Cardiac function in relation to myocardial injury in hospitalised patients with COVID-19.

BACKGROUND: Previous studies have reported on myocardial injury in patients with coronavirus infectious disease 19 (COVID-19) defined as elevated cardiac biomarkers. Whether elevated biomarkers truly represent myocardial dysfunction is not known. The aim of this study was to explore the incidence of ventricular dysfunction and assess its relationship with biomarker analyses. METHODS: This cross-sectional study ran from April 1 to May 12, 2020, and consisted of all consecutively admitted patients to the Radboud university medical centre nursing ward for COVID-19. Laboratory assessment included high-sensitivity Troponin T and N­terminal pro-B-type natriuretic peptide (NT-proBNP). Echocardiographic evaluation focused on left and right ventricular systolic function and global longitudinal strain (GLS). RESULTS: In total, 51 patients were included, with a median age of 63 years (range 51-68 years) of whom 80% was male. Troponin T was elevated (>14 ng/l) in 47%, and a clinically relevant Troponin T elevation (10â€¯× URL) was found in three patients (6%). NT-proBNP was elevated (>300 pg/ml) in 24 patients (47%), and in four (8%) the NT-proBNP concentration was >1,000 pg/ml. Left ventricular dysfunction (ejection fraction <52% and/or GLS >-18%) was observed in 27%, while right ventricular dysfunction (TAPSE <17 mm and/or RV S' < 10 cm/s) was seen in 10%. There was no association between elevated Troponin T or NT-proBNP and left or right ventricular dysfunction. Patients with confirmed pulmonary embolism had normal right ventricular function. CONCLUSIONS: In hospitalised patients, it seems that COVID-19 predominantly affects the respiratory system, while cardiac dysfunction occurs less often. Based on a single echocardiographic evaluation, we found no relation between elevated Troponin T or NT-proBNP, and ventricular dysfunction. Echocardiography has limited value in screening for ventricular dysfunction.

Is 2D speckle tracking echocardiography useful for detecting and monitoring myocardial dysfunction in adult m.3243A>G carriers? - a retrospective pilot study.

OBJECTIVES: Cardiomyopathy is a common complication of mitochondrial disorders, associated with increased mortality. Two dimensional speckle tracking echocardiography (2DSTE) can be used to quantify myocardial deformation. Here, we aimed to determine the usefulness of 2DSTE in detecting and monitoring subtle changes in myocardial dysfunction in carriers of the 3243A>G mutation in mitochondrial DNA. METHODS: In this retrospective pilot study, 30 symptomatic and asymptomatic carriers of the mitochondrial 3243A>G mutation of whom two subsequent echocardiograms were available were included. We measured longitudinal, circumferential and radial strain using 2DSTE. Results were compared to published reference values. RESULTS: Speckle tracking was feasible in 90 % of the patients for longitudinal strain. Circumferential and radial strain showed low face validity (low number of images with sufficient quality; suboptimal tracking) and were therefore rejected for further analysis. Global longitudinal strain showed good face validity, and was abnormal in 56-70 % (depending on reference values used) of the carriers (n = 27). Reproducibility was good (mean difference of 0.83 for inter- and 0.40 for intra-rater reproducibility; ICC 0.78 and 0.89, respectively). The difference between the first and the second measurement exceeded the measurement variance in 39 % of the cases (n = 23; feasibility of follow-up 77 %). DISCUSSION: Even in data collected as part of clinical care, two-dimensional strain echocardiography seems a feasible method to detect and monitor subtle changes in longitudinal myocardial deformation in adult carriers of the mitochondrial 3243A>G mutation. Based on our data and the reported accuracy of global longitudinal strain in other studies, we suggest the use of global longitudinal strain in a prospective follow-up or intervention study.

Abnormal two-dimensional strain echocardiography findings in children with congenital valvar aortic stenosis.

