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Shear Wave Elastography
Using Ultrasound
Mickael Tanter, PhD
Institute Langevin
Ecole Supérieure de Physique et Chimie Industrielles (ESPCI)
Paris, France
Disclosure: M. Tanter is co-founder and shareholder of Supersonic Imagine company
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Fibrotic
lesion
Carcinoma
Grade II
Viscous Cyst
A limitation of Ultrasound Imaging
Benin Benin Malignant
Example of Breast Cancer Diagnosis
Tanter M, Bercoff J, Athanasiou A, et al. Ultrasound in Medicine and Biology, 34(9), 1373-1386 ,Sep. 2008
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2 autres coefficients mécaniques sont très utilisés pour définir l’élasticité d’un solide
K module de compression volumique pratiquement constant, de l’ordre 109 Pa, quasi incompressible
µ module de cisaillement, très hétérogène, dépend beaucoup de la pathologie, entre 10 2 et 10 7 Pa
K >> m
K
m
E 3 µ
E = s
e e
s
Un module : le module d’Young E E
Palpation et Elasticité
µ
µ
-
- =
K
K m
4 3
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Ondes mécaniques et élasticité
Les ondes de compression se propagent à
Les ondes de cisaillement à
m=sc
KcP ( 1500 m.s-1)
( 1-10 m.s-1)
Deux types d’ondes qui se propagent à des vitesses complètement
différentes !!
Les ultrasons se propagent uniquement sous la forme d’ondes de compression
Les ondes de cisaillement ne se propagent qu’aux basses fréquences < 500 Hz
Heart
Le vent
ultrasonore
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D
F
Conventional Imaging Ultrafast Imaging
RAM
Parallel Processing Processing
128 to 512 transmits for a full image
(typically 10 to 50 ms)
1 single transmit for a full image
(typically 100 to 500 µs)
The key concept of ultrafast Imaging is plane wave transmission
M. Tanter, J. Bercoff, L. Sandrin, M. Fink. IEEE Transactions on Ultrasonics, 49 (10), pp 1363-1374, 2002
L. Sandrin, S. Catheline, M. Tanter, X. Hennequin, M. Fink, Ultrasonic Imaging 21(4), 259—272, 1999
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First Ultrafast scanner built in 1998
(128 Channels)
The first Ultrafast Ultrasound Scanner at Institute Langevin
The great thing in 1998 :
• 128 fully independent electronic channels
• Analog Log/lin Amplifiers
• 9 Bits A/D converters • 256 MBytes Embedded memory
• up to 10000 frames/s Acquisition
• Acq of 100 ms Ultrafast imaging sequences
The bad thing in 1998 … :
• 40 minutes of processing
(Data transfer + beamforming process)
L. Sandrin, M. Tanter, S. Catheline, M. Fink. IEEE Transactions on Ultrasonics, 49 (4), pp 426-435, 2002
L. Sandrin, S. Catheline, M. Tanter, X. Hennequin, M. Fink, Ultrasonic Imaging 21(4), 259—272, 1999
M. Tanter, J. Bercoff, L. Sandrin, M. Fink. IEEE Transactions on Ultrasonics, 49 (10), pp 1363-1374, 2002
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~ 100 µs
Step 1
Shear wave generation by remote palpation
Plane wave insonification at
some kHz
Texp=20 ms ~ 0.3 ms
Step 2
Ultrafast imaging
A kind of Human Body Sismology
J. Bercoff, M. Tanter, M. Fink.
IEEE Transactions on Ultrasonics, Ferroelectrics And Frequency Control., Vol 51(4), pp 396-409, April 2004.
Combining Ultrafast Imaging and Acoustic Radiation Force palpation
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Ultrafast imaging of the shear wave propagation
10000 frames/second in a US Phantom
Frame to frame correlation
M. Fink, M. Tanter, “Multiwave Imaging and Superresolution”
Physics Today, 63(2), 28-33, Feb. 2010
J. Bercoff, M. Tanter, M. Fink.
IEEE Transactions on Ultrasonics, Ferroelectrics And Frequency Control ., Vol 51(4), pp 396-409, April 2004.
