Lee, Hyungkyi

The diaphragm muscle is important in both sustaining ventilation and performing higher-force behaviors necessary for maintaining airway patency. Ventilatory behaviors (i.e., eupnea and response to hypoxia-hypercapnia) require only ~20% of maximal force generation, whereas coughing requires forces ~60% of maximal. Existing techniques to measure the full range of forces generated by respiratory muscles are limited by their invasiveness (e.g., balloon manometry for transdiaphragmatic pressure (Pdi) measurements), requirements for training, supervision and subjectivity (e.g., maximal inspiratory and expiratory pressures). Ultrasound-based shear-wave elastography (SWE) assesses muscle stiffness and has shown promising results in being used as a surrogate for Pdi to evaluate diaphragm muscle force. Previous literature has demonstrated a correlation between diaphragm SWE and Pdi at lower force behaviors and the goal of the present study was to evaluate the efficacy of SWE-based measurements of the diaphragm in correlating with Pdi measurements across the range of forces generated by the diaphragm. In this pilot study, we recruited 6 male and 5 female healthy volunteers. Subjects were positioned in a seated position with their torso unsupported. Pdi was measured during graded inspiratory threshold loading trials using a POWERbreathe Plus commercial inspiratory loading device, as well as during maximal inspiratory pressure (MIP). Simultaneously, SWE was performed at the zone of apposition in the right anterior axillary line, and diaphragm Young’s modulus and shear wave speed were subsequently measured. The average Pdi during MIP testing was 149 ± 66 cm H2O. Pdi during inspiratory loading at a low resistance was 39 ± 14 cm H2O and at a high resistance was 78 ± 29 cm H2O. Subjects were able to generate an average Pdi range of 39 ± 19 cm H2O across the graded resistance levels, and the average percent of MIP obtained was 54 ± 13%. Average Young’s modulus as measured with SWE during inspiratory loading at a low resistance was 46 ± 19 kPa and at a high resistance was 104 ± 19 kPa. From low to high resistance, Pdi, Young’s modulus, and shear wave speed increased by an average of 100%, 126%, and 59%, respectively. Taken together, SWE is a promising method of non-invasive assessment of diaphragm muscle forces across a range of voluntary behaviors. Support from NIH grant R21 DA055848 and the Mayo Clinic. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Applications, such as shear wave elastography and Doppler imaging, require high frame rates. Plane wave compounding (PWC) is widely used for these applications. Comb detection was proposed to combine the high frame rate of PWC and the high signal quality of focused beam scanning. Comb detection transmits multiple focused beams simultaneously to increase the frame rate. These comb beams are scanned laterally to cover the whole region-of-interest. The simultaneous multiple transmission of focused beams causes crosstalk between neighboring beams. Transmit crosstalk is related to the pressure field of transmit beams, and receive crosstalk is determined by the beam profile of receive beamforming. In this study, we varied f-number (F/N) and apodization window and measured their effects on crosstalk based on the pressure field and an arterial wall simulation using Field II. For transmit design, transmit apodization with a Hamming window significantly reduced crosstalk compared to a rectangular window and transmit F/N had little impact on the crosstalk. Regarding receive beamforming, a Hamming window led to lower crosstalk than the rectangular window and F/N from 1 to 5 suppressed crosstalk to below 30 dB. The effects of crosstalk in shear wave motion data from phantom experiments were also analyzed. Comb detection showed less motion artifact than PWC in phantom experiments.

Synthetic aperture (SA) acquisition allows for focusing at all points in ultrasound images during reconstruction. Both delay-and-sum (DAS) and delay-multiply-and-sum (DMAS) have been used to reconstruct SA images. An integral part of both algorithms is the aperture size used to define the beam shape with the f-number. Although f-number variation has been studied in DAS reconstruction, there has not been a systematic study on this topic for DMAS reconstruction in SA imaging. In this work, we evaluated the effects of f-number in DMAS reconstruction using an imaging phantom (CIRS 040GSE). We reconstructed DAS and DMAS images of hyperechoic, hypoechoic, and anechoic contrast targets, as well as point targets, while varying the transmit and receive f-numbers between 0 and 7 in 0.2 increments. Generalized contrast-to-noise ratio (gCNR) was measured for contrast targets. The full width at half maximum (FWHM) was evaluated using point targets. When imaging contrast targets, the DAS and DMAS algorithms responded very differently when varying the f-numbers. DMAS produced higher gCNR values with low transmit f-numbers and high receive f-numbers, while DAS produced higher gCNR values with high transmit and receive f-numbers. When evaluating FWHM, the optimal receive f-number was close to 1 for both algorithms.

