The non-invasive quantification of regional myocardial function is an important goal in clinical cardiology. Myocardial thickening/thinning indices is one method of attempting to define regional myocardial function. A new ultrasonic method of quantifying regional deformation has been introduced based on the principles of 'strain' and 'strain rate' imaging. These new imaging modes introduce concepts derived from mechanical engineering which most echocardiographers are not familiar with. In order to maximally exploit these new techniques, an understanding of what they measure is indispensable. This paper will define each of these modalities in terms of physical principles and will give an introduction to the principles of data acquisition and processing required to implement ultrasonic strain and strain rate imaging. In addition, the current status of development of the technique and its limitations will be discussed, together with examples of potential clinical applications.

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Regional Strain and Strain Rate Measurements by Cardiac Ultrasound: Principles, Implementation and Limitations

Early detection of cardiovascular diseases has been a very active research area in the medical imaging field. Assessment of the local and global mechanical functions is one of the major goals of accurate diagnosis. In this study, we investigated the feasibility of elastography for estimation and imaging of the local cardiac muscle displacement and strain in a human heart in vivo. In its noninvasive applications, elastography has been typically used to determine local tissue strain through the use of externally applied compression. For our study, we utilized the cardiac muscle motion during a cardiac cycle as the mechanical stimulus, and acquired successive radiofrequency (RF) data frames of the septal and posterior walls over a few cardiac cycles in parasternal and apical views, respectively. High-quality cine-loop elastograms were obtained due to high frame rates and the resulting low decorrelation noise. Furthermore, the strain contrast was higher in the parasternal case, when only the posterior wall was imaged, and strain estimation was more robust in the apical view. High repeatability of the results was observed through elastographic measurements over several cardiac cycles. Finally, an M-mode version of elastography was used to follow part of the interventricular septum or the posterior wall over the course of two cardiac cycles. Not only do these preliminary results show that elastography is feasible in cardiac applications in vivo, but also that it can provide new information regarding cardiac motion and mechanical function. Future prospects include assessment of the role of elastography in detection of ischemia and infarction.

Myocardial elastography—a feasibility study in vivo

Though myocardial viscoelasticity is essential in the evaluation of heart diastolic properties, it has never been noninvasively measured in vivo. By the ultrasonic measurement of the myocardial motion, we have already found that some pulsive waves are spontaneously excited by aortic-valve closure (AVC) at end-systole (To). These waves may serve as an ideal source of the intrinsic heart sound caused by AVC. In this study, using a sparse sector scan, in which the beam directions are restricted to about 16, the pulsive waves were measured almost simultaneously at about 160 points set along the heart wall at a sufficiently high frame rate. The consecutive spatial phase distributions, obtained by the Fourier transform of the measured waves, clearly revealed wave propagation along the heart wall for the first time. The propagation time of the wave along the heart wall is very small (namely, several milliseconds) and cannot be measured by conventional equipment. Based on this phenomenon, we developed a means to measure the myocardial viscoelasticity in vivo. In this measurement, the phase velocity of the wave is determined for each frequency component. By comparing the dispersion of the phase velocity with the theoretical one of the Lamb wave (the plate flexural wave), which propagates along the viscoelastic plate (heart wall) immersed in blood, the instantaneous viscoelasticity is determined noninvasively. This is the first report of such noninvasive determination. In in vivo experiments applied to five healthy subjects, propagation of the pulsive wave was clearly visible in all subjects. For the 60-Hz component, the typical propagation speed rapidly decreased from 5 m/s just before the time of AVC (t = To - 8 ms) to 3 m/s at t = To + 10 ms. In the experiments, it was possible to determine the viscosity more precisely than the elasticity. The typical value of elasticity was about 24-30 kPa arid did not change around the time of AVC. The typical transient values of viscosity decreased rapidly from 400 Pa/spl middot/s at t = To - 8 ms to 70 Pa-s at t = To + 10 ms. The measured shear elasticity and viscosity in this study are comparable to those obtained for the human tissues using audio frequency in in vitro experiments reported in the literature.

