BACKGROUND: Ultrasound is receiving growing interest for improving the guidance of needle insertion in epidural anesthesia. Defining a paramedian ultrasound scanning technique would be helpful for correctly identifying the vertebral level. Finding surrogate measures of the depth of the epidural space may also improve the ease of scanning. METHODS: We examined 20 parturients with pre-epidural ultrasound in the paramedian plane, and the predicted depth was compared with the actual midline depth. The actual depth was also compared with subject biometrics, depth of transverse process, and thickness of lumbar fat. RESULTS: The scanning technique allowed the depth of the epidural space to be measured in all subjects. The depth measured in ultrasound was strongly correlated to the actual depth (R² = 0.8 and 95% limits of agreement of −14.8 to 5.2 mm), unlike patient biometrics (R² < 0.25), the depth of the neighboring transverse processes (R² = 0.35 and 95% limits of agreement of −13.8 to 19.1 mm), or the thickness of overlying fat (R² = 0.66). The duration of the ultrasound scan was 10 min at the beginning of the trial and 3 min for the last subjects. CONCLUSIONS: Paramedian ultrasound can be used to estimate the midline depth to the epidural space. The surrogate measures are not sufficiently correlated with the depth to the epidural space to recommend them as a replacement for the actual depth to the epidural space measurement.

As part of tissue elasticity imaging or elastography, an inverse problem needs to be solved to find the elasticity distribution from the measured displacements. The finite element method (FEM) is a common method for solving the inverse problem in dynamic elastography. This problem has been solved with both direct and iterative FEM schemes. Each of these methods has its own advantages and disadvantages which are examined in this paper. Choosing the data resolution and the excitation frequency are critical for achieving the best estimation of the tissue elasticity in FEM methods. In this paper we investigate the performance of both direct and iterative FEMs for different ranges of excitation frequency. A new form of iterative method is suggested here which requires a lower mesh density compared to the original form. Also two forms of the direct method are compared in this paper: one using the exact fit for derivatives calculation and the other using the least squares fit. We also perform a study on the spatial resolution of these methods using simulations. The comparison is also validated using a phantom experiment. The results suggest that the direct method with least squares fit is more robust to noise compared to other methods but has slightly lower resolution results. For example, for the homogenous region with 20 dB noise added to the data, the RMS error for the direct method with least squares fit is approximately half of the iterative method. It was observed that the ratio of voxel size to the wavelength should be within a specific range for the results to be reliable. For example for the direct method with least squares fit, for the case of 20 dB noise level, this ratio should be between 0.1 to 0.2. On balance, considering the much higher computational cost of the iterative method, the dependency of the iterative method on the initial guess, and the greater robustness of the direct method to noise, we suggest using the direct method with least squares fit for linear elasticity cases.

In shear wave absolute vibro-elastography (S-WAVE), a steady-state multi-frequency external mechanical excitation is applied to tissue, while a time-series of ultrasound radio-frequency (RF) data are acquired. Our objective is to determine the potential of S-WAVE to classify breast tissue lesions as malignant or benign. We present a new processing pipeline for feature-based classification of breast cancer using S-WAVE data, and we evaluate it on a new data set collected from 40 patients. Novel bi-spectral and Wigner spectrum features are computed directly from the RF time series and are combined with textural and spectral features from B-mode and elasticity images. The Random Forest permutation importance ranking and the Quadratic Mutual Information methods are used to reduce the number of features from 377 to 20. Support Vector Machines and Random Forest classifiers are used with leave-one-patient-out and Monte Carlo cross-validations. Classification results obtained for different feature sets are presented. Our best results (95% confidence interval, Area Under Curve = 95%±1.45%, sensitivity = 95%, and specificity = 93%) outperform the state-of-the-art reported S-WAVE breast cancer classification performance. The effect of feature selection and the sensitivity of the above classification results to changes in breast lesion contours is also studied. We demonstrate that time-series analysis of externally vibrated tissue as an elastography technique, even if the elasticity is not explicitly computed, has promise and should be pursued with larger patient datasets. Our study proposes novel directions in the field of elasticity imaging for tissue classification.

Magnetic resonance elastography (MRE) is commonly regarded as the imaging-based gold-standard for liver fibrosis staging, comparable to biopsy. While ultrasound-based elastography methods for liver fibrosis staging have been developed, they are confined to a 1D or a 2D region of interest and to a limited depth. 3D Shear Wave Absolute Vibro-Elastography (S-WAVE) is a steady-state, external excitation, volumetric elastography technique that is similar to MRE, but has the additional advantage of multi-frequency excitation. We present a novel ultrasound matrix array implementation of S-WAVE that takes advantage of 3D imaging. We use a matrix array transducer to sample axial multi-frequency steady-state tissue motion over a volume, using a Color Power Angiography sequence. Tissue motion with the frequency components {40,50,60} and {45,55,65} Hz are acquired over a (90° lateral)×(40° elevational)×(16 cm depth) sector with an acquisition time of 12 seconds. We compute the elasticity map in 3D using local spatial frequency estimation. We characterize this new approach in tissue phantoms against measurements obtained with transient elastography and MRE. Six healthy volunteers and eight patients with chronic liver disease were imaged. Their MRE and S-WAVE volumes were aligned using T1 to B-mode registration for direct comparison in common regions of interest. S-WAVE and MRE results are correlated with R2 = 0.92, while MRE and TE results are correlated with R2 = 0.71. Our findings show that S-WAVE with matrix array has the potential to deliver a similar assessment of liver fibrosis as MRE in a more accessible, inexpensive way, to a broader set of patients.

We consider the inverse problem of continuum mechanics with the tissue deformation described by a mixed displacement-pressure finite element formulation. The mixed formulation is used to model nearly incompressible materials by simultaneously solving for both elasticity and pressure distributions. To improve numerical conditioning, a common solution to this problem is to use regularization to constrain the solutions of the inverse problem. We present a sparsity regularization technique that uses the discrete cosine transform to transform the elasticity and pressure fields to a sparse domain in which a smaller number of unknowns is required to represent the original field. We evaluate the approach by solving the dynamic elastography problem for synthetic data using such a mixed finite element technique, assuming time harmonic motion, and linear, isotropic and elastic behavior for the tissue. We compare our simulation results to those obtained using the more common Tikhonov regularization. We show that the sparsity regularization is less dependent on boundary conditions, less influenced by noise, requires no parameter tuning and is computationally faster. The algorithm has been tested on magnetic resonance elastography data captured from a CIRS elastography phantom with similar results as the simulation.