Simultaneous Coherent and Displacement Compounding for 2D Noninvasive Carotid Strain Imaging: a Proof of Principle Study.

Arteriosclerosis results from lipid buildup in artery walls, leading to plaque formation, and is a leading cause of death. Plaque rupture can cause blood clots that might lead to a stroke. Distinguishing plaque types is a challenge, but ultrasound elastography can help by assessing plaque composition based on strain values. Since the artery has a circular structure, an accurate axial and lateral displacement strategy is needed to derive the radial and circumferential strains. A high precision lateral displacement is challenging due to the lack of phase information in the lateral direction of the beamformed RF data. Previously, our group has developed a compounding technique in which the lateral displacement is estimated using tri-angulation of the axial displacement estimated from transmitting and beamforming ultrasound beams at ±20°. However, transmitting with a single plane wave will reduce signal-to-noise and contrast-to-noise ratio as well as lateral resolution. In this paper, we combine our displacement compounding with coherent compounding. Instead of transmitting a single plane wave, multiple plane waves are transmitted at certain angles centered on the angle of the beamforming grids, and then the backscattered wavefronts are beamformed and coherently compounded on the center of the transmit beams (-20°, +20° and 0°). The numerical investigation using the GE9LD probe (f0 = 5.32 MHz, pitch = 230 µm, width = 43.9 mm) led us to 19 plane waves spanning angles within -10° to 10° (with respect to center of the transmit beams); resulting in a total of 57 plane wave transmit (for 3 beamforming grids at 0° and ±20°). FIELD II simulations of a cylindrically-shaped phantom (mimicking the carotid artery) at a signal-to-noise ratio ≥ 20 dB shows that the proposed method decreases the root-mean-square-error of the lateral displacement and strain estimations by 40% and 45% compared to the previous method, respectively. The results of our experiments with a carotid artery phantom (made out of 10% PVA) show that the proposed method provides strain images with a higher quality and more in agreement with the theory, with 26% lower standard deviation, specially at the peak systolic phase. The proposed method paves the path toward improved quality in vivo 2D strain imaging using our displacement compounding technique and translating it to 3D with a row-column array.

Flexible large-area ultrasound arrays for medical applications made using embossed polymer structures.

With the huge progress in micro-electronics and artificial intelligence, the ultrasound probe has become the bottleneck in further adoption of ultrasound beyond the clinical setting (e.g. home and monitoring applications). Today, ultrasound transducers have a small aperture, are bulky, contain lead and are expensive to fabricate. Furthermore, they are rigid, which limits their integration into flexible skin patches. New ways to fabricate flexible ultrasound patches have therefore attracted much attention recently. First prototypes typically use the same lead-containing piezo-electric materials, and are made using micro-assembly of rigid active components on plastic or rubber-like substrates. We present an ultrasound transducer-on-foil technology based on thermal embossing of a piezoelectric polymer. High-quality two-dimensional ultrasound images of a tissue mimicking phantom are obtained. Mechanical flexibility and effective area scalability of the transducer are demonstrated by functional integration into an endoscope probe with a small radius of 3 mm and a large area (91.2×14 mm2) non-invasive blood pressure sensor.

Extending arterial stiffness assessment along the circumference using beam-steered ARFI and wave-tracking: A proof-of-principle study in phantoms and ex vivo.

Background: To fully quantify arterial wall and plaque stiffness, acoustic radiation force impulse (ARFI)-induced wave-tracking along the entire vessel circumference is desired. However, attenuation and guided wave behavior in thin vessel walls limits wave-tracking to short trajectories. This study investigated the potential of beam-steered ARFI and wave-tracking to extend group velocity estimation over a larger proportion of the circumference compared to conventional 0° ARFI-induced wave-tracking. Methods: Seven vessel-mimicking polyvinyl alcohol cryogel phantoms with various dimensions and compositions and an ex vivo human carotid artery were imaged in a dedicated setup. For every 20° phantom rotation, transverse group wave velocity measurements were performed with an Aixplorer Ultimate system and SL18-5 transducer using 0°/20°/-20°-angled ultrasound pushes. Transmural angular wave velocities were derived along 60°-trajectories. A 360°-angular velocity map was composed from the top-wall 60°-trajectories 0°-data, averaged over all physical phantom rotations (reference). For each phantom rotation, 360°-angular velocity maps were composed using 0°-data (0°-approach) or data from all angles (beam-steered approach). Percentages of rotations with visible waves and relative angular velocity errors compared to the reference map as function of the circumferential angle were determined for both approaches. Results: Reference 360°-angular velocity maps could be derived for all samples, representing their stiffness. Beam-steering decreased the proportion of the circumference where waves were untraceable by 20% in phantoms and 10% ex vivo, mainly at 0° push locations. Relative errors were similar for both approaches (phantoms: 10-15%, ex vivo: 15-35%). Conclusion: Beam-steering enables wave-tracking along a higher proportion of the wall circumference than 0° ARFI-induced wave-tracking.

