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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (10 May 2020) | Viewed by 33783

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Dr. Juan Melchor

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1. Department of Statistics and Operations Research, University of Granada, 18071 Granada, Spain
2. Excellence Research Unit “ModelingNature” (MNat), University of Granada, 18071 Granada, Spain
3. Instituto de Investigación Biosanitaria, ibs.GRANADA, 18012 Granada, Spain
Interests: biostatistics; computational mathematics; mathematical modelling; mechanical engineering; public health; statistics; applied mathematics; mathematical statistics; cancer; epidemiology; finite element method; computational; simulation; wave propagation; numerics; surveillance; finite difference; acoustics; waves; transducers; ultrasonics; piezoelectricity; finite-difference schemes; scientific computation; numerical integration; tissue mechanics; elastography; biomechanics; biomathematicas; biomedical engineering; mechanical properties; fluid mechanics; modeling and simulation; computational fluid dynamics; numerical simulation; numerical modeling; numerical analysis; engineering; inverse problem
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Dr. Guillermo Rus

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Department of Structural Mechanics, University of Granada, 18071 Granada, Spain
Interests: mechanical properties; fluid mechanics; modeling and simulation; computational fluid dynamics; numerical simulation; numerical modeling; numerical analysis; engineering; applied and computational mathematics; mathematical modelling; mechanical engineering; public health; statistics; applied mathematics; composites; mathematical statistics; cancer; epidemiology; finite element method; computational; simulation; wave propagation; numerics; computational mathematics; surveillance; finite difference; acoustics; waves, transducers; ultrasonics; piezoelectricity; finite-difference schemes; scientific computation; numerical integration; tissue mechanics; elastography; biomechanics; biomathematicas; biomedical engineering

Dr. Antonio Gomez

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Guest Editor

UCL Mechanical Engineering, University College London, London, UK
Interests: acoustics; ultrasonics; elastography; medical imaging; prostate cancer; numerical modelling; inverse problem; wave propagation; transducers; nanotechnology; microfabrication; structural mechanics; fluid dynamics; biomechanics; biomedical engineering

Special Issue Information

Dear Colleagues,

The structural architecture of tissue has recently been receiving a great deal of great attention among the biomechanics and clinical community, as the elastic changes of tissue, which are associated with a broad spectrum of pathologies, promise a new class of diagnostic mechanical biomarkers that extend beyond linear stiffness to viscosity and nonlinear elastic parameters. The theory of ultrasonics physics and its relationship with elastography carries modeling approaches involving bulk and biomechanical properties of the medium, sources, responses, and ultrasonic scattered fields.

The recent and future developments in elastography techniques are allowing for the in vivo and noninvasive quantification of biomechancial markers. They are derived from ultrasound signal processing, which are direct measures and are intimately related to the pathological changes of the structural microarchitecture of tissue.

This Special Issue is focused on new trends of both compressional and shear waves in elastography, beyond the current standard of stiffness maps, from experimental assessment, which constitutes a set of biomarkers, to histology and biochemistry, which, combined with preliminary clinical evidence, suggest a powerful diagnostic potential, with a range of highly prevalent pathologies, from birth and labor disorders (prematurity, induction failures, etc.), solid tumors (e.g., prostate, cervix, breast, and melanoma) or liver fibrosis, just to name a few. Rheological models and hyperelasticity or viscoelasticity theoretical considerations are also taken into account in this Issue, especially when the wave propagation reconstructs the biomechanical parameters considered. The potential of shear wave elastography using correlation, acoustic radiation force impulse, single tracking location, anisotropic shear wave elastography, and ultrafast imaging for clinical applications are key for new research lines.

