WO2015104582A1 - Procédé et dispositif d'estimation des propriétés élastiques de tissus, notamment de tissus musculaires - Google Patents

Procédé et dispositif d'estimation des propriétés élastiques de tissus, notamment de tissus musculaires Download PDF

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Publication number
WO2015104582A1
WO2015104582A1 PCT/IB2014/058124 IB2014058124W WO2015104582A1 WO 2015104582 A1 WO2015104582 A1 WO 2015104582A1 IB 2014058124 W IB2014058124 W IB 2014058124W WO 2015104582 A1 WO2015104582 A1 WO 2015104582A1
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Prior art keywords
tissue
sequences
probe
deformations
pressure
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Ceased
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PCT/IB2014/058124
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English (en)
Inventor
Carlo Apostolo
Laura BERTELÈ
Gianni Pedrizzetti
Gianni TONTI
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FONDAZIONE APOSTOLO
Amid Srl
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FONDAZIONE APOSTOLO
Amid Srl
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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/48—Diagnostic techniques
    • A61B8/485—Diagnostic techniques involving measuring strain or elastic properties
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/42—Details of probe positioning or probe attachment to the patient
    • A61B8/4272—Details of probe positioning or probe attachment to the patient involving the acoustic interface between the transducer and the tissue
    • A61B8/429—Details of probe positioning or probe attachment to the patient involving the acoustic interface between the transducer and the tissue characterised by determining or monitoring the contact between the transducer and the tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/52—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/5215—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving processing of medical diagnostic data
    • A61B8/5238—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving processing of medical diagnostic data for combining image data of patient, e.g. merging several images from different acquisition modes into one image
    • A61B8/5246—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving processing of medical diagnostic data for combining image data of patient, e.g. merging several images from different acquisition modes into one image combining images from the same or different imaging techniques, e.g. color Doppler and B-mode
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/44—Constructional features of the ultrasonic, sonic or infrasonic diagnostic device
    • A61B8/4444—Constructional features of the ultrasonic, sonic or infrasonic diagnostic device related to the probe
    • A61B8/4472—Wireless probes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/46—Ultrasonic, sonic or infrasonic diagnostic devices with special arrangements for interfacing with the operator or the patient
    • A61B8/461—Displaying means of special interest
    • A61B8/463—Displaying means of special interest characterised by displaying multiple images or images and diagnostic data on one display
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/48—Diagnostic techniques
    • A61B8/483—Diagnostic techniques involving the acquisition of a 3D volume of data

Definitions

  • tissue In contrast to engineering materials, biological tissues are not very well behaved, in the sense of being easily described in closed-form mathematical expressions because they are dependent on many parameters. When living, they are metabolically active and exhibit certain mechanical properties, which change soon after death. Moreover, these mechanical properties may be age, strain rate and strain range dependent. A complete and reliable tissue characterization is thus not an easy task to achieve.
  • the present invention has not the eager to solve the general problem of determining the elastic properties of tissues, but aims at providing a smart way to determine parameters related to such elastic properties that can be particularly useful for dynamic evaluation of skeletal muscles functionality.
  • the performance of skeletal muscles depends on the ability of the same to develop a force and, for that reason, the training is generally focused on muscle mass development. It is also true that the quality of the muscle action depends on many additional factors that are rarely assessed.
  • the first element of the quality of the development of strength relates to the uniformity of the distribution of muscle tension along the anatomical structure, from bone insertion, through the tendons and along the muscle. It is thus important to be able to verify, from a dynamic point of view, the correct direction of stress and traction on the insertion points and how the muscle shortens according to its contractile ability.
  • a muscle that presents, for example, a reinforced element connected to a less powerful region causes a local increase of the stresses in the areas of connection, with a corresponding increase in the potential risk of injury.
  • a second element of fundamental importance for the performance of the musculature relates to the presence or not of an adequate dynamic balance between the various muscular structures.
  • Each action of the musculoskeletal system is driven by a number of muscles (agonists) that work together to perform the action in the most appropriate manner with the desired strength in the required time and along the correct direction in space and a corresponding number of muscles (antagonists) that are released so as not to oppose the motion.
  • This is what happens in every joint motion, the flexion of the hips, knees, ankles, as in the movements of the arms, hands and feet, even up to the toes, lumbar and cervical spine to mention only the main ones, or the opening and closing of the jaw.
  • every action performed by a muscle element involves a reaction of a second element (antagonist): the contraction of a muscle agonist is necessarily accompanied by the corresponding relaxation of the antagonist muscle. It is therefore evident how necessary it is a balanced development between agonist and antagonist.