PURPOSE: Congenital valvar aortic stenosis (VAS) causes a pressure overload to the left ventricle. In the clinical setting, the severity of stenosis is graded by the pressure drop over the stenotic valve (pressure gradient). This parameter is dependent on the hemodynamic status and does not provide information regarding myocardial performance. This study was undertaken to reveal the potential of two-dimensional strain echocardiography (2DSTE) for the detection of myocardial functional changes due to congenital VAS in children. MATERIALS AND METHODS: A total of 86 patients (aged from birth to 18 years) with various degrees of isolated congenital VAS were enrolled in this study. None of the patients had undergone any form of surgical or balloon intervention. 139 healthy children served as a control group. Two-dimensional cine-loop recordings of apical 4-chamber, mid-cavity short-axis and basal short-axis views were digitally stored for off-line analysis. Longitudinal, circumferential and radial peak systolic strain and strain rate values were determined as well as the time to peak systolic strain (T2P). Two-way analysis of variance was performed to assess the relationship between VAS severity and 2DSTE parameters. RESULTS: In all patients conventional echocardiographic findings did not indicate systolic left ventricular dysfunction. All strain parameters of the control group were significantly different from those of VAS patients. There was a statistically significant, inverse relationship between global peak systolic strain parameters in all three directions and the degree of VAS (p < 0.05). Local peak systolic strain (rate) in the interventricular septum was most affected. T 2P increased significantly with VAS severity (p < 0.05). The decline in LV longitudinal systolic performance preceded that in other directions. CONCLUSION: 2DSTE detects alterations in myocardial function in children diagnosed with congenital VAS, whose conventional echocardiographic findings did not indicate ventricular systolic dysfunction.

Noninvasive detection of hepatic lipidosis in dairy cows with calibrated ultrasonographic image analysis.

The aim was to test the accuracy of calibrated digital analysis of ultrasonographic hepatic images for diagnosing fatty liver in dairy cows. Digital analysis was performed by means of a novel method, computer-aided ultrasound diagnosis (CAUS), previously published by the authors. This method implies a set of pre- and postprocessing steps to normalize and correct the transcutaneous ultrasonographic images. Transcutaneous hepatic ultrasonography was performed before surgical correction on 151 German Holstein dairy cows (mean +/- standard error of the means; body weight: 571+/-7 kg; age: 4.9+/-0.2 yr; DIM: 35+/-5) with left-sided abomasal displacement. Concentration of triacylglycerol (TAG) was biochemically determined in liver samples collected via biopsy and values were considered the gold standard to which ultrasound estimates were compared. According to histopathologic examination of biopsies, none of the cows suffered from hepatic disorders other than hepatic lipidosis. Hepatic TAG concentrations ranged from 4.6 to 292.4 mg/g of liver fresh weight (FW). High correlations were found between the hepatic TAG and mean echo level (r=0.59) and residual attenuation (ResAtt; r=0.80) obtained in ultrasonographic imaging. High correlation existed between ResAtt and mean echo level (r=0.76). The 151 studied cows were split randomly into a training set of 76 cows and a test set of 75 cows. Based on the data from the training set, ResAtt was statistically selected by means of stepwise multiple regression analysis for hepatic TAG prediction (R(2)=0.69). Then, using the predicted TAG data of the test set, receiver operating characteristic analysis was performed to summarize the accuracy and predictive potential of the differentiation between various measured hepatic TAG values, based on TAG predicted from the regression formula. The area under the curve values of the receiver operating characteristic based on the regression equation were 0.94 (<50 vs. >or=50mg of TAG/g of FW), 0.83 (<100 vs. >or=100mg of TAG/g of FW), and 0.97 (<50 vs. >or=100mg of TAG/g of FW). The CAUS methodology and software for digitally analyzing liver ultrasonographic images is considered feasible for noninvasive screening of fatty liver in dairy herd health programs. Using the single parameter linear regression equation might be ideal for practical applications.

In vivo validation of cardiac output assessment in non-standard 3D echocardiographic images.