Dr. Juan Melchor
Dr. Guillermo Rus
Dr. Antonio Gomez
Guest Editors

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Keywords

Elastography
Ultrasonics
Nonlinearity
Viscoelasticity
Hyperelasticity
Imaging techniques in elastography
SMURF
STL-SWEI
Anisotropic shear wave elastography
Time reversal
ARFI
HIFU
Straing imaging
Ultrafast imaging
Shear waves
Inverse problem
Biomechanics
Compressional waves
Ultrasonic diagnosis
Elasticity maps
Clinical echography and elastography
Acoustoelasticity
Volumetric ultrasound data

Related Special Issue

Elastography 2.0 in Diagnostics (9 articles)

Published Papers (10 papers)

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Research

14 pages, 968 KiB

Open AccessArticle

Ultrasonic Assessment of the Medial Temporal Lobe Tissue Displacements in Alzheimer’s Disease

by Mindaugas Baranauskas, Rytis Jurkonis, Arūnas Lukoševičius, Monika Makūnaitė, Vaidas Matijošaitis, Rymantė Gleiznienė and Daiva Rastenytė

Diagnostics 2020, 10(7), 452; https://doi.org/10.3390/diagnostics10070452 - 03 Jul 2020

Cited by 4 | Viewed by 2575

Abstract

We aim to estimate brain tissue displacements in the medial temporal lobe (MTL) using backscattered ultrasound radiofrequency (US RF) signals, and to assess the diagnostic ability of brain tissue displacement parameters for the differentiation of patients with Alzheimer’s disease (AD) from healthy controls (HC). Standard neuropsychological evaluation and transcranial sonography (TCS) for endogenous brain tissue motion data collection are performed for 20 patients with AD and for 20 age- and sex-matched HC in a prospective manner. Essential modifications of our previous method in US waveform parametrization, raising the confidence of micrometer-range displacement signals in the presence of noise, are done. Four logistic regression models are constructed, and receiver operating characteristic (ROC) curve analyses are applied. All models have cut-offs from 61.0 to 68.5% and separate AD patients from HC with a sensitivity of 89.5% and a specificity of 100%. The area under a ROC curve of predicted probability in all models is excellent (from 95.2 to 95.7%). According to our models, AD patients can be differentiated from HC by a sharper morphology of some individual MTL spatial point displacements (i.e., by spreading the spectrum of displacements to the high-end frequencies with higher variability across spatial points within a region), by lower displacement amplitude differences between adjacent spatial points (i.e., lower strain), and by a higher interaction of these attributes. Full article

(This article belongs to the Special Issue Elastography)

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9 pages, 2416 KiB

Open AccessArticle

Development of Stiffness Measurement Program Using Color Mapping in Shear Wave Elastography

by Haneul Lee, Kyuseok Kim and Youngjin Lee

Diagnostics 2020, 10(6), 362; https://doi.org/10.3390/diagnostics10060362 - 01 Jun 2020

Cited by 4 | Viewed by 3385

Abstract

Shear wave elastography with ultrasound is a noninvasive method used for measuring stiffness in the human body. Shear wave elastography can be used for accurately and quantitatively measuring stiffness. However, its disadvantage is that the stiffness value can vary significantly because the region of interest (ROI) setting depends on the diagnostic operator. In this study, a stiffness measurement program using color mapping in shear wave elastography was developed to address the above-mentioned disadvantage. Color map and color ratios were obtained and evaluated for major lower limb muscles (i.e., biceps femoris, medial gastrocnemius, rectus femoris, and tibialis anterior) at active voluntary contraction. According to the result, when the developed program was used, a small standard deviation compared to the conventional stiffness measurement method, such as kilopascal or meter per second unit using ROIs, was measured in all cases. In conclusion, our results demonstrate that the stiffness measurement method using our program is expected to improve reliability in shear wave elastography ultrasound imaging. Full article

(This article belongs to the Special Issue Elastography)

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9 pages, 733 KiB

Open AccessArticle

Two-Dimensional Shear Wave Elastography versus Transient Elastography: A Non-Invasive Comparison for the Assessment of Liver Fibrosis in Patients with Chronic Hepatitis C

by Rosanna Villani, Francesco Cavallone, Antonino Davide Romano, Francesco Bellanti and Gaetano Serviddio

Diagnostics 2020, 10(5), 313; https://doi.org/10.3390/diagnostics10050313 - 16 May 2020

