2-D and 3-D high frame-rate Pulse Wave Imaging for the characterization of focal vascular disease

Cardiovascular diseases are major causes of morbidity and mortality in Western-style populations. Atherosclerosis and Abdominal Aortic Aneurysms (AAAs) are two prevalent vascular diseases that may progress without symptoms and contribute to acute cardiovascular events such as stroke and AAA rupture, which are consistently among the leading causes of death worldwide. The imaging methods used in the diagnosis of these diseases, have been reported to present several limitations. Given that both are associated with mechanical changes in the arterial wall, imaging of the arterial mechanical properties may improve early disease detection and patient care. Pulse wave velocity (PWV) refers to the velocity at which arterial waves generated by ventricular ejection travel along the arterial tree. PWV is a surrogate marker of arterial stiffness linked to cardiovascular mortality. The foot-to-foot method that is typically used to calculate PWV suffers from errors of distance measurements and time-delay measurements. Additionally, a single PWV estimate is provided over a relatively long distance, thus inherently lacking the capability to provide regional arterial stiffness measurements. Pulse Wave Imaging (PWI) is a noninvasive, ultrasound-based technique for imaging the propagation of pulse waves along the wall of major arteries and providing a regional PWV value for the imaged artery. The aim of this work was to enable PWI to provide more localized PWV and stiffness measurements within the imaged arterial segment and to further extend it into a 2-D and 3-D technique for the detection and monitoring of focal vascular disease at high temporal and spatial resolution. The improved modality was integrated with blood flow imaging modalities aiming to render PWI a comprehensive methodology for the study of arterial biomechanics in vivo. Spatial information was increased with the introduction of piecewise PWI. This novel technique was used to measure PWV within small sub-regions of the imaged vessel in murine aneurysmal (n = 8) and atherosclerotic aortas (n = 11) in vivo. It provided PWV and stiffness maps while capturing the progressive arterial stiffening caused by atherosclerosis. PWI was further augmented with a sophisticated adaptive algorithm, enabling it to optimally partition the imaged artery into relatively homogeneous segments, automatically isolating arterial stiffness inhomogeneities. Adaptive PWI was validated in silicone phantoms consisting of segments of varying stiffness and then tested in murine aortas in vivo. Subsequently, the conventional tradeoff between spatial and temporal resolution was addressed with a plane wave compounding implementation of PWI, allowing the acquisition of full field of view frames at over 2000 Hz. A GPU-accelerated PWI post-processing framework was developed for the processing of the big bulk of generated data. The parameters of coherent compounding were optimized in vivo. The optimized sequences were then used in the clinic to assess the mechanical properties of atherosclerotic carotids (n=10) and carotids of patients after endarterectomy (n=7), a procedure to remove the plaque and restore blood flow to the brain. In the case of atherosclerotic patients undergoing carotid endarterectomy, the results were compared against the histology of the excised plaques. Investigation of the mechanical properties of plaques was also conducted for the first time with a high-frequency transducer (18.5 MHz). Additionally, 4-D PWI was introduced, utilizing high frame rate 3-D plane wave acquisitions with a 2-D matrix array transducer (16x16 elements, 2.5 MHz). A novel methodology for PWV estimation along the direction of pulse wave propagation was implemented and validated in silicone phantoms. 4-D PWI provided comprehensive views of the pulse wave propagation in a plaque phantom and the results were compared against conventional PWI. Finally, its feasibility was tested in the carotid arteries of healthy human subjects (n=6). PWVs derived in 3-D were within the physiological range and showed good agreement with the results of conventional PWI. Finally, PWI was integrated with flow imaging modalities (Color and Vector Doppler). Thus, full field-of-view, high frame-rate, simultaneous and co-localized imaging of the arterial wall dynamics and color flow as well as 2-D vector flow was implemented. The feasibility of both techniques was tested in healthy subjects (n=6) in vivo. The relationship between the timings of the flow and wall velocities was investigated at multiple locations of the imaged artery. Vector flow velocities were found to be aligned with the vessel’s centerline during peak systole in the common carotid artery and interesting flow patterns were revealed in the case of the carotid bifurcation Consequently, with the aforementioned improvements and the inclusion of 3-D imaging, PWI is expected to provide comprehensive information on the mechanical properties of pathological arteries, providing clinicians with a powerful tool for the early detection of vascular abnormalities undetectable on the B-mode, while also enabling the monitoring of fully developed vascular pathology and of the recovery of post-operated vessels

