Ultrasound-based Imaging Method Research Articles

Ultrasound-Based Imaging Methods for the Assessment of Kidney Fibrosis on Artificial Intelligence

Ultrasound-Based Imaging Methods for the Assessment of Kidney Fibrosis on Artificial Intelligence

A New Combined Non-invasive Method for Assessment of Liver Steatosis and Fibrosis in NAFLD Patients – Pilot Study

The aim of this study was to investigate the clinical efficacy (sensitivity, specificity) of ultrasound-based imaging methods for the assessment of fibrosis and steatosis in patients with non-àlcoholic fatty liver disease (NAFLD). Sixty-six patients with NAFLD and 43 healthy volunteers (control group) were tested. Liver biopsy was used as a reference method for the evaluation of NAFLD. Liver stiffness measurement (LSM) with transient elastography (TE) and two-dimensional shear wave elastography (2D-SWE) was used to assess fibrosis. Steatosis was assessed by Controlled Attenuation Parameter (CAP) and EchoLevels (ELs). Using the ELs, two hepato-renal indices were calculated – the hepato-renal index difference (HRIdiff) and hepato-renal index ratio (HRIratio). Additionally, one serum biomarker was calculated – APRI. Cut-offs of cirrhosis (F4) were defined as follows: ≥ 9.64 kPa and ≥ 9.85 kPa for 2D-SWE and TE. Only 2D-SWE had a correlation for significant fibrosis – the cut-off was ≥ 6.50 kPa and for lack of significant fibrosis (F < 2) less than 5.26 kPa. Steatosis was diagnosed with a cut-off of 240.50 dB/m for CAP, and HRIdiff ≥ 0.39, and HRIratio ≤ 0.99 for ELs. Both types of SWE and the two methods for evaluation of ultrasound (US) attenuation have good correlation with fibrosis and steatosis in NAFLD.

Passive Acoustic Mapping for ultrasound therapy monitoring

Abstract Passive Acoustic Mapping (PAM) is an ultrasoundbased imaging method developed for monitoring therapeutic ultrasound. By using diagnostic transducers to passively record the acoustic signals that are emitted by cavitation bubbles, the origin of the bubbles can be reconstructed and displayed as intensity maps. In this study, two matrix arrays with different aperture sizes were used for the volumetric reconstruction of simulated and experimental data. In a second step, the number of elements being used for the reconstruction was reduced by more than the factor of eight in order to assess the influence on the imaging quality. In the numerical part of the study, the image quality was greatly improved by increasing the aperture size, while a high number of elements used for the reconstruction merely offers minor improvements. The experimentally obtained results were able to confirm the numerical findings regarding the achievable reconstruction quality.

Is There a Place for Elastography in the Assessment of Chronic Kidney Disease?

Renal elastography is a real-time ultrasound-based imaging method that can potentially be used in order to assess diffuse diseases of native kidneys. In order to find a place in the clinical practice for renal elastography, what is influencing the obtained results should be known. The kidney shear wave speed is influenced by different factors such as age, gender, measurement depth or urinary pressure. The relationship with renal function and also with renal fibrosis is different across different studies, with not all studies showing an increase in renal stiffness in more advanced renal diseases. However, the changes in renal blood flow seem to influence renal elastography, and a decrease in renal blood flow could be the cause of the decrease in the shear wave speed and could have a bigger influence on elastography compared to renal fibrosis. This paper provides a summary about the factors that seem to influence renal elastography and also regarding the limitations of this method according to the published studies thus far.

Development of Custom Wall-Less Cardiovascular Flow Phantoms with Tissue-Mimicking Gel

PurposeFlow phantoms are used in experimental settings to aid in the simulation of blood flow. Custom geometries are available, but current phantom materials present issues with degradability and/or mimicking the mechanical properties of human tissue. In this study, a method of fabricating custom wall-less flow phantoms from a tissue-mimicking gel using 3D printed inserts is developed.MethodsA 3D blood vessel geometry example of a bifurcated artery model was 3D printed in polyvinyl alcohol, embedded in tissue-mimicking gel, and subsequently dissolved to create a phantom. Uniaxial compression testing was performed to determine the Young’s moduli of the five gel types. Angle-independent, ultrasound-based imaging modalities, Vector Flow Imaging (VFI) and Blood Speckle Imaging (BSI), were utilized for flow visualization of a straight channel phantom.ResultsA wall-less phantom of the bifurcated artery was fabricated with minimal bubbles and continuous flow demonstrated. Additionally, flow was visualized through a straight channel phantom by VFI and BSI. The available gel types are suitable for mimicking a variety of tissue types, including cardiac tissue and blood vessels.ConclusionCustom, tissue-mimicking flow phantoms can be fabricated using the developed methodology and have potential for use in a variety of applications, including ultrasound-based imaging methods. This is the first reported use of BSI with an in vitro flow phantom.

