Magnetic resonance elastography (MRE) is a rapidly developing technology for quantitatively assessing the mechanical properties of tissue. The technology can be considered to be an imaging-based counterpart to palpation, commonly used by physicians to diagnose and characterize diseases. The success of palpation as a diagnostic method is based on the fact that the mechanical properties of tissues are often dramatically affected by the presence of disease processes, such as cancer, inflammation, and fibrosis. MRE obtains information about the stiffness of tissue by assessing the propagation of mechanical waves through the tissue with a special magnetic resonance imaging technique. The technique essentially involves three steps: (1) generating shear waves in the tissue, (2) acquiring MR images depicting the propagation of the induced shear waves, and (3) processing the images of the shear waves to generate quantitative maps of tissue stiffness, called elastograms. MRE is already being used clinically for the assessment of patients with chronic liver diseases and is emerging as a safe, reliable, and noninvasive alternative to liver biopsy for staging hepatic fibrosis. MRE is also being investigated for application to pathologies of other organs including the brain, breast, blood vessels, heart, kidneys, lungs, and skeletal muscle. The purpose of this review article is to introduce this technology to clinical anatomists and to summarize some of the current clinical applications that are being pursued. Clin. Anat. 23:497–511, 2010. © 2010 Wiley-Liss, Inc.

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Magnetic resonance elastography: A review

Magnetic resonance elastography (MRE) is a non-invasive imaging technique used to visualise and quantify mechanical properties of tissue, providing information beyond what can be currently achieved with standard MR sequences and could, for instance, provide new insight into pathological processes in the brain. This study uses the MRE technique at 3 T to extract the complex shear modulus for in vivo brain tissue utilizing a full three-dimensional approach to reconstruction, removing contributions of the dilatational wave by application of the curl operator. A calibrated phantom is used to benchmark the MRE measurements, and in vivo results are presented for healthy volunteers. The results provide data for in vivo brain storage modulus (G'), finding grey matter (3.1 kPa) to be significantly stiffer than white matter (2.7 kPa). The first in vivo loss modulus (G'') measurements show no significant difference between grey matter (2.5 kPa) and white matter (2.5 kPa).

In vivo brain viscoelastic properties measured by magnetic resonance elastography.

From times immemorial manual palpation served as a source of information on the state of soft tissues and allowed detection of various diseases accompanied by changes in tissue elasticity. During the last two decades, the ancient art of palpation gained new life due to numerous emerging elasticity imaging (EI) methods. Areas of applications of EI in medical diagnostics and treatment monitoring are steadily expanding. Elasticity imaging methods are emerging as commercial applications, a true testament to the progress and importance of the field.In this paper we present a brief history and theoretical basis of EI, describe various techniques of EI and, analyze their advantages and limitations, and overview main clinical applications. We present a classification of elasticity measurement and imaging techniques based on the methods used for generating a stress in the tissue (external mechanical force, internal ultrasound radiation force, or an internal endogenous force), and measurement of the tissue response. The measurement method can be performed using differing physical principles including magnetic resonance imaging (MRI), ultrasound imaging, X-ray imaging, optical and acoustic signals.Until recently, EI was largely a research method used by a few select institutions having the special equipment needed to perform the studies. Since 2005 however, increasing numbers of mainstream manufacturers have added EI to their ultrasound systems so that today the majority of manufacturers offer some sort of Elastography or tissue stiffness imaging on their clinical systems. Now it is safe to say that some sort of elasticity imaging may be performed on virtually all types of focal and diffuse disease. Most of the new applications are still in the early stages of research, but a few are becoming common applications in clinical practice.

An overview of elastography - an emerging branch of medical imaging.