  • a very common example in football caused by normal training techniques, is the imbalance between the quadriceps (agonist of knee extension) and the flexors (antagonist). Excessively enhanced flexors restrain the action of the quadriceps and cause inaccuracy in the shooting besides causing overload on the knee with subsequent risk of muscle and tendon injuries.
  • tissue stiffness could be smartly determined with an ultrasound system to allow to make reproducible measurements, for example, to follow up the behaviour of a muscle after a training or a massage.
  • the invention reaches the aim with a method for estimation of elastic properties of tissues, particularly skeletal muscles, subjected to a mechanical stress, the method comprising the following steps:
  • Such measurements may be, in fact, normalized by taking into account the pressure exerted by the probe while acquiring the sequences of images so that it is possible to make reproducible measurements not only on different areas of interest but also at different time instants.
  • the stiffness-related parameters measured according to the present invention may vary from the 81 stiffness constants of the strain tensor as will be defined hereinafter to a simple ratio stress/deformation according to the well- known Hookean formula assuming a pure elastic mono-dimensional behaviour. In any case, whatever are the parameters calculated, they can be used to provide, during the same or different exam, a normalized diagram of deformations and/or strain rates to increase reproducibility and accuracy, particularly in follow-up examinations.
  • the mechanical stress is substantially orthogonal to the surface of the tissue. It is preferably induced by the probe used for obtaining the echographic images of the tissue.
  • the probe comprises at least one sensor capable of measuring such pressure.
  • Such sensor detects pressure components along at least one direction, preferably three orthogonal directions, of a reference system. They are typically piezoelectric sensors, load cells, strain gages or the like.
  • step b) comprises determining the distribution of the deformation and/or strain rates through Optical Flow and/or Particle Image Velocimetry techniques for tracking the differential motion of the imaged regions of the tissue.
  • the method comprises the step of calculating the main directions of the deformations and the deformation values in such directions, the stiffness-related parameters being calculated as a function of the deformation values in such directions and the applied stress.
  • the method comprises the following steps:
  • the step of calculating stiffness-related parameters comprises calculating the ratio ⁇ / ⁇ wherein ⁇ is the strain defined as ⁇ / ⁇ .
  • the invention relates to a device for estimation of elastic properties of tissues, particularly skeletal muscles, subjected to a mechanical stress, comprising:
  • processing unit is configured to transform such sequence or sequences of images in sequences of measurements of deformations and/or strain rates in one or more spatial locations of the tissue, determine the entity of the applied stress and calculate stiffness-related parameters as a function of the stress and the deformations and/or strain rates as measured.
  • the processing unit is configured to calculate the main directions of the deformations and the deformation values in said directions.
  • the device outputs the stiffness-related parameters calculated as a function of the deformation values in said directions and the applied stress.
  • the device may be provided in combination with a sensor associated to an ultrasound probe for acquiring sequences of two-dimensional or three- dimensional echographic images of a tissue.
  • the sensor is connected or connectible to the second input of the device for acquiring information related to the pressure exerted by the probe on the surface of the tissue.
  • the probe is preferable of the hand-held type having an emitting surface for transmitting and/or receiving ultrasonic signals when placed in contact with the surface of the tissue under investigation.
  • the emitting surface is adapted to exert a mechanical pressure on the surface of the tissue when the probe is moved back and forth, while the pressure sensor is rigidly coupled to the probe to contact the surface of the tissue to detect the pressure exerted by the emitting surface on the surface of the tissue.
  • the at least one pressure sensor is coupled to an enlargement or frame of the probe, typically coplanar with the emitting surface, which surrounds the emitting surface containing the array of electro- acoustic transducers, such enlargement or frame having a surface adapted to rest on the surface of the tissue.
  • the pressure sensors may be advantageously located on the enlargement or frame in proximity of each side of the emitting surface, particularly in proximity of the middle of each side.
  • at least two pressure sensors may be located on the enlargement or frame in proximity of each longest side of the emitting surface.
  • the device may be advantageously provided in combination with an echographic apparatus having at least a probe for acquiring sequences of two- dimensional or three-dimensional echographic images of a tissue to be transferred to the first input of the device, the probe comprising, or being associated to, at least a sensor connected or connectible to the second input of the device for acquiring pressure-related information.
  • the invention relates to an echographic apparatus for estimation of elastic properties of tissues, particularly skeletal muscles, subjected to a mechanical stress, comprising the above device configured to measure deformations and/or strain rates from sequences obtained acquiring with at least one echographic probe one or more zones of a tissue, determine the entity of the applied stress and calculate stiffness-related parameters as a function of the stress and the deformations and/or strain rates as measured.