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

Development of novel ultrasound techniques for imaging and elastography. From simulation to real-time implementation

Ultrasound techniques offer many advantages, in terms of ease of realization and patients’ safety. The availability of suitable hardware and software tools is condicio sine qua non for new methods testing. This PhD project addresses medical ultrasound signal processing and seeks to achieve two scientific goals: the first is to contribute to the development of an ultrasound research platform, while the second is introducing and validating, through this platform, non-standard methods. During the thesis, the capabilities of the system were improved by creating advanced software tools, such as acoustic field simulators, and by developing echo-signals elaboration programs. In particular, a novel technique for quasi-static elastography was developed, in-vitro tested and implemented in real-time

Advanced signal processing methods for plane-wave color Doppler ultrasound imaging

Conventional medical ultrasound imaging uses focused beams to scan the imaging scene line-by-line, but recently however, plane-wave imaging, in which plane-waves are used to illuminate the entire imaging scene, has been gaining popularity due its ability to achieve high frame rates, thus allowing the capture of fast dynamic events and producing continuous Doppler data. In most implementations, multiple low-resolution images from different plane wave tilt angles are coherently averaged (compounded) to form a single high-resolution image, albeit with the undesirable side effect of reducing the frame rate, and attenuating signals with high Doppler shifts. This thesis introduces a spread-spectrum color Doppler imaging method that produces high-resolution images without the use of frame compounding, thereby eliminating the tradeoff between beam quality, frame rate and the unaliased Doppler frequency limit. The method uses a Doppler ensemble formed of a long random sequence of transmit tilt angles that randomize the phase of out-of-cell (clutter) echoes, thereby spreading the clutter power in the Doppler spectrum without compounding, while keeping the spectrum of in-cell echoes intact. The spread-spectrum method adequately suppresses out-of-cell blood echoes to achieve high spatial resolution, but spread-spectrum suppression is not adequate for wall clutter which may be 60 dB above blood echoes. We thus implemented a clutter filter that re-arranges the ensemble samples such that they follow a linear tilt angle order, thereby compacting the clutter spectrum and spreading that of the blood Doppler signal, and allowing clutter suppression with frequency domain filters. We later improved this filter with a redesign of the random sweep plan such that each tilt angle is repeated multiple times, allowing, after ensemble re-arrangement, the use of comb filters for improved clutter suppression. Experiments performed using a carotid artery phantom with constant flow demonstrate that the spread-spectrum method more accurately measures the parabolic flow profile of the vessel and outperforms conventional plane-wave Doppler in both contrast resolution and estimation of high flow velocities. To improve velocity estimation in pulsatile flow, we developed a method that uses the chirped Fourier transform to reduce stationarity broadening during the high acceleration phase of pulsatile flow waveforms. Experimental results showed lower standard deviations compared to conventional intensity-weighted-moving-average methods. The methods in this thesis are expected to be valuable for Doppler applications that require measurement of high velocities at high frame rates, with high spatial resolution

