The feasibility of using poroelastographic techniques for distinguishing between normal and lymphedematous tissues in vivo

Lymphedema is a common condition involving an abnormal accumulation of lymphatic fluid in the interstitial space that causes swelling, most often in the arm(s) and leg(s). Lymphedema is a significant lifelong concern that can be congenital or develop following cancer treatment or cancer metastasis. Common methods of evaluation of lymphedema are mostly qualitative making it difficult to reliably assess the severity of the disease, a key factor in choosing the appropriate treatment. In this paper, we investigate the feasibility of using novel elastographic techniques to differentiate between lymphedematous and normal tissues. This study represents the first step of a larger study aimed at investigating the combined use of elastographic and sonographic techniques for the detection and staging of lymphedema. In this preliminary study, poroelastographic images were generated from the leg (8) and arm (4) subcutis of five normal volunteers and seven volunteers having lymphedema, and the results were compared using statistical analyses. The preliminary results reported in this paper suggest that it may be feasible to perform poroelastography in different lymphedematous tissues in vivo and that poroelastography techniques may be of help in differentiating between normal and lymphedematous tissues.

[1]  J Ophir,et al.  Analysis of an Adaptive Strain Estimation Technique in Elastography , 2002, Ultrasonic imaging.

[2]  Jonathan Ophir,et al.  Assessing image quality in effective Poisson's ratio elastography and poroelastography: II , 2007, Physics in medicine and biology.

[3]  Jonathan Ophir,et al.  A method for generating permeability elastograms and Poisson's ratio time-constant elastograms. , 2005, Ultrasound in medicine & biology.

[4]  L. Gerber,et al.  A review of measures of lymphedema , 1998, Cancer.

[5]  Jonathan Ophir,et al.  Assessing image quality in effective Poisson's ratio elastography and poroelastography: I , 2007, Physics in medicine and biology.

[6]  T. Matsumura,et al.  Breast disease: clinical application of US elastography for diagnosis. , 2006, Radiology.

[7]  Jonathan Ophir,et al.  Performance Optimization in Elastography: Multicompression with Temporal Stretching , 1996 .

[8]  G. V. von Schulthess,et al.  Swollen lower extremity: role of MR imaging. , 1992, Radiology.

[9]  Robert A. Smith,et al.  Lymphedema: current issues in research and management. , 2000, CA: a cancer journal for clinicians.

[10]  Fiona Myint,et al.  Differential diagnosis, investigation, and current treatment of lower limb lymphedema. , 2003, Archives of surgery.

[11]  Jay C Buckey,et al.  Dual-frequency ultrasound for detecting and sizing bubbles. , 2005, Acta astronautica.

[12]  Jonathan Ophir,et al.  Visualization of bonding at an inclusion boundary using axial-shear strain elastography: a feasibility study , 2007, Physics in medicine and biology.

[13]  J Ophir,et al.  Elastographic Imaging Using Staggered Strain Estimates , 2002, Ultrasonic imaging.

[14]  C. S. Spalding,et al.  In vivo real-time freehand palpation imaging. , 2003, Ultrasound in medicine & biology.

[15]  Jonathan Ophir,et al.  The feasibility of estimating and imaging the mechanical behavior of poroelastic materials using axial strain elastography. , 2007, Physics in medicine and biology.

[16]  K. Winzer,et al.  Real‐time elastography — an advanced method of ultrasound: first results in 108 patients with breast lesions , 2006, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[17]  R. Righetti,et al.  Trade-offs between the axial resolution and the signal-to-noise ratio in elastography. , 2003 .

[18]  J. Petrek,et al.  Incidence of breast carcinoma‐related lymphedema , 1998, Cancer.

[19]  M. Zappa,et al.  Ultrasonography of extremity lymphedema. , 1992, Lymphology.

[20]  E. Unger,et al.  Advances in imaging of lymph flow disorders. , 2000, Radiographics : a review publication of the Radiological Society of North America, Inc.

[21]  L. Banks,et al.  The role of CT in the diagnosis of primary lymphedema of the lower limb. , 1985, AJR. American journal of roentgenology.

[22]  Jonathan Ophir,et al.  A New Method for Generating Poroelastograms in Noisy Environments , 2005, Ultrasonic imaging.

[23]  Jonathan Ophir,et al.  The feasibility of using elastography for imaging the Poisson's ratio in porous media. , 2004, Ultrasound in medicine & biology.

[24]  N. Bush,et al.  Dual‐Frequency Ultrasound Examination of Skin and Subcutis Thickness in Breast Cancer‐Related Lymphedema , 2004, The breast journal.

[25]  P A Narayana,et al.  The attenuation of ultrasound in biological fluids. , 1984, The Journal of the Acoustical Society of America.

[26]  M. Gniadecka Localization of dermal edema in lipodermatosclerosis, lymphedema, and cardiac insufficiency. High-frequency ultrasound examination of intradermal echogenicity. , 1996, Journal of the American Academy of Dermatology.

[27]  J Ophir,et al.  Elastographic image quality vs. tissue motion in vivo. , 2006, Ultrasound in medicine & biology.

[28]  J Ophir,et al.  Tradeoffs between the axial resolution and the signal-to-noise ratio in elastography , 2002, Proceedings of the Second Joint 24th Annual Conference and the Annual Fall Meeting of the Biomedical Engineering Society] [Engineering in Medicine and Biology.

[29]  K. Åström,et al.  MR imaging of primary, secondary, and mixed forms of lymphedema , 2001, Acta radiologica.

[30]  J. Ophir,et al.  Elastography: A Quantitative Method for Imaging the Elasticity of Biological Tissues , 1991, Ultrasonic imaging.

[31]  D. Wright Lymphology , 1980 .

[32]  J. Bendat,et al.  Random Data: Analysis and Measurement Procedures , 1971 .

[33]  Interstitial fluid pressure changes in pregnant rats. , 1983, Acta physiologica Hungarica.

[34]  T. Varghese,et al.  A theoretical framework for performance characterization of elastography: the strain filter , 1997, IEEE Transactions on Ultrasonics, Ferroelectrics and Frequency Control.

[35]  L. Clodius Textbook of Lymphology , 2005 .

[36]  B. Garra,et al.  Elastography of breast lesions: initial clinical results. , 1997, Radiology.

[37]  T. Krouskop,et al.  Poroelastography: imaging the poroelastic properties of tissues. , 2001, Ultrasound in medicine & biology.

[38]  S. Ödman,et al.  Noninvasive method for the assessment of subcutaneous oedema , 1986, Medical and Biological Engineering and Computing.