In Vivo 3D Power Doppler Imaging Using Continuous Translation and Ultrafast Ultrasound.

The introduction of ultrafast ultrasound and spatiotemporal filtering has significantly improved the sensitivity of Doppler ultrasound imaging. This work describes the development of a 3D power Doppler imaging technique which uses a 1D-array ultrasound probe that mechanically translates at a constant speed. The continuous translation allows for a fast scan of a large 3D volume without requiring complex hardware. The technique was realized in a prototype and its feasibility illustrated using phantom and in vivo kidney and breast lesion experiments. Although this 3D Doppler imaging technique is limited in some aspects, it enables power Doppler imaging of a large volume in a short acquisition time with less computational costs.

Point Spread Function Formation in Plane-Wave Imaging: A Theoretical Approximation in Fourier Migration.

The point spread function (PSF) is often analyzed to determine the image quality of an ultrasound system. The formation of PSF is determined by practical factors, such as transducer aperture, element directivity, apodization, pitch, imaging position, and steering angle. Conventional numerical simulations provide an iterative approach to examine those factors' effects but cannot explain the inherent mechanism of PSF formation. This article presents a theoretical approximation of PSF formation for plane-wave imaging throughout the Fourier-based reconstruction process. Aforementioned factors are incorporated in the theory. The proposed theory is used to analyze the effects of those factors and presents a high degree of consistency with numerical simulations and experiments.

In Vivo Blood Velocity Vector Imaging Using Adaptive Velocity Compounding in the Carotid Artery Bifurcation.

Visualization and quantification of blood flow are considered important for early detection of atherosclerosis and patient-specific diagnosis and intervention. As conventional Doppler imaging is limited to 1-D velocity estimates, 2-D and 3-D techniques are being developed. We introduce an adaptive velocity compounding technique that estimates the 2-D velocity vector field using predominantly axial displacements estimated by speckle tracking from dual-angle plane wave acquisitions. Straight-vessel experiments with a 7.8-MHz linear array transducer connected to a Verasonics Vantage ultrasound system revealed that the technique performed with a maximum velocity magnitude bias and angle bias of -3.7% (2.8% standard deviation) and -0.16° (0.41° standard deviation), respectively. In vivo, complex flow patterns were visualized in two healthy and three diseased carotid arteries and quantified using a vector complexity measure that increased with increasing wall irregularity. This measure could potentially be a relevant clinical parameter which might aid in early detection of atherosclerosis.

3-D Strain Imaging of the Carotid Bifurcation: Methods and in-Human Feasibility.

Atherosclerotic plaque development in the carotid artery bifurcation elevates the risk for stroke, which is often initiated by plaque rupture. The risk-to-rupture of a plaque is related to its composition. Two-dimensional non-invasive carotid elastography studies have found a correlation between wall strain and plaque composition. This study introduces a technique to perform non-invasive volumetric elastography in vivo. Three-dimensional ultrasound data of carotid artery bifurcations were acquired in four asymptomatic individuals using an electrocardiogram-triggered multislice acquisition device that scanned over a length of 35 mm (350 slices) using a linear transducer (L11-3, fc = 9 MHz). For each slice, three-angle ultrasound plane wave data were acquired and beamformed. A correction for breathing-induced motion was applied to spatially align the slices, enabling 3-D cross-correlation-based compound displacement, distensibility and strain estimation. Distensibility values matched with previously published values, while the corresponding volumetric principal strain maps revealed locally elevated compressive and tensile strains. This study presents for the first time 3-D elastography of carotid arteries in vivo.

