Ultrasound Elastography System Research Articles

Simultaneous Assessment of the Whole Eye Biomechanics Using Ultrasonic Elastography.

Current elastography techniques in the field of ophthalmology usually target one specific tissue, such as the cornea or the sclera. However, the eye is an inter-related organ, and some ocular diseases can alter the biomechanical properties of multiple anatomical structures. Hence, there is a need to develop an imaging tool that can non-invasively, quantitatively, and accurately characterize dynamic changes among these biomechanical properties. A high resolution ultrasound elastography system was developed to achieve this goal. The efficacy and accuracy of the system was first validated on tissue-mimicking phantoms while mechanical testing measurements served as the gold standard. Next, an in vivo elevated intraocular pressure (IOP) model was established in rabbits to further test our system. In particular, elastography measurements were obtained at 5 IOP levels, ranging from 10 mmHg to 30 mmHg in 5 mmHg increments. Spatial-temporal maps of the multiple ocular tissues (cornea, lens, iris, optic nerve head, and peripapillary sclera) were obtained. The spatial-temporal maps were acquired simultaneously for the ocular tissues at the 5 different IOP levels. The statistical analysis of the elastic wave speed was presented for ocular tissues. Finally, the mapping for the elastic wave speed of each ocular component was acquired at each IOP level. Our elastography system can concurrently assess the biomechanical properties of multiple ocular structures and detect changes in biomechanical properties associated with changes in IOP. This system provides a novel tool to measure and quantify the biomechanical properties of the whole eye.

Suspected Malignant Thyroid Nodules in Children and Adolescents According to Ultrasound Elastography and Ultrasound-Based Risk Stratification Systems-Experience from One Center.

The risk of malignancy in thyroid nodules correlates with the presence of ultrasonographic features. In adults, ultrasound risk-classification systems have been proposed to indicate the need for further invasive diagnosis. Furthermore, elastography has been shown to support differential diagnosis of thyroid nodules. The purpose of our study was to assess the application of the American Thyroid Association (ATA), British Thyroid Association (BTA) ultrasound risk-classification systems and strain elastography in the management of thyroid nodules in children and adolescents from one center. Seventeen nodules with Bethesda III, IV, V and VI were selected from 165 focal lesions in children. All patients underwent ultrasonography and elastography followed by fine needle aspiration biopsy. Ultrasonographic features according to the ATA and BTA stratification systems were assessed retrospectively. The strain ratio in the group of thyroid nodules diagnosed as malignant was significantly higher than in benign nodules (6.07 vs. 3.09, p = 0.036). According to the ATA guidelines, 100% of malignant nodules were classified as high suspicion and 73% of benign nodules were assessed as low suspicion. Using the BTA U-score classification, 80% of malignant nodules were classified as cancerous (U5) and 20% as suspicious for malignancy (U4). Among benign nodules, 82% were classified as indeterminate or equivocal (U3) and 9% as benign (U2). Our results suggest that application of the ATA or BTA stratification system and elastography may be a suitable method for assessing the level of suspected malignancy in thyroid nodules in children and help make a clinical decision about the need for further invasive diagnosis of thyroid nodules in children.

Shear wave speed measurement bias in a viscoelastic phantom across six ultrasound elastography systems: a comparative study with transient elastography and magnetic resonance elastography

PurposeTo quantify the bias of shear wave speed (SWS) measurements in a viscoelastic phantom across six different ultrasound (US) systems and to compare the SWS with those from transient elastography (TE) and magnetic resonance elastography (MRE).MethodsA viscoelastic phantom of stiffness representing fibrotic liver or healthy thyroid was measured with nine (linear probe) and 10 (convex probe) modes of six different US-based shear wave elastography (SWE) systems using linear and convex probes. SWS measurements of three regions of interest were repeated thrice at two focal depths, coupling the probe to the phantom using a jig. An MRE system using three motion-encoding gradient frequencies of 60, 90, and 120 Hz and TE were also used to measure the stiffness of the phantom.ResultsThe SWS from different SWE systems had mean coefficients of variation of 9.0–9.2% and 5.4–5.6% with linear and convex probes, respectively, in viscoelastic phantom measurement. The focal depth was a less significant source of SWS variability than the system. The total average SWS obtained with US-SWE systems was 19.9% higher than that obtained with MRE at 60 Hz, which is commonly used in clinical practice, and 31.5% higher than that obtained with TE using the M probe.ConclusionsDespite the measurement biases associated with the SWE systems, biases were not necessarily consistent, and they changed with the probes used and depth measured. The SWS of the viscoelastic phantom obtained using different modalities increased according to the shear wave frequency used.