Cited by 9 | Viewed by 3210

Abstract

In recent years, several non-invasive methods have been developed for staging liver fibrosis in patients with chronic hepatitis C. A 2D-Shear wave elastography (SWE) technique has been recently introduced on the EPIQ 7 US system (ElastQ), but its accuracy has not been validated in patients with chronic hepatitis C virus (HCV) infection. We enrolled 178 HCV patients to assess their liver fibrosis stage with ElastQ software using transient elastography as a reference standard. The best cut-off values to diagnose ≥ F2, ≥ F3, and F4 were 8.15, 10.31, and 12.65 KPa, respectively. Liver stiffness values had a positive correlation with transient elastography (r = 0.57; p < 0.001). The area under the receiver operating characteristics (AUROC) was 0.899 for ≥ F2 (moderate fibrosis), 0.900 for ≥ F3 (severe fibrosis), and 0.899 for cirrhosis. 2D-SWE has excellent accuracy in assessing liver fibrosis in patients with chronic hepatitis C and an excellent correlation with transient elastography. Full article

(This article belongs to the Special Issue Elastography)

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16 pages, 4706 KiB

Open AccessArticle

TI-RADS Diagnostic Performance: Which Algorithm Is Superior and How Elastography and 4D Vascularity Improve the Malignancy Risk Assessment

by Andreea Borlea, Florin Borcan, Ioan Sporea, Cristina Adriana Dehelean, Romeo Negrea, Laura Cotoi and Dana Stoian

Diagnostics 2020, 10(4), 180; https://doi.org/10.3390/diagnostics10040180 - 26 Mar 2020

Cited by 15 | Viewed by 3538

Abstract

Given the increased prevalence of thyroid nodules in the general population (~50%), the real challenge resides in correctly recognizing the suspicious ones. This study proposes to compare four important Thyroid Imaging and Reporting Data Systems (TI-RADS) and evaluate the contribution of elastography and 4D Color Doppler assessment of vascularity in estimating the risk of malignancy. In the study, 133 nodules with histopathological examination were included. Of these, 35 (26.31%) proved to be malignant. All nodules were classified using the four selected systems and our proposed improved score. The American College of Radiology (ACR) and EU TI-RADS had good sensitivity (94.28%, 97.14%) and NPV (93.33%, 95.83%), but fairly poor specificity (31.81%, 23.46%) and PPV (35.48%, 31.19%), with an accuracy of 42.8% and 45.8%, respectively. Horvath TI-RADS had better accuracy of 66.9% and somewhat improved specificity (62.24%), but poorer sensitivity (80%). Russ’ French TI-RADS includes elastography in the risk assessment strategy. This classification proved superior in all aspects (Se: 91.42%, Sp:82.65%, NPV:96.42%, PPV:65.30%, and Acc of 84.96%). The mean strain ratio (SR) value for malignant lesions was 5.56, while the mean SR value for benign ones was significantly lower, 2.54 (p < 0.05). It also correlated well with the response variable: histopathological result (p < 0.001). Although, adding 4D vascularity to the French score generated a similar calculated accuracy and from a statistical point of view, the parameter itself proved beneficial for predicting the malignancy risk (p < 0.001) and may add important knowledge in uncertain situations. Advanced ultrasound techniques definitely improved the risk estimation and should be used more extensively. Full article

(This article belongs to the Special Issue Elastography)

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11 pages, 2709 KiB

Open AccessArticle

Can Strain Elastography Predict Malignancy of Soft Tissue Tumors in a Tertiary Sarcoma Center?

by Jonathan Cohen, Iben Riishede, Jonathan Frederik Carlsen, Trine-Lise Lambine, Mikkel Seidelin Dam, Michael Mørk Petersen, Michael Bachmann Nielsen and Caroline Ewertsen

Diagnostics 2020, 10(3), 148; https://doi.org/10.3390/diagnostics10030148 - 07 Mar 2020