心臓内血流動態可視化のための血球エコーの高フレームレート超音波イメージング

Tohoku University金井浩課

Time-domain Compressive Beamforming for Medical Ultrasound Imaging

Over the past 10 years, Compressive Sensing has gained a lot of visibility from the medical imaging research community. The most compelling feature for the use of Compressive Sensing is its ability to perform perfect reconstructions of under-sampled signals using l1-minimization. Of course, that counter-intuitive feature has a cost. The lacking information is compensated for by a priori knowledge of the signal under certain mathematical conditions. This technology is currently used in some commercial MRI scanners to increase the acquisition rate hence decreasing discomfort for the patient while increasing patient turnover. For echography, the applications could go from fast 3D echocardiography to simplified, cheaper echography systems. Real-time ultrasound imaging scanners have been available for nearly 50 years. During these 50 years of existence, much has changed in their architecture, electronics, and technologies. However one component remains present: the beamformer. From analog beamformers to software beamformers, the technology has evolved and brought much diversity to the world of beam formation. Currently, most commercial scanners use several focalized ultrasonic pulses to probe tissue. The time between two consecutive focalized pulses is not compressible, limiting the frame rate. Indeed, one must wait for a pulse to propagate back and forth from the probe to the deepest point imaged before firing a new pulse. In this work, we propose to outline the development of a novel software beamforming technique that uses Compressive Sensing. Time-domain Compressive Beamforming (t-CBF) uses computational models and regularization to reconstruct de-cluttered ultrasound images. One of the main features of t-CBF is its use of only one transmit wave to insonify the tissue. Single-wave imaging brings high frame rates to the modality, for example allowing a physician to see precisely the movements of the heart walls or valves during a heart cycle. t-CBF takes into account the geometry of the probe as well as its physical parameters to improve resolution and attenuate artifacts commonly seen in single-wave imaging such as side lobes. In this thesis, we define a mathematical framework for the beamforming of ultrasonic data compatible with Compressive Sensing. Then, we investigate its capabilities on simple simulations in terms of resolution and super-resolution. Finally, we adapt t-CBF to real-life ultrasonic data. In particular, we reconstruct 2D cardiac images at a frame rate 100-fold higher than typical values

Dual modality optical coherence tomography : Technology development and biomedical applications

Optical coherence tomography (OCT) is a cross-sectional imaging modality that is widely used in clinical ophthalmology and interventional cardiology. It is highly promising for in situ characterization of tumor tissues. OCT has high spatial resolution and high imaging speed to assist clinical decision making in real-time. OCT can be used in both structural imaging and mechanical characterization. Malignant tumor tissue alters morphology. Additionally, structural OCT imaging has limited tissue differentiation capability because of the complex and noisy nature of the OCT signal. Moreover, the contrast of structural OCT signal derived from tissue’s light scattering properties has little chemical specificity. Hence, interrogating additional tissue properties using OCT would improve the outcome of OCT’s clinical applications. In addition to morphological difference, pathological tissue such as cancer breast tissue usually possesses higher stiffness compared to the normal healthy tissue, which indicates a compelling reason for the specific combination of structural OCT imaging with stiffness assessment in the development of dual-modality OCT system for the characterization of the breast cancer diagnosis. This dissertation seeks to integrate the structural OCT imaging and the optical coherence elastography (OCE) for breast cancer tissue characterization. OCE is a functional extension of OCT. OCE measures the mechanical response (deformation, resonant frequency, elastic wave propagation) of biological tissues under external or internal mechanical stimulation and extracts the mechanical properties of tissue related to its pathological and physiological processes. Conventional OCE techniques (i.e., compression, surface acoustic wave, magnetomotive OCE) measure the strain field and the results of OCE measurement are different under different loading conditions. Inconsistency is observed between OCE characterization results from different measurement sessions. Therefore, a robust mechanical characterization is required for force/stress quantification. A quantitative optical coherence elastography (qOCE) that tracks both force and displacement is proposed and developed at NJIT. qOCE instrument is based on a fiber optic probe integrated with a Fabry-Perot force sensor and the miniature probe can be delivered to arbitrary locations within animal or human body. In this dissertation, the principle of qOCE technology is described. Experimental results are acquired to demonstrate the capability of qOCE in characterizing the elasticity of biological tissue. Moreover, a handheld optical instrument is developed to allow in vivo real-time OCE characterization based on an adaptive Doppler analysis algorithm to accurately track the motion of sample under compression. For the development of the dual modality OCT system, the structural OCT images exhibit additive and multiplicative noises that degrade the image quality. To suppress noise in OCT imaging, a noise adaptive wavelet thresholding (NAWT) algorithm is developed to remove the speckle noise in OCT images. NAWT algorithm characterizes the speckle noise in the wavelet domain adaptively and removes the speckle noise while preserving the sample structure. Furthermore, a novel denoising algorithm is also developed that adaptively eliminates the additive noise from the complex OCT using Doppler variation analysis