Breast Tumour Classification Using Ultrasound Elastography with Machine Learning: A Systematic Scoping Review.

Simple SummaryBreast cancer is one of the most common cancers among women globally. Early and accurate screening of breast tumours can improve survival. Ultrasound elastography is a non-invasive and non-ionizing imaging approach to characterize lesions for breast cancer screening, while machine learning techniques could improve the accuracy and reliability of computer-aided diagnosis. This review focuses on the state-of-the-art development and application of the machine learning model in breast tumour classification.Ultrasound elastography can quantify stiffness distribution of tissue lesions and complements conventional B-mode ultrasound for breast cancer screening. Recently, the development of computer-aided diagnosis has improved the reliability of the system, whilst the inception of machine learning, such as deep learning, has further extended its power by facilitating automated segmentation and tumour classification. The objective of this review was to summarize application of the machine learning model to ultrasound elastography systems for breast tumour classification. Review databases included PubMed, Web of Science, CINAHL, and EMBASE. Thirteen (n = 13) articles were eligible for review. Shear-wave elastography was investigated in six articles, whereas seven studies focused on strain elastography (5 freehand and 2 Acoustic Radiation Force). Traditional computer vision workflow was common in strain elastography with separated image segmentation, feature extraction, and classifier functions using different algorithm-based methods, neural networks or support vector machines (SVM). Shear-wave elastography often adopts the deep learning model, convolutional neural network (CNN), that integrates functional tasks. All of the reviewed articles achieved sensitivity ≥80%, while only half of them attained acceptable specificity ≥95%. Deep learning models did not necessarily perform better than traditional computer vision workflow. Nevertheless, there were inconsistencies and insufficiencies in reporting and calculation, such as the testing dataset, cross-validation, and methods to avoid overfitting. Most of the studies did not report loss or hyperparameters. Future studies may consider using the deep network with an attention layer to locate the targeted object automatically and online training to facilitate efficient re-training for sequential data.

Evaluation of Hand Tendon Elastic Properties During Rehabilitation Through High-Frequency Ultrasound Shear Elastography.

Tendon injuries lead to tendon stiffness, which impairs skeletal muscle movement. Most studies have focused on patellar or Achilles tendons by using ultrasound elastography. Only a few studies have measured the stiffness of hand tendons because their thickness is only 1-2 mm, rendering clinical ultrasound elastography unsuitable for mapping hand tendon stiffness. In this study, a high-frequency ultrasound shear elastography (HFUSE) system was proposed to map the shear wave velocity (SWV) of hand flexor tendons. A handheld vibration system that was coaxially mounted with an external vibrator on a high-frequency ultrasound (HFUS) array transducer allowed the operators to scan hand tendons freely. To quantify the performance of HFUSE, six parameters were comprehensively measured from homogeneous, two-sided, and three-sided gelatin phantom experiments: bias, precision, lateral resolution, contrast, contrast-to-noise ratio (CNR), and accuracy. HFUSE demonstrated an excellent resolution of [Formula: see text] to distinguish the local stiffness of thin phantom (thickness: 1.2 mm) without compromising bias, precision, contrast, CNR, and accuracy, which has been noted with previous systems. Human experiments involved four patients with hand tendon injuries who underwent ≥2 months of rehabilitation. Using HFUSE, two-dimensional SWV images of flexor tendons could be clearly mapped for healthy and injured tendons, respectively. The findings demonstrate that HFUSE can be a promising tool for evaluating the elastic properties of the injured hand tendon after surgery and during rehabilitation and thus help monitor progress.