  • the processing unit of the device is one of the processing unit of the apparatus and the second input of the device is a port of the apparatus connected or connectible to the sensor associated to the probe for acquiring information related to the pressure exerted by the probe on the surface of the tissue.
  • the apparatus is advantageously configured to:
  • stiffness-related parameter a normalized diagram of deformations and/or strain rates for different areas of the tissue.
  • the apparatus typically outputs a pressure curve, which is used to normalize the measurements of deformations and/or strain rates, particularly by dividing the values of such measurements by the value of the measured pressure at the corresponding time instant.
  • the apparatus is particularly advantageous when configured to evaluate the uniformity of the muscle activity within same muscles and/or different muscle elements involved in the same action and/or the synchronicity of deformation between agonist and antagonist muscles by measuring deformations and/or strain rates from sequences obtained acquiring with one or more echographic probes one or more zones of the same muscle or of different muscles involved in the same action and operate a comparison between such measurements in terms of intensity and/or synchronicity, such measurements being normalized by taking into account the pressure exerted by the probe while acquiring the sequences of images.
  • Fig. 1 shows a simplified sketch of a tissue subjected to an orthogonal force with related relationship stress/deformation.
  • Fig. 2 shows exemplary normalized curves of longitudinal (upper part) and radial (lower part) strain calculated with a method and device according to the invention.
  • Fig. 3 shows, in its upper part, the echographic image of a muscle subjected to a pressure by the same ultrasound probe used for acquiring the image.
  • the lower part shows the same figure of the upper part with superimposed a diagram of deformation as obtained with the method and device of the present invention.
  • Fig. 4 shows how different zones of the same muscle may have differences in the entity and time of the contraction.
  • the curves have been obtained by normalizing the diagrams of the deformation with stiffness-related parameters calculated applying a pressure with the same probe used for the imaging.
  • Fig. 5 shows an exemplified block diagram of a first embodiment of the device according to the invention
  • Fig. 6 shows an exemplified block diagram of a second embodiment of the device according to the invention.
  • Fig. 7 shows a longitudinal section of an ultrasound probe according the invention
  • Fig. 8 and 9 show a view taken from the emitting side of the probe head respectively in a first and a second embodiment.
  • the relationship stress/strain is a so-called constitutive law, i.e. it's not a physical law, but characterizes the type of material. Stiffness- related parameters are part of such a constitutive law for each material.
  • Fig. 1 shows how this relation applies to the deformation ⁇ of a tissue of initial length H subjected to an external pressure increase p.
  • the relationship pressure/strain becomes
  • ⁇ is the stress, ⁇ the strain, C and b stiffness constants that vary with age, pathologies and training. This not linear relationship is due to a sort of self- compensating mechanism which is triggered to avoid too high deformations which could lead to a rupture of the tissue.
  • the mapping information M can be determined using several methods. Particularly advantageous is the usage of image processing tracking procedures, such as "Optical Flow” or "Particle Image Velocimetry” (OF-PIV). See, for example, Singh A. Optic Flow Computation: A Unified Perspective. Piscataway, NJ: IEEE Comput. Soc. Press, 1992, Barron JL, Fleet DJ, Beauchemin S. Performance of optical flow techniques. International Journal of Computer Vision 1994; 12:43-77, Adrian RJ Twenty years of particle image velocimetry. Experiments in Fluids 2005; 39, 159-169.
  • the deformation gradient is commonly best suited for Lagrangian analysis (i.e. referring all measurements on particles moving with the tissue), while the velocity gradient is usually preferred for Eulerian analysis (i.e. using reference points fixed in space).
  • these tensors can be decomposed into two other tensors, R and U, that represent two phenomena R, for the rotation, and U for pure deformation where U is a symmetric matrix.
  • the velocity gradient can be decomposed into its rotation-rate ⁇ and rate-of-deformation D components.
  • the deformation U, or rate-of-deformation D, tensors are those that are related with the applied forces and the tissue elastic properties.
  • the elastic properties of a tissue are parameters that enter in a relationship between stress and strain. There are numerous strain measures that can be constructed from matrix U or D, such as, for example, Green Strain Tensor
  • the elastic parameters that enter in a stress-strain relationship can be estimated.
  • F is the Stress tensor
  • S the Strain tensor
  • E the stiffness matrix
  • tissue can be considered homogeneous and isotropic, it is possible to demonstrate that among the 81 Ej jk h coefficients only two are independent, namely Young's module E and Poisson's module v.
