Table Of ContentTissue Elasticity
Imaging
Volume 2: Clinical Applications
Edited by
S. Kaisar Alam
Imagine Consulting LLC
Dayton, NJ, United States
The Center for Computational Biomedicine Imaging
and Modeling (CBIM)
Rutgers University
Piscataway, NJ, United States
Brian S. Garra
Division of Imaging, Diagnostics, and Software Reliability
Office of Science and Engineering Laboratories, Center for Devices
and Radiological Health, FDA, Silver Spring, MD, United States
Elsevier
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Contributors
M. Abd Ellah
Department ofRadiology,Medical University ofInnsbruck,Innsbruck,Tyrol,
Austria;DepartmentofDiagnosticRadiology,SouthEgyptCancerInstitute,Assiut
University,Assiut, Egypt;Radiology/Neuroradiology Department
Rehabilitationskliniken Ulm, Germany
RichardG. Barr
Radiology,Northeast Ohio Medical University,RadiologyConsultantsInc.,
Youngstown, OH, United States
Fanny L. Casado
Instituto de Ciencias O´micasy Biotecnologı´aAplicada, Pontificia Universidad
Cato´lica delPeru´, Lima, Peru´
BenjaminCastaneda
Laboratorio de Ima´genes Me´dicas, Pontificia Universidad Cato´licadelPeru´,
Lima, Peru
Manjiri Dighe
DepartmentofRadiology,Abdominalimagingsection,UniversityofWashington,
Seattle,WA, United States
Helen Feltovich
Maternal-Fetal Medicine,Intermountain Healthcare, Provo, UT, United States;
QuantitativeUltrasoundLaboratory,DepartmentofMedicalPhysics,Universityof
Wisconsin,Madison, WI, United States
BrianS. Garra
Division ofImaging,Diagnostics and SoftwareReliability,Office ofScience and
Engineering Laboratories,CDRH,FDA, Silver Spring,Maryland,MD, United
States
Eduardo Gonzalez
Laboratorio de Ima´genes Me´dicas, Pontificia Universidad Cato´licadelPeru´,
Lima, Peru;Department ofBiomedical Engineering, Johns Hopkins University,
Baltimore, MD, United State
Kullervo Hynynen
Physical Sciences Platform, Sunnybrook Research Institute;Department of
Medical Biophysics and InstituteofBiomaterials and Biomedical Engineering,
University ofToronto,Toronto, ON, Canada
A.S. Klauser
Department ofRadiology,Medical University ofInnsbruck,Innsbruck,Tyrol,
Austria
xi
xii Contributors
Elisa Konofagou
ColumbiaUniversity,New York, NY,United States
Roxana S¸irli
Department ofGastroenterologyandHepatology, Victor Babes¸ University of
Medicine and Pharmacy,Timis¸oara, Romania
Ioan Sporea
Department ofGastroenterologyandHepatology, Victor Babes¸ University of
Medicine and Pharmacy,Timis¸oara, Romania
M. Taljanovic
Department ofMedical Imaging,University ofArizona, College ofMedicine,
Banner- University Medical Center,Tucson, AZ, United States
About the editors
S. Kaisar Alam, Ph.D.
PresidentandChiefEngineer,ImagineConsultingLLC,Dayton,NJ,UnitedStates
Visiting Research Faculty, Center for Computational Biomedicine Imaging and
Modeling (CBIM),RutgersUniversity, Piscataway,NJ, United States
Adjunct Faculty, Electrical & Computer Engineering, The College of New Jersey
(TCNJ),Ewing,NJ, United States
Dr. S. Kaisar Alam received his B.Tech (Honors) from IIT, Kharagpur, India.
Following a 3-year stint as a Lecturer at RUET, Bangladesh, he came to the
University of Rochester, Rochester, New York, for graduate studies and received
hisM.S.andPh.D.degreesinelectricalengineeringin1991and1996,respectively.
After spending 3years (1995e1998) as a postdoctoral fellow at the University of
Texas Health Science Center, Houston, Dr. Alam was a Principal Investigator at
RiversideResearch,NewYork,from1998to2013,workingonavarietyofresearch
topics inbiomedical imaging. Hewas the Chief ResearchOfficer at Improlabs Pte
Ltd, an upcoming tech startup in Singapore until 2017. Then he founded his own
consultingcompanyforbiomedicalimageanalysis,signalprocessing,andmedical
imaging.Hehasalsobeeninvolvedintrainingandmentoringhighschoolstudents.