Automatic segmentation of the endocardial surface in three-dimensional (3D) echocardiographic images is an important tool to assess left ventricular (LV) geometry and cardiac output (CO). The presence of speckle noise as well as the nonisotropic characteristics of the myocardium impose strong demands on the segmentation algorithm. In the analysis of normal heart geometries of standardized (apical) views, it is advantageous to incorporate a priori knowledge about the shape and appearance of the heart. In contrast, when analyzing abnormal heart geometries, for example in children with congenital malformations, this a priori knowledge about the shape and anatomy of the LV might induce erroneous segmentation results. This study describes a fully automated segmentation method for the analysis of non-standard echocardiographic images, without making strong assumptions on the shape and appearance of the heart. The method was validated in vivo in a piglet model. Real-time 3D echocardiographic image sequences of five piglets were acquired in radiofrequency (rf) format. These ECG-gated full volume images were acquired intra-operatively in a non-standard view. Cardiac blood flow was measured simultaneously by an ultrasound transit time flow probe positioned around the common pulmonary artery. Three-dimensional adaptive filtering using the characteristics of speckle was performed on the demodulated rf data to reduce the influence of speckle noise and to optimize the distinction between blood and myocardium. A gradient-based 3D deformable simplex mesh was then used to segment the endocardial surface. A gradient and a speed force were included as external forces of the model. To balance data fitting and mesh regularity, one fixed set of weighting parameters of internal, gradient and speed forces was used for all data sets. End-diastolic and end-systolic volumes were computed from the segmented endocardial surface. The cardiac output derived from this automatic segmentation was validated quantitatively by comparing it with the CO values measured from the volume flow in the pulmonary artery. Relative bias varied between 0 and -17%, where the nominal accuracy of the flow meter is in the order of 10%. Assuming the CO measurements from the flow probe as a gold standard, excellent correlation (r = 0.99) was observed with the CO estimates obtained from image segmentation.

3D quantitative breast ultrasound analysis for differentiating fibroadenomas and carcinomas smaller than 1cm.

PURPOSE: In (3D) ultrasound, accurate discrimination of small solid masses is difficult, resulting in a high frequency of biopsies for benign lesions. In this study, we investigate whether 3D quantitative breast ultrasound (3DQBUS) analysis can be used for improving non-invasive discrimination between benign and malignant lesions. METHODS AND MATERIALS: 3D US studies of 112 biopsied solid breast lesions (size <1cm), were included (34 fibroadenomas and 78 invasive ductal carcinomas). The lesions were manually delineated and, based on sonographic criteria used by radiologists, 3 regions of interest were defined in 3D for analysis: ROI (ellipsoid covering the inside of the lesion), PER (peritumoural surrounding: 0.5mm around the lesion), and POS (posterior-tumoural acoustic phenomena: region below the lesion with the same size as delineated for the lesion). After automatic gain correction (AGC), the mean and standard deviation of the echo level within the regions were calculated. For the ROI and POS also the residual attenuation coefficient was estimated in decibel per cm [dB/cm]. The resulting eight features were used for classification of the lesions by a logistic regression analysis. The classification accuracy was evaluated by leave-one-out cross-validation. Receiver operating characteristic (ROC) curves were constructed to assess the performance of the classification. All lesions were delineated by two readers and results were compared to assess the effect of the manual delineation. RESULTS: The area under the ROC curve was 0.86 for both readers. At 100% sensitivity, a specificity of 26% and 50% was achieved for reader 1 and 2, respectively. Inter-reader variability in lesion delineation was marginal and did not affect the accuracy of the technique. The area under the ROC curve of 0.86 was reached for the second reader when the results of the first reader were used as training set yielding a sensitivity of 100% and a specificity of 40%. Consequently, 3DQBUS would have achieved a 40% reduction in biopsies for benign lesions for reader 2, without a decrease in sensitivity. CONCLUSION: This study shows that 3DQBUS is a promising technique to classify suspicious breast lesions as benign, potentially preventing unnecessary biopsies.

Three-dimensional ultrasound strain imaging of skeletal muscles.