Évaluation de la biomécanique cardiovasculaire par élastographie ultrasonore non-invasive

L’élastographie est une technique d’imagerie qui vise à cartographier in vivo les propriétés mécaniques des tissus biologiques dans le but de fournir des informations diagnostiques additionnelles. Depuis son introduction en imagerie ultrasonore dans les années 1990, l’élastographie a trouvé de nombreuses applications. Cette modalité a notamment été utilisée pour l’étude du sein, du foie, de la prostate et des artères par imagerie ultrasonore, par résonance magnétique ou en tomographie par cohérence optique. Dans le contexte des maladies cardiovasculaires, cette modalité a un fort potentiel diagnostique puisque l’athérosclérose modifie la structure des tissus biologiques et leurs propriétés mécaniques bien avant l’apparition de tout symptôme. Quelle que soit la modalité d’imagerie utilisée, l’élastographie repose sur : l’excitation mécanique du tissu (statique ou dynamique), la mesure de déplacements et de déformations induites, et l’inversion qui permet de recouvrir les propriétés mécaniques des tissus sous-jacents. Cette thèse présente un ensemble de travaux d’élastographie dédiés à l’évaluation des tissus de l’appareil cardiovasculaire. Elle est scindée en deux parties. La première partie intitulée « Élastographie vasculaire » s’intéresse aux pathologies affectant les artères périphériques. La seconde, intitulée « Élastographie cardiaque », s’adresse aux pathologies du muscle cardiaque. Dans le contexte vasculaire, l’athérosclérose modifie la physiologie de la paroi artérielle et, de ce fait, ses propriétés biomécaniques. La première partie de cette thèse a pour objectif principal le développement d’un outil de segmentation et de caractérisation mécanique des composantes tissulaires (coeur lipidique, tissus fibreux et inclusions calciques) de la paroi artérielle, en imagerie ultrasonore non invasive, afin de prédire la vulnérabilité des plaques. Dans une première étude (Chapitre 5), nous présentons un nouvel estimateur de déformations, associé à de l’imagerie ultrarapide par ondes planes. Cette nouvelle méthode d’imagerie permet d’augmenter les performances de l’élastographie non invasive. Dans la continuité de cette étude, on propose une nouvelle méthode d’inversion mécanique dédiée à l’identification et à la quantification des propriétés mécaniques des tissus de la paroi (Chapitre 6). Ces deux méthodes sont validées in silico et in vitro sur des fantômes d’artères en polymère. Dans le contexte cardiaque, les ischémies et les infarctus causés par l’athérosclérose altèrent la contractilité du myocarde et, de ce fait, sa capacité à pomper le sang dans le corps (fonction myocardique). En échocardiographie conventionnelle, on évalue généralement la fonction myocardique en analysant la dynamique des mouvements ventriculaires (vitesses et déformations du myocarde). L’abscence de contraintes physiologiques agissant sur le myocarde (contrairement à la pression sanguine qui contraint la paroi vasculaire) ne permet pas de résoudre le problème inverse et de retrouver les propriétés mécaniques du tissu. Le terme d’élastographie fait donc ici référence à l’évaluation de la dynamique des mouvements et des déformations et non à l’évaluation des propriétés mécanique du tissu. La seconde partie de cette thèse a pour principal objectif le développement de nouveaux outils d’imagerie ultrarapide permettant une meilleure évaluation de la dynamique du myocarde. Dans une première étude (Chapitre 7), nous proposons une nouvelle approche d’échocardiographie ultrarapide et de haute résolution, par ondes divergentes, couplée à de l'imagerie Doppler tissulaire. Cette combinaison, validée in vitro et in vivo, permet d’optimiser le contraste des images mode B ainsi que l’estimation des vitesses Doppler tissulaires. Dans la continuité de cette première étude, nous proposons une nouvelle