  • deformations are calculated using image processing tracking procedures, such as "Optical Flow” or “Particle Image Velocimetry” (OF-PIV), that allow to evaluate instantaneous velocity or displacements of points or particles by comparing images taken at successive moments of time assuming that the brightness of each point of the original image moves rigidly in the images of the sequence.
  • image processing tracking procedures such as "Optical Flow” or “Particle Image Velocimetry” (OF-PIV)
  • the images can be either two- dimensional three-dimensional. The following will, however, only deal with the two-dimensional case. Obviously, this should not be construed as limiting the scope of protection, but represents only an exemplification for an immediate grasp of the mathematical concepts used.
  • the speed for each point of the image can be advantageously estimated by defining a window of pixels W and minimizing the quantity:
  • the deformation rates calculated by the method and the device according to an embodiment of the invention are represented by the changes of velocities in space i.e. by the gradient of the velocity vectors
  • This matrix can be written as a sum of a symmetric matrix U and an antisymmetric matrix R in the following way
  • the symmetric matrix U is a pure deformation, while the asymmetric matrix R a pure rigid rotation.
  • the invention comprises the step to diagonalize the symmetric matrix U to determine the lengthening / shortening (eigenvalues) along the principal directions (eigenvectors), i.e. the amount of pure deformation without shear.
  • This new diagonalized matrix is the basis for the calculation of the Strain Tensor S, which, from the knowledge of the stress tensor F, allows to calculate the stiffness parameters that in their simplest form are represented by the ratio between the stress and the corresponding strain in the principal directions.
  • the entity and the direction of the stress is advantageously calculated by using sensors in the ultrasonic probe used for acquiring the sequences of two- dimensional or three-dimensional echographic images upon which the deformations are derived. If, in fact, it is the same imaging probe that is advantageously used also for exerting a force on the tissue by transaxially moving the transducer to compress or displace a proximal region of the tissue, by placing pressure sensors in the probe is thus possible to monitor the curve of pressure and thus strain in time.
  • Fig. 7 shows an ultrasound probe 3 of the hand-held type having an emitting surface 203 for transmitting and/or receiving ultrasonic signals when placed in contact with the surface of the tissue under investigation.
  • the emitting surface 203 is composed of a series of ultrasound transducer placed side by side in an array configuration. By acting on the grip of the probe 3, the physician can use the same emitting surface 203 to exert also a mechanical pressure on the surface of the tissue.
  • any type of ultrasound probe can be adapted for the aim. It can be a classical mono-dimensional probe, i.e. with transducers placed side by side along one direction, or a more sophisticated bi-dimensional probe with transducers placed in a matrix array configuration. It can be of the linear, convex or phased array type, although for the specific application to muscular analysis the linear probe seems more appropriate to better follow the longitudinal extension of the muscles.
  • the head of the probe has typically a rectangular or square shape following the structure of the array of transducers. Square shapes are generally employed in bi-dimensional probes for volume acquisitions.
  • the invention advantageously provides for pressure sensors coupled to the probe.
  • the pressure sensors 103 can be advantageously placed on an enlargement or frame 303 of the probe 3 which surrounds the emitting surface containing the array of electro-acoustic transducers as shown in Fig. 8 and 9.
  • the enlargement or frame 303 has a surface, typically coplanar with the emitting surface 203, which is adapted to rest on the surface of the tissue. The surface of contact is thus increased with a resulting effect of a more uniform mechanical pressure exerted when the probe is moved back and forth.
  • the pressure sensors 103 can be, for example, located on the enlargement or frame 303 in proximity of each side of the emitting surface, particularly in proximity of the middle of each side. To increase sensitivity and accuracy, two pressure sensors may be located on the enlargement or frame 303 in proximity of each longest side of the emitting surface 203.
  • sensors are not to be considered limitative of the scope of protection.
  • Just one sensor capable to detect pressure components along at least one direction, or better along three orthogonal directions, of a reference system could, in fact, suffice for the purpose.
  • pressure sensors may be of any known type such as piezoelectric sensors, load cells, strain gages or the like.
  • the probe 3 is connected to an ultrasound apparatus 2 capable of acquiring sequences of images of the tissue under investigation.
  • the ultrasound apparatus exchanges data, particularly in the form of sequences of images, with the device 1 according to the invention which is also directly connected to the sensors 103 of the probe 3 to read the value of the pressure.
  • the ultrasound machine 2 is connected in a physical manner or through wireless connections through an input 101 . It is also possible to provide that the exchange of data between the ultrasound apparatus 2 and the device 1 is carried out through mass memories in a completely transparent way with the operation mode of the ultrasound system that, for this reason, can be of any type.