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J. Bercoff, M. Tanter, M. Fink
Applied Physics Letters, 84(12), pp 2202-2204, March 2004
6 m/s
2 m/s
Transducer
A complete experiment in less time than a conventional US image
Conventional US time
0 s 1 s
Transducer
A 30 ms Experiment !!
Ultrafast US
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The local Shear Wave speeed gives access to mechanical properties
m/s or kPa
• Freehand / does not change anything to the echographic exam
• Quantitative
• The palpation is Operator independent = reproducible
• Ultrafast / Insensitive to motion artefacts and boundary conditions.
Tanter M, Bercoff J, Athanasiou A, et al. Ultrasound in Medicine and Biology, 34(9), 1373-1386 ,Sep. 2008
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True assessment of tissue stiffness
Hard lesion with a liquid center
Superresolution in Multiwave Imaging
Elasticity
contrast
Axial Res
(mm)
Lateral Res
(mm)
2 1 1.1
3 1.2 1.2
10 1.3 1.1
Lateral resolution
Axial resolution
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kPa
No artefacts
Smaller variance
Elasticity Quantification
Comparison between Shear Wave Elastography and Static Elastography
E = s/e
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True assessment of tissue stiffness
Hard lesion with a liquid center
Comparison between Shear Wave Elastography and Static Elastography
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First Clinical Evaluation (breast) on 25 patients in 2007
c (ms-1)
Tanter M, Bercoff J, Athanasiou A, et al. Ultrasound in Medicine and Biology, 34(9), 1373-1386 ,Sep. 2008
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SuperSonic Imagine
Startup funded by Mathias Fink, Mickael Tanter, Jacques Souquet and Claude Cohen-Bacrie end of 2005.
Aix en Provence
120 employees today
102 M€ fund Raising
More than 650 imaging systems sold worlwide since 2009
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From a research platform to a clinical product
Aixplorer ©,2008
1996-2002 2004-2005
(CE and FDA marked) M. Fink, M. Tanter, “Multiwave Imaging and Superresolution”
Physics Today, 63(2), 28-33, Feb. 2010
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A new paradigm for Ultrasound Imaging
1980 1990 1995 2010
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Echographic System with Real-time and Quantitative elastography
First SSI experiments : 2000-2002
45 Minutes processing
SSI Prototype 2006
some seconds processing
October 2007
0.2 seconds processing
Moore’s Law fastened by Video Game Industry
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Breast imaging examples
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Breast imaging examples
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Conclusion :
Adding SW elastographic features to BI-RADS feature analysis improved specificity of breast US mass assessment without loss of sensitivity.
Results :
By using visual color stiffness to selectively upgrade category 3 and lack of stiffness to downgrade category 4a masses, specificity
improved from 61.1% (397 of 650) to 78.5% (510 of 650) (P < .001); AUC increased to 0.962 (P = .005).
BE1 study : September 2008 – September 2010
Clinical proof : SWE multicentric study on 939 breast masses
Specificity Sensitivity PPV3 of 4a
biopsies
Maximum
Value +26% No loss +122%
Color-Coding +28% No loss +155%
1,800 patients over 17 sites worldwide (USA, France,
Italy, Germany, UK)
Conducted under the leadership of Professor David
Cosgrove (Imperial College of Medicine, London)
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Ultrafast Imaging gives key features
to Shear Wave Elastography :
Real time and quantitative imaging
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Monitoring of therapeutic treatments
= 2.04
cm
≈ 1.80 cm = 1.64 cm ≈ 0.1 cm
(Collaboration Alexandra Athanasiou & Anne Tardivon, Curie Institute, Paris, France)
June/2011 July/2011 August/2011 October/2011
coil
Preliminary investigations for the monitoring
of breast chemotherapy treatments
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Staging liver fibrosis using SWE
-
Bavu E., Gennisson J.-L., Couade, M. Bercoff j., Mallet V., Fink M. Vallet-Pichard A., Nalpas B., Tanter M., Pol S.
Non-invasive liver fibrosis staging using supersonic shear imaging: A clinical study on 113 HCV patients.,
Ultrasound in Medicine and Biology, 2011
Preliminary study on 113 HCV patients
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Shear Wave Elastography for Liver fibrosis Staging
F 3 versus F 4
Clinical Study on 118 patients with
Hepatitis C
Fibroscan®
S.W.E.
