies, from birth and labor disorders (prematurity, induction failures, etc.), to solid tumors (e.g., prostate, cervix, breast, melanoma) and liver fibrosis, just to name a few. This review aims to elucidate the potential of viscous and nonlinear elastic parameters as conceivable diagnostic mechanical biomarkers. First, by providing an insight into the classic role of soft tissue microstructure in linear elasticity; secondly, by understanding how viscosity and nonlinearity could enhance the current diagnosis in elastography; and finally, by compounding preliminary investigations of those elastography parameters within different technologies. In conclusion, evidence of the diagnostic capability of elastic parameters beyond linear stiffness is gaining momentum as a result of the technological and imaging developments in the field of biomechanics.This research was funded by Ministerio de Educación, Cultura y Deporte grant numbers DPI2017-83859-R, DPI2014-51870-R, UNGR15-CE-3664 and EQC2018-004508-P; Ministerio de Sanidad, Servicios Sociales e Igualdad grant numbers DTS15/00093 and PI16/00339; Instituto de Salud Carlos III y Fondos Feder; Junta de Andalucía grant numbers PI-0107-2017, PIN-0030-2017 and IE2017-5537; Juan de la Cierva Incorporación IJC2018-037167-I, Ministerio de Ciencia, Innovación y Universidades grant number PRE2018-086085

    WFUMB Guidelines and Recommendations for Clinical Use of Ultrasound Elastography: Part 1: Basic Principles and Terminology

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    Abstract Conventional diagnostic ultrasound images of the anatomy (as opposed to blood flow) reveal differences in the acoustic properties of soft tissues (mainly echogenicity but also, to some extent, attenuation), whereas ultrasound-based elasticity images are able to reveal the differences in the elastic properties of soft tissues (e.g., elasticity and viscosity). The benefit of elasticity imaging lies in the fact that many soft tissues can share similar ultrasonic echogenicities but may have different mechanical properties that can be used to clearly visualize normal anatomy and delineate pathologic lesions. Typically, all elasticity measurement and imaging methods introduce a mechanical excitation and monitor the resulting tissue response. Some of the most widely available commercial elasticity imaging methods are 'quasi-static' and use external tissue compression to generate images of the resulting tissue strain (or deformation). In addition, many manufacturers now provide shear wave imaging and measurement methods, which deliver stiffness images based upon the shear wave propagation speed. The goal of this review is to describe the fundamental physics and the associated terminology underlying these technologies. We have included a questions and answers section, an extensive appendix, and a glossary of terms in this manuscript. We have also endeavored to ensure that the terminology and descriptions, although not identical, are broadly compatible across the WFUMB and EFSUMB sets of guidelines on elastography ( Bamber et al. 2013; Cosgrove et al. 2013 )

    Development and Evaluation of an Actuator System based on Centrifugal Force for Magnetic Resonance Elastography

