Citations

Background— Several echocardiographic dyssynchrony indexes have been proposed to identify responders to cardiac resynchronization therapy using tissue velocity and strain. The present study aimed to compare tissue velocity–derived and strain-derived dyssynchrony indexes in patients with or without systolic dysfunction and left bundle-branch block. Methods and Results— Tissue Doppler imaging was performed in 120 subjects divided into 4 groups: group 1 (n=40), normal subjects; group 2 (n=20), normal left ventricular ejection fraction and left bundle-branch block; group 3 (n=20), left ventricular ejection fraction <35% and normal conduction; and group 4 (n=40), left ventricular ejection fraction <35% and left bundle-branch block. Dyssynchrony indexes based on time to peak tissue velocity (septal-lateral delay, anteroseptal-posterior delay, and SD in time to peak systolic velocity in the 12 left ventricular segments) and strain (SD of time to peak strain in 12 segments) were measured. The SD in time to peak systolic velocity in the 12 left ventricular segments was greater in group 4 (54 ms; 25th and 75th percentiles, 46 to 64 ms) than group 1 (44 ms; 25th and 75th percentiles, 28 to 53 ms; P =0.006), but there was a considerable overlap of all tissue velocity–derived indexes among 4 groups, with 40% to 68% of group 1 having values proposed for predicting the responders of cardiac resynchronization therapy. The SD of time to peak strain in 12 segments distinguished these groups with much less overlap ( P <0.01 for all pairwise comparisons). Conclusions— A substantial proportion of normal subjects have tissue velocity–derived dyssynchrony indexes higher than the cutoff value proposed for predicting beneficial effect of cardiac resynchronization therapy. Strain-derived timing index appears to be more specific for dyssynchrony in patients with systolic dysfunction and left bundle-branch block. Identifying an optimal tissue velocity– or strain-derived dyssynchrony index requires a large prospective clinical trial.

Considerable interest in the elastic properties of soft tissue has increased in medicine due to their clinical relevance for monitoring various diseases as well as a biomarker for cancer. A recent emerging field is the use of acoustic radiation force for imaging and estimating the elastic properties of tissue. Newly developed imaging modalities include shear wave elasticity imaging, supersonic shear wave imaging, acoustic radiation force impulse imaging, and vibro-acoustography. In these new methods, the shear wave is used to estimate the elasticity of tissue. We have developed a novel surface wave method for noninvasively estimating the elasticity of tissue [X. Zhang et al., J. Acoust. Soc. Am., 122, 2522-2525 (2007)]. In this method, a localized ultrasound radiation force is remotely and noninvasively applied inside the tissue. The surface wave speed is used to estimate the elasticity of tissue. This method has been further developed and applied to estimate the viscoelasticity of animal myocardium tissue. In this abstract, we report our recent results of in vitro studies on animal myocardium tissue. Both the surface wave and shear wave are measured and analyzed. Noninvasive characterization of viscoelastic properties of myocardium tissue may be a very important tool for assessing heart function.

Vibro-acoustography (VA) is based on conversion of ultrasound energy from high frequency to a low frequency. This conversion, which results from the nonlinear nature of wave equation, gives VA some key advantages over linear ultrasound imaging such as B-mode. Two key features of VA are analyzed: lack of speckle noise, and angle-independency, which is the ability of imaging specular reflectors regardless of their orientation. Both the speckle noise and angle dependency are major artifacts in B-mode. Lack of speckle noise results from the fact that VA images are constructed from the low frequency acoustic signal. Using an acoustical model, it is shown that the random scatterers within soft tissue do not promote speckle noise in VA as they do in B-mode; thus VA generally produces high contrast images. Angle-independency results from the broad beam pattern of the low-frequency acoustic field. A model is constructed describing the amplitude of the acoustic signal versus object orientation angle. It is shown that the signal amplitude is relatively insensitive to object orientation; thus VA may be suitable for imaging specular objects such as implants. It is concluded that VA may be advantageous in applications where speckle noise and angle dependency are of concern.

