Deep brain stimulation of the dorsal raphe induces anxiolytic and panicolytic-like effects and alters serotonin immunoreactivity.

Previously we showed that Deep Brain Stimulation (DBS) of the dorsal region (DRD) and of the lateral wings of the dorsal raphe (lwDR) respectively decreases anxiety and panic-like responses in the elevated T-maze (ETM). This study investigates neurobiological alterations which might respond for these behavioral effects. Male Wistar rats were submitted to high-frequency stimulation (100 µA, 100 Hz) of the DRD or of the lwDR for 1 h, and subsequently tested in the avoidance or escape tasks of the ETM. Since serotonin (5-HT) reuptake inhibitors are first line pharmacological treatment for anxiety disorders, we also tested the effects of chronic fluoxetine administration (10 mg/kg, IP, 21 days) on a separate group of rats. An open field was used for locomotor activity assessment. Additionally, we evaluated c-Fos immunoreactivity (Fos-ir) in serotonergic cells of the dorsal raphe (DR). Results showed that DBS of the DRD decreases avoidance reactions, an anxiolytic-like effect, without altering escape or locomotor activity. Both fluoxetine and DBS of the lwDR decreased escape responses in the ETM, a panicolytic-like effect, without altering avoidance measurements or locomotor activity. While DBS of the DRD decreased double immunostaining in the DRD, DBS of the lwDR increased Fos-ir and double immunostaining in the DRD and lwDR. Fluoxetine also increased double immunostaining in the lwDR and in the DRV but decreased it in the DRD. These results suggest that both the anxiolytic and panicolytic-like effects of DBS and fluoxetine are related to 5-HT modulation in different subnuclei of the DR.

Chronic unpredictable mild stress alters an anxiety-related defensive response, Fos immunoreactivity and hippocampal adult neurogenesis.

Previous results show that elevated T-maze (ETM) avoidance responses are facilitated by acute restraint. Escape, on the other hand, was unaltered. To examine if the magnitude of the stressor is an important factor influencing these results, we investigated the effects of unpredictable chronic mild stress (UCMS) on ETM avoidance and escape measurements. Analysis of Fos protein immunoreactivity (Fos-ir) was used to map areas activated by stress exposure in response to ETM avoidance and escape performance. Additionally, the effects of the UCMS protocol on the number of cells expressing the marker of migrating neuroblasts doublecortin (DCX) in the hippocampus were investigated. Corticosterone serum levels were also measured. Results showed that UCMS facilitates ETM avoidance, not altering escape. In unstressed animals, avoidance performance increases Fos-ir in the cingulate cortex, hippocampus (dentate gyrus) and basomedial amygdala, and escape increases Fos-ir in the dorsolateral periaqueductal gray and locus ceruleus. In stressed animals submitted to ETM avoidance, increases in Fos-ir were observed in the cingulate cortex, ventrolateral septum, hippocampus, hypothalamus, amygdala, dorsal and median raphe nuclei. In stressed animals submitted to ETM escape, increases in Fos-ir were observed in the cingulate cortex, periaqueductal gray and locus ceruleus. Also, UCMS exposure decreased the number of DCX-positive cells in the dorsal and ventral hippocampus and increased corticosterone serum levels. These data suggest that the anxiogenic effects of UCMS are related to the activation of specific neurobiological circuits that modulate anxiety and confirm that this stress protocol activates the hypothalamus-pituitary-adrenal axis and decreases hippocampal adult neurogenesis.

Effects of chronic treatment with corticosterone and imipramine on fos immunoreactivity and adult hippocampal neurogenesis.