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    Magnetic resonance elastography (MRE) serves as an important diagnostic tool. It represents one of numerous approaches to monitor tissue stiffness. The most fundamental challenges that MRE face are posed by two linking factors: Constructing a mechanical device that induces tissue motion to the depth of interest and meaningfully resolving said movement in the complex magnetic resonance imaging (MRI) signal. This work aims to address these challenges by improving the quantification of tissue stiffness through the development of a new actuation system for MRE. Firstly, a 3D printed pneumatic turbine vibrator was developed to induce sinusoidal mechanical waves. It used an eccentrically rotating mass generating a centrifugal force in the turbine. Contrary to conventionally used acoustic pressure drivers, the pneumatic turbine was capable of producing wave amplitudes in the range of appropriate shear waves in human tissue - especially at higher frequencies due to the centrifugal force increasing quadratically in relation to the rotational frequency. A technical assessment showed that the turbine generated vibrations in the range of 30 Hz to 150 Hz. The extent of artifacts caused by the materials brought into the field of view was restricted to the proximity of the actuator. It did not affect image quality in the region of interest. The turbine was MR-safe and an in-house certification according to §3 MPG was conducted, which enabled in-house clinical in vivo studies. The actuation system was additionally extended to a dual turbine actuator in order to investigate if the attenuation of shear waves could be further compensated by using two wave sources. Secondly, a motion encoding sequence was developed to meaningfully encode the tissue motion in the MRI signal. It was a spin-echo echo-planar-imaging sequence (SE-EPI) and contained a motion encoding gradient (MEG) adjustable for actuation frequencies ranging from 40 Hz to 120 Hz. To accurately reconstruct the wave velocities, i.e tissue elasticity, a trigger was implemented that synchronized the motion encoding sequence to the mechanical waves. Thirdly, the actuator system was evaluated regarding its performance for MRE image acquisition in a clinical MRI scanner. Silicone-based tissue elasticity mimicking phantoms were developed as test objects with known elasticity. Their shear moduli were in the range of 1.47 kPa to 7.29 kPa, which corresponds to the range of human soft tissue elasticities. A prostate phantom and an anthropomorphic abdominal phantom were manufactured. MR images were acquired with the SE-EPI sequence and were sufficient in terms of signal to noise ration (liver: SNR = 71.5) and contrast to noise ratio (liver: CNR = 16.5). The phantoms may also be used for multi-modal imaging; besides MRI, computed tomography (liver: 106+/-6 HU) and ultrasound imaging by adding scatter particles is feasible. The actuator did not interfere with the imaging procedure and could be integrated into existing clinic equipment. Three actuation set-ups were evaluated: a single, a large surface and a dual source actuation. For each, the strength of the MEG was varied from 5 mT/m to 20 mT/m for actuation frequencies ranging from 50 Hz to 80 Hz. The dual source actuation demonstrated a more uniform penetration of a larger volume of interest, especially in the peripheral region of the abdominal phantom. The obtained elasticity maps showed elasticity values (liver: 1.12+/-0.16 kPa, filling material: 4.37+/-0.52 kPa) in accordance to the results obtained by rheometric testing of the silicone samples. Additionally, an in vivo MRE examination was conducted, which served as a proof-of-principle for the successful implementation of the first developed MRE actuator system in our clinic. For both liver and prostate MRE, the actuator was well tolerated by the volunteer. Since the developed actuation technique is non-invasive, its incorporation into routine MRI protocols will facilitate patient acceptance, while its short additional set-up time will also increase clinical acceptance. MRE is a unique technique for the identification of various pathologies and the quantification of the shear modulus has the potential to become a further independent parameter for MRI diagnostics in a variety of clinical applications

    Shear wave pulse compression for dynamic elastography using phase-sensitive optical coherence tomography

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    Assessing the biomechanical properties of soft tissue provides clinically valuable information to supplement conventional structural imaging. In the previous studies, we introduced a dynamic elastography technique based on phase-sensitive optical coherence tomography (PhS-OCT) to characterize submillimetric structures such as skin layers or ocular tissues. Here, we propose to implement a pulse compression technique for shear wave elastography. We performed shear wave pulse compression in tissue-mimicking phantoms. Using a mechanical actuator to generate broadband frequency-modulated vibrations (1 to 5 kHz), induced displacements were detected at an equivalent frame rate of 47 kHz using a PhS-OCT. The recorded signal was digitally compressed to a broadband pulse. Stiffness maps were then reconstructed from spatially localized estimates of the local shear wave speed. We demonstrate that a simple pulse compression scheme can increase shear wave detection signal-to-noise ratio ([Formula: see text] gain) and reduce artifacts in reconstructing stiffness maps of heterogeneous media

    Efficacy of shear wave elastography for evaluating right ventricular myocardial fibrosis in monocrotaline-induced pulmonary hypertension rats

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    Background: Right ventricular (RV) function is important for outcomes in pulmonary hypertension. Evaluation of RV myocardial characteristics is useful to assess the disease severity. Shear wave elastography (SWE) provides information of shear wave (SW) elasticity, which is related to tissue hardness, and SW dispersion slope, which reflects tissue viscosity. This study aimed to test the hypothesis that SW elasticity is increased and SW dispersion slope is decreased in the right ventricle of monocrotaline (MCT)-induced pulmonary hypertension rats. Methods: Rats were divided into MCT-induced pulmonary hypertension group (n = 10) and control group (n = 10). SW elasticity and SW dispersion slope were measured on excised hearts. Myocardial fibrosis was evaluated histologically. Results: RV hypertrophy was observed in the MCT group. SW elasticity of right ventricle was higher in the MCT group than in the control group (3.5 ± 0.9 kPa vs. 2.5 ± 0.4 kPa, p Conclusions: Higher SW elasticity and lower SW dispersion slope were observed in the fibrotic myocardium of right ventricle in MCT-induced pulmonary hypertension rats. SWE may have the potential to evaluate RV function by assessing myocardial characteristics

