Zhou, Jinling

Pulmonary edema is common in patients with congestive heart failure. Extravascular lung water (EVLW) correlates to the disease prognosis but the assessment is challenging. The current standard method, computed tomography (CT), poses a significant logistic burden and exposes patents to ionizing radiation. Non-invasive lung ultrasound (LUS) is introduced to subjectively evaluate B-lines for EVLW but results in significant inter-observer variability. We have developed ultrasound vibro-elastography (USVE) to safely measure lung surface wave speed quantitatively. In this abstract, we presented the technique for analyzing water content in a lung phantom model. A sponge is used as the lung phantom. Twelve water contents were injected in the phantom for different EVLW values. The mass density of the phantom was measured for each water content. Wave propagation was generated at five frequencies between 100 Hz and 300 Hz in the phantom, and the surface wave speeds were collected. The viscoelasticity was derived from the wave speed dispersion with frequency. The obtained surface wave speeds showed no clear correlation with different water content. The elasticity and viscosity, however, were found increased with water content. This research pinpoints the likelihood and possible direction for USVE to assess EVLW for patients with pulmonary edema.

Many lung diseases including interstitial lung disease (ILD) are associated with changes in the lung’s biomechanical properties. ILD comprises a number of serious diseases in which fibrosis stiffens and damages lung tissue. Most ILDs are typically distributed in the lung’s peripheral and subpleural regions. Pulmonary function test (PFT) and high-resolution computed tomography (HRCT) are used to assess ILD. Ultrasonography is not widely used for lung assessment because ultrasound cannot image deep lung tissue. We have developed lung ultrasound surface wave elastography (LUSWE) for measuring superficial lung wave speed. In LUSWE, a 0.1-s harmonic vibration is generated on the chest wall of a subject using a handheld vibrator. An ultrasound probe is aligned with the vibration excitation in the same intercostal space to measure the generated surface wave propagation on the lung. A human subject is examined in a sitting position. The lung is tested at the total lung volume and through six intercostal spaces. Significant differences of surface wave speed between patients and controls were found in 6 lung regions and for 3 excitation frequencies. A positive correlation between LUSWE and clinical tests including HRCT and PTF was found. LUSWE may complement the clinical standard HRCT for assessing ILD.

Lung ultrasound (LUS) detects the presence of extravascular lung water (EVLW) through the visualization of B-Line artifacts. However, the qualitative nature of LUS limits its effectiveness in serial or longitudinal studies such as evaluating changes in EVLW at different time points in patients undergoing diuretic therapy for congestive heart failure. Lung ultrasound surface wave elastography (LUSWE) is a novel technique using a small handheld device that can measure superficial lung tissue elastic properties. We aimed to evaluate the use of LUSWE to measure quantitative changes in lung elasticity caused by acute changes in EVLW. We performed LUSWE on consecutive days in 14 patients hospitalized for acute congestive heart failure with evidence of pulmonary edema (clinical EVLW). From day#1 to day#2, the patients had an average diuresis of net negative 2.1 l associated with an average decrease in 13 B-Lines by lung ultrasound, signifying a reduction in EVLW. LUSWE analysis demonstrated a significant reduction (p < 0.05) in surface wave velocity in all interrogated intercostal spaces from day#1 to day#2. In summary, LUSWE performed at the bedside was able to demonstrate improvement in lung compliance (decreased elasticity) correlating with a reduction in EVLW in hospitalized patients being treated for congestive heart failure.

Lung ultrasound surface wave elastography (LUSWE) was developed as a non-invasive tool for assessing pulmonary fibrosis. In this research, the effect of the fleural fluid on surface wave speed measurement of the lung is studied. Low-cost sponges [J. Ultrasound Med. 2017; 36, 2133], as good lung phantoms, were used in this study. The ultrasound transmission gel was used to simulate the pleural fluid. A harmonic vibration was generated at sponge surfaces using a shaker at 100, 150, and 200 Hz. The sponge surface wave speeds were measured with a 6 MHz ultrasound probe for both with and without a thin layer gel. The ultrasound features of A and B-lines were clearly observed in every sponge model in our experiment. The surface wave speeds for the sponges with the gel were indistinguishable from those without the gel for each frequency. The surface wave speeds were faster at higher excitation frequencies which is consistent with our patient study results. It was conclude that the pleural fluid may not affect the lung surface wave speed measurement based upon our lung phantom sponge models.

A lung ultrasound surface wave elastography (LUSWE) technique is developed for assessing interstitial lung disease (ILD). In LUSWE, a 0.1 second harmonic vibration is generated on the chest wall of a subject using a handheld vibrator. An ultrasound probe is aligned with the vibration indenter in the same intercostal region to measure the generated surface wave speed of the lung. A human subject is examined in a sitting position. The lung is tested at the total lung volume. The upper anterior lungs are tested through the second intercostal space in the mid-clavicular line. The lower lateral lungs are tested in the mid-axillary line and the lower posterior lungs are tested in the mid-scapular line. In a prospective clinical study, we measure both lungs through the six intercostal regions for patients and healthy controls. The surface wave speed is measured at 100 Hz, 150 Hz, and 200 Hz. Significant differences of wave speed between patients and controls were found in all lung regions at all frequencies. We also found positive correlation between LUSWE and CT analyses. LUSWE is a safe and noninvasive technique for generating and measuring surface wave propagation on the lung. LUSWE may be useful for assessing ILD.