In this study, a multi-dimensional strain estimation method is presented to assess local relative deformation in three orthogonal directions in 3D space of skeletal muscles during voluntary contractions. A rigid translation and compressive deformation of a block phantom, that mimics muscle contraction, is used as experimental validation of the 3D technique and to compare its performance with respect to a 2D based technique. Axial, lateral and (in case of 3D) elevational displacements are estimated using a cross-correlation based displacement estimation algorithm. After transformation of the displacements to a Cartesian coordinate system, strain is derived using a least-squares strain estimator. The performance of both methods is compared by calculating the root-mean-squared error of the estimated displacements with the calculated theoretical displacements of the phantom experiments. We observe that the 3D technique delivers more accurate displacement estimations compared to the 2D technique, especially in the translation experiment where out-of-plane motion hampers the 2D technique. In vivo application of the 3D technique in the musculus vastus intermedius shows good resemblance between measured strain and the force pattern. Similarity of the strain curves of repetitive measurements indicates the reproducibility of voluntary contractions. These results indicate that 3D ultrasound is a valuable imaging tool to quantify complex tissue motion, especially when there is motion in three directions, which results in out-of-plane errors for 2D techniques.

Characterization of plaque components with intravascular ultrasound elastography in human femoral and coronary arteries in vitro.

BACKGROUND: The composition of plaque is a major determinant of coronary-related clinical syndromes. Intravascular ultrasound (IVUS) elastography has proven to be a technique capable of reflecting the mechanical properties of phantom material and the femoral arterial wall. The aim of this study was to investigate the capability of intravascular elastography to characterize different plaque components. METHODS AND RESULTS: Diseased human femoral (n=9) and coronary (n=4) arteries were studied in vitro. At each location (n=45), 2 IVUS images were acquired at different intraluminal pressures (80 and 100 mm Hg). With the use of cross-correlation analysis on the high-frequency (radiofrequency) ultrasound signal, the local strain in the tissue was determined. The strain was color-coded and plotted as an additional image to the IVUS echogram. The visualized segments were stained on the presence of collagen, smooth muscle cells, and macrophages. Matching of elastographic data and histology were performed with the use of the IVUS echogram. The cross sections were segmented in regions (n=125) that were based on the strain value on the elastogram. The dominant plaque types in these regions (fibrous, fibro-fatty, or fatty) were obtained from histology and correlated with the average strain and echo intensity. The strain for the 3 plaque types as determined by histology differed significantly (P=0.0002). This difference was mainly evident between fibrous and fatty tissue (P=0.0004). The plaque types did not reveal echo-intensity differences in the IVUS echogram (P=0.882). CONCLUSIONS: Different strain values are found between fibrous, fibro-fatty, and fatty plaque components, indicating the potential of intravascular elastography to distinguish different plaque morphologies.

Carotid plaque elasticity estimation using ultrasound elastography, MRI, and inverse FEA - A numerical feasibility study.

The material properties of atherosclerotic plaques govern the biomechanical environment, which is associated with rupture-risk. We investigated the feasibility of noninvasively estimating carotid plaque component material properties through simulating ultrasound (US) elastography and in vivo magnetic resonance imaging (MRI), and solving the inverse problem with finite element analysis. 2D plaque models were derived from endarterectomy specimens of nine patients. Nonlinear neo-Hookean models (tissue elasticity C1) were assigned to fibrous intima, wall (i.e., media/adventitia), and lipid-rich necrotic core. Finite element analysis was used to simulate clinical cross-sectional US strain imaging. Computer-simulated, single-slice in vivo MR images were segmented by two MR readers. We investigated multiple scenarios for plaque model elasticity, and consistently found clear separations between estimated tissue elasticity values. The intima C1 (160 kPa scenario) was estimated as 125.8 ± 19.4 kPa (reader 1) and 128.9 ± 24.8 kPa (reader 2). The lipid-rich necrotic core C1 (5 kPa) was estimated as 5.6 ± 2.0 kPa (reader 1) and 8.5 ± 4.5 kPa (reader 2). A scenario with a stiffer wall yielded similar results, while realistic US strain noise and rotating the models had little influence, thus demonstrating robustness of the procedure. The promising findings of this computer-simulation study stimulate applying the proposed methodology in a clinical setting.

