Liver disease diagnosis and treatment represents a significant cost to the United States health care system. Chronic liver disease and cirrhosis affects over 2,600,000 people in the United States, leading to over 700,000 hospitalizations annually. Chronic liver diseases progress over several decades at an estimated annual cost of $1.3 billion. Definitive diagnosis of liver disease is performed by liver biopsy;however, this invasive procedure has associated risks and is not well tolerated by patients. As a result, frequent staging of disease progression is not possible, and non-specific blood tests are often used as surrogates for biopsy to determine hepatic fibrosis stage. A separate challenge for liver disease diagnosis involves characterization of focal lesions. Focal liver lesions are detected during ultrasound imaging studies both incidentally and in patients who have an underlying malignancy. Distinguishing benign from malignant lesions with ultrasound is challenging, and many patients with lesions discovered during sonograms are referred for contrast enhanced CT or MRI for further characterization. These additional imaging studies are expensive and require additional patient visits, and they increase patient anxiety. The long term goal of this research i to develop an ultrasonic, quantitative acoustic radiation force impulse (ARFI) based elastography imaging system capable of noninvasive staging of liver fibrosis and differentiation between benign and malignant liver lesions. We propose the development of novel algorithms and beam sequences using both simulation and experimental tools to achieve the required spatial resolution, accuracy, and precision. There are three specific aims: 1) To develop and implement novel stiffness reconstruction methods combining qualitative and quantitative ARFI technologies to provide structurally accurate quantitative stiffness estimates and images of hepatic tumors. 2) To develop and implement 3D shear wave speed monitoring beam sequences and algorithms using a 2D matrix array to improve the accuracy and precision of shear wave speed estimates, and 3) To evaluate this next-generation system in the context of hepatic fibrosis staging and hepatic tumor characterization.

Public Health Relevance

Diagnosing liver disease and monitoring its progression is expensive, and currently requires liver biopsy and often multiple contrast CT and MR imaging studies. We propose to develop and implement a low- cost ultrasonic elasticity imaging system that we hypothesize will be capable of non-invasively differentiating benign from malignant lesions in the liver, in addition to noninvasively determining liver fibrosis stage.

Agency
National Institute of Health (NIH)
Institute
National Institute of Biomedical Imaging and Bioengineering (NIBIB)
Type
Research Project (R01)
Project #
5R01EB002132-10
Application #
8520301
Study Section
Special Emphasis Panel (ZRG1-SBIB-X (03))
Program Officer
Lopez, Hector
Project Start
2001-09-10
Project End
2016-07-31
Budget Start
2013-08-01
Budget End
2014-07-31
Support Year
10
Fiscal Year
2013
Total Cost
$593,552
Indirect Cost
$185,407
Name
Duke University
Department
Biomedical Engineering
Type
Schools of Engineering
DUNS #
044387793
City
Durham
State
NC
Country
United States
Zip Code
27705
Doherty, Joshua R; Trahey, Gregg E; Nightingale, Kathryn R et al. (2013) Acoustic radiation force elasticity imaging in diagnostic ultrasound. IEEE Trans Ultrason Ferroelectr Freq Control 60:685-701
Rouze, Ned C; Wang, Michael H; Palmeri, Mark L et al. (2013) Finite element modeling of impulsive excitation and shear wave propagation in an incompressible, transversely isotropic medium. J Biomech 46:2761-8
Wang, Michael; Byram, Brett; Palmeri, Mark et al. (2013) On the precision of time-of-flight shear wave speed estimation in homogeneous soft solids: initial results using a matrix array transducer. IEEE Trans Ultrason Ferroelectr Freq Control 60:758-70
Wang, Michael; Byram, Brett; Palmeri, Mark et al. (2013) Imaging transverse isotropic properties of muscle by monitoring acoustic radiation force induced shear waves using a 2-D matrix ultrasound array. IEEE Trans Med Imaging 32:1671-84
Rotemberg, V; Palmeri, M; Nightingale, R et al. (2012) The impact of hepatic pressurization on liver shear wave speed estimates in constrained versus unconstrained conditions. Phys Med Biol 57:329-41
Zhai, Liang; Polascik, Thomas J; Foo, Wen-Chi et al. (2012) Acoustic radiation force impulse imaging of human prostates: initial in vivo demonstration. Ultrasound Med Biol 38:50-61
Palmeri, Mark L; Wang, Michael H; Rouze, Ned C et al. (2011) Noninvasive evaluation of hepatic fibrosis using acoustic radiation force-based shear stiffness in patients with nonalcoholic fatty liver disease. J Hepatol 55:666-72
Anderson, Pamela G; Rouze, Ned C; Palmeri, Mark L (2011) Effect of graphite concentration on shear-wave speed in gelatin-based tissue-mimicking phantoms. Ultrason Imaging 33:134-42
Rotemberg, Veronica; Palmeri, Mark; Rosenzweig, Stephen et al. (2011) Acoustic Radiation Force Impulse (ARFI) imaging-based needle visualization. Ultrason Imaging 33:1-16
Palmeri, Mark L; Nightingale, Kathryn R (2011) What challenges must be overcome before ultrasound elasticity imaging is ready for the clinic? Imaging Med 3:433-444

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