In a previous study we showed that rats chronically treated with corticosterone (CORT) display anxiogenic behavior, evidenced by facilitation of avoidance responses in the elevated T-maze (ETM) model of anxiety. Treatment with the tricyclic antidepressant imipramine significantly reversed the anxiogenic effects of CORT, while inhibiting ETM escape, a response related to panic disorder. To better understand the neurobiological mechanisms underlying these behavioral effects, analysis of c-fos protein immunoreactivity (fos-ir) was used here to map areas activated by chronic CORT (200 mg pellets, 21-day release) and imipramine (15 mg/kg, IP) administration. We also evaluated the number of cells expressing the neurogenesis marker doublecortin (DCX) in the hippocampus and measured plasma CORT levels on the 21st day of treatment. Results showed that CORT increased fos-ir in the ventrolateral septum, medial amygdala and paraventricular hypothalamic nucleus and decreased fos-ir in the lateral periaqueductal gray. Imipramine, on the other hand, increased fos-ir in the medial amygdala and decreased fos-ir in the anterior hypothalamus. CORT also decreased the number of DCX-positive cells in the ventral and dorsal hippocampus, an effect antagonized by imipramine. CORT levels were significantly higher after treatment. These data suggest that the behavioral effects of CORT and imipramine are mediated through specific, at times overlapping, neuronal circuits, which might be of relevance to a better understanding of the physiopathology of generalized anxiety and panic disorder.

Acute restraint differently alters defensive responses and fos immunoreactivity in the rat brain.

Results from a previous study show that rats exposed to acute restraint display anxiogenic-like behavior, evidenced by facilitation of avoidance responses in the elevated T-maze (ETM) model of anxiety. In contrast, escape responses were unaltered by stress exposure. Since ETM avoidance and escape tasks seem to activate distinct sets of brain structures, it is possible that the differences observed with acute restraint are due to particularities in the neurobiological mechanisms which modulate these responses. In the present study, analysis of fos protein immunoreactivity (fos-ir) was used to map areas activated by exposure of male Wistar rats to restraint stress (30 min) previously (30 min) to the ETM. Corticosterone levels were also measured in stressed and non-stressed animals. Confirming previous observations restraint facilitated avoidance performance, an anxiogenic result, while leaving escape unaltered. Performance of the avoidance task increased fos-ir in the frontal cortex, intermediate lateral septum, basolateral amygdala, basomedial amygdala, lateral amygdala, anterior hypothalamus and dorsal raphe nucleus. In contrast, performance of escape increased fos-ir in the ventromedial hypothalamus, dorsolateral periaqueductal gray and locus ceruleus. Both behavioral tasks also increased fos-ir in the dorsomedial hypothalamus. Restraint significantly raised corticosterone levels. Additionally after restraint, fos-ir was predominantly seen in the basolateral amygdala and dorsal raphe of animals submitted to the avoidance task. This data confirms that different sets of brain structures are activated by ETM avoidance and escape tasks and suggests that acute restraint differently alters ETM behavior and the pattern of fos activation in the brain.

[Temporomandibular joint dysfunction, disability and oral health in a community-dwelling elderly population]. / Disfunción temporomandibular, discapacidad y salud oral en una población geriátrica semi-institucionalizada.

INTRODUCTION: Temporomandibular joint dysfunction (TMD) is involved in important activities of the stomatognathic system for nutrition, such as chewing or swallowing. If the physiological tolerance of its components is exceeded, it can trigger symptoms of temporomandibular dysfunction (TMD). OBJECTIVES: To assess and relate the symptoms of TMD, functional limitations and estimates of self-perceived oral health and general geriatric population in a communitydwelling elderly population. METHODS: An observational study was performed. Ninetyfour persons belonging to units of Granada Geriatric Day were assessed symptoms of TMD (Helkimo Simplified Index), pain (VAS scale), functional limitation of stomatognathic system (research diagnostic criteria for temporomandibular disorders CDI/TTM), jaw opening index, general health index (1-5) and oral health (geriatric oral health assessment). RESULTS: In the total sample, 42.7% had at least one symptom of TMD. The most common symptoms were muscular fatigue (26.6%), noise (21.3%) and TMD pain (14.9%). The most common non-specific symptoms in the symptomatic group were neck pain and nervousness. A 48.9% of the sample had functional limitation in orofacial activities. Also, there was a statistically significant association (p<0.05) between the jaw opening index and symptomatic and asymptomatic groups with TMD. CONCLUSIONS: In the group with symptoms of TMD were more common temporomandibular joint departures and pain, and they presented lower values in oral and general health self-perception.