Simultaneous Vascular Strain and Blood Vector Velocity Imaging Using High-Frequency Versus Conventional-Frequency Plane Wave Ultrasound: A Phantom Study.

Plaque strain and blood vector velocity imaging of stenosed arteries are expected to aid in diagnosis and prevention of cerebrovascular disease. Ultrafast plane wave imaging enables simultaneous strain and velocity estimation. Multiple ultrasound vendors are introducing high-frequency ultrasound probes and systems. This paper investigates whether the use of high-frequency ultrafast ultrasound is beneficial for assessing blood velocities and strain in arteries. The performance of strain and blood flow velocity estimation was compared between a high-frequency transducer (MS250, fc = 21 MHz) and a clinically utilized transducer (L12-5, fc = 9 MHz). Quantitative analysis based on straight tube phantom experiments revealed that the MS250 outperformed the L12-5 in the superficial region: low velocities near the wall were more accurately estimated and wall strains were better resolved. At greater than 2-cm echo depth, the L12-5 performed better due to the high attenuation of the MS250 probe. Qualitative comparison using a perfused patient-specific carotid bifurcation phantom confirmed these findings. Thus, in conclusion, for strain and blood velocity estimation for depths up to ~2 cm, a high-frequency probe is recommended.

Automated 3D ultrasound elastography of the breast: a phantom validation study.

In breast cancer screening, the automated breast volume scanner (ABVS) was introduced as an alternative for mammography since the latter technique is less suitable for women with dense breasts. Although clinical studies show promising results, clinicians report two disadvantages: long acquisition times (>90 s) introducing breathing artefacts, and high recall rates due to detection of many small lesions of uncertain malignant potential. Technical improvements for faster image acquisition and better discrimination between benign and malignant lesions are thus required. Therefore, the aim of this study was to investigate if 3D ultrasound elastography using plane-wave imaging is feasible. Strain images of a breast elastography phantom were acquired by an ABVS-mimicking device that allowed axial and elevational movement of the attached transducer. Pre- and post-deformation volumes were acquired with different constant speeds (between 1.25 and 40.0 mm s(-1)) and by three protocols: Go-Go (pre- and post-volumes with identical start and end positions), Go-Return (similar to Go-Go with opposite scanning directions) and Control (pre- and post-volumes acquired per position, this protocol can be seen as reference). Afterwards, 2D and 3D cross-correlation and strain algorithms were applied to the acquired volumes and the results were compared. The Go-Go protocol was shown to be superior with better strain image quality (CNRe and SNRe) than Go-Return and to be similar as Control. This can be attributed to applying opposite mechanical forces to the phantom during the Go-Return protocol, leading to out-of-plane motion. This motion was partly compensated by using 3D cross-correlation. However, the quality was still inferior to Go-Go. Since these results were obtained in a phantom study with controlled deformations, the effect of possible uncontrolled in vivo tissue motion artefacts has to be addressed in future studies. In conclusion, it seems feasible to implement 3D ultrasound quasi-static elastography on an ABVS-like system and to reduce scan times within one breath-hold (~10 s) by plane-wave acquisitions.

Fast 2-D ultrasound strain imaging: the benefits of using a GPU.

Deformation of tissue can be accurately estimated from radio-frequency ultrasound data using a 2-dimensional normalized cross correlation (NCC)-based algorithm. This procedure, however, is very computationally time-consuming. A major time reduction can be achieved by parallelizing the numerous computations of NCC. In this paper, two approaches for parallelization have been investigated: the OpenMP interface on a multi-CPU system and Compute Unified Device Architecture (CUDA) on a graphics processing unit (GPU). The performance of the OpenMP and GPU approaches were compared with a conventional Matlab implementation of NCC. The OpenMP approach with 8 threads achieved a maximum speed-up factor of 132 on the computing of NCC, whereas the GPU approach on an Nvidia Tesla K20 achieved a maximum speed-up factor of 376. Neither parallelization approach resulted in a significant loss in image quality of the elastograms. Parallelization of the NCC computations using the GPU, therefore, significantly reduces the computation time and increases the frame rate for motion estimation.