Noninvasive Young's modulus visualization of fibrosis progression and delineation of pancreatic ductal adenocarcinoma (PDAC) tumors using Harmonic Motion Elastography (HME) in vivo.

Background and aims: Poor specificity and predictive values of current cross-sectional radiological imaging methods in evaluation of pancreatic adenocarcinoma (PDAC) limit the clinical capability to accurately stage the tumor pre-operatively and provide optimal surgical treatment and improve patient outcomes.Methods: In this study, we applied Harmonic Motion Elastography (HME), a quantitative ultrasound-based imaging method to calculate Young's modulus (YM) in PDAC mouse models (n = 30) and human pancreatic resection specimens of PDAC (n=32). We compared the YM to the collagen assessment by Picrosirius red (PSR) stain on corresponding histologic sections.Results: HME is capable of differentiating between different levels of fibrosis in transgenic mice. In mice without pancreatic fibrosis, the measured YM was 4.2 ± 1.3 kPa, in fibrotic murine pancreata, YM was 5.5 ± 2.0 kPa and in murine PDAC tumors, YM was 11.3 ± 1.7 kPa. The corresponding PSR values were 2.0 ± 0.8 %, 9.8 ± 3.4 %, and 13.2 ± 1.2%, respectively. In addition, three regions within each human surgical PDAC specimen were assessed: tumor, which had both the highest Young's modulus (YM > 40 kPa) and collagen density (PSR > 40 %); non-neoplastic adjacent pancreas, which had the lowest Young's modulus (YM < 15 kPa) and collagen density (PSR < 10%) and a transitional peri-lesional region between the tumor and non-neoplastic pancreas with an intermediate value of measured Young's modulus (15 kPa < YM < 40 kPa) and collagen density (15% < PSR < 35 %).Conclusion: In conclusion, a non-invasive, quantitative imaging tool for detecting, staging and delineating PDAC tumor margins based on the change in collagen density was developed.

Correlation of Point Shear Wave Velocity and Kidney Function in Chronic Kidney Disease.

Point shear wave elastography is a quantitative ultrasound-based imaging method used in the assessment of renal disease. Among point shear wave elastographic options, 2 techniques have been studied considerably: Virtual Touch quantification (VTQ; Siemens AG, Erlangen, Germany) and ElastPQ (EPQ; Philips Healthcare, Bothell, WA). Both rely on the tissue response to an acoustic beam generated by the ultrasound transducer. The data on renal VTQ are more extensive, whereas EPQ has been used less thus far in the assessment of the kidneys. This study aimed to evaluate the performance of EPQ in the kidney and compare it with VTQ. We studied 124 participants using EPQ: 22 with no renal disease and 102 with chronic kidney disease (CKD). Ninety-one were studied with both the EPQ and VTQ methods. We obtained 5 valid measurements in each kidney, expressed in meters per second. The mean kidney stiffness measurements ± SD obtained with EPQ in the healthy control group were as follows: right kidney, 1.23 ± 0.33 m/s; and left kidney, 1.26 ± 0.32 m/s (P = .6). In the patients with CKD (all stages), the mean kidney stiffness measurements obtained were significantly lower: right kidney, 1.09 ± 0.39 m/s; and left kidney, 1.04 ± 0.38 m/s (P = .4). We observed that, similar to VTQ, EPQ values decreased with CKD progression, based on analysis of variance results using different CKD stages. From a receiver operating characteristic curve analysis, the cutoff value for an estimated glomerular filtration rate of less than 45 mL/min was 1.24 m/s, and the value for an estimated glomerular filtration rate of less than 30 mL/min was 1.07 m/s. When using EPQ, the kidney shear wave velocity is decreased in patients with CKD, an observation similar to that obtained by using the VTQ method.

Non-invasive evaluation of placental blood flow: lessons from animal models.

In human obstetrics, placental vascularisation impairment is frequent as well as linked to severe pathological events (preeclampsia and intrauterine growth restriction), and there is a need for reliable methods allowing non-invasive evaluation of placental blood flow. Uteroplacental vascularisation is complex, and animal models are essential for the technical development and safety assessment of these imaging tools for human clinical use; however, these techniques can also be applied in the veterinary context. This paper reviews how ultrasound-based imaging methods such as 2D and 3D Doppler can provide valuable insight for the exploration of placental blood flow both in humans and animals and how new approaches such as the use of ultrasound contrast agents or ultrafast Doppler may allow to discriminate between maternal (non-pulsatile) and foetal (pulsatile) blood flow in the placenta. Finally, functional magnetic resonance imaging could also be used to evaluate placental blood flow, as indicated by studies in animal models, but its safety in human pregnancy still requires to be confirmed.

