Uterine In-vivo Strain Imaging Using Saline Infusion

描述(申请人提供)：这项研究的总体目标是开发使用超声应变成像或弹性成像对子宫肿块进行成像和识别弥漫性病理情况的技术。绝经后出血是常见的妇科问题，占就诊人次的近5%。虽然大多数病例是良性病因(子宫内膜萎缩或增生、息肉、肌瘤)，但大约10%到30%的妇女会被发现患有子宫内膜癌。癌症的特征之一是周围肿瘤组织相对僵硬。我们推测，弹性成像可以通过区分弥漫性僵硬子宫内膜组织(癌)、弥漫性子宫内膜软组织(增生)、局灶性僵硬肿块(平滑肌瘤)和局灶性软组织肿块(息肉)来有效地诊断绝经后出血。子宫肌瘤和子宫腺肌病的鉴别是僵硬变异可能提供诊断手段的另一个领域。子宫肌瘤和子宫腺肌病在传统的超声扫描上有相似的表现，这使得超声医生难以区分--如果不是不可能的话。然而，这种区分在临床上很重要，因为这两种疾病的治疗方法非常不同，临床医生现在必须使用更昂贵但更难获得的成像测试。我们的研究将开发超声应变成像来区分这两种情况。在本研究的R21阶段提出了三个具体目标。第一项研究是研究正常和异常子宫组织之间的硬度对比。杨氏模数的测量将在子宫切除术后获得的切除子宫样本上进行。其次，将使用拟人模型研究基于体内生理盐水诱导超声宫腔成像(SIS)的应变成像中在子宫内机械变形和数据采集之间的最佳时机的策略。还将利用模体来优化位移跟踪和应变估计性能，并提出用于扇形应变成像的多级别算法。第三，本研究还将探讨基于SIS的应变成像在体内应用的可行性。这将通过将该方法应用于15-20名人类患者并评估子宫肿块的描绘/分化和识别弥漫性子宫病理的能力来完成。当完整的子宫标本可用于与体内成像结果进行比较时，将获得完整的子宫标本的体外应变图像。提案(图10和图11)中提出的初步体内结果强烈表明，我们的方法将是有效的。因此，这一可行性项目可能会导致未来的深入临床试验。 公共卫生相关声明：绝经后出血是常见的妇科问题，占就诊人数的近5%。虽然大多数病例是由良性病因引起的，但大约10%到30%的妇女会被发现患有子宫内膜癌。癌症的特征之一是周围组织相对僵硬。我们推测，弹性成像可以通过区分弥漫性僵硬子宫内膜组织(癌)、弥漫性子宫内膜软组织(增生)、局灶性僵硬肿块(肌瘤)和局灶性软组织肿块(息肉)来有效地诊断绝经后出血。

DESCRIPTION (provided by applicant): The overall goal of this research is to develop technology for imaging uterine masses and identifying diffuse pathological conditions using ultrasound strain imaging or elastography. Postmenopausal bleeding is a common gynecological problem, accounting for nearly 5% of office visits. Though the majority of cases result from a benign etiology (endometrial atrophy or hyperplasia, polyps, leiomyomas), approximately 10% to 30% of women will be found to have endometrial cancer. One of the features of cancer is the relative rigidity of the surrounding neoplastic tissue. We hypothesize that elastography could usefully be applied to the diagnosis of postmenopausal bleeding by distinguishing diffuse stiff endometrial tissue (cancer), diffuse endometrial soft tissue (hyperplasia), focal stiff masses (leiomyomas), and focal soft masses (polyps). Differentiation between fibroids and adenomyosis in the uterus is another area where stiffness variation may provide a means of diagnosis. Uterine fibroids and adenomyosis have a similar appearance on conventional US scans, making differentiation problematic- if not impossible- for the sonologist. This differentiation is, however, clinically important because treatment for the two conditions is very different, and clinicians must now use more expensive but less accessible imaging tests. Our research will develop ultrasound strain imaging for differentiating between these two conditions. Three specific aims are proposed in the R21 phase of this research. The first investigates the stiffness contrast that is present between normal and abnormal uterine tissue. Young's modulus measurements will be done on excised uterine samples obtained following hysterectomy procedures. Secondly, strategies for optimizing the timing between mechanical deformation and data acquisition in the uterus for in vivo saline induced sonohysterography (SIS) based strain imaging will be studied using anthropomorphic phantoms. Phantoms will also be utilized to optimize displacement tracking and strain estimation performance with the multi-level algorithm proposed for sector strain imaging. Thirdly, the research will also investigate the feasibility of utilizing SIS based strain imaging in-vivo. This will be done by applying the method to 15-20 human patients and evaluating uterine mass delineation/ differentiation and the ability to identify diffuse uterine pathology. Exvivo strain images will be obtained of intact uterine specimens when they become available for comparisons with these in-vivo imaging results. Preliminary in-vivo results presented in the proposal (Fig. 10 and 11) strongly indicate that our approaches will be effective. Thus, this feasibility project will likely lead to future in depth clinical trials. PUBLIC HEALTH RELEVANCE STATEMENT: Postmenopausal bleeding is a common gynecological problem, accounting for nearly 5% of office visits. Though the majority of cases result from benign etiology approximately 10% to 30% of women will be found to have endometrial cancer. One of the features of cancer is the relative rigidity of the surrounding tissue. We hypothesize that elastography could usefully be applied to the diagnosis of postmenopausal bleeding by distinguishing diffuse stiff endometrial tissue (cancer), diffuse endometrial soft tissue (hyperplasia), focal stiff masses (fibroids), and focal soft masses (polyps).