Bavu E., Gennisson J.-L., Couade, M. Bercoff j., Mallet V., Fink M. Vallet-
Pichard A., Nalpas B., Tanter M., Pol S. Non-invasive liver fibrosis staging
using supersonic shear imaging: A clinical study on 113 HCV patients.,
under review, 2010.
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2000 frames
per second
50
mm
36 mm
26 Years old healthy volunteer
In vivo Quantitative imaging of liver elasticity for Fibrosis Staging
Muscle
E = 120 +/- 14 kPa
Liver
E = 6.4 +/- 0.4 kPa
Muller M, Gennisson JL, Deffieux T, Tanter M. and Fink M.
Quantitative Viscoelasticity mapping of human liver using Supersonic Shear Imaging
ULTRASOUND IN MEDICINE AND BIOLOGY, 35 Issue: 2 Pages: 219-229 FEB 2009
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Shear Wave Spectroscopy using Shear Wave Dispersion
2.7 ms
-0.05
0
0.05
-0.05
-0.04
-0.03
-0.02
-0.01
0
0.01
0.02
0.03
0.04
0.05
4.6 ms
-0.05
0
0.05
-0.05
-0.04
-0.03
-0.02
-0.01
0
0.01
0.02
0.03
0.04
0.05
6.5 ms
-0.05
0
0.05
-0.05
-0.04
-0.03
-0.02
-0.01
0
0.01
0.02
0.03
0.04
0.05
Z
X
0 100 200 300 400 500 600 7000
1
2
3
4
5
6
Frequency (Hz)
She
ar W
ave
Spe
ed
Shear Wave Phase Speed (m.s-1)
Versus Frequency
0 100 200 300 400 500 600 7000
1
2
3
4
5
6
Frequency (Hz)
She
ar W
ave
Spe
ed
0 100 200 300 400 500 600 7000
1
2
3
4
5
6
Frequency (Hz)
She
ar W
ave
Spe
ed
Low Visc. Gel In vivo Liver
High Visc. Gel
Deffieux T, Montaldo G, Tanter M, and Fink M.
IEEE TRANSACTIONS ON MEDICAL IMAGING, 28(3), 313-322 MAR 2009
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Prostate – multiwave imaging
Suspicious lesion: much harder in SWE
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Prostate : Biopsy guidance ?
Courtesy Jean Michel Correas, Necker
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Carotid Plaque Stifness
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Dynamics of Muscle Contraction
Gastrocnemius
Contraction
Soleus
Contraction
Shinohara S., Sabra K., Genisson J.-L., Fink M., Tanter M.
"Real-time visualization of muscle stiffness distribution with ultrasound SWI during muscle contractions », Muscle and Nerve, June 2010
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Quantitative Monitoring of Uterin Contraction during Pregnancy
O. Ami, J-L. Gennisson, M. Tanter
Coll. CHU Antoine Beclere, Service Pr. Friedman
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Real Time Elasticity Changes of in vivo Cardiac Muscle (Sheep Model)
M. Couade, M. Pernot, P. Matteo, B. Crozatier, R. Fischmeister and M. Tanter
Ultr. Med. Biol., Oct. 2010
5000 fps
Pernot M, Matteo P., Couade M., Crozatier B., Fischmeister R., Tanter M.