Comparison of 2 shear wave elastography systems in reproducibility and accuracy using an elasticity phantom

This study aimed to compare the accuracy and inter- and intra-observer reproducibility of the measured elasticity between 2 shear wave elastography systems. Three breast radiologists examined 8 targets of 4 different levels of stiffness (size: 11 mm, 4 mm) in an elasticity phantom (Customized 049A Elasticity QA Phantom, CIRS, Norfolk, VA, USA) using 2 different shear wave ultrasound elastography systems: SuperSonic Imagine (SSI) (SSI, Aix en Provence, France) and ShearScan (RS-80A, Samsung Medison, Seoul, Korea). Three radiologists performed ultrasound (US) elastography examinations for the phantom lesions using 2 equipment over a 1-week interval. Intra- and inter-observer reproducibility and the accuracy of the measured elasticity were analyzed and compared between the 2 systems. The accuracy of shape was also analyzed by shape-matching between B-mode and elastography color image. Intra-class correlation coefficients (ICC) were used in statistical analysis. For measured elasticity, the intra-observer and inter-observer reproducibility were excellent in both SSI and ShearScan (0.994 and 0.998). The overall accuracy was excellent in both systems, but the accuracy in small lesions (4 mm target) was lower in SSI than ShearScan (0.780 vs 0.967). The accuracy of shape-matching on the elastography image was 59.0% and 81.4% in the SSI and ShearScan, respectively. In conclusion, the SSI and ShearScan showed excellent intra- and inter-observer reproducibility. The accuracy of the Young's modulus was high in both the SSI and ShearScan, but the SSI showed decreased accuracy in measurement of elasticity in small targets and poor shape-matching between the B-mode image and color-coded elastography image.

Mapping of Back Muscle Stiffness along Spine during Standing and Lying in Young Adults: A Pilot Study on Spinal Stiffness Quantification with Ultrasound Imaging.

Muscle stiffness in the spinal region is essential for maintaining spinal function, and might be related to multiple spinal musculoskeletal disorders. However, information on the distribution of muscle stiffness along the spine in different postures in large subject samples has been lacking, which merits further investigation. This study introduced a new protocol of measuring bilateral back muscle stiffness along the thoracic and lumbar spine (at T3, T7, T11, L1 & L4 levels) with both ultrasound shear-wave elastography (SWE) and tissue ultrasound palpation system (TUPS) in the lying and standing postures of 64 healthy adults. Good inter-/intra-reliability existed in the SWE and TUPS back muscle stiffness measurements (ICC ≥ 0.731, p < 0.05). Back muscle stiffness at the L4 level was found to be the largest in the thoracic and lumbar regions (p < 0.05). The back muscle stiffness of males was significantly larger than that of females in both lying and standing postures (p < 0.03). SWE stiffness was found to be significantly larger in standing posture than lying among subjects (p < 0.001). It is reliable to apply SWE and TUPS to measure back muscle stiffness. The reported data on healthy young adults in this study may also serve as normative reference data for future studies on patients with scoliosis, low back pain, etc.

Noninvasive stiffness assessment of the human lens nucleus in patients with anisometropia using an ultrasound elastography system.

To investigate the significance of ultrasound elastography for evaluating stiffness of the human lens nucleus in patients with anisometropia. A total of 14 patients (28 eyes) with anisometropia were enrolled. The difference in refractive status between two eyes ≥-4.0 diopters (D) and the difference in axial length (AL) of the eyes was ≥3 mm. There were 5 males and 9 females with an average age of 62±3.3y. The test data of the long AL eye of each patient was included in group A (14 eyes), and test data of the eye with relative short AL was included in group B. Lens nuclear stiffness was measured with free-hand qualitative elastography by independent operators. Strain gray scale and color-coded elastography maps were recorded. In each case, three consecutive measurements were performed and strain ratio was used for statistical analysis. Photograph and sectional view of the lens were analyzed and archived by anterior segment image. In the long AL group, the strain rate in the nucleus of the lens was 0.16%±0.08%; in the short AL group, the strain rate in the nucleus of the lens was 0.54%±0.16%. Independent sample t-test analyses showed that the long AL group lens had a significantly smaller nuclear strain rate than the relatively short AL group, P<0.05. The relationship between human lens stiffness and different AL is demonstrated by ultrasound elastography. The long AL is associated with lower strain ratio and less resilience of the lens.