méthode d’imagerie des vecteurs de vitesses tissulaires (Chapitre 8). Cette approche, validée in vitro et in vivo, associe les informations de vitesses Doppler tissulaires et le mode B ultrarapide de l’étude précédente pour estimer l’ensemble du champ des vitesses 2D à l’intérieur du myocarde.Elastography is an imaging technique that aims to map the in vivo mechanical properties of biological tissues in order to provide additional diagnostic information. Since its introduction in ultrasound imaging in the 1990s, elastography has found many applications. This method has been used for the study of the breast, liver, prostate and arteries by ultrasound imaging, magnetic resonance imaging (MRI) or optical coherence tomography (OCT). In the context of cardiovascular diseases (CVD), this modality has a high diagnostic potential as atherosclerosis, a common pathology causing cardiovascular diseases, changes the structure of biological tissues and their mechanical properties well before any symptoms appear. Whatever the imaging modality, elastography is based on: the mechanical excitation of the tissue (static or dynamic), the measurement of induced displacements and strains, and the inverse problem allowing the quantification of the mechanical properties of underlying tissues. This thesis presents a series of works in elastography for the evaluation of cardiovascular tissues. It is divided into two parts. The first part, entitled « Vascular elastography » focuses on diseases affecting peripheral arteries. The second, entitled « Cardiac elastography » targets heart muscle pathologies. In the vascular context, atherosclerosis changes the physiology of the arterial wall and thereby its biomechanical properties. The main objective of the first part of this thesis is to develop a tool that enables the segmentation and the mechanical characterization of tissues (necrotic core, fibrous tissues and calcium inclusions) in the vascular wall of the peripheral arteries, to predict the vulnerability of plaques. In a first study (Chapter 5), we propose a new strain estimator, associated with ultrafast plane wave imaging. This new imaging technique can increase the performance of the noninvasive elastography. Building on this first study, we propose a new inverse problem method dedicated to the identification and quantification of the mechanical properties of the vascular wall tissues (Chapter 6). These two methods are validated in silico and in vitro on polymer phantom mimicking arteries. In the cardiac context, myocardial infarctions and ischemia caused by atherosclerosis alter myocardial contractility. In conventional echocardiography, the myocardial function is generally evaluated by analyzing the dynamics of ventricular motions (myocardial velocities and deformations). The abscence of physiological stress acting on the myocardium (as opposed to the blood pressure which acts the vascular wall) do not allow the solving the inverse problem and to find the mechanical properties of the fabric. Elastography thus here refers to the assessment of motion dynamics and deformations and not to the evaluation of mechanical properties of the tissue. The main objective of the second part of this thesis is to develop new ultrafast imaging tools for a better evaluation of the myocardial dynamics. In a first study (Chapter 7), we propose a new approach for ultrafast and high-resolution echocardiography using diverging waves and tissue Doppler. This combination, validated in vitro and in vivo, optimize the contrast in B-mode images and the estimation of myocardial velocities with tissue Doppler. Building on this study, we propose a new velocity vector imaging method (Chapter 8). This approach combines tissue Doppler and ultrafast B-mode of the previous study to estimate 2D velocity fields within the myocardium. This original method was validated in vitro and in vivo on six healthy volunteers