The technical part of these Guidelines and Recommendations, produced under the auspices of EFSUMB, provides an introduction to the physical principles and technology on which all forms of current commercially available ultrasound elastography are based. A difference in shear modulus is the common underlying physical mechanism that provides tissue contrast in all elastograms. The relationship between the alternative technologies is considered in terms of the method used to take advantage of this. The practical advantages and disadvantages associated with each of the techniques are described, and guidance is provided on optimisation of scanning technique, image display, image interpretation and some of the known image artefacts.

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EFSUMB Guidelines and Recommendations on the Clinical Use of Ultrasound Elastography. Part 1: Basic Principles and Technology

The basic principles of using sonographic techniques for imaging the elastic properties of tissues are described, with particular emphasis on elastography. After some preliminaries that describe some basic tissue stiffness measurements and some contrast transfer limitations of strain images are presented, four types of elastograms are described, which include axial strain, lateral strain, modulus and Poisson's ratio elastograms. The strain filter formalism and its utility in understanding the noise performance of the elastographic process is then given, as well as its use for various image improvements. After discussing some main classes of elastographic artefacts, the paper concludes with recent results of tissue elastography in vitro and in vivo.

Elastography: ultrasonic estimation and imaging of the elastic properties of tissues.

A method of acoustic remote palpation, capable of imaging local variations in the mechanical properties of tissue, is under investigation. In this method, focused ultrasound is used to apply localized (on the order of 2 mm3) radiation force within tissue. and the resulting tissue displacements are mapped using ultrasonic correlation based methods. The tissue displacements are inversely proportional to the stiffness of the tissue, and thus a stiffer region of tissue exhibits smaller displacements than a more compliant region. In this paper, the feasibility of remote palpation is demonstrated experimentally using breast tissue phantoms with spherical lesion inclusions, and in vitro liver samples. A single diagnostic transducer and modified ultrasonic imaging system are used to perform remote palpation. The displacement images are directly correlated to local variations in tissue stiffness with higher contrast than the corresponding B-mode images. Relationships between acoustic beam parameters, lesion characteristics and radiation force induced tissue displacement patterns are investigated and discussed. The results show promise for the clinical implementation of remote palpation.

On the feasibility of remote palpation using acoustic radiation force.

Purpose To understand and quantify intraocular pressure (IOP) measurement errors introduced by corneal variables during applanation tonometry using a cornea biomechanical model. Setting Department of Ophthalmology, Biomedical Engineering Center, The Ohio State University, Columbus, Ohio, USA. Methods The model assumed an overall resultant pressure that was based on the summation of the applanation pressure, the true IOP, and the surface tension caused by the tear film to determine the final deformation of the corneal apex during IOP measurement. Corneal resistance was varied according to the cornea's biomechanical properties, thickness, and curvature, and the effect of each variable on the accuracy of IOP tonometry readings was examined quantitatively. Results The model demonstrated that tonometry readings do not always reflect true IOP values. They deviate when corneal thickness, curvature, or biomechanical properties vary from normal values. Based on the model, predicted IOP readings have a 2.87 mm Hg range resulting from the variation in the corneal thickness in the normal population and a 1.76 mm Hg range from the variation in the corneal radius of curvature. Considering that Young's modulus of the corneal varies from 0.1 to 0.9 MPa in the normal population, the model predicts tonometry IOP readings will have a range of 17.26 mm Hg because of the variation in this corneal biomechanical parameter alone. Conclusions The simulation based on the model demonstrated quantitatively that variations in each corneal variable cause errors in tonometry IOP readings. The simulation results indicate that differences in corneal biomechanics across individuals may have greater impact on IOP measurement errors than corneal thickness or curvature.

Influence of corneal biomechanical properties on intraocular pressure measurement: quantitative analysis.

PURPOSE: To prospectively evaluate the elastographic appearance of thyroid gland tumors and explore the potential sensitivity and specificity of ultrasonographic (US) elastography for differentiating benign and malignant tumors, with histopathologic analysis as the reference standard. MATERIALS AND METHODS: The study was institutional review board approved, and each patient gave written informed consent. Fifty-two thyroid gland lesions (22 malignant, 30 benign) in 31 consecutive patients (six men, 25 women; mean age, 49.7 years ± 14.7 [standard deviation]) were examined with real-time elastography in the elasticity imaging mode implemented on a clinical US scanner modified for research. In addition, the radiofrequency echo data stored during US were exported from the scanner and used for off-line strain image reconstruction. All elastograms were evaluated for the lesion visibility, relative brightness, and margin regularity and definition by using a four-point scale. In addition, normal thyroid gland tiss...

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Thyroid gland tumor diagnosis at US elastography

Elastography is based on the estimation of strain due to applied tissue compression. In conventional elastography, strain is computed from the gradient of the displacement estimates between gated pre- and postcompression echo signals. Gradient-based estimation methods are known to be susceptible to noise. In elastography, in addition to the electronic noise, a principal source of estimation error is the decorrelation of the echo signal as a result of tissue compression (decorrelation noise). Temporal stretching of postcompression signals previously was shown to reduce the decorrelation noise. In this paper, we introduce a novel estimator that uses the stretch factor itself as an estimator of the strain. It uses an iterative algorithm that adaptively maximises the correlation between the pre- and postcompression echo signals by appropriately stretching the latter. We investigate the performance of this adaptive strain estimator using simulated and experimental data. The estimator has exhibited a vastly superior performance compared with the conventional gradient-based estimator.

An adaptive strain estimator for elastography

Spectral estimation of tissue strain has been performed previously by using the centroid shift of the power spectrum or by estimating the variation in the mean scatterer spacing in the spectral domain. The centroid shift method illustrates the robustness of the direct, incoherent strain estimator. In this paper, we present a strain estimator that uses spectral cross-correlation of the pre- and postcompression power spectrum. The centroid shift estimator estimates strain from the mean center frequency shift, while the spectral cross-correlation estimates the shift over the entire spectrum. Spectral cross-correlation is shown to be more sensitive to small shifts in the power spectrum and, thus, provides better estimation for smaller strains when compared to the spectral centroid shift. Spectral cross-correlation shares all the advantages gained using the spectral centroid shift, in addition to providing accurate and precise strain estimation for small strains. The variance and noise properties of the spectral strain estimators quantified by their respective strain filters are also presented.

Direct strain estimation in elastography using spectral cross-correlation.

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.

S.K. Alam

Papers

Elastography: ultrasonic estimation and imaging of the elastic properties of tissues.

An adaptive strain estimator for elastography

Direct strain estimation in elastography using spectral cross-correlation.

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

Elastographic Imaging Using Staggered Strain Estimates