Uterine In-vivo Strain Imaging Using Saline Infusion

描述（由申请人提供）：本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并识别弥漫性病理状态的技术。绝经后出血是一种常见的妇科问题，占门诊就诊的近5%。虽然大多数病例是由良性病因（子宫内膜萎缩或增生，息肉，平滑肌瘤）引起的，但大约10%至30%的女性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的相对刚性。我们假设，弹性成像可以有效地应用于绝经后出血的诊断，通过区分弥漫性硬子宫内膜组织（癌症），弥漫性子宫内膜软组织（增生），局灶性硬肿块（平滑肌瘤），局灶性软肿块（息肉）。子宫肌瘤和子宫腺肌病的鉴别是另一个硬度变化可以提供诊断手段的领域。子宫肌瘤和子宫腺肌症在常规超声扫描上有相似的表现，这使得超声医师很难区分。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。第一项研究了正常和异常子宫组织之间存在的硬度对比。将对子宫切除术后获得的切除子宫样本进行杨氏模量测量。其次，将使用拟人模型研究用于优化体内生理盐水诱导的子宫超声造影术（SIS）的应变成像的子宫中的机械变形和数据采集之间的时序的策略。还将利用该方法优化位移跟踪和应变估计性能，并提出了用于扇形应变成像的多级算法。第三，本研究也将探讨利用SIS为基础的应变成像在体内的可行性。这将通过将该方法应用于15-20名人类患者并评估子宫质量描绘/分化和识别弥漫性子宫病理的能力来完成。当完整子宫标本可用于与这些体内成像结果进行比较时，将获得其体外应变图像。该提案中提出的初步体内结果（图10和11）强烈表明我们的方法将是有效的。因此，该可行性项目可能会导致未来的深入临床试验。 公共卫生相关性声明：绝经后出血是一种常见的妇科问题，占门诊就诊的近5%。虽然大多数病例是由良性病因引起的，但大约10%至30%的女性会被发现患有子宫内膜癌。癌症的特征之一是周围组织的相对刚性。我们假设，弹性成像可以有效地应用于绝经后出血的诊断，通过区分弥漫性硬子宫内膜组织（癌症），弥漫性子宫内膜软组织（增生），局灶性硬肿块（肌瘤），局灶性软肿块（息肉）。

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).