As more pretreatment imaging becomes integrated into the treatment planning process and full three-dimensional image-guidance becomes part of the treatment delivery the need for a deformable image registration technique becomes more apparent. A novel finite element model-based multiorgan deformable image registration method, MORFEUS, has been developed. The basis of this method is twofold: first, individual organ deformation can be accurately modeled by deforming the surface of the organ at one instance into the surface of the organ at another instance and assigning the material properties that allow the internal structures to be accurately deformed into the secondary position and second, multi-organ deformable alignment can be achieved by explicitly defining the deformation of a subset of organs and assigning surface interfaces between organs. The feasibility and accuracy of the method was tested on MR thoracic and abdominal images of healthy volunteers at inhale and exhale. For the thoracic cases, the lungs and external surface were explicitly deformed and the breasts were implicitly deformed based on its relation to the lung and external surface. For the abdominal cases, the liver, spleen, and external surface were explicitly deformed and the stomach and kidneys were implicitly deformed. The average accuracy (average absolute error) of the lung and liver deformation, determined by tracking visible bifurcations, was 0.19 (s.d.: 0.09), 0.28 (s.d.: 0.12) and 0.17 (s.d.: 0.07) cm, in the LR, AP, and IS directions, respectively. The average accuracy of implicitly deformed organs was 0.11 (s.d.: 0.11), 0.13 (s.d.: 0.12), and 0.08 (s.d.: 0.09) cm, in the LR, AP, and IS directions, respectively. The average vector magnitude of the accuracy was 0.44 (s.d.: 0.20) cm for the lung and liver deformation and 0.24 (s.d.: 0.18) cm for the implicitly deformed organs. The two main processes, explicit deformation of the selected organs and finite element analysis calculations, require less than 120 and 495 s, respectively. This platform can facilitate the integration of deformable image registration into online image guidance procedures, dose calculations, and tissue response monitoring as well as performing multi-modality image registration for purposes of treatment planning.

Accuracy of finite element model‐based multi‐organ deformable image registration

MR elastography (MRE) enables the noninvasive determination of the viscoelastic behavior of human internal organs based on their response to oscillatory shear stress. An experiment was developed that combines multifrequency shear wave actuation with broad-band motion sensitization to extend the dynamic range of a single MRE examination. With this strategy, multiple wave images corresponding to different driving frequencies are simultaneously received and can be analyzed by evaluating the dispersion of the complex modulus over frequency. The technique was applied on the brain and liver of five healthy volunteers. Its repeatability was tested by four follow-up studies in each volunteer. Five standard rheological models (Maxwell, Voigt, Zener, Jeffreys and fractional Zener model) were assessed for their ability to reproduce the observed dispersion curves. The three-parameter Zener model was found to yield the most consistent results with two shear moduli mu(1) = 0.84 +/- 0.22 (1.36 +/- 0.31) kPa, mu(2) = 2.03 +/- 0.19 (1.86 +/- 0.34) kPa and one shear viscosity of eta = 6.7 +/- 1.3 (5.5 +/- 1.6) Pa s (interindividual mean +/- SD) in brain (liver) experiments. Significant differences between the rheological parameters of brain and liver were found for mu(1) and eta (P < 0.05), indicating that human brain is softer and possesses a higher viscosity than liver.

https://iopscience.iop.org/article/10.1088/0031-9155/52/24/006/pdf

Noninvasive assessment of the rheological behavior of human organs using multifrequency MR elastography: a study of brain and liver viscoelasticity.

The aim of this study was to examine the diffusive properties of adjacent muscles at rest, and to determine the relationship between diffusive and architectural properties, which are task-specific to muscles. The principle, second, and third eigenvalues, trace of the diffusion tensor, and two anisotropic parameters, ellipsoid eccentricity (e) and fractional anisotropy (FA), of various muscles in the human calf were calculated by diffusion tensor imaging (DTI). Linear correlations of the calculated parameters to the muscle physiological cross-sectional area (PCSA), which is proportional to maximum muscle force, were performed to ascertain any linear relation between muscle architecture and diffusivity. Images of the left calf were acquired from six healthy male volunteers. Seven muscles were investigated in this study. These comprised the soleus, lateral gastrocnemius, medial gastrocnemius, posterior tibialis, anterior tibialis, extensor digitorum longus, and peroneus longus. All data were presented as the mean and standard error of the mean (SEM). In general, differences in diffusive parameter values occurred primarily between functionally different muscles. A strong correlation was also found between PCSA and the third eigenvalue, e, and FA. A mathematical derivation revealed a linear relationship between PCSA and the third eigenvalue as a result of their dependence on the average radius of all fibers within a single muscle. These findings demonstrated the ability of DTI to differentiate between functionally different muscles in the same region of the body on the basis of their diffusive properties.