Hemodynamics in fetal arrhythmia.

Fetal arrhythmias are among the few conditions that can be managed in utero. However, accurate diagnosis is essential for appropriate management. Ultrasound-based imaging methods can be used to study fetal heart structure and function noninvasively and help to understand fetal cardiovascular pathophysiology, and they remain the mainstay of evaluating fetuses with arrhythmias in clinical settings. Hemodynamic evaluation using Doppler echocardiography allows the elucidation of the electrophysiological mechanism and helps to make an accurate diagnosis. It can also be used as a tool to understand fetal cardiac pathophysiology, for assessing fetal condition and monitoring the effect of antiarrhythmic treatment. This narrative review describes Doppler techniques that are useful for evaluating fetal cardiac rhythms to refine diagnosis and provides an overview of hemodynamic changes observed in different types of fetal arrhythmia.

Reliability and validity of an ultrasound-based imaging method for measuring interspinous process distance in the lumbar spine using two different index points.

[Purpose] This study assessed the reliability and validity of an ultrasound-based imaging method for measuring the interspinous process distance in the lumbar spine using two different index points. [Subjects and Methods] Ten healthy males were recruited. Five physical therapy students participated in this study as examiners. The L2–L3 interspinous distance was measured from the caudal end of the L2 spinous process to the cranial end of the L3 spinous process (E-E measurement) and from the top of the L2 spinous process to the top of the L3 spinous process (T-T measurement). Intraclass correlation coefficients were calculated to estimate the relative reliability. Validity was assessed using a model resembling the living human body. [Results] The reliability study showed no difference in intra-rater reliability between the two measurements. However, the E-E measurement showed higher inter-rater reliability than the T-T measurement (Intraclass correlation coefficients: 0.914 vs. 0.725). Moreover, the E-E measurement method had good validity (Intraclass correlation coefficients: 0.999 and 95% confidence interval for minimal detectable change: 0.29 mm). [Conclusion] These results demonstrate the high reliability and validity of ultrasound-based imaging in the quantitative assessment of lumbar interspinous process distance. Of the two methods, the E-E measurement method is recommended.

Mapping the longitudinal wall stiffness heterogeneities within intact canine aortas using Pulse Wave Imaging (PWI) ex vivo

The aortic stiffness has been found to be a useful independent indicator of several cardiovascular diseases such as hypertension and aneurysms. Existing methods to estimate the aortic stiffness are either invasive, e.g. catheterization, or yield average global measurements which could be inaccurate, e.g., tonometry. Alternatively, the aortic pulse wave velocity (PWV) has been shown to be a reliable marker for estimating the wall stiffness based on the Moens–Korteweg (M–K) formulation. Pulse Wave Imaging (PWI) is a relatively new, ultrasound-based imaging method for noninvasive and regional estimation of PWV. The present study aims at showing the application of PWI in obtaining localized wall mechanical properties by making PWV measurements on several adjacent locations along the ascending thoracic to the suprarenal abdominal aortic trunk in its intact vessel form. The PWV estimates were used to calculate the regional wall modulus based on the M–K relationship and were compared against conventional mechanical testing. The findings indicated that for the anisotropic aortic wall, the PWI estimates of the modulus are smaller than the circumferential modulus by an average of −32.22% and larger than the longitudinal modulus by an average of 25.83%. Ongoing work is focused on the in vivo applications of PWI in normal and pathological aortas with future implications in the clinical applications of the technique.

Magnetite Nanoparticles Can Be Coupled to Microbubbles to Support Multimodal Imaging

Microbubbles (MBs) are commonly used as injectable ultrasound contrast agent (UCA) in modern ultrasonography. Polymer-shelled UCAs present additional potentialities with respect to marketed lipid-shelled UCAs. They are more robust; that is, they have longer shelf and circulation life, and surface modifications are quite easily accomplished to obtain enhanced targeting and local drug delivery. The next generation of UCAs will be required to support not only ultrasound-based imaging methods but also other complementary diagnostic approaches such as magnetic resonance imaging or computer tomography. This work addresses the features of MBs that could function as contrast agents for both ultrasound and magnetic resonance imaging. The results indicate that the introduction of iron oxide nanoparticles (SPIONs) in the poly(vinyl alcohol) shell or on the external surface of the MBs does not greatly decrease the echogenicity of the host MBs compared with the unmodified one. The presence of SPIONs provides enough magnetic susceptibility to the MBs to accomplish good detectability both in vitro and in vivo. The distribution of SPIONs on the shell and their aggregation state seem to be key factors for the optimization of the transverse relaxation rate.