    Shear Wave Propagation in Soft Tissue with Ultrasound Vibrometry

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    Studies have found that shear moduli, having the dynamic range of several orders of magnitude for various biological tissues, are highly correlated with the pathological statues of human tissue such as livers. Shear moduli can be investigated by measuring the attenuation and velocity of the shear wave propagation in a tissue region. Many efforts have been made to measure shear wave propagations induced by different types of force, which include the motion force of human organs, external applied force, and ultrasound radiation force. In the past 15 years, ultrasound radiation force has been successfully used to induce tissue motion for imaging tissue elasticity. Vibroacoustography (VA) uses bifocal beams to remotely induce vibration in a tissue region and detect the vibration using a hydrophone. The vibration center is sequentially moved in the tissue region to form a two-dimensional image. Acoustic Radiation Force Imaging (ARFI) uses focused ultrasound to apply localized radiation force to small volumes of tissue for short durations and the resulting tissue displacements are mapped using ultrasonic correlation based methods. Supersonic shear image remotely vibrates tissue and sequentially moves vibration center along the beam axis to create intense shear plan wave that is imaged at a high frame rate (5000 frames per second). These image methods provide measurements of tissue elasticity, but not the viscosity. Because of the dispersive property of biological tissue, the induced tissue displacement and the shear wave propagation are frequency dependent. Tissue shear property can be modeled by several models including Kelvin-Voigt (Voigt) model, Maxwell model, and Zener model. The Voigt model effectively describes the creep behavior of tissue, The Maxwell model effectively describes the relaxation process, and the Zener model effectively describes both creep and relaxation but it requires one extra parameter. The Voigt model is often used by many researchers because of its simplicity and the effectiveness of modeling soft tissue. The Voigt model consists of a purely viscous damper and a purely elastic spring connected in parallel. For Voigt tissue, the tissue motion at a very low frequency largely depends on the elasticity, while the motion at a very high frequency largely depends on the viscosity. In general, the tissue motion depends on both elasticity and viscosity, and estimates of elasticity by ignoring viscosity are biased or erroneous. In 1951, Dr. Oestreicher published his work to solve the wave equation for the Voigt soft tissue with harmonic motions. With assumptions of isotropic tissue and plane wave, he derived equations that relate the shear wave attenuation and speed to the elasticity and viscosity of soft tissue. However, Oestreicher’s method was not realized for applications until the half century later. In the past ten years, Oestreicher’s method was utilized to quantitatively measure both tissue elasticity and viscosity. Ultrasound vibrometry has been developed to noninvasively and quantitatively measure tissue shear moduli. It induces shear waves using ultrasound radiation force and estimates the shear moduli using shear wave phase velocities at several frequencies by measuring the phase shifts of the propagating shear wave over a short distance using pulse echo ultrasound. Applications of the ultrasound vibrometry were conducted for viscoelasticities of liver, bovine and porcine striated muscles, blood vessels, and hearts. A recent in vivo liver study shows that the ultrasound vibrometry can be implemented on a clinical ultrasound scanner of using an array transducer. One potential application of ultrasound vibrometry is to characterize shear moduli of livers. The shear moduli of liver are highly correlated with liver pathology status. Recently, the shear viscoelasticity of liver tissue has been investigated by several research groups. Most of these studies applied ultrasound radiation force in liver tissue regions, measured the phase velocities of shear wave in a limited frequency range, and inversely solved the Voigt model with an assumption that liver local tissue is isotropic without considering boundary conditions. Because of the boundary conditions, shear wave propagations are impacted by the limited physical dimensions of tissue. Studies shows that considerations of boundary conditions should be taken for characterizing tissue that have limited physical dimensions such as heart, blood vessels, and liver, when ultrasound vibrometry is used

    Viscoelasticidad renal durante la disminución gradual de flujo sanguíneo en un modelo porcino in vivo: estudio piloto

