Quantifying Cervical Softness with Elasticity Imaging

描述(由申请人提供)：本建议的目标是开发一种定量超声技术(声辐射力脉冲)，以非侵入性和客观地评估颈椎的僵硬/柔软。我们工作的一个主要好处是，仅开发一种测量宫颈硬度/柔软度的方法就可能产生重大影响；宫颈柔软度是产科诊所每天进行的一项关键但主观的测量。我们的目标是使用这样的工具来建立对宫颈微结构的全面了解，以及它在正常和异常妊娠过程中的变化。我们预计，对宫颈微结构变化的进一步了解将导致对妊娠中特定的重塑过程的有针对性的研究，这将促进对宫颈功能不全的理解。这反过来又可以指导探索新的治疗策略。 公共卫生相关性：这是一项在体外子宫切除标本中使用声辐射力脉冲(ARFI)工具开发定量超声技术的建议，以最终成像和客观量化体内妊娠宫颈软化。宫颈软化在整个正常妊娠期间都会发生，但当宫颈太软、太早(早产)或太硬太晚(晚产)时，可能会发生发病率。目前，我们只有对这一重要参数的主观评估。仅此一点，就使得宫颈软化的客观量化在临床上是有用的。更重要的是，颈椎软化与颈椎的微结构排列有关，从而与其强度有关。拟议的工作涉及(A)确定超声波对人类宫颈硬度/软度变化的敏感性，(B)在各向同性和各向异性的模体以及体外宫颈组织中测试ARFI，以确定过渡到活体宫颈扫描的参数，以及(C)通过二次谐波产生显微镜确认与我们的超声测量相关的宫颈微结构变化。除了提供临床有用参数的客观测量外，开发一种量化宫颈软化的工具也应该让人们深入了解宫颈的结构和功能，包括导致早产的功能障碍。

DESCRIPTION (provided by applicant): The objective of this proposal is to develop a quantitative ultrasound technique (acoustic radiation force impulse) to noninvasively and objectively assess cervical stiffness/softness. A key benefit of our work is that development of a method to measure cervical stiffness/softness alone could have significant impact; cervical softness is a critical, yet subjective, measure made daily in an obstetrics clinic. Our goal is to use such a tool to build a comprehensive understanding of cervical microstructure and how it changes throughout normal and abnormal pregnancy. We anticipate that an enhanced understanding of cervical microstructural changes will lead to targeted investigation of specific remodeling processes in pregnancy that will promote understanding of cervical insufficiency. This in turn could guide the exploration of novel therapeutic strategies. PUBLIC HEALTH RELEVANCE: This is a proposal to develop quantitative ultrasound technology using acoustic radiation force impulse (ARFI) tools in ex vivo hysterectomy specimens in order to ultimately image and objectively quantify in vivo cervical softening in pregnancy. Cervical softening occurs throughout normal pregnancy but morbidity may occur when the cervix is too soft too early (preterm delivery) or too firm too late (postterm delivery). Currently, we have only subjective assessment of this important parameter. That alone makes objective quantification of cervical softening clinically useful. Even more, cervical softening is related to cervical microstructural arrangement and thus strength. The proposed effort involves (a) determining the sensitivity of ultrasound to the changes in stiffness/softness of the human cervix, (b) testing ARFI in isotropic and anisotropic phantoms as well as ex vivo cervical tissue in order to establish parameters for transition to in vivo cervical scanning, and (c) confirming through second harmonic generation microscopy the cervical microstructural changes that are associated with our ultrasound measurements. Besides providing an objective measure of a clinically useful parameter, development of a tool to quantify cervical softening should also give insight into cervical structure and function, including the dysfunction that leads to preterm delivery.