Cited by 8 | Viewed by 3159

Abstract

This study aims to investigate the ability of ultrasound strain elastography as an adjunct to predict malignancy in soft tissue tumors suspect of sarcoma or metastasis in a tertiary reference center for sarcoma. A total of 137 patients were included prospectively. Patients were referred on the basis of clinical or radiological suspicion of malignant soft tissue tumor. All patients had previously undergone diagnostic imaging (MRI, CT or PET-CT). After recording strain elastography cine loops, ultrasound guided biopsy was performed. Three investigators, who were blinded to final diagnosis, reviewed all elastograms retrospectively. For each elastogram, a qualitative, visual 5-point score was decided in consensus and a strain ratio was calculated. Final pathology obtained from biopsy or tumor resection served as gold standard. Eighty-one tumors were benign, and 56 were malignant. t-tests showed a significant difference in mean visual score between benign and malignant tumors. There was no significant difference in mean strain ratio between the two groups. Strain elastography may be a valuable adjunct to conventional B-mode ultrasound, perhaps primarily in primary care, when considering whether to refer to a sarcoma center or to biopsy, although biopsies cannot reliably be ruled out based on the current data. Full article

(This article belongs to the Special Issue Elastography)

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18 pages, 16179 KiB

Open AccessArticle

Viscoelastic Biomarkers of Ex Vivo Liver Samples via Torsional Wave Elastography

by Inas H. Faris, Juan Melchor, Antonio Callejas, Jorge Torres and Guillermo Rus

Diagnostics 2020, 10(2), 111; https://doi.org/10.3390/diagnostics10020111 - 19 Feb 2020

Cited by 9 | Viewed by 3302

Abstract

The clinical ultrasound community demands mechanisms to obtain the viscoelastic biomarkers of soft tissue in order to quantify the tissue condition and to be able to track its consistency. Torsional Wave Elastography (TWE) is an emerging technique proposed for interrogating soft tissue mechanical viscoelastic constants. Torsional waves are a particular configuration of shear waves, which propagate asymmetrically in-depth and are radially transmitted by a disc and received by a ring. This configuration is shown to be particularly efficient in minimizing spurious p-waves components and is sensitive to mechanical constants, especially in cylinder-shaped organs. The objective of this work was to validate (TWE) technique against Shear Wave Elasticity Imaging (SWEI) technique through the determination of shear wave velocity, shear moduli, and viscosity of ex vivo chicken liver samples and tissue mimicking hydrogel phantoms. The results of shear moduli for ex vivo liver tissue vary 1.69–4.0kPa using TWE technique and 1.32–4.48kPa using SWEI technique for a range of frequencies from 200 to 800Hz. Kelvin–Voigt viscoelastic parameters reported values of

μ

= 1.51kPa and

η

= 0.54Pa·s using TWE and

μ

= 1.02kPa and

η

= 0.63Pa·s using SWEI. Preliminary results show that the proposed technique successfully allows reconstructing shear wave velocity, shear moduli, and viscosity mechanical biomarkers from the propagated torsional wave, establishing a proof of principle and warranting further studies. Full article

(This article belongs to the Special Issue Elastography)

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16 pages, 4940 KiB

Open AccessArticle

Quantification of Endogenous Brain Tissue Displacement Imaging by Radiofrequency Ultrasound

by Rytis Jurkonis, Monika Makūnaitė, Mindaugas Baranauskas, Arūnas Lukoševičius, Andrius Sakalauskas, Vaidas Matijošaitis and Daiva Rastenytė

Diagnostics 2020, 10(2), 57; https://doi.org/10.3390/diagnostics10020057 - 21 Jan 2020

Cited by 8 | Viewed by 3351

Abstract

The purpose of this paper is a quantification of displacement parameters used in the imaging of brain tissue endogenous motion using ultrasonic radiofrequency (RF) signals. In a preclinical study, an ultrasonic diagnostic system with RF output was equipped with dedicated signal processing software and subject head–ultrasonic transducer stabilization. This allowed the use of RF scanning frames for the calculation of micrometer-range displacements, excluding sonographer-induced motions. Analysis of quantitative displacement estimates in dynamical phantom experiments showed that displacements of 55 µm down to 2 µm were quantified as confident according to Pearson correlation between signal fragments (minimum p ≤ 0.001). The same algorithm and scanning hardware were used in experiments and clinical imaging which allows translating phantom results to Alzheimer’s disease patients and healthy elderly subjects as examples. The confident quantitative displacement waveforms of six in vivo heart-cycle episodes ranged from 8 µm up to 263 µm (Pearson correlation p ≤ 0.01). Displacement time sequences showed promising possibilities to evaluate the morphology of endogenous displacement signals at each point of the scanning plane, while displacement maps—regional distribution of displacement parameters—were essential for tissue characterization. Full article