Journal of the American College of Cardiology , 2011
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In vivo pig kidney during surgery
Seringe inserted the uretra
to control urinary pressure
Influence of Urinary Pressure : In Vivo pig experiments
0,00
20,00
40,00
60,00
80,00
100,00
120,00
140,00
160,00
180,00
10 20 30 40
E //
(kP
a)
Pressure (mmHg)
J.L Gennisson, N. Grenier, M. Tanter
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Occlusion of the renal vein Occlusion of the renal artery
Influence of the Bloodstream : In Vivo pig experiments
• Arterial ischemia/ infarction
- reduced interstitial pressure
• Renal vein thrombosis
- major increase in interstitial pressure
J.L Gennisson, N. Grenier, M. Tanter
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3D Ultrasonic Wobbler Probe
JL Gennisson, N. Felix, Bercoff J. IEEE Proc. Ultrasonics, Beijing 2008
In vivo 3D Breast Shear Wave Imaging
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MultiPlanar Display of BIRADS 5 lesion
3D Breast Imaging
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Monitoring of RF ablation using Supersonic Shear Wave Imaging
• RF ablation in the liver
(sheep), bipolar needle
electrode 4W, 1min
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The link between elasticity changes and the necrosis threshold
is independent of the temperature-time curve
Experimental results for different animals and temperature-time curves
N = 7 animals
Sapin-de Brosses E., Pernot M., Tanter M., ' The link between tissue elasticity and thermal dose in vivo', Physics in
Medicine and Biology, 2012
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Shear Wave Elastography During RF Ablation on Patients
Courtesy Pr. E. Leen, Hammersmith Hospital, London
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Small Animal
Shear Wave Elastography
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Liver Elasticity on a control Rat during one Month
220210
030310
150310
Stable Young’s Modulus :
E ~ 10 kPa
N. Grenier, J.-L. Gennisson, B. Larrat, M. Derieppe, M. Tanter
20 MHz probe (256 elements)
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E= 70 kPa
E= 21 kPa 20 MHz probe (256 elements)
SWE Imaging on a rat Liver fibrosis model during one Month
N. Grenier, J.-L. Gennisson, B. Larrat, M. Derieppe, M. Tanter
E= 35 kPa
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Elastography in mice
Elastograph
y
Elasticity
[kPa]
B-mode (acq. ┴ and ═)
Volume
[mm3]
HES
staining
Chalkley
Count
Masson’s
Trichrome
Histo-Pathological studies
% Cellularity
and % necrosis % Vascularity % Fibrosis
Coll. F. Chamming’s, H. Latorre-Ossa,J.-L. Gennisson, M-A Le Frère-Belda , L. Fournier,
C.A. Cuenod, O. Clément, HEGP, PARCC, Paris
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0
10
20
30
40
50
60
70
80
90
100
0 10 20 30 40 50 60 70 80 90
Me
dia
n t
um
or
ela
stic
ity
(kP
a)
Time (Days)
Tumour heterogeneity increases with size
Ø = 6.9 mm
E = 13.6 kPa
Ø = 7.8 mm
E = 21.1 kPa
Ø = 10.5 mm
E = 36.3 kPa
Ø = 14.1 mm
E = 56.9 kPa
Ø = 15.8 mm
E = 107.6 kPa
Elasticity increases with time
Coll. F. Chamming’s, H. Latorre-Ossa, J.-L. Gennisson, M-A Le Frère-Belda ,
L. Fournier, C.A. Cuenod, O. Clément, HEGP, PARCC, Paris
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Elastic Tensor Imaging :
An ultrasonic analog of
DTI imaging using MRI ?
W.-N. Lee et al, Elastic tensor imaging with ultrasound: comparison with MR Diffusion Tensor Imaging in the myocardium
Physics in Medicine and Biology, 2012
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Axial plane Radial plane
Quantitative Elasticity imaging of biceps muscle using SSI
Biceps Brachii
θ
: wave propagation direction
: fiber coordinates
x1
x2
x3
Deffieux, T.; Gennisson, J.-L.; Tanter, M. & Fink, M. (2008), Ieee Trans. On Ultr. Ferr.and Freq. Ctrl 55(10), 2177--2190.
Gennisson, J.-L.; Deffieux, T.; Mace, E.; Montaldo, G.; Fink, M. & Tanter, M. (2010), Ultrasound In Medicine and Biology 36(5), 789--801.
Shinohara, M.; Sabra, K.; Gennisson, J.-L.; Fink, M. & Tanter, M. (2010), Muscle & Nerve 42(3), 438--441.
