Quantifying Cervical Softness with Elasticity Imaging

描述（由申请人提供）：本提案的目的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僵硬/柔软度。我们工作的一个关键好处是，开发一种单独测量颈椎僵硬/柔软度的方法可能会产生重大影响；宫颈柔软度是一个关键的，但主观的，衡量每天在产科诊所。我们的目标是使用这样的工具来全面了解宫颈微结构及其在正常和异常妊娠期间的变化。我们预计，对宫颈微结构变化的进一步了解将导致对妊娠期特定重塑过程的有针对性的研究，从而促进对宫颈功能不全的了解。这反过来又可以指导新的治疗策略的探索。

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.