Characterization of the extensor digitorum communis tendon using high‐frequency ultrasound shear wave elastography

Hand tendon injuries caused by various accidents are common in emergency departments. The assessment of tendon properties is crucial for evaluating the effectiveness of therapy or rehabilitation during recovery after hand injuries. Many recent studies have indicated that the shear wave velocity (SWV) of tendons is related to their stiffness. However, measurement of SWV of hand tendon is still a challenge because the small size of tendon and the limitation of existing ultrasound systems for detecting fast SWV. We propose a high-frequency ultrasound (HFUS) elastography system using an external vibrator to measure the SWV of the extensor digitorum communis (EDC) tendon. First, animal studies were performed by measuring the SWV and stress of porcine tendons using the proposed HFUS elastography and materials testing systems respectively. In the human experiment, SWVs were measured during hand extension and flexion. The applied stress from a finger during the movements was recorded synchronously by using a load cell. The experimental results reveal that a favorable linear correction (R2 of 0.96) was obtained between tendon SWV and stress in animal studies. In the human (hand) EDC tendon experiments, the SWV increased with the extension and flexion of the hand. The SWV of the EDC tendon was in the range of 20 to 135m/s as the applied force from the finger of a healthy human increased to 50% maximal voluntary contraction. All the experimental results show that the proposed HFUS elastography system can be used to characterize the EDC tendon and has potential use for evaluating tendon stiffness during recovery after hand injures.

Predictors of external pancreatic fistulae after pancreatic resection

Despite a significant decrease in postoperative mortality after pancreatic resections in recent years (5.2-15% after pancreatoduodenectomy and about 5% after distal pancreatectomy), incidence of postoperative complications remains high (30-50% and 22-50%, respectively). Postoperative pancreatic fistula is one of the most common and formidable complications. Currently, most authors use the classification proposed by the International Study Group for Pancreatic Fistula (biochemical failure, fistula type B and C). Prediction of the risk of postoperative fistula is still a complex and unresolved problem of modern surgical pancreatology. According to the literature, the main risk factors of postoperative pancreatic fistulae are obesity and high body mass index, concomitant cardiovascular diseases, no neoadjuvant chemo- and radiotherapy, soft pancreatic texture, narrow pancreatic duct, no fibrotic changes in parenchyma, adipose infiltration of the pancreas, advanced intraoperative blood loss, as well as center experience. Most often, magnetic resonance imaging, computed tomography, ultrasound elastography and various multivariate risk assessment systems are used to estimate the risk of pancreatic fistulae. However, a generally accepted technique does not exist. This manuscript is devoted to analysis of risk factors of postoperative pancreatic fistulae and diagnostic methods for assessment of this risk.

A New Multimodel Machine Learning Framework to Improve Hepatic Fibrosis Grading Using Ultrasound Elastography Systems from Different Vendors

The purpose of the work described here was to determine if the diagnostic performance of point and 2-D shear wave elastography (pSWE; 2-DSWE) using shear wave velocity (SWV) with a new machine learning (ML) technique applied to systems from different vendors is comparable to that of magnetic resonance elastography (MRE) in distinguishing non-significant (<F2) from significant (≥F2) fibrosis. We included two patient groups with liver disease: (i) 144 patients undergoing pSWE (Siemens) and MRE; and (ii) 60 patients undergoing 2-DSWE (Philips) and MRE. Four ML algorithms using 10 SWV measurements as inputs were trained with MRE. Results were validated using twofold cross-validation. The performance of median SWV in binary grading of fibrosis was moderate for pSWE (area under the curve [AUC]: 0.76) and 2-DSWE (0.84); the ML algorithm support vector machine (SVM) performed particularly well (pSWE: 0.96, 2-DSWE: 0.99). The results suggest that the multivendor ML-based algorithm SVM can binarily grade liver fibrosis using ultrasound elastography with excellent diagnostic performance, comparable to that of MRE.