-90 -45 0 45 902
2.5
3
3.5
4
4.5
5
v (
m/s
)
(degrees)
//v
v
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1009080706050403020100
7o
-32o-24o-15o
-37o
-1o
-42o
14o 21
o 42
o 49o 57
o 67o 72
o
1009080706050403020100
-6o
-41o
-13o
-49o
-34o
1o 14o 21
o 33
o 45o 60
o 63o
Fiber Tracking using
Elastic Tensor Imaging
Based on Ultrafast Ultrasound
Fiber Tracking using
Diffusion Tensor Imaging
Using MRI
Fiber tracking in the myocardium : ex vivo experiment
W.-N. Lee et al, Elastic tensor imaging with ultrasound: comparison with MR Diffusion Tensor Imaging in the myocardium
Physics in Medicine and Biology, 2012
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200 µm
3D
200 µm
3D
Elastic Tensor Imaging using Ultrasound
scan
u Polarization
k
Propagation
k
Propagation
u Polarization
Sagittal Coronal
E. Macé, G. Montaldo, I. Cohen, M. Fink, M.Tanter
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u k y u
k x
sag
sagcor
c
cc -=
Fractional anisotropy
index
Corpus callosum 80%
- 80%
0%
80%
- 80%
0%
80%
- 80%
0%
In vivo maps of the brain « shear anisotropy » using Ultrasound
5 mm
1
4
9
16
25 kPa
1
16
25
1
4
9
16
25 kPa
1
16
25
E. Macé, G. Montaldo, I. Cohen, Miles R., Fink M. ,Tanter M.
IEEE Trans. Medical Imaging, in proofs, 2011
Elastic Tensor Imaging using Ultrasound
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Conclusions
• ShearWave Elastography is a reliable quantitative modality
• Many applications under clinical evaluation
Breast, liver, kidney, thyroid, arteries, heart, brain, tendons …
• Shear Wave Elastography is also giving access to new information :
Elasticity anisotropy correlated with Diffusion Tensor Imaging in MRI
Systolic Elasticity correlated with contractility in cardiology
Elasticity changes correlated with the thermal dose and thermal changes
Elasticity changes correlated with pressure changes
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Concluding Remarks
Shear Wave Elastography Already in clinics
(breast, liver, thyroid, muscle,…) Real Time and Quantitative Imaging
Tissue
Motion
fUS imaging of brain Activity Great new imaging tool in Neuroscience
Portable fUS imaging on chronic and awake animals Transfontanellar and peroperative fUS
Neurovascular
coupling
Ultrafast Doppler Imaging Both Imaging and quantification
Cardiovascular applications Tumor vascularization imaging
Blood
Motion
Ultrafast Ultrasonic Imaging Reaching the physical limits of Ultrasound
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Ultrasound Technology Evolution
Multicore CPU
GPU
Real time imaging
Doppler imaging Compound Harmonic
Portable devices
Ultrafast Imaging
2010 2000 1990 1980 1970
DSP Low cost A/D
Innovation
Technology enabler
Broadband Transducers
Microprocessor Miniaturization
Ne pas imiter, Ne pas suivre
Innover très en amont, Prendre des risques scientifiques
De l’expérience de «coin de table» au succès clinique
Conclusion
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Science is only human interactions
Many Thanks to
M. Couade, Miguel Bernal, Patricia Daenens, Mathias Fink, Thomas Deffieux, Benoit Larrat, Wojiceck Kwieciscki, Bastien Arnal, Heldmuth Latorre, Emmanuel Bossy, Olivier Couture, Yan Desailly,
Arnaud Tourin, Philippe Annic, Youliana Younan, Christelle Jacquet, Jean-Luc Gennisson, Mathieu Pernot,
Charlie Demene, Clement Papadacci, Thu-Mai Nguyen, Jean-Francois Aubry, Weining Lee, ...
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2000 frames
per second
50
mm
36 mm
26 Years old healthy volunteer
In vivo Quantitative imaging of liver elasticity for Fibrosis Staging
Muscle
E = 120 +/- 14 kPa
Liver
E = 6.4 +/- 0.4 kPa
Muller M, Gennisson JL, Deffieux T, Tanter M. and Fink M.