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    Elasticity imaging methods have been used to study kidney mechanical properties and have demonstrated that the kidney elastic modulus increases with disease state. However, studies in swine suggest that kidney elastic modulus is also affected by hemodynamic variables. A newly emerging method called Shearwave Dispersion Ultrasound Vibrometry (SDUV) offers a tool to determine renal elasticity and viscosity in vivo. The purpose of this study was directed toward evaluating the feasibility of SDUV for in vivo measurements of healthy swine kidney during acute gradual decease of renal blood flow. In this study in vivo SDUV measurements were made on a group of 5 normal swine kidneys at baseline renal blood flow (RBF) and 25, 50, 75 and 100% decrease in RBF. The shear elastic modulus at full baseline was 7.04 ± 0.92 kPa and 3.48 ± 0.20 kPa at 100% decrease in RBF. The viscosity did not change between baseline (2.23 ± 0.33 Pa•s) and 100% decrease in RBF (2.03 ± 0.32 Pa•s). The data from this study indicates that other variables such as local blood flow, pressure and volume as well as method accuracy need to be measured to illustrate the relationship between shear elasticity and viscosity associated with acute kidney processes.Métodos de imágenes de elasticidad se han utilizado para estudiar las propiedades mecánicas renales y han demostrado que el módulo elástico de los riñones del aumenta con el estado de enfermedades renales. Sin embargo, estudios en cerdos sugieren que el riñón módulo elástico también se ve afectada por las variables hemodinámicas. Un método emergente llamado Shearwave Dispersion Ultrasound Vibrometry (SDUV) ofrece una herramienta para determinar la elasticidad y la viscosidad renal. El propósito de este estudio se dirige a la evaluación de la viabilidad de SDUV para mediciones las propiedades viscoelasticas del riñón saludable durante variación aguda del flujo sanguíneo renal. En este estudio el método SDUV se realizó en un grupo de 5 riñones porcinos normales al inicio del flujo sanguíneo renal (RBF) basal y 25, 50, 75 y 100% de disminución en el RBF. El módulo elástico basal fue de 7,04 ± 0,92 kPa y 3,48 ± 0,20 kPa a 100% de disminución del RBF. La viscosidad no cambió entre el momento basal (2,23 ± 0,33 Pa • s) y el 100% de disminución del RBF (2,03 ± 0,32 Pa • s). Los datos de este estudio indican que variables tales como el flujo local de sangre, la presión y el volumen así como el método exactitud deben ser medidos para ilustrar la relación entre la elasticidad y la viscosidad asociada con los procesos renales agudos

    On the Quantitative Potential of Viscoelastic Response (VisR) Ultrasound Using the One-Dimensional Mass-Spring-Damper Model

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    Viscoelastic Response (VisR) ultrasound is an acoustic radiation force (ARF)-based imaging method that fits induced displacements to a one-dimensional (1D) mass-spring-damper (MSD) model to estimate the ratio of viscous to elastic moduli, τ, in viscoelastic materials. Error in VisR τ estimation arises from inertia and acoustic displacement underestimation. These error sources are herein evaluated using finite element method (FEM) simulations, error correction methods are developed, and corrected VisR τ estimates are compared to true simulated τ values to assess VisR’s relevance to quantifying viscoelasticity. In regards to inertia, adding a mass term in series with the Voigt model, to achieve the MSD model, accounts for inertia due to tissue mass when ideal point force excitations are used. However, when volumetric ARF excitations are applied, the induced complex system inertia is not described by the single-degree-of-freedom MSD model, causing VisR to overestimate τ. Regarding acoustic displacement underestimation, associated deformation of ARF-induced displacement profiles further distorts VisR τ estimates. However, median error in VisR τ is reduced to approximately −10% using empirically derived error correction functions applied to simulated viscoelastic materials with viscous and elastic properties representative of tissue. The feasibility of corrected VisR imaging is then demonstrated in vivo in the rectus femoris muscle of an adult with no known neuromuscular disorders. These results suggest VisR’s potential relevance to quantifying viscoelastic properties clinically

    Surface wave elastography is a reliable method to correlate muscle elasticity, torque, and electromyography activity level

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    Abstract The shear elastic modulus is one of the most important parameters to characterize the mechanical behavior of soft tissues. In biomechanics, ultrasound elastography is the gold standard for measuring and mapping it locally in skeletal muscle in vivo. However, their applications are limited to the laboratory or clinic. Thus, low‐frequency elastography methods have recently emerged as a novel alternative to ultrasound elastography. Avoiding the use of high frequencies, these methods allow obtaining a mean value of bulk shear elasticity. However, they are frequently susceptible to diffraction, guided waves, and near field effects, which introduces biases in the estimates. The goal of this work is to test the performance of the non‐ultrasound surface wave elastography (NU‐SWE), which is portable and is based on new algorithms designed to correct the incidence of such effects. Thus, we show its first application to muscle biomechanics. We performed two experiments to assess the relationships of muscle shear elasticity versus joint torque (experiment 1) and the electromyographic activity level (experiment 2). Our results were comparable regarding previous works using the reference ultrasonic methods. Thus, the NU‐SWE showed its potentiality to get wide the biomechanical applications of elastography in many areas of health and sports sciences
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