HehasbeenavisitingresearchprofessoratCBIM,RutgersUniversity,Piscataway,
NewJersey(since2013),avisitingprofessoratIUT,Gazipur,Bangladesh(2010and
2012), and an adjunct faculty at The College of New Jersey (TCNJ), Ewing, New
Jersey(since 2017).
Dr.Alamhasbeenactiveinresearchformorethan30years.Hisresearchinterests
includediagnosticandtherapeuticapplicationsofultrasoundandoptics,andsignal/
imageprocessingwithapplicationstomedicalimaging.Theareasofhismostactive
research include elasticity imaging and quantitativeultrasound; he is among a few
researchers with experience in both quasistatic and dynamic elasticity imaging.
Dr.Alamhaswrittenover40papersininternationaljournalsandholdsseveralpat-
ents.HeisacoauthorofthetextbookComputationalHealthInformatics(tobepub-
lished late 2019 or early 2020 by CRC Press). He is a Fellow of AIUM, a Senior
Member of IEEE, and a Member of Sigma Xi, AAPM, ASA, and SPIE. Dr. Alam
hasservedintheAIUMTechnicalStandardsCommitteeandtheUltrasoundCoor-
dinatingCommitteeoftheRSNAQuantitativeImagingBiomarkerAlliance(QIBA).
HeisanAssociateEditorofUltrasonics(Elsevier)andUltrasonicImaging(Sage).
Dr.AlamwasarecipientoftheprestigiousFulbrightScholarAwardin2011e2012.
xiii
xiv About the editors
Brian S. Garra, M.D.
Division of Imaging, Diagnostics, and Software Reliability, Office of Science and
EngineeringLaboratories,CenterforDevicesandRadiologicalHealth,FDA,Silver
Spring, MD, UnitedStates
Dr. Brian S. Garra completed his residency training at the University of Utah and
spent 3years as an Army radiologist in Germany before returning to Washington
DC and the National Institutes of Health in the mid 1980s. After 4years at the
NIH, he joined the faculty of Georgetown University as Director of Ultrasound.
In 1998, he left Georgetown to become Professor & Vice Chairman of Radiology
attheUniversityofVermont/FletcherAllenHealthcare.In2009,Dr.Garrareturned
totheWashingtonDCareaasChiefofImagingSystems&ResearchinRadiologyat
theWashingtonDCVeteransAffairsMedicalCenter.InApril2010,healsojoined
the FDA as an Associate Director in the Division of Imaging and Applied Mathe-
matics/OSEL. In 2018, he left the VA and currently splits his time between the
FDAand private practice radiologyin Florida.
Dr. Garra’s clinical activities include spinal MRI and general ultrasound. His
research interests include PACS, digital signal processing, and quantitative ultra-
sound including Doppler, ultrasound elastography, and photoacoustic tomography.
He was chair of the FDA radiological Devices Panel from 1999 to 2002 and has
beeninvolvedintheapprovalofseveralnewtechnologiesincludinghighresolution
breast ultrasound, the first digital mammographic system, the first computer-aided
detection system for mammography, and the first computer-aided nodule detection
system for chest radiographs as well as the ultrasound contrast agent albunex. He
alsoledtheteamthatdevelopedtheAIUMbreastultrasoundaccreditationprogram,
and helped develop the ARDMS registry in breast ultrasound. He is currently also
Vice Chairman of the Ultrasound Coordinating Committee of the RSNAQuantita-
tive Imaging Biomarker Alliance (QIBA) and is the Principal Author of the forth-
coming QIBA Ultrasound Shear Wave Speed Profile which will provide a
standard approach to acquisition of shear wave speed data for research, clinical
application,and regulatorytesting.
Foreword
Given the heavy relatively successful use of manual palpation over the past few
thousand years, the ultrasound community, and medicine in general, was very
excitedtounderstandandrealizethepossibilityofmeasuringandimagingthestiff-
nessoftissues.Thisincludedtissuestoodeepformanualpalpation.Improvingthe
spatialandquantitativefidelityofelasticityimageswasaddressedaggressively.Also
pursuedweremanyextensionsrelatedtoelasticproperties,suchastheanisotropyof
elasticity,thecomplexelasticmodulus(viscousandelasticcomponents),andelas-
ticityasa functionof time under compression.