(This article belongs to the Special Issue Elastography)

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17 pages, 2017 KiB

Open AccessArticle

Shear-Wave Elastography Variability Analysis and Relation with Kidney Allograft Dysfunction: A Single-Center Study

by Sorana D. Bolboacă, Florin Ioan Elec, Alina Daciana Elec, Adriana Milena Muntean, Mihai Adrian Socaciu, Gheorghita Iacob, Răzvan Zaro, Alexandra-Ioana Andrieș, Ramona Maria Bădulescu, Radu Mihai Ignat, Mihaela Iancu and Radu Ion Badea

Diagnostics 2020, 10(1), 41; https://doi.org/10.3390/diagnostics10010041 - 13 Jan 2020

Cited by 19 | Viewed by 3654

Abstract

Shear-wave elastography (SWE) showed the absence or presence of significant differences among stable kidney allograft function and allograft dysfunction. We evaluated the variability of kidney allograft stiffness in relation to allograft dysfunction, respectively, in terms of a correlation of stiffness with patients’ characteristics. A single-center prospective study on patients who had undergone renal transplantation was conducted between October 2017 and November 2018. Patients were clinically classified as having a stable allograft function or allograft dysfunction. SWE examinations performed by the same radiologist with a LOGIQ E9 were evaluated. Ten measurements were done for Young’s modulus (kPa) at the level of allograft cortex and another ten at the level of medulla. Eighty-three SWE examinations from 63 patients, 69 stable allografts, and 14 allografts with dysfunction were included in the analysis. The intra-examinations stiffness showed high variability, with the quantile covariation coefficient ranging from 2.21% to 45.04%. The inter-examinations stiffness showed heterogeneity (from 28.66% to 42.38%). The kidney allograft cortex stiffness showed significantly higher values in cases with dysfunction (median = 28.70 kPa, interquartile range (IQR) = (25.68–31.98) kPa) as compared to those with stable function (median = 20.99 kPa, interquartile range = (16.08–27.68) kPa; p-value = 0.0142). Allograft tissue stiffness (both cortex and medulla) was significantly negatively correlated with body mass index (−0.44, p-value < 0.0001 for allograft cortex and −0.42, p-value = 0.0001 for allograft medulla), and positively correlated with Proteinuria/Creatinuria ratio (0.33, p-value = 0.0021 for allograft cortex and 0.28, p-value = 0.0105 for allograft medulla) but remained statistically significant only in cases with stable function. The cortical tissue stiffness proved significantly higher values for patients with allograft dysfunction as compared to patients with stable function, but to evolve as an additional tool for the evaluation of patients with a kidney transplant and to change the clinical practice, more extensive studies are needed. Full article

(This article belongs to the Special Issue Elastography)

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16 pages, 5078 KiB

Open AccessArticle

Shear Wave Elastography in Diagnosing Secondary Hyperparathyroidism

by Laura Cotoi, Florin Borcan, Ioan Sporea, Dana Amzar, Oana Schiller, Adalbert Schiller, Cristina Adriana Dehelean, Gheorghe Nicusor Pop and Dana Stoian

Diagnostics 2019, 9(4), 213; https://doi.org/10.3390/diagnostics9040213 - 05 Dec 2019