Osteochondritis dissecans (OCD) is a focal joint defect that is prevalent among youth athletes. With the application of medical ultrasound, OCD of the humeral capitellum could be detected earlier and prevent surgery. In this work, we tested a modified Delay-Multiply-and-Sum (DMAS) reconstruction algorithm to evaluate how it affects medical ultrasound’s ability to detect OCD. Starting with the DMAS reconstruction algorithm described by Matrone et al. (2015), we modified the implementation of filtering and envelope detection steps. Delay-and-Sum (DAS), DMAS, and modified DMAS algorithms were tested on phantom and cadaveric models of capitellar OCD. The DMAS and modified DMAS images were histogram matched to the DAS image for quantitative comparison. By taking several profiles across the images of the artificial OCD lesions, we compared the lesion contrast and bone surface clarity produced by each algorithm. We found that the unmodified DMAS algorithm showed little improvement over the DAS algorithm, particularly after histogram matching. The modified DMAS algorithm showed a much greater improvement in the detection of OCD lesions compared to the DMAS algorithm. This modified DMAS algorithm could be used for other bone surface imaging applications. Future work includes evaluating these algorithms in vivo with patients diagnosed with OCD.

Arterial stiffness is recognized as a highly clinically relevant and independent prognostic biomarker of cardiovascular disease. Arterial dispersion ultrasound vibrometry (ADUV) uses acoustic radiation force to generate propagating waves in the arterial wall and measures the wave motion to estimate arterial mechanical properties from fitting phase velocity dispersion curves to a waveguide model. ADUV measurements were made with a Verasonics V1 system with a L7-4 linear array transducer in 63 human subjects (27 male/36 female) from ages 50–88 years old. We made measurements at 10 time points within the cardiac cycle, termed cardiac stages. We estimated the phase velocity (median of cp from 400-600 Hz) and G determined from matching the dispersion curves with those from a waveguide model incorporating the artery diameter and wall thickness. Within the same study visit, we measured the intima-media thickness and diameter changes through the cardiac cycle with a General Electric Logiq E9 or E10 scanner. We also tonometry to determine the carotid-femoral pulse wave velocity. We report here comparisons of median phase velocity, cp, and inverted shear modulus, G, at different stages of the cardiac cycle with clinical metrics of arterial stiffness.

Osteochondritis dissecans (OCD) is a joint disease that is prevalent among youth athletes. Medical ultrasound is currently limited in its ability to detect and monitor OCD due to limitations of current Delay-and-Sum (DAS) reconstruction algorithms. In this work, we used a Delay-Multiply-and-Sum (DMAS) reconstruction algorithm to improve medical ultrasound’s ability to diagnose OCD. We artificially generated OCD lesions in unfixed cadaveric elbows and imaged them with a research ultrasound machine. We also imaged these cadaveric limbs with x-ray computed tomography (CT) with a high-resolution acquisition. These CT images were used as a gold standard for OCD geometry. We reconstructed the ultrasound images using both DAS and DMAS algorithms and compared them quantitatively by taking several profiles across the images of the artificial OCD lesions. The image metrics that we measured within these profiles were OCD lesion contrast, bone interface clarity, and lesion crack thickness accuracy. We found that the DMAS algorithm improved OCD lesion contrast by up to 26% when compared to DAS. We also found that the DMAS algorithm reduced the variability of bone interface clarity overall. Future work will involve an in vivo study, as well as optimization, of the DMAS algorithm for OCD lesion imaging.