http://www.ecei.tohoku.ac.jp/~hkanai/pdf-fullpaper/105kanai2005.pdf

Propagation of spontaneously actuated pulsive vibration in human heart wall and in vivo viscoelasticity estimation

Background— Knowledge of the physical properties of atherosclerotic plaque is essential when evaluating its vulnerability in a clinical setting. Such knowledge, however, is still difficult to obtain with the various approaches developed to date. Methods and Results— This article describes a noninvasive method for evaluating the regional elasticity (the elastic modulus in the circumferential direction) of tissue surrounding atherosclerotic plaque in which a novel phased tracking method is applied to measure minute changes in thickness of each of the multiple layers of the arterial wall during one heartbeat. By comparing the pathological findings with the distribution of elasticity, average elasticity of lipid and that of a mixture of smooth muscle and collagen fiber can be determined. On the basis of these reference parameters, each point is statistically categorized as lipid, mixture, or other. Thus, the plaque is electronically stained using transcutaneous ultrasound. By applying the method to the common...

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Elasticity Imaging of Atheroma With Transcutaneous Ultrasound Preliminary Study

Ultrasonic imaging is the noninvasive clinical imaging modality of choice for diagnosing heart disease. At present, two-dimensional ultrasonic grayscale images provide a relatively cheap, fast, bedside method to study the morphology of the heart. Several methods have been proposed to assess myocardial function. These have been based on either grayscale or motion (velocity) information measured in real-time. However, the quantitative assessment of regional myocardial function remains an important goal in clinical cardiology. To do this, ultrasonic strain and strain-rate imaging have been introduced. In the clinical setting, these techniques currently only allow one component of the true three-dimensional deformation to be measured. Clinical, multidimensional strain (rate) information can currently thus only be obtained by combining data acquired using different transducer positions. Nevertheless, given the appropriate postprocessing, the clinical value of these techniques has already been shown. Moreover, multidimensional strain and strain-rate estimation of the heart in vivo by means of a single ultrasound acquisition has been shown to be feasible. In this paper, the new techniques of ultrasonic strain rate and strain imaging of the heart are reviewed in terms of definitions, data acquisition, strain-rate estimation, postprocessing, and parameter extraction. Their clinical validation and relevance are discussed using clinical examples on relevant cardiac pathology. Based on these examples, suggestions are made for future developments of these techniques.

Echocardiographic strain and strain-rate imaging: a new tool to study regional myocardial function

We have already developed a new method, namely, the phased tracking method, to track the movement of the heart wall and arterial wall accurately based on both the phase and magnitude of the demodulated signals to determine the instantaneous position of an object. This method has been realized by an off-line measurement system, which cannot be applied to transient evaluation of rapid response of the cardiovascular system to physiological stress. In this paper, therefore, a real-time system to measure change in the thickness of the myocardium and the arterial wall is presented. In this system, an analytic signal from standard ultrasonic diagnostic equipment is analogue-to-digital (A/D) converted at a sampling frequency of 1 MHz. By pipelining and parallel processing using four high-speed digital signal processing (DSP) chips, the method described is realized in real time. The tracking results for both sides of the heart and/or arterial wall are superimposed on the M (motion)-mode image in the work station (WS), and the thickness changes of the heart and/or arterial wall are also displayed and digital-to-analogue (D/A) converted in real time. From the regional change in thickness of the heart wall, spatial distribution of myocardial motility and contractility can be evaluated. For the arterial wall, its local elasticity can be evaluated by referring to the blood pressure. In in vivo experiments, the rapid response of the change in wall thickness of the carotid artery to the dose of the nitroglycerine (NTG) is evaluated. This new real-time system offers potential for quantitative diagnosis of myocardial motility, early stage atherosclerosis, and the transient evaluation of the rapid response of the cardiovascular system to physiological stress.

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Jianping Zhang

Papers

Real-time measurements of local myocardium motion and arterial wall thickening