Cited by 8 | Viewed by 3656

Abstract

This study evaluates the diagnostic value of two-dimensional shear wave elastography (2 D-SWE) technique in the evaluation of hyperplastic parathyroid glands in cases with secondary and tertiary hyperparathyroidism. A total of 59 patients (end-stage renal disease, under supplemental dialysis program) with visible parathyroid hyperplastic glands on ultrasound, confirmed by biochemical assay and scintigraphy, were enrolled; they were examined on grayscale ultrasound and 2 D shear wave elastography. We determined the elasticity index (EI) in the parathyroid gland, thyroid parenchyma and surrounding muscles, and the elasticity ratio of hyperplastic parathyroid glands compared to muscle, specifically sternocleidomastoid muscle. Patients presented fibrocystic bone disease with secondary hyperparathyroidism induced by end-stage chronic kidney disease; being on prolonged chronic dialysis therapy, they had positive sestamibi scintigraphy and high values of serum parathormone (1141.04 pg/mL). Nodules placed posterior to the thyroid capsule that were cystic, had a hypoechoic aspect, and were homogenous with an independent afferent artery were found. Mean EI in the parathyroid gland was 7.83 kPa, the median value in thyroid parenchyma was 13.76 kPa, and mean muscle EI value was 15.78 kPa. The observed mean parathyroid/muscle SWE ratio was 0.5356 and the value for parathyroid/normal thyroid parenchyma was 0.5995. Using receiver operating characteristic (ROC) analysis, we found that EI below 9.74 kPa correctly identifies parathyroid tissue, with a sensitivity of 94.8%, specificity of 90.7%, and accuracy of 92.26% when compared to normal thyroid tissue. Compared with the muscle tissue, we identified that EI below 9.98 kPa has a sensitivity, specificity, and accuracy of 93.8%, 90.7%, and 91.75%, respectively. Ultrasound elastography is a helpful tool in identifying parathyroid hyperplasia in patients with chronic kidney disease. A cutoff value of 9.98 kPa can be used in 2 D-SWE for accurate diagnosis of parathyroid disease. Full article

(This article belongs to the Special Issue Elastography)

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11 pages, 1224 KiB

Open AccessArticle

Strain Elastography as a Valuable Diagnosis Tool in Intermediate Cytology (Bethesda III) Thyroid Nodules

by Dana Stoian, Florin Borcan, Izabella Petre, Ioana Mozos, Flore Varcus, Viviana Ivan, Andreea Cioca, Adrian Apostol and Cristina Adriana Dehelean

Diagnostics 2019, 9(3), 119; https://doi.org/10.3390/diagnostics9030119 - 13 Sep 2019

Cited by 16 | Viewed by 3175

Abstract

Fine needle aspiration (FNA) is considered the gold standard in the diagnostic of thyroid nodules. Using the recommended BETHESDA reporting system, up to 20% of results are classified as intermediate cytology. As there is no consensus whether ultrasound evaluation, lobectomy or surgery is the best treatment option, intermediate cytology results are considered a grey zone of the FNA. The main aim of our study was to evaluate the performance of combined advanced ultrasound techniques in the process of diagnosis and evaluation of the intermediate cytology cases after FNA. We evaluated 54 consecutive cases with intermediate cytology on FNA, using conventional B-mode ultrasound (2B), and strain elastography, using a linear multifrequency 6–13 MHz linear probe (Hitachi Prerius Machine, Hitachi Inc, Japan). All nodules were classified with our Thyroid Imaging Report and Data System (TI-RADS) proposed model, considering: vertical appearance, with antero-posterior diameter bigger than the transvers diameter, the so called taller than wide shape, irregular borders, intranodular inhomogeneity, marked hypoecogenicity, micro calcifications, the presence of suspect lymph nodes, and increased stiffness as suspicious for malignancy. The classification outcomes were compared with the pathology results, considered the gold standard diagnosis. The prevalence of cancer was 28.8%, with 13/45 cases having a clear diagnostic of cancer. Six cases were diagnosed with borderline follicular neoplasia, a category with unclear evolution, also considered as malignant in the analysis of the imaging results. In total, 16/19 cancer cases had increased stiffness on elastography. The cancer prevalence increased with TI-RADS category, being 25% in TI-RADS 4b category and 92.8% in TI-RADS 5 category. The AUROC (Area Under Receiver Operating Curve) of elastography alone, in differentiation of malignant thyroid nodules was 74.9%; the combination of elastographic and conventional ultrasound characteristics generated an even better AUROC, of 84.5%. The combined conventional ultrasound and elastography identified thyroid cancer in cases with intermediate cytology with a sensitivity of 89.5% with a specificity of 50%. High risk thyroid nodules, identified by combined high risk conventional ultrasound characteristics and increased stiffness, on strain elastography, are highly predictive for malignancy, in the intermediate cytology cases. Full article

(This article belongs to the Special Issue Elastography)

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