2-D arterial wall motion imaging using ultrafast ultrasound and transverse oscillations

Arterial stiffening is the most important cause of increasing systolic and pulse pressure, and for decreasing diastolic pressure beyond 40 years of age. Stiffening affects predominantly the aorta and proximal elastic arteries, and to a lesser degree the peripheral muscular arteries. While conceptually a Windkessel model is the simplest way to visualize the cushioning function of arteries, this is not useful clinically under changing conditions when effects of wave reflection become prominent. Many measures have been applied to quantify stiffness, but all are approximations only, on account of the nonhomogeneous structure of the arterial wall, its variability in different locations, at different levels of distending pressure, and with changes in smooth muscle tone. This article summarizes the methods and indices used to estimate arterial stiffness, and provides values from a survey of the literature, followed by recommendations of an international group of workers in the field who attended the First Consensus Conference on Arterial Stiffness, which was held in Paris during 2000, under the chairmanship of M.E. Safar and E.D. Frohlich.

The emergence of ultrafast frame rates in ultrasonic imaging has been recently made possible by the development of new imaging modalities such as transient elastography. Data acquisition rates reaching more than thousands of images per second enable the real-time visualization of shear mechanical waves propagating in biological tissues, which convey information about local viscoelastic properties of tissues. The first proposed approach for reaching such ultrafast frame rates consists of transmitting plane waves into the medium. However, because the beamforming process is then restricted to the receive mode, the echographic images obtained in the ultrafast mode suffer from a low quality in terms of resolution and contrast and affect the robustness of the transient elastography mode. It is here proposed to improve the beamforming process by using a coherent recombination of compounded plane-wave transmissions to recover high-quality echographic images without degrading the high frame rate capabilities. A theoretical model is derived for the comparison between the proposed method and the conventional B-mode imaging in terms of contrast, signal-to-noise ratio, and resolution. Our model predicts that a significantly smaller number of insonifications, 10 times lower, is sufficient to reach an image quality comparable to conventional B-mode. Theoretical predictions are confirmed by in vitro experiments performed in tissue-mimicking phantoms. Such results raise the appeal of coherent compounds for use with standard imaging modes such as B-mode or color flow. Moreover, in the context of transient elastography, ultrafast frame rates can be preserved while increasing the image quality compared with flat insonifications. Improvements on the transient elastography mode are presented and discussed.

The paper describes the use of synthetic aperture (SA) imaging in medical ultrasound. SA imaging is a radical break with today's commercial systems, where the image is acquired sequentially one image line at a time. This puts a strict limit on the frame rate and the possibility of acquiring a sufficient amount of data for high precision flow estimation. These constrictions can be lifted by employing SA imaging. Here data is acquired simultaneously from all directions over a number of emissions, and the full image can be reconstructed from this data. The paper demonstrates the many benefits of SA imaging. Due to the complete data set, it is possible to have both dynamic transmit and receive focusing to improve contrast and resolution. It is also possible to improve penetration depth by employing codes during ultrasound transmission. Data sets for vector flow imaging can be acquired using short imaging sequences, whereby both the correct velocity magnitude and angle can be estimated. A number of examples of both phantom and in vivo SA images will be presented measured by the experimental ultrasound scanner RASMUS to demonstrate the many benefits of SA imaging.