Characterization of plaque components and vulnerability with intravascular ultrasound elastography.

Intravascular ultrasound elastography is a method for measuring the local elastic properties using intravascular ultrasound (IVUS). The elastic properties of the different tissues within the atherosclerotic plaque are measured through the strain. Knowledge of these elastic properties is useful for guiding interventional procedures (balloon dilatation, ablation) and detection of the vulnerable plaque. In the last decade, several groups have applied elastography intravascularly with various levels of success. In this paper, the approaches of the different research groups will be discussed. The focus will be on our approach to the application of intravascular elastography. Elastograms were acquired in vitro and in vivo using the relative local displacements between IVUS images acquired at two levels of intravascular pressure with a 30 MHz mechanical or a 20 MHz array echo catheter. These displacements were estimated from the time shift between gated radiofrequency echo signals using cross-correlation algorithms with interpolation around the peak. Experiments on gel-based phantoms mimicking atherosclerotic vessels demonstrated the capability of elastography to identify soft and hard tissues independently of the echogenicity contrast. In vitro experiments on human arteries have demonstrated the potential of intravascular elastography to identify different plaque types based on their mechanical properties. These plaques could not be identified using the IVUS image alone. In vivo experiments revealed that reproducible elastograms could be obtained near end-diastole. Partial validation using the echogram was performed. Intravascular elastography provides information that is frequently unavailable or inconclusive from the IVUS image and which may therefore assist in the diagnosis and treatment of atherosclerotic disease.

Intravascular elasticity imaging using ultrasound: feasibility studies in phantoms.

A technique is described for measuring the local hardness of the vessel wall and atheroma using intravascular ultrasound. Strain images were constructed using the relative local displacements, which are estimated from the time shifts between gated echo signals acquired at two levels of intravascular pressure. Time shifts were estimated using one-dimensional correlation with bandlimited interpolation around the peak. Tissue-mimicking phantoms with typical morphology and hardness topology of some atherosclerotic vessels were constructed. Hard and soft regions could be distinguished on the strain image, independently of their contrast in echogenicity. Thus, the potential of ultrasonic hardness imaging to provide information that may be unavailable from the echogram alone was demonstrated. The strain images of the homogeneous and layered phantoms showed some artifacts that need to be corrected for, to obtain images of the modulus of elasticity. For in vitro and in vivo experiments, the spatial resolution of the technique needs to be improved. Furthermore, two-dimensional correlation techniques may be necessary in case of nonradial expansion and an off-centre catheter position.

Intraluminal ultrasonic palpation: assessment of local and cross-sectional tissue stiffness.

Many intravascular therapeutic techniques for the treatment of significant atherosclerotic lesions are mechanical in nature: examples are angioplasty, stenting and atherectomy. The selection of the most adequate treatment would be advantageously aided by knowledge of the mechanical properties of the lesion and surrounding tissues. Based on the success of intravascular ultrasound (IVUS) in accurately depicting the morphology of atheromatous lesions, ultrasonic tissue characterisation has been proposed as a tool to determine the composition of atheroma. We describe the addition of local compliance information to the IVUS image in the form of a colour-coded line congruent with the lumen perimeter. The technique involves analysis of echo signals obtained at two or more states of incremental intravascular pressure. Using vessel phantoms and specimens, we demonstrate the utility of intravascular compliance imaging. The palpograms are able to identify lesions of different elasticity independently of the echogenicity contrast, because the information provided by the elastograms is generally independent of that obtained from the IVUS image. Thus, the palpogram can complement the characterisation of lesion from the IVUS image. We also describe cross-sectional measures of elasticity that are based on the elastogram. Finally, natural extensions of intravascular palpation to other endoluminal ultrasound applications are proposed.

Acoustic velocity and attenuation of eye tissues at 20 MHz.