Disfunción temporomandibular, discapacidad y salud oral en una población geriátrica semi-institucionalizada / Temporomandibular joint dysfunction, disability and oral health in a community-dwelling elderly population

Introducción: Las articulaciones temporomandibulares (ATM) intervienen en importantes acciones del sistema estomatognático para la nutrición, como son la masticación o la deglución. Si la tolerancia fisiológica de sus componentes es superada, pueden desencadenarse síntomas de disfunción temporomandibular (DTM). Objetivos: Valorar y relacionar los síntomas de la DTM, las limitaciones funcionales y la estimación de la salud oral y general autopercibida en una población geriátrica semi-institucionalozada. Métodos: Se realizó un estudio descriptivo, observacional. A 94 personas pertenecientes a Unidades de Día Geriátricas de Granada se les evaluó la sintomatología de DTM (índice anamnésico de Helkimo), el dolor (escala EVA), la limitación funcional del sistema estomatognático (criterios diagnósticos de investigación de los trastornos temporomandibulares CDI/TTM), el índice de apertura mandibular, la salud general (índice de 1-5) y lasalud oral (índice de evaluación de salud oral geriátrica). Resultados: Del total de la muestra el 42,7% presentó al menos un síntoma de DTM. Los síntomas más comunes fueron la fatiga muscular (26,6%), los ruidos (21,3%) y el dolor en la ATM (14,9%). La clínica inespecífica más frecuente en el grupo sintomático fue la cervicalgia y el nerviosismo. El 48,9% de la muestra presentó limitación funcional en actividades orofaciales. También, se encontró una asociación estadísticamente significativa (p < 0,05) entre el índice de apertura mandibular y los grupos sintomáticos y asintomáticos de DTM. Conclusiones: En el grupo con sintomatología de DTM fueron más frecuentes las desviaciones y algias de la articulación temporomandibular, y se presentaron valores inferiores de autopercepción de salud oral y general (AU)

Introduction: Temporomandibular joint dysfunction (TMD) is involved in important activities of the stomatognathic system for nutrition, such as chewing or swallowing. If the physiological tolerance of its components is exceeded, it can trigger symptoms of temporomandibular dysfunction (TMD). Objectives: To assess and relate the symptoms of TMD, functional limitations and estimates of self-perceived oral health and general geriatric population in a communitydwelling elderly population. Methods: An observational study was performed. Ninetyfour persons belonging to units of Granada Geriatric Day were assessed symptoms of TMD (Helkimo Simplified Index), pain (VAS scale), functional limitation of stomatognathic system (research diagnostic criteria for temporomandibular disorders CDI/TTM), jaw opening index, general health index (1-5) and oral health (geriatric oral health assessment). Results: In the total sample, 42.7% had at least one symptom of TMD. The most common symptoms were muscular fatigue (26.6%), noise (21.3%) and TMD pain (14.9%). The most common non-specific symptoms in the symptomatic group were neck pain and nervousness. A 48.9% of the sample had functional limitation in orofacial activities. Also, there was a statistically significant association (p < 0.05) between the jaw opening index and symptomatic and asymptomatic groups with TMD. Conclusions: In the group with symptoms of TMD were more common temporomandibular joint departures and pain, and they presented lower values in oral and general health self-perception (AU)

Electroterapia, hiperhidrosis y enfermedades neurovasculares / Electrotherapy, hyperhidrosis and neurovascular diseases

Los síndromes vasoespásticos son alteraciones vasculares que afectan a las extremidades, principalmente las superiores; tienen carácter funcional y, como denominador común, su sintomatología está producida por un aumento de la capacidad vasoconstrictiva de etiología poco conocida. Entre los factores precipitantes se encuentran la exposición al frío y los estímulos emocionales. La exploración generalmente muestra, entre las crisis, dedos fríos y lividez con hiperhidrosis. Los objetivos de nuestro estudio son exponer la evolución antes y después del tratamiento del cortejo sintomático acompañante de la hiperhidrosis palmar, como la hipotermia y la lividez en los pacientes que la sufren. Para cumplir los objetivos, se planteó un estudio experimental con sendos grupos: control normal de 10 pacientes sin tratamiento y experimental con un total de 60 pacientes con hiperhidrosis, distribuidos en 6 subgrupos y sometidos a tratamiento de iontoforesis con agua corriente. Los resultados obtenidos indican que, aunque la terapéutica aplicada suprimió en el 100% de los casos el problema de la hipersudación palmar que presentaban los pacientes, no se obtuvo un paralelismo en los resultados del cortejo clínico acompañante, lo que confirma cierta idiosincrasia evolutiva en los pacientes con hiperhidrosis y problemas vasomotores en partes acras(AU)