Characterization of Hand Tendons Through High-Frequency Ultrasound Elastography.

Tendon stiffness plays an important role in the tendon healing process, and many studies have indicated that measuring the shear wave velocity (SWV) on tendons relates to their stiffness. Because the thickness of hand tendons is a few millimeters, high-resolution imaging is required for visualizing hand tissues. However, the resolution of current ultrasound elastography systems is insufficient. In this study, a high-frequency (HF) ultrasound elastography system is proposed for measuring the SWVs of hand tendons. The HF ultrasound elastography system uses an external vibrator to create shear waves on hand tendons. Then, it uses a 40-MHz HF ultrasound array transducer with ultrafast ultrasound imaging technology to measure the SWV for characterizing hand tendons. A handheld device that combines a transducer and a vibrator allows the user to scan hand tissues. The biases of HF ultrasound elastography were measured in gelatin phantom experiments and were less than 6% compared to standard mechanical testing approach. Human experiments showed the ability to use HF ultrasound elastography to distinguish different SWVs of hand tendons. The SWVs were 0.73 ± 0.65 m/s and 1 ± 0.54 m/s for flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP), respectively, and 0.52 ± 0.14 m/s and 4.02 ± 0.77 m/s for extensor tendon under stretch and contraction conditions, respectively. The simplicity and convenience of the HF ultrasound elastography system for measuring hand tendon stiffness make it a promising tool for evaluating the severity of hand injuries and the performance of rehabilitation after hand injuries.

Direct-Acting Antiviral Treatment of HCV Infection Does Not Resolve the Dysfunction of Circulating CD8+ T-Cells in Advanced Liver Disease.

Chronic hepatitis C virus (HCV) infection disrupts immune functions, including that of cytotoxic CD8+ T-cells which are important mediators of immune response. While HCV cure aims to eliminate long term sequelae of infection, whether direct-acting antiviral (DAA) treatment results in immune reconstitution remains unclear. We and others have reported generalized CD8+ T-cell dysfunction in chronic HCV infection and our research suggests that the degree of liver damage is a factor in this process. Our recent research indicates that liver fibrosis is not readily reversed after DAA-mediated clearance of chronic HCV infection. We therefore examined the function of circulating CD8+ T-cell subsets in chronic HCV infection in the context of liver fibrosis severity, determined by ultrasound elastography and Metavir F-score system. We observed progressive shifts in CD8+ T-cell subset distribution in HCV-infected individuals with advanced liver fibrosis (F4) compared to minimal fibrosis (F0-1) or uninfected controls, and this remained unchanged after viral cure. Impaired CD8+ T-cell function was observed as a reduced proportion of CD107+ and perforin+ late effector memory cells in HCV+(F4) and HCV+(F0-1) individuals, respectively. In HCV+(F4) individuals, nearly all CD8+ T-cell subsets had an elevated proportion of perforin+ cells while naïve cells had increased proportions of IFN-γ+ and CD107+ cells. These exaggerated CD8+ T-cell activities were not resolved when evaluated 24 weeks after completion of DAA therapy and HCV clearance. This was further supported by sustained, high levels of cell proliferation and cytolytic activity. Furthermore, DAA therapy had no effect on elevated concentrations of systemic inflammatory cytokines and decreased levels of inhibitory TGF-β in the plasma of HCV+(F4) individuals, suggesting HCV infection and advanced liver disease result in a long-lasting immune activating microenvironment. These data demonstrate that in chronic HCV infection, liver fibrosis severity is associated with generalized hyperfunctional CD8+ T-cells, particularly with perforin production and cytotoxicity, and this persists after viral clearance. Whether DAA therapy will eliminate other related long-term sequelae in HCV+(F4) individuals remains an important research question.