The ultrasound velocity and frequency-dependent attenuation of human and porcine eye tissues (cornea, lens, retina, choroid, sclera, vitreous body) were measured in the frequency range from 17 to 23 MHz. The results for the ultrasound velocity were compared to values taken from the literature and appeared to be in the same range. A comparison made between the acoustic parameters of human and porcine eyes showed that the porcine eye can serve as an animal model for the human eye. A mathematical operation is proposed to extrapolate the attenuation to the lower frequencies that are commonly used in clinical equipment. Finally, a first attempt was made to investigate the age dependence of the acoustic parameters of human tissues: some tissues showed a significant age effect.

Ultrasonic spectroscopy of the porcine eye lens.

The purpose of the work is to measure and study the acoustic characteristics of the porcine eye lens and find correlations with chemical and optical parameters, obtained from literature. Ultrasonic spectroscopy was performed by using a scanning acoustic macroscope (frequency 20 MHz, resolution 150 microns). The transducer performed a two-dimensional scan over a central slice (1 mm thickness) of porcine lens (number of lenses = 10). A double transmission pulse-echo method was used to acquire the ultrasonic data from the lens. Two-dimensional images were reconstructed of the local ultrasound velocity and the frequency-dependent ultrasound attenuation. Axial and equatorial profiles of these parameters were calculated from the images. The acoustic parameters are not constant, but show a systematic dependence on the location within the lens. The profiles of the acoustic parameters are similar in shape to profiles of the protein and water contents of eye lens and to the profiles of the optical refractive index. A thorough quantitative correlation study is indicated, which should be based on detailed protein content data in porcine lenses.

Intravascular ultrasound elastography in human arteries: initial experience in vitro.

Intravascular elastography is a new technique to obtain the local mechanical properties of the vessel wall and its pathology using intravascular ultrasound (IVUS). Knowledge of these mechanical properties may be useful for guiding interventional procedures. An experimental set-up is described for assessment of the strain data of arteries. Using a 30-MHz IVUS catheter, radio frequency data are acquired with a custom-made high-performance data acquisition system. High-resolution, local tissue displacement estimation by cross-correlation is followed by computation of local strain. An algorithm that uses a priori knowledge of the correlation coefficient function was applied to filter the obtained strain data. With this experimental set-up, intravascular elastograms containing 400 angles/revolution with a radial resolution of 200 microns can be produced. The feasibility of intravascular elastography with this experimental set-up is demonstrated using two diseased human femoral arteries. Qualitative comparison of the elastograms with the echograms and the histology demonstrates the potential of intravascular elastography to obtain mechanical information from the vessel wall and from plaque.

Advancing intravascular ultrasonic palpation toward clinical applications.

This paper describes the first reported attempt to develop a real-time intravascular ultrasonic palpation system. We also report on our first experience in the catherization laboratory with this new elastographic imaging technique. The prototype system was based on commercially available intravascular ultrasound (US) scanner that was equipped with a 20-MHz array catheter. Digital beam-formed radiofrequency (RF) echo data (i.e., 12 bits, 100 Hz) was captured at full frame rate from the scanner and transferred to personal computer (PC) memory using a fast data-acquisition system. Composite palpograms were created by applying a one-dimensional (1-D) echo tracking technique in combination with global motion compensation and multiframe averaging to several pairs of RF echo frames that were obtained in the diastolic phase of the cardiac cycle. The quality of palpograms was assessed by conducting experiments on vessel phantoms and on patients. The results demonstrated that robust and consistent palpograms could be generated in almost real-time using the proposed system. Good correlation was observed between low strain values and regions of calcification as identified from the intravascular US (IVUS) sonograms. Although the clinical results are clearly preliminary, it was concluded that the prototype system performed sufficiently well to warrant further and more in-depth clinical investigation.

Influence of catheter position on estimated strain in intravascular elastography.