Vasospastic syndromes are vascular alterations affecting the limbs, mainly the upper ones. They have a special function, that is, they are functional and have a common denominator that is produced by their symptoms due to an increase in vasoconstrictor capacity whose etiology is little known. Exposure to cold and emotional stimuli is among its precipitating factors. The examination generally shows cold fingers and lividness with hyperhidrosis among the episodes. The goals outlined in our study are exposing the pre and post therapeutic course of the main symptoms accompanying the palmar hyperhidrosis, such as hypothermia and lividness in patients with osteoporosis. In order to fulfill the objectives, a pilot study was proposed with two groups: control group of 10 patients without normal and experimental treatment and a total of 60 patients with hyperhidrosis, divided into 6 subgroups who underwent treatment with tap water iontophoresis. The results obtained suggest that although the therapy applied eliminated the problem of palmar hyperhidrosis presented by the patients in all of the cases, a parallel result was not obtained in the main accompanying symptoms, confirming some evolutionary idiosyncrasy in patients with hyperhidrosis and acral vasomotor problems(AU)

Pathogenesis of mousepox in H-2(d) mice: evidence for MHC class I-restricted CD8(+) and MHC class II-restricted CD4(+) CTL antiviral activity in the lymph nodes, spleen and skin, but not in the conjunctivae.

Genetically sensitive mice (i.e. H-2(d) haplotype) infected with a natural mouse pathogen named ectromelia virus (EV) can develop a mousepox. Virus replicates well in the skin, next in the draining lymph nodes (DLNs) and then in the spleen and liver, where it may induce extensive necrosis with strong inflammatory reaction. It is well known from the studies defined on some other viruses that a correlation, functional link and powerful help exist between MHC class I-restricted CD8(+) and MHC class II-restricted CD4(+) virus-specific cytotoxic T lymphocytes (CTLs). However, in the case of mousepox the role of CD4(+) CTLs is still controversial and some reports support the notion that induction of EV-specific CD4(+) CTLs is nonessential for the generation of virus-specific immune response. Consequently, this study was designed to evaluate EV-specific CD8(+) and CD4(+) CTL activity in the DLNs, spleen, skin and conjunctivae of BALB/c (H-2(d)) mice at 7 and 14 days p.i. with Moscow strain of EV. By using bulk cytotoxicity assay and immunosurgery of effector T cells with mAb specific for CD4(+) and/or CD8(+) T cells our data show that EV-specific CD8(+) CTLs predominated in DLNs and spleen at 7 days (67 and 66% of total CTLs, respectively) and 14 days p.i. (63 and 69% of total CTLs, respectively). In contrast, we found that EV clearance from the cutaneous lesions during mousepox is CD4(+) CTL-dependent at 7 days p.i. (59% of total CTLs), whereas at 14 days p.i. CD8(+) CTLs predominated in the epidermis, accounting for 72% of the total EV-specific CTLs. Our studies showed that the population of EV-specific CTLs is heterogeneous and contains cells of both phenotypes: CD8(+) and CD4(+). However, these effector cells did not express a similar tendency in cytotoxic activity in the DLNs, spleen and skin in comparison to the conjunctivae where EV-specific CD8(+) and CD4(+) CTLs were not detected at 7 days p.i. and at peak of mousepox conjunctivitis (14 days p.i.). Our results are discussed in terms of the value of EV to study antiviral CTL responses in the genetically susceptible host.

Homing studies on distribution of ectromelia (mousepox) virus-specific T cells adoptively transferred into syngeneic H-2d mice: paradigm of lymphocyte migration.