Quantitative Viscoelasticity mapping of human liver using Supersonic Shear Imaging
ULTRASOUND IN MEDICINE AND BIOLOGY, 35 Issue: 2 Pages: 219-229 FEB 2009
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Shear Wave Spectroscopy using Shear Wave Dispersion
2.7 ms
-0.05
0
0.05
-0.05
-0.04
-0.03
-0.02
-0.01
0
0.01
0.02
0.03
0.04
0.05
4.6 ms
-0.05
0
0.05
-0.05
-0.04
-0.03
-0.02
-0.01
0
0.01
0.02
0.03
0.04
0.05
6.5 ms
-0.05
0
0.05
-0.05
-0.04
-0.03
-0.02
-0.01
0
0.01
0.02
0.03
0.04
0.05
Z
X
0 100 200 300 400 500 600 7000
1
2
3
4
5
6
Frequency (Hz)
She
ar W
ave
Spe
ed
Shear Wave Phase Speed (m.s-1)
Versus Frequency
0 100 200 300 400 500 600 7000
1
2
3
4
5
6
Frequency (Hz)
She
ar W
ave
Spe
ed
0 100 200 300 400 500 600 7000
1
2
3
4
5
6
Frequency (Hz)
She
ar W
ave
Spe
ed
Low Visc. Gel In vivo Liver
High Visc. Gel
Deffieux T, Montaldo G, Tanter M, and Fink M.
IEEE TRANSACTIONS ON MEDICAL IMAGING, 28(3), 313-322 MAR 2009
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Shear Wave Spectroscopy : a Broadband approach for Elasticity
Shear Wave Bandwidth
Static elastography
Dynamic elastography
SSI
50 150 250 350 450 550 0 650 Hz
Deffieux T, Montaldo G, Tanter M, and Fink M.
IEEE TRANSACTIONS ON MEDICAL IMAGING, 28(3), 313-322 MAR 2009
Fibroscan
1
0
2
0
3
0
5
1
0 1
5 2
0 2
5 3
0 3
5 4
0 4
5
(a
)
Agar gel
Viscous gel
Frequency in Hertz Lateral position in mm
100 200 300 400 500 600 0
2
4
6
8 b
Agar gel
Viscous inclusionl
Agar gel
Viscous inclusion P
hase v
elo
city in
m/s
Dep
th in
mm
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A new paradigm for Ultrasound Imaging
1980 1990 1995 2010
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Safety and Efficiency issues in Elastography
A Key difference between SSI and ARFI is ULTRAFAST IMAGING
SSI ARFI ARFI- SWS
« Flash » Imaging
+
Limited nb of « push »
Imaging only at push location
+
High number of pushes
Synthetic building
of «flash» sequence
+ repeated local «Push»
Real Time
Quantitative
No motion artefacts
Qualitative
Quantitative
Not Real Time
Potential motion Artefacts
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Ultrafast ultrasound gives access to real time SWE
A limited number of « push »
imaged by Ultrafast plane wave Imaging
It optimally satisfies the ALARA principle
« As low as Reasonably Achievable »
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The arterial stiffness varies with
blood pressure (diastole/systole)
- Carotid • 13 successive 20 ms experiment every 120 ms = 13 elasticity per
cardiac cycle
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The Urinary Tract Obstruction : In Vivo pig experiments
Outer Cortex Medulla Inner Cortex
E
(k
Pa
) E
// (k
Pa
)
In vivo Stiffness Estimates averaged on N=6 kidneys
2,3 kPa/mmHg 3,2 kPa/mmHg 1,3 kPa/mmHg
1,3 kPa/mmHg 1,4 kPa/mmHg 1,4 kPa/mmHg
J.L Gennisson, N. Grenier, M. Tanter
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Ultrafast imaging of the pulse wave
along the carotid • Frame rate : 3.000 frames/second
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1
time after R-wave (s)E
CG
late
ral p
ositio
n a
lon
g th
e a
rte
ria
l se
gm
en
t (m
m)
Wall motion (mm/s)
5
10
15
20
25-6
-4
-2
0
2
4
6
8
10
12
image n°
ligne n°
406080100120140
50
100
150
200
250
300
350PWV ~ 5 m/s (carotid) 0.08 0.1 0.12 0.14 0.16 0.18 0.2
0
1
2
3
4
5
6
time (s)
depth
(m
m)
INC
REF