In Vivo Layer-Specific Mechanical Characterization of Porcine Stomach Tissue Using a Customized Ultrasound Elastography System.

This paper presents in vivo mechanical characterization of the muscularis, submucosa, and mucosa of the porcine stomach wall under large deformation loading. This is particularly important for the development of gastrointestinal pathology-specific surgical intervention techniques. The study is based on testing the cardiac and fundic glandular stomach regions using a custom-developed compression ultrasound elastography system. Particular attention has been paid to elucidate the heterogeneity and anisotropy of tissue response. A Fung hyperelastic material model has been used to model the mechanical response of each tissue layer. A univariate analysis comparing the initial shear moduli of the three layers indicates that the muscularis (5.69 ± 4.06 kPa) is the stiffest followed by the submucosa (3.04 ± 3.32 kPa) and the mucosa (0.56 ± 0.28 kPa). The muscularis is found to be strongly distinguishable from the mucosa tissue in the cardiac and fundic regions based on a multivariate discriminant analysis. The cardiac muscularis is observed to be stiffer than the fundic muscularis tissue (shear moduli of 7.96 ± 3.82 kPa versus 3.42 ± 2.96 kPa), more anisotropic (anisotropic parameter of 2.21 ± 0.77 versus 1.41 ± 0.38), and strongly distinguishable from its fundic counterpart. The results are consistent with the tissue morphology and are in accordance with our previous ex vivo tissue study. Finally, a univariate comparison of the in vivo and ex vivo initial shear moduli for each layer shows that the muscularis and submucosa tissues are softer while in vivo, but the mucosa tissue is stiffer while in vivo. The results concerning the mechanical properties highlight the inhomogeneity and anisotropy of multilayer stomach tissue.

In vivo assessment of the mechanical properties of crystalline lenses in a rabbit model using ultrasound elastography: Effects of ultrasound frequency and age

PurposeThe occurrence of presbyopia and cataract is closely related to changes in the mechanical properties of the crystalline lens. There are no established methods so far for in vivo assessment. By introducing ultrasound elastography, we proposed group velocity (Vg) of an induced shear wave as a new biomarker to characterize the mechanical properties of the lens in our previous study. Here, we investigated the effect of the ultrasound frequency on measurement accuracy and validated the results with a conventional ex vivo compression testing. We also demonstrated a change trend in Vg and its correlation with age in a rabbit model. MethodsEight New Zealand white rabbits were fed normally from the fourth to seventh month. An ultrasound elastography system was developed to measure Vgin vivo on every eye once per month. The performances when using a high-frequency (L22-11v) and low-frequency (L11-4v) probe were compared. Rabbits were sacrificed after in vivo measurements by the end of the seventh month and this was followed by ex vivo ultrasound measurements and conventional compression tests on the extracted lenses. ResultsThe results demonstrated that there were no significance differences in Vg between measurements with high-frequency (USE-HF) and low-frequency (USE-LF) probes in the same month-age group. The mean Vg and the standard deviation of four rabbits that were 7 months old were 2.37 ± 0.24 m/s, 2.36 ± 0.25 m/s, 2.43 ± 0.26 m/s and 2.44 ± 0.38 m/s, with USE-HF for ex vivo and in vivo measurements and USE-LF for ex vivo and in vivo measurements, respectively. There were no significant differences (p > 0.05) and they were all in agreement with the results of compression tests, which was 16.16 ± 1.84 kPa in Young's modulus. The results also showed that Vg increased with age. In combination with the results of our previous study, Vg showed a relatively sharp increase from 2 to 5 months, while it had a slight increase from 5 to 7 months. ConclusionsThe USE-HF and USE-LF has comparable accuracy in Vg measurements while USE-HF had an advantage regarding better spatial resolution. The change trend of Vg was in accord with the growth phase of New Zealand white rabbits, which usually results in sexual maturity at 5 months old. This implies that Vg can be used as a biomarker parameter for evaluating the mechanical properties of the lens undergoing physiological changes.