Effect of bladderbox alarms during venoarterial extracorporeal membrane oxygenation on cerebral oxygenation and hemodynamics in lambs.

To determine the effects of bladderbox alarms during venoarterial extracorporeal membrane oxygenation (va-ECMO) on cerebral oxygenation and hemodynamics, six lambs were prospectively treated with va-ECMO and bladderbox alarms were simulated. Changes in concentrations of oxyhemoglobin (deltacO2Hb), deoxyhemoglobin (deltacHHb), and total Hb (deltactHb) were measured using near infrared spectrophotometry. Fluctuations in Hb oxygenation index (deltaHbD) and cerebral blood volume (deltaCBV) were calculated. Heart rate (HR), mean arterial pressure (MAP), blood flow in the left carotid artery (Qcar), and central venous pressure (CVP) were registered. Bladderbox alarms were simulated by increasing the ECMO flow or partially clamping the venous cannula and resolved by decreasing the ECMO flow, unclamping the cannula, or intravascular volume administration. CBV, HbD, MAP, and Qcar decreased significantly during bladderbox alarms, whereas HR and CVP increased. After the bladderbox alarms, CBV and HbD increased significantly to values above baseline. For HbD, this increase was higher during intravascular volume administration.MAP, Qcar, and CVP recovered to preexperiment values but increased further with volume administration. HR was increased at the end of our measurements. We conclude that Bladderbox alarms during va-ECMO treatment result in significant fluctuations in cerebral oxygenation and hemodynamics, a possible risk factor for intracranial lesions.

A method to calculate arterial and venous saturation from near infrared spectroscopy (NIRS).

For adequate development and functioning of the neonatal brain, sufficient oxygen (O2) should be available. With a fast sampling (f(s) > 50 Hz) continuous wave NIRS device, arterial (SaO2) and venous (SvO2) saturation can be measured using the physiological fluctuations in the oxyhemoglobin (O2Hb) and total hemoglobin (tHb) concentrations due to heart action and respiration. Before using this technique in a neonatal setting, the method was verified on adult volunteers (n=7) by decreasing inspired oxygen down to an arterial saturation of 70% using a pulse oximeter as reference. NIRS optodes were placed on the left forehead; the pulse oximeter sensor was placed on the right forehead. The experiments were repeated with different optode spacings. SaO2 and SvO2 were determined using the ratio between the O2Hb and tHb value in the amplitude spectrum at the heart rate and respiration rate, respectively. A good agreement between calculated SaO2 and reference SaO2 from pulse oximetry was found (bias range -3.5% to 5.2%, SD of the residuals 1.3% to 3.5%). Optode spacing of 15 mm yielded a negative bias compared to optode spacing of 45 mm. It was not always possible to calculate SvO2 because the respiration peak could not always be detected.

Lateral frontal cortex oxygenation changes during translation and language switching revealed by non-invasive near-infrared multi-point measurements.

The organisation of language in the brain of multilingual people remains controversial. Using a high temporal resolution 12-channel near-infrared continuous wave spectroscopy system, we have demonstrated that it is possible to monitor non-invasively, comfortably and, without the interferences due to intrinsic limitations of positron emission tomography (PET) and functional magnetic resonance imaging (fMRI), cortical oxygenation changes in the Broca's area in response to translation of short sentences and language switching. Eight Dutch students proficient in English translated aloud from their native language into English or vice versa or alternating (switching) short visually presented sentences. These tasks provoked, in the left inferior frontal cortex which includes the Broca's area, a consistent and incremental rise in oxyhaemoglobin accompanied by a smaller decrease in deoxyhaemoglobin. The investigated cortical areas surrounding the Broca's area showed no uniform and consistent oxygenation changes upon the three different translation tasks. These results confirm that Broca's area is involved in the translation process and its so called activation is unaffected by the direction of the translation. In addition, these results strengthen the role of near-infrared multi-point measurements as a powerful tool for investigating the spatial and temporal features of the cortical oxygenation changes during language processing.