Diffusive sensitivity to muscle architecture: a magnetic resonance diffusion tensor imaging study of the human calf

MR elastography (MRE) has been shown to be capable of non-invasively measuring tissue elasticity even in deep-lying regions. Although limited studies have already been published examining in vivo muscle elasticity, it is still not clear over what range the in vivo elasticity values vary. The present study intends to produce further information by examining four different skeletal muscles in a group of 12 healthy volunteers in the age range of 27-38 years. The examinations were performed in the biceps brachii, the flexor digitorum profundus, the soleus and the gastrocnemius. The average shear modulus was determined to be 17.9 (+/- 5.5), 8.7 (+/- 2.8), 12.5 (+/- 7.3) and 9.9 (+/- 6.8) kPa for each muscle, respectively. To ascertain the reproducibility of the examination, the stiffness measurements in two volunteers were repeated seven times for the biceps brachii. These examinations yielded a mean shear modulus of 11.3 +/-.7 and 13.3 +/- 4.7 kPa for the two subjects. For elasticity reconstruction, an automated reconstruction algorithm is introduced which eliminates variation due to subjective manual image analysis. This study yields new information regarding the expected variation in muscle elasticity in a healthy population, and also reveals the expected variability of the MRE technique in skeletal muscle.

In vivo elasticity measurements of extremity skeletal muscle with MR elastography.

The diffusive properties of adjacent muscles at rest were evaluated in male (n = 12) and female (n = 12) subjects using diffusion tensor imaging (DTI). The principle, second and third eigenvalues, trace of the diffusion tensor [Tr(D)], and two anisotropic parameters, ellipsoid eccentricity (e) and fractional anisotropy (FA), of various muscles in the human calf were calculated from the diffusion tensor. Seven muscles were investigated in this study from images acquired of the left calf: the soleus, lateral gastrocnemius, medial gastrocnemius, posterior tibialis, anterior tibialis, extensor digitorum longus and peroneus longus. A mathematical model was also derived that relates the eigenvalues of the diffusion tensor to the muscle fiber volume fraction, which is defined as the volume of muscle fibers within a well-defined arbitrary muscle volume. Females on average had higher eigenvalues and Tr(D) compared with males, with the majority of muscles being statistically different between the sexes. In contrast, males on average had higher e and FA than females, with the large plantar flexors--soleus, lateral gastrocnemius, and medial gastrocnemius--producing statistically different results. The behavior of the mathematical model for variations in fiber volume fraction produced similar trends to those seen when the experimental data were fit to the model. The model predicts that a larger volume fraction of skeletal muscle in males is devoted to fibers than in females, but the true underlying source of the gender discrepancy remains unclear. Although the model does not fully account for other transport processes, it does provide some insight into the limiting factors that affect the diffusion of water in skeletal muscle measured by DTI.

A diffusion tensor imaging analysis of gender differences in water diffusivity within human skeletal muscle.

Magnetic Resonance (MR) elastography is a method for measuring tissue elasticity via phase images acquired with an MR scanner. The propagation of periodic mechanical waves through the tissue can be captured by means of a modified phase contrast sequence. These waves are generated with a mechanical oscillator (actuator) and coupled into the tissue through the skin. The actuator must be capable of generating a sinusoidal excitation with excellent phase and amplitude stability, while not disturbing the MR imaging process. In this work, an actuator based on a piezoelectric principle was developed. Based on the imaging evaluation of several material samples, the housing for the piezoelectric ceramic was constructed of aluminum. Smaller parts of the housing were manufactured from brass and titanium to fulfill the mechanical constraints. A lever was used to transfer the oscillation generated by the piezoelectric ceramic to the point of excitation. The lever amplifies the piezoelectric motion, allowing for a more compact design. Three different lever designs were characterized by an acceleration sensor both outside and inside the magnet. It was shown that the rigidity of the lever, as determined by its material and form, was decisive in determining the resonant frequency of the system and therefore the maximum practical frequency of operation. It was also shown that the motion of the oscillator is unaffected by the electromagnetic fields of the MR imager. The final design can be placed directly in the magnet bore within a few centimeters of the tissue volume to be imaged without generating significant artifacts. An amplitude range of 0–1 mm in the frequency range from 0 to over 300 Hz was achieved, sufficient for performing most MR elastography applications. © 2002 Wiley Periodicals, Inc. Concepts in Magnetic Resonance (Magn Reson Engineering) 15: 239–254, 2002

Kai Uffmann

Papers

Diffusive sensitivity to muscle architecture: a magnetic resonance diffusion tensor imaging study of the human calf

In vivo elasticity measurements of extremity skeletal muscle with MR elastography.

A diffusion tensor imaging analysis of gender differences in water diffusivity within human skeletal muscle.

Design of an MR‐compatible piezoelectric actuator for MR elastography

Cerebral activation using a MR-compatible piezoelectric actuator with adjustable vibration frequencies and in vivo wave propagation control