Accelerating 3-D GPU-based Motion Tracking for Ultrasound Strain Elastography Using Sum-Tables: Analysis and Initial Results

Now, with the availability of 3-D ultrasound data, a lot of research efforts are being devoted to developing 3-D ultrasound strain elastography (USE) systems. Because 3-D motion tracking, a core component in any 3-D USE system, is computationally intensive, a lot of efforts are under way to accelerate 3-D motion tracking. In the literature, the concept of Sum-Table has been used in a serial computing environment to reduce the burden of computing signal correlation, which is the single most computationally intensive component in 3-D motion tracking. In this study, parallel programming using graphics processing units (GPU) is used in conjunction with the concept of Sum-Table to improve the computational efficiency of 3-D motion tracking. To our knowledge, sum-tables have not been used in a GPU environment for 3-D motion tracking. Our main objective here is to investigate the feasibility of using sum-table-based normalized correlation coefficient (ST-NCC) method for the above-mentioned GPU-accelerated 3-D USE. More specifically, two different implementations of ST-NCC methods proposed by Lewis et al. and Luo-Konofagou are compared against each other. During the performance comparison, the conventional method for calculating the normalized correlation coefficient (NCC) was used as the baseline. All three methods were implemented using compute unified device architecture (CUDA; Version 9.0, Nvidia Inc., CA, USA) and tested on a professional GeForce GTX TITAN X card (Nvidia Inc., CA, USA). Using 3-D ultrasound data acquired during a tissue-mimicking phantom experiment, both displacement tracking accuracy and computational efficiency were evaluated for the above-mentioned three different methods. Based on data investigated, we found that under the GPU platform, Lou-Konofaguo method can still improve the computational efficiency (17–46%), as compared to the classic NCC method implemented into the same GPU platform. However, the Lewis method does not improve the computational efficiency in some configuration or improves the computational efficiency at a lower rate (7–23%) under the GPU parallel computing environment. Comparable displacement tracking accuracy was obtained by both methods.

RSNA/QIBA efforts to standardize shear wave speed as a biomarker for liver fibrosis staging

Commercial shear elasticity systems have been available to clinicians for several years for characterizing liver stiffness. The Radiological Society of North America (RSNA) established a Quantitative Imaging Biomarker Alliance (QIBA) committee on Ultrasound Shear Wave Speed to help achieve better consistency between the shear wave speed and elastic modulus values reported by different manufacturer systems. An inter-laboratory study of shear wave speed estimation was conducted at academic, industry and clinical laboratories using commercial ultrasound and magnetic resonance elastography systems in elastic (Phase I) and viscoelastic (Phase II) homogeneous, isotropic tissue-mimicking phantoms. In the elastic phantoms, shear wave speeds from different systems were within ±5% of the grand mean of all system measurements. Different appraisers and replicate measurements at a given site were not sources of significant variability in shear wave speed measurements. In the viscoelastic phantoms, shear wave speeds from different systems were within ±15% of the grand mean of all systems, with the stiffest phantoms at the deepest focal depth (7 cm) having the greatest measurement variance. Magnetic resonance elastography measurements at 140 Hz in the viscoelastic phantoms were consistent to within ±5% of thosemade with the ultrasound shear elasticity systems, while measurements made at 60 Hz had a mean bias of -2.6% relative to ultrasound systems. A method for reporting group shear wave velocities using both displacement and velocity data, along with shear wave phase velocity analysis, has been developed as a common calibration approach for the phantoms. An open-source repository of research scanner shear wave sequences and processing code has been created to allow manufacturers to have a calibration standard to assess compliance with the QIBA US shear wave speed profile and to achieve more consistent results to facilitate more rapid clinical adoption of this technology to evaluate liver fibrosis.