In elastography, an erroneous strain estimate is obtained when the radial strain and the probing ultrasound beam are not properly aligned: the "strain projection artifact". In practice, an angle between the strain and the ultrasound beam will be present in most of the cases due to inhomogeneities or nonuniform compression. In this study, a theoretical function describing the strain projection artifact is derived as a function of the angle between the radial strain and the ultrasound beam. Two main factors for an angle between strain and ultrasound beam in intravascular elastographic experiments are eccentricity and tilt of the transducer. The theoretical functions describing these errors are corroborated with strain estimates from an experiment with a circular, homogeneous gel-based vessel phantom. Comparison between the theoretical functions and the experimental results reveals that the strain projection artifact is well described by the theoretical findings. As a result, the experimental data can be corrected for this artifact. The corrected elastograms reveal that correct strain estimates are obtained when the eccentricity of the intravascular catheter is less than 63%. An "off-the-wall" device may be required to advance intravascular elastography to in vivo implementation.

Echo decorrelation from displacement gradients in elasticity and velocity estimation.

Several ultrasonic techniques for the estimation of blood velocity, tissue motion and elasticity are based on the estimation of displacement through echo time-delay analysis. A common assumption is that tissue displacement is constant within a short observation time used for time delay estimation (TDE). The precision of TDE is mainly limited by noise sources corrupting the echo signals. In addition to electronic and quantization noise, a substantial source of TDE error is the decorrelation of echo signals because of displacement gradients within the observation time. The authors present a theoretical model that describes the mean changes of the crosscorrelation function as a function of observation time and displacement gradient. The gradient is assumed to be small and uniform within the observation time; the decorrelation introduced by the lateral and elevational displacement components is assumed to be small compared with the decorrelation caused by the axial component. The decorrelation model predicts that the expected value of the crosscorrelation function is a low-pass filtered version of the autocorrelation function (i.e., the crosscorrelation obtained without gradients). The filter is a function of the axial gradient and the observation time. This theoretical finding is corroborated experimentally. Limitations imposed by decorrelation in displacement estimation and potential uses of decorrelation in medical ultrasound are discussed.

Performance of time delay estimation methods for small time shifts in ultrasonic signals.

In this study several time delay estimation (TDE) methods were investigated for estimation of time shifts of less than 10 ns at a frequency of 30 MHz. Using simulated and experimental echosignals we investigated the performance of five methods: two phase related methods (phase shift and phase difference method); two correlation methods (cross-correlation and correlation interpolation method); and a demodulation method. The results showed that the correlation interpolation method is by far the most accurate for all time delays. With this method, estimation errors of about 200 ps are achievable with an signal-to-noise ratio (SNR) of 40 dB (f0 = 30 MHz, bandwidth = 20 MHz) for time shifts of up to 10 ns.

Effect of temperature increase and freezing on intravascular elastography.

Intravascular ultrasound (IVUS) elastography is a technique that assesses the local strain in the vessel wall and plaque. The strain is an important parameter for characterization of different plaque components. These regions are related to plaque vulnerability. IVUS elastography was validated in vitro using human coronary and femoral arteries. These experiments were performed on specimens that were stored frozen and measured at room temperature for practical issues. The aim of this study is to determine the influence of freezing and measuring the tissues at room temperature (23 degrees C instead of 37 degrees C) on the elastic properties. Four human coronary, one carotid and one femoral arteries were first measured at 23 degrees C and next at 37 degrees C. Additionally they were stored at -80 degrees C for up to 24 h and finally measured at 23 degrees C. Acquisitions at intraluminal pressures of 80 and 100 mmHg were performed using an EndoSonics 20 MHz Visions catheter. Elastograms were determined from the IVUS rf-data (sampled at 100 MHz in 12 bits) that were obtained from a digital interface. Qualitative and quantitative analysis of the elastograms obtained from fresh and frozen specimens measured at 23 degrees C reveals that storage of the specimen at -80 degrees C has no significant influence. In vitro experiments can be performed at room temperature after storage of the tissue at -80 degrees C without significant affection of the information with respect to measuring fresh ex vivo material at body temperature.