Single-heartbeat electromechanical wave imaging with optimal strain estimation using temporally unequispaced acquisition sequences

Electromechanical Wave Imaging (EWI) is a non-invasive, ultrasound-based imaging method capable of mapping the electromechanical wave (EW) in vivo, i.e. the transient deformations occurring in response to the electrical activation of the heart. Optimal imaging frame rates, in terms of the elastographic signal-to-noise ratio, to capture the EW cannot be achieved due to the limitations of conventional imaging sequences, in which the frame rate is low and tied to the imaging parameters. To achieve higher frame rates, EWI is typically performed by combining sectors acquired during separate heartbeats, which are then combined into a single view. However, the frame rates achieved remain potentially sub-optimal and this approach precludes the study of non-periodic arrhythmias. This paper describes a temporally unequispaced acquisition sequence (TUAS) for which a wide range of frame rates are achievable independently of the imaging parameters, while maintaining a full view of the heart at high beam density. TUAS is first used to determine the optimal frame rate for EWI in a paced canine heart in vivo and then to image during ventricular fibrillation. These results indicate how EWI can be optimally performed within a single heartbeat, during free breathing and in real time, for both periodic and non-periodic cardiac events.

EP News: Basic and Translational

Provost et al (Proc Natl Acad Sci U S A 2011;108:8565, PMID 21571641) developed electromechanical wave imaging (EWI), a novel ultrasound-based imaging method. It is capable of mapping the electromechanics of all four cardiac chambers. The transient deformations resulting from the electrical activation of the myocardium were mapped in two dimensions and combined in three-dimensional biplane ventricular views. EWI maps were acquired during five distinct conduction configurations and were found to be closely correlated to the electrical activation sequences.

Imaging the electromechanical activity of the heart in vivo.

Cardiac conduction abnormalities remain a major cause of death and disability worldwide. However, as of today, there is no standard clinical imaging modality that can noninvasively provide maps of the electrical activation. In this paper, electromechanical wave imaging (EWI), a novel ultrasound-based imaging method, is shown to be capable of mapping the electromechanics of all four cardiac chambers at high temporal and spatial resolutions and a precision previously unobtainable in a full cardiac view in both animals and humans. The transient deformations resulting from the electrical activation of the myocardium were mapped in 2D and combined in 3D biplane ventricular views. EWI maps were acquired during five distinct conduction configurations and were found to be closely correlated to the electrical activation sequences. EWI in humans was shown to be feasible and capable of depicting the normal electromechanical activation sequence of both atria and ventricles. This validation of EWI as a direct, noninvasive, and highly translational approach underlines its potential to serve as a unique imaging tool for the early detection, diagnosis, and treatment monitoring of arrhythmias through ultrasound-based mapping of the transmural electromechanical activation sequence reliably at the point of care, and in real time.

A Method for Characterization of Tissue Elastic Properties Combining Ultrasonic Computed Tomography With Elastography

The correlation between various diseases and the change in the local mechanical properties of soft tissues has been long known. Over the past 20 years, there have been increasing research efforts to characterize mechanical properties of biological tissues using ultrasonic elastography. However, most of these works were based on characterization of only 1 type of waves (longitudinal or shear). The goal of this work was to devise a comprehensive ultrasound-based imaging method capable of measuring elastic parameters by combining both backscattered elastography and through-transmitted ultrasonic computed tomography. Our suggested technique provides measurements of both longitudinal and shear wave velocities. This enables the noninvasive computation of several tissue elasticity parameters such as Young's and shear moduli, Poisson's ratio, and, more importantly, the bulk modulus, the determination of which requires both wave velocities. Four different phantom types were examined: agar-gelatin-based phantoms and porcine fat tissue, turkey breast tissue, and bovine liver tissue in vitro specimens. The values of Young's modulus, the shear modulus, and Poisson's ratio were estimated and were consistent with values published in the literature. The average bulk modulus values of the phantoms +/- SD were 2.83 +/- 0.001, 2.25 +/- 0.01, 2.48 +/- 0.01, and 2.53 +/- 0.02 GPa, respectively. A statistically significant difference (P < .001) in the values of the bulk modulus of the different phantoms was found. The bulk modulus is suitable for differentiation between different tissue types. The obtained results show the feasibility of using a comprehensive ultrasonic imaging technique for noninvasive quantitative tissue characterization.