Mousepox (infectious ectromelia) may be used as a model for studies on the cellular immune response and pathogenesis of generalized viral infections. Ectromelia virus (EV) initially replicates in the footpad (f.p.) skin at the site of infection, next in draining lymph nodes, and then in the spleen and liver where the virus may induce extensive necrotic process with inflammatory reaction. We show in this study that after recipient BALB/c mice (H-2d) f.p. infection with EV prior to the adoptive transfer of syngeneic donor EV-specific cytotoxic T lymphocytes interferon-gamma-positive (IFN-gamma-+), interleukin-2-positive (IL-2+), and IL-4+ of both phenotypes, CD8+ approximately 70%, and CD4+ approximately 30%) preferentially migrated to the inguinal and auxiliary lymph nodes, spleen, liver, and skin at the site of infection (f.p.). Many particles of EV with the morphology characteristic for orthopoxviruses and virus-specific immunofluorescence within the cells of inguinal and auxiliary lymph nodes, liver, spleen, and skin have been observed using high-resolution transmission electron microscopy and fluorescence antibody technique, respectively. Results presented in this article support the concept that immune T cells adoptively transferred into infected recipient mice are able not only to specific migration in the host and homing in the sites of virus replication, but also to develop immunoprotection in the transferred animals.

Effect of catheter placement on 3-D velocity profiles in curved tubes resembling the human coronary system.

Novel measurement techniques based on intravenous ultrasound (IVUS) technology ('IVUS-Flowmetry') require the location of a catheter inside the coronary bed. The present study quantifies disturbances in the 3-D velocity profile induced by catheter placement inside a tube, applying computational fluid dynamics. Two curved, circular meshes (radius K = 0.025 m and K = 0.035 m) with and without a catheter inside the lumen were applied. The catheter was located at the inner curve, the outer curve and at the top position. Boundary conditions were: no slip on the wall, zero stress at the outlet, uniform inflow with entrance velocities of 0.1, 0.2 and 0.4 m/s. Curvature-associated centrifugal forces shifted the maximal velocity to the outer curve and introduced two symmetrical vortices. Additional catheter placement redistributed the 3-D axial velocity field away from the catheter, which was accompanied by the appearance of multiple low-strength vortices. In addition, peak axial velocity increased, peak secondary velocities decreased, axial pressure drop increased and shear stress increased. Flow calculations simulated to resemble IVUS-based flowmetry changed by only 1% after considering secondary velocity. In conclusion, placement of a catheter inside a curved tube resembling the human coronary system changes the velocity field and reduces secondary patterns. The present study supports the usefulness of catheter-based flowmetry during resting flow conditions. During hyperemic flow conditions, flow measurements might be accompanied by large axial pressure drops because the catheter, itself, might act as a significant stenosis.

Echo decorrelation estimated from signal powers.

Volume flow can be estimated from the decorrelation of radiofrequency (RF) intravascular ultrasound signals. The method is based on a rather time-consuming process that measures the decorrelation slope from a time signal sequence. To improve the speed of flow processing, a more efficient way of estimating the flow velocity from the ratio between the power of the temporal averaged signal and the mean signal power is described in this paper. The relationship between the signal power-ratio index and the decorrelation slope was analyzed and tested using computer-simulated data. Volumetric flow data obtained with the power-ratio method were compared to those derived from the decorrelation slope in five patients. Results of the comparison studies indicate that no significant differences in flow measurements were found between the two methods, but the power-ratio method is able to improve the processing speed significantly.

Blood flow imaging and volume flow quantitation with intravascular ultrasound.

Current intravascular ultrasound techniques produce real-time imaging of a vessel cross-section with a scan plane approximately normal to blood flow. When a cluster of randomly distributed blood particles moves across the ultrasound beam, the received echo signals decorrelate as a function of time. This phenomenon may be used to estimate blood velocities by measuring the decorrelation rate from a sequence of blood scattering signals. A decorrelation-based method for measuring local blood velocity and quantifying volume flow from cross-sectional radio frequency intravascular echo signals was developed. Serial in vitro measurements were performed with a flow phantom to test the principle of the proposed velocity estimation method. An in vivo pig experiment was carried out to study the feasibility of applying this method in clinical settings. Preliminary results of this study indicate that the proposed decorrelation method is able to extract cross-sectional velocity data and volumetric flow both in vitro and in vivo.