Harmonic or pulsed radiation pressure and subsequent measurement of the tissue response can be used to accurately quantitatively measure fundamental material properties of tissue. The measurement of shear wave dispersion can be used to estimate elastic shear moduli of tissue using an appropriate model. Fundamental model free properties such as complex modulus can also be measured. Ultrasound radiation pressure is used to induce free propagating shear waves. The measurable properties of the shear waves such as speed are sensitive to only the local material properties of the tissue under certain circumstances. A model relating the shear wave speed as a function of frequency is related to the elastic and viscous moduli within small regions of tissue according to, for instance, the Voigt model. Shear and elastic moduli in tissue are measured with high accuracy and precision given appropriate models of wave propagation within the geometry of the tissue. Complex modulus in liver of live pig and other tissues have been made. Careful use of shear wave propagation and subsequent measurements can provide fundamental quantitative measurements of tissue mechanical properties if models are accurate. An application of this method is the noninvasive measurement of liver stiffness as a surrogate for fibrosis.

Arterial elasticity is an independent predictor of cardiovascular disease and mortality. Measurment of waves in thin shells can be used to estimate the circumferential and the longitudinal elastic moduli. Latex tubes and excised pig arteries were used as isotropic and anisotropic models. Waves were generated using focused ultrasound (1 ms, 3 MHz) in different locations of the wall. The modes of propagation of the waves were detected with a laser vibrometer or an ultrasound pulse echo tool while the excitation was moved known distances. Bending waves were predominant when exciting in the center of the wall, while a combination of torsion and bending waves resulted from exciting off center. Wave speeds of 15 m/s and 5 m/s respectively, were measured for the bending waves. Using the Moens-Korteweg equation, values of 1.1 and 0.350 MPa were found for the longitudinal elastic modulus in the tube and artery respectively. Generation of different modes in the tubes and arteries is possible using focused ultrasound. Elastic components of the tubes and vessels in the longitudinal and the circumferential direction can be estimated from the speed of propagation and the frequency of the bending and the torsional waves.

Vibro-acoustography (VA) is an imaging modality that uses the radiation force of ultrasound to vibrate tissue at a low frequency and records the resulting acoustic field to produce an image that is represents object characteristics at both ultrasound as well as low (audio) frequencies. Currently, B-mode ultrasound is used for prostate imaging. This imaging method has some limitations, including the speckle noise, which limit its ability in detection of lesions and calcifications. The purpose of this study is to explore the potentials of VA for prostate imaging. VA, B-mode ultrasound, and radiography were performed on 12 excised human prostate samples and the resulting images were compared. VA system parameters were, center frequency 3 MHz, Δf=50 kHz, image area 5×5 cm, pixel size 0.2×0.2 mm. Images evaluated in terms of visibility of anatomical and pathological structures and contrast. Results showed that prostate anatomical structures, mass lesions, and calcifications were visible in the VA images taken at different depths, and VA image quality was superior to B-mode. VA images exhibited significant contrast between the central and peripheral zones with enhanced borders. It is concluded that, with further development, VA may become suitable modality for in prostate imaging.

High-resolution ultrasound imaging systems for inspection of defects and flaws in materials are of great demand in many industries. Among these systems, Vibro-acoustography (VA) has shown excellent capabilities as a non-contact method for non-destructive high-resolution imaging applications. This method consists of mixing two confocal ultrasound beams, slightly shifted in frequency, to produce an acoustic emission field at the difference frequency of the primary incident ultrasound beams. In addition to the difference frequency signal, there exists another signal at the sum frequency, formed in the intersection region of the two primary beams. The goal of this study is to investigate the formation of high-resolution images using the sum frequency of ultrasound waves in VA while concurrently forming the conventional difference-frequency VA image, thereby increasing the amount of information acquired during a single scan. A theoretical model describing the sum frequency wave propagation, including beam forming and image formation in the confocal configuration is developed and verified experimentally. Moreover, sample experiments are performed on a flawed fiber-reinforced ceramic composite plate. Images at both the difference and sum frequencies are compared and discussed. Results show that the sum frequency image produces a high-resolution C-scan of the plate by which the flaws and structural details of the plate can be detected.