Ultrasound Shear Wave Elastography: Variations of Liver Fibrosis Assessment as a Function of Depth, Force and Distance from Central Axis of the Transducer with a Comparison of Different Systems

We evaluated variation in fibrosis staging caused by depth, pre-load force and measurement off-axis distance on different ultrasound shear wave elastography (SWE) systems prospectively in 20 patients with diffuse liver disease. Shear wave speed (SWS) was measured with transient elastography, acoustic radiation force impulse (ARFI) and 2-D shear wave elastography (SWE). ARFI and 2-D-SWE measurements were obtained at different depths (3, 5 and 7 cm), with different pre-load forces (4, 7 and 10N and variable) and at 0, 2 and 4cm off the central axis of the transducer. A single, blinded pathologist staged fibrosis using the METAVIR system (F0-F4). Area under the receiver operating characteristic curve was charted to differentiate significant fibrosis (F ≥ 2). Depth was the only factor found to influence ARFI-derived values; no acquisition factors were found to affect 2-D-SWE SWS values. ARFI and 2-D-SWE for diagnosis of significant fibrosis at a depth of 7cm along the central axis had good diagnostic performance (areas under the receiver operating characteristic curve: 0.92 and 0.82, respectively), comparable to that of transient elastography. Further investigation of this finding will likely be of interest.

Viscoelasticity Measurement in Rat Livers Using Shear-Wave US Elastography

To investigate the usefulness of shear-wave speed and dispersion slope measurements obtained, using an ultrasound elastography system in rat livers with various degrees of necroinflammation and fibrosis. A total of 25 male Sprague Dawley rats were randomly divided into 5 groups of 5 rats each: G0 (control), G1 (CCl4 injected twice a week for 1 wk), G2 (CCl4 injected four times a wk for 1 wk), G3 (CCl4 injected twice a wk for 6 wk) and G4 (CCl4 injected twice a wk for 10 wk). The shear-wave speed (m/s) and the dispersion slope ([m/s]/kHz) were measured. Histologic features (inflammation, necrosis and fibrosis) were used as reference standards. In multivariable analysis with histologic features as independent variables, the fibrosis grade was significantly related to shear-wave speed (p < 0.05) and the necrosis grade was significantly related to dispersion slope (p < 0.05). Dispersion slope is more useful than shear-wave speed for predicting the degree of necroinflammation.

An ultrasound transient elastography system with coded excitation

BackgroundUltrasound transient elastography technology has found its place in elastography because it is safe and easy to operate. However, it’s application in deep tissue is limited. The aim of this study is to design an ultrasound transient elastography system with coded excitation to obtain greater detection depth.MethodsThe ultrasound transient elastography system requires tissue vibration to be strictly synchronous with ultrasound detection. Therefore, an ultrasound transient elastography system with coded excitation was designed. A central component of this transient elastography system was an arbitrary waveform generator with multi-channel signals output function. This arbitrary waveform generator was used to produce the tissue vibration signal, the ultrasound detection signal and the synchronous triggering signal of the radio frequency data acquisition system. The arbitrary waveform generator can produce different forms of vibration waveform to induce different shear wave propagation in the tissue. Moreover, it can achieve either traditional pulse-echo detection or a phase-modulated or a frequency-modulated coded excitation. A 7-chip Barker code and traditional pulse-echo detection were programmed on the designed ultrasound transient elastography system to detect the shear wave in the phantom excited by the mechanical vibrator. Then an elasticity QA phantom and sixteen in vitro rat livers were used for performance evaluation of the two detection pulses.ResultsThe elasticity QA phantom’s results show that our system is effective, and the rat liver results show the detection depth can be increased more than 1 cm. In addition, the SNR (signal-to-noise ratio) is increased by 15 dB using the 7–chip Barker coded excitation.ConclusionsApplying 7-chip Barker coded excitation technique to the ultrasound transient elastography can increase the detection depth and SNR. Using coded excitation technology to assess the human liver, especially in obese patients, may be a good choice.