Guidance of intracoronary radiation therapy based on dose-volume histograms derived from quantitative intravascular ultrasound.

Application of ionizing radiation to prevent restenosis in atherosclerotic vessels treated by balloon angioplasty is a new treatment under investigation in interventional cardiology and radiology. There is variability in dose prescription, and both gamma- and beta-emitters are used, leading to a wide range of dose distribution over the arterial vessel wall. We present a new modality of dosimetry based on a method that three-dimensional (3-D) image reconstruction of electrocardiogram (ECG)-gated intravascular ultrasound (IVUS) images. Dose volume histograms (DVH) are used to describe the cumulative distribution of dose over two specific volumes: i) at the level of the luminal surface, defined with a thickness of 0.1 mm from the automatically detected contour of the highly echogenic blood-vessel interface, and ii) the adventitia volume is computed considering a 0.5-mm thickness from the echogenic media-adventitia interface. DVH provide a tool for reporting the actual delivered dose at the site believed to be the target: the adventitia, and to detect excessive radiation which could lead to vascular complications. Simulation of a gamma-emitter or of a radioactive source train in the center of the lumen are possible. The data obtained from the first ten patients included in the beta-irradiation trial (BERT 1.5) conducted in our institution are presented, supporting the use of DVH based on quantitative IVUS measurements for optimal dose prescription in vascular interventional radiation therapy.

A deconvolution filter for improvement of time-delay estimation in elastography.

In elastography, tissue under investigation is compressed, and the resulting strain is estimated from the gradient of displacement estimates. Therefore, it is important to accurately estimate the displacements (time-delay) for good quality elastograms. A principal source of error in time-delay estimation in elastography is the decorrelation of the echo signal due to tissue compression (decorrelation noise). Temporal stretching of the postcompression signals has been shown to reduce the decorrelation noise at small strains. In this article, we present a deconvolution filter that reduces the decorrelation even further when applied in conjunction with signal stretching. The performance of the proposed filter is evaluated using simulated data.

The combined effect of signal decorrelation and random noise on the variance of time delay estimation.

Tissue motion and elasticity imaging techniques commonly use time delay estimation (TDE) for the assessment of tissue displacement. The performance of these techniques is limited because the signals are corrupted by various factors including electronic noise, quantization, and speckle decorrelation. Speckle decorrelation is caused by changes in the coherent interference among scatterers when the tissue moves relative to the ultrasound beam. In time delay estimation, the effect of noise is usually addressed through the signal-to-noise ratio (SNR) term. Decorrelation, often a significant source of error in medical ultrasound, is commonly described in terms of the correlation coefficient. A relationship between the correlation coefficient and the SNR was previously derived in the literature, for identical signals corrupted by uncorrelated random noise. In this paper, we derive the relationship between the peak of the correlation coefficient function and the SNR for two jointly stationary signals when a delay is present between the signals. Recently, an expression for the Cramer-Rao lower bound (CRLB) has been derived in the literature for partially decorrelated signals in terms of the SNR and the correlation coefficient. Since the applicability of the CRLB is determined not only by the SNR, but also by the correlation coefficient, it is important to unify the expression for the CRLB for partially correlated signals. In this paper, we derive an expression for the CRLB in term of an equivalent SNR converted from the correlation coefficient using an SNR-p relationship, and show this expression to be equivalent to the expression for CRLB. We also corroborate the validity of the SNR-p expression with a simulation. Using this formulation, correlation measurements can be converted to SNR to obtain a composite SNR. The use of this composite SNR in lieu of those in the CRLB expression in the literature allows the extension of the literature results to the solution of the common TDE problems that involve signal decorrelation.

Reduction of stress nonuniformities by apodization of compressor displacement in elastography.