This two-volume book Tissue Elasticity Imaging extensively covers the princi-
ples,implementation,andapplicationsofalltheseapproachestoimagethebiome-
chanical properties of tissues. The achieved and future biomedical applications of
these many capabilities are alsowell explained, as are important optical and mag-
neticresonanceimagingtechniquesthatfollowed,andthatsometimesleapedahead
of the manyultrasounddevelopments.
Theserapidadvancesarebroughttolifeforthereaderofthesebooksbyphysi-
ciansandotherimagingscientistsandengineerswhomadeleadingadvancesineach
of the covered areas. I initially wished to list key lead authors with a summary of
theircontributions,butthatwouldessentiallyberepeatingmostofthetableofcon-
tents.Theeditorsofthesebooks,Drs.BrianGarraandS.KaisarAlam,excelledin
recruiting the many luminaries to author the various chapters, defining the topics,
andeditingtheworkforreadabilitybythetargetaudienceofimagingscientists,en-
gineers, entrepreneurs, clinicians, and operators of the systems. The work should
serveasadefinitivereferenceforthoseteachingandthosewritingshorterexplana-
tionsforvariousgroups.Thisisamuch-neededworkinthefield.Luckily,itwillnot
be the last, as advances are and will continue tobemade.
PaulL. Carson,Ph.D.
Universityof Michigan
Ann Arbor, Michigan
United States
July 14, 2019
xv
Preface
Volume 2 of Tissue Elasticity Imaging reviews the state of clinical elastographic
applications as of late 2018. It begins with an introductory chapter that contains a
briefexplanationofelastographybasics,discussesattemptstostandardizequantita-
tiveelastographyforapplicationssuchasdetectionandimagingofliverfibrosis,and
discussessomeofthereasonswhyelastographyisnotusedmorewidely(atleastin
the United States) 20 years after the technique was first introduced. Potential ave-
nues for futurework in elastography are also discussed. The later chapters discuss
various specific applications and their potential for widespread clinical use from
the perspectiveofleaders in clinical elastographywho author those chapters.
Asclinicalelastographyinallofitsformsisprogressingrapidlyandevolvingas
new clinical applications are explored, some of the specifics in each chapter may
quickly become somewhat outdated. The reader can however use the authors of
thechaptersandthereferencesgivenineachchapterasresourcestoobtainguidance
onthelatestineachareaofclinicalelastography.Thereadermaycontactthechapter
andreference authors byemailorothermeansandmaysearch viagoogleorother
searchenginesonthetypeofelastographyandtheauthorname(s)toobtainnewin-
formationoneachclinicalelastographicapplicationandinformationonnewappli-
cations coming online.
Ihopethatcliniciansnewtoelastographywillfindthisvolumeusefulasawayto
getintroducedtotheuseofelastographyinyourareaofclinicalinterestandexper-
tise.Ifthebriefexplanationsofthebasicscienceandmethodsbywhichelastograms
arecreatedarenotsufficient,Isuggestthatthereaderrefertothemoredetaileddis-
cussions inVolume 1.
Forthosecliniciansalreadyusingelastography,Ihopeyouwillfindinthisvol-
umesometipsonhowtorefineyourelastographictechniquesandinsightintonew
waysto use elastography that you may not have already considered. Forbasicsci-
entistsinterestedinelastography,thisvolumewillintroducetoyouthewidevariety
ofclinicalapplicationsandproblemswithusingthecurrenttechnologyforthoseap-
plications.Itshouldhelpyoutoexplorewaysinwhichelastographytechnologycan
beimprovedtoprovideeasiertouseelastographicsystemsthatprovidehigherqual-
ity imaging and quantification for clinical use.
Ilookforwardtoparticipatewithyouallinhelpingelastographyrealizeitsvast
potential for improvingthe healthofpatients.Thefuturewill beexciting!
Brian S. Garra
May 31, 2019
xvii
xviii Preface
Chapter reviewers:
Volume 2: Clinicalapplications
Arrigo Fruscalzo
Caroline Malecke
David Cosgrove (nowdeceased)
Eleni E Drakonaki
Giovanna Ferraioli
Jonathan Langdon
Manjiri D.Dighe
MatthewUrban
MohammadMehrmohammadi
Ogonna K.Nwawka
Qian Li
Remi Souchon
Richard Barr
Richard Lopata
SiddharthaSikdar