Elastography is a method for imaging the elastic properties of compliant tissues that produces gray-scale strain or elasticity images called elastograms. The method is based on external tissue compression, with ultrasonic detection of local target displacements and subsequent computation of strain profiles along the compression axis. The internal strain variations are a result of the tissue elasticity variations and the applied deformation or compression. A number of mechanical artifacts that appear in elastograms have been identified. One such artifact appears as the result of a nonuniform stress distribution under the compressors used, including darkening (low stress) of the central region and brightening (high stress) of the peripheral regions under the compressor. On an elastogram, these areas may be misinterpreted as being respectively harder and softer than the rest of the target. In this article, a displacement apodization method for the minimization of this artifact is discussed, and its effects are studied using finite element simulations. When the isometric compression of standard elastography was replaced by an apodized displacement profile calculated from reciprocity conditions, a significant improvement in stress uniformity under the compressor was achieved.

Noise reduction in elastograms using temporal stretching with multicompression averaging.

Elastography uses estimates of the time delay (obtained by cross-correlation) to compute strain estimates in tissue due to quasistatic compression. Because the time delay estimates do not generally occur at the sampling intervals, the location of the cross-correlation peak does not give an accurate estimate of the time delay. Sampling errors in the time-delay estimate are reduced using signal interpolation techniques to obtain subsample time-delay estimates. Distortions of the echo signals due to tissue compression introduce correlation artifacts in the elastogram. These artifacts are reduced by a combination of small compressions and temporal stretching of the postcompression signal. Random noise effects in the resulting elastograms are reduced by averaging several elastograms, obtained from successive small compressions (assuming that the errors are uncorrelated). Multicompression averaging with temporal stretching is shown to increase the signal-to-noise ratio in the elastogram by an order of magnitude, without sacrificing sensitivity, resolution or dynamic range. The strain filter concept is extended in this article to theoretically characterize the performance of multicompression averaging with temporal stretching.

Methods for estimation of subsample time delays of digitized echo signals.

Time delay estimation (TDE) is commonly performed in practice by crosscorrelation of digitized echo signals. Since time delays are generally not integral multiples of the sampling period, the location of the largest sample of the crosscorrelation function (ccf) is an inexact estimator of the location of the peak. Therefore, one must interpolate between the samples of the ccf to improve the estimation precision. Using theory and simulations, we review and compare the performance of several methods for interpolation of the ccf. The maximum likelihood approach to interpolation is the application of a reconstruction filter to the discrete ccf. However, this method can only be approximated in practice and can be computationally intensive. For these reasons, a simple method is widely used that involves fitting a parabola (or other curve) to samples of the ccf in the neighborhood of its peak. We describe and compare two curve-fitting methods: parabolic and cosine interpolation. Curve-fitting interpolation can yield biased time-delay estimates, which may preclude the use of these methods in some applications. The artifactual effect of these bias errors on elasticity imaging by elastography is discussed. We demonstrate that reconstructive interpolation is unbiased. An iterative implementation of the reconstruction procedure is proposed that can reduce the computation time significantly.

Fundamental mechanical limitations on the visualization of elasticity contrast in elastography.

Elastography is a new ultrasonic imaging technique that produces images (elastograms) of the elastic properties of complaint tissue. To determine the Young's modulus it is necessary to measure or estimate any five of seven relevant variables. In elastography, the measured quantity is the normal strain component in the direction of the applied load, and the three normal components of stress may be estimated using the modified Love's analytical models while assuming a value close to 0.5 (incompressible) for Poisson's ratio. The distribution of Young's moduli can thus be computed and displayed in the form of two-dimensional images called elastrograms. The analytical models used for the estimation of the three normal components of stress assume that the target is semi-infinite and homogeneous in composition. The objective of this article is to determine some of the errors associated with the assumption of homogeneity of the target. Experiments using computer simulations were performed to study the efficiency with which elastograms display the contrast in the Young's modulus of a lesion or target, with respect to its background under certain conditions. It was observed (using the definition of contrast-transfer efficiency of elastography as the ratio of the elasticity contrast as measured from an elastogram, to the true contrast) that elastograms were consistently efficient in quantitatively depicting the elasticity contrast of hard lesions; however, they showed suboptimal contrast-transfer efficiency in cases of soft lesions in a hard background. In general, elastograms are efficient in displaying the elasticity contrast of hard or soft lesions which have a low contrast level with respect to the surroundings, irrespective of their size and location.