  • the processing unit 201 of the device 1 reads the input sequences and process them to assess the deformation and/or strain rate and show the results of the analysis, for example in the graphics form of fig. 2, on a monitor 301 .
  • the processing unit 201 may be a dedicated microprocessor system or, more generally, a PC of the general purpose type. The characteristics of the processing unit 201 will obviously reflect on the processing speed.
  • the processing unit 201 is configured to transform the sequences of images coming from the ultrasound apparatus 2 in sequences of measurements of deformations and/or strain rates, determine the entity of the applied stress and calculate stiffness-related parameters as a function of the stress and the deformations and/or strain rates as measured.
  • the stiffness-related parameters are used, for example, to normalize subsequent measurements of deformations, for example to determine the behaviour of different zones of a contracting muscle as shown in fig. 4.
  • FIG 6 A more sophisticated embodiment is shown in Fig 6, where the device 1 is integrated within the ultrasound apparatus 2.
  • the device 1 in this case, may be part of the processing system of the ultrasound images with the monitor 301 that coincides with the same main monitor of the ultrasound apparatus.
  • the second input 401 of the device 1 can be a port of the ultrasound apparatus 2 that can be used to read the exerted pressure through an auxiliary channel as it normally happens for EKG, EMG signals. This results in a very compact system that can be dedicated, for example, to the analysis of muscle deformations.

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Abstract

La présente invention concerne un procédé d'évaluation des propriétés élastiques de tissus, notamment des muscles squelettiques, soumis à une contrainte mécanique, le procédé étant caractérisé en ce qu'il comprend les étapes suivantes : a) réception d'une ou plusieurs séquences d'images échographiques en deux dimensions ou en trois dimensions du tissu examiné ; b) transformation de cette séquence ou de ces séquences d'images en séquences de mesures de déformations et/ou de taux de contrainte dans un ou plusieurs emplacements spatiaux du tissu ; c) acquisition d'au moins un capteur d'au moins un signal indiquant la contrainte appliquée pour obtenir, par traitement dudit signal, des informations relatives à l'entité de la contrainte ; d) calcul de paramètres liés à la rigidité en fonction de la contrainte et des déformations et/ou des taux de contrainte tels que mesurés ; e) production de ces paramètres liés à la rigidité en format numérique et/ou graphique. La présente invention concerne également un dispositif correspondant.
PCT/IB2014/058124 2014-01-08 2014-01-08 Procédé et dispositif d'estimation des propriétés élastiques de tissus, notamment de tissus musculaires Ceased WO2015104582A1 (fr)

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IT201600099938A1 (it) * 2016-10-05 2017-01-05 Carlo Apostolo Dispositivo per l’analisi simultanea dei muscoli masseteri in relazione a tutti gli aspetti legati all’occlusione e relativo metodo di analisi utilizzante tale dispositivo
IT201600076665A1 (it) * 2016-07-21 2018-01-21 Carlo Apostolo Metodo e dispositivo per la stima delle proprietà elastiche dei tessuti, in particolare dei tessuti muscolari
KR101945300B1 (ko) 2017-05-30 2019-02-07 고려대학교산학협력단 근육 초음파 에코강도 평가를 통한 루게릭병 진단에 관한 정보를 제공하는 방법
CN109875609A (zh) * 2019-03-01 2019-06-14 清华大学 肌肉力学参数的测量装置及方法、弹性成像方法
CN110664434A (zh) * 2019-09-23 2020-01-10 上海交通大学 一种面向骨骼肌的非线性声参量在体测量技术
EP3566655A4 (fr) * 2017-12-12 2020-06-03 Shenzhen Institutes of Advanced Technology Procédé et appareil pour acquérir un paramètre biomécanique en fonction d'un myogramme d'élasticité ultrasonore
IT201900004976A1 (it) 2019-04-03 2020-10-03 Carlo Apostolo Apparato miometrico
CN112155547A (zh) * 2020-10-19 2021-01-01 广东工业大学 一种生物组织识别系统
WO2021008218A1 (fr) * 2019-07-15 2021-01-21 无锡海斯凯尔医学技术有限公司 Sonde et système de mesure d'élasticité de tissu
WO2021093745A1 (fr) * 2019-11-11 2021-05-20 深圳先进技术研究院 Procédé et système d'évaluation de maladie musculaire, et dispositif électronique
US20210161496A1 (en) * 2017-09-06 2021-06-03 Texas Tech University System System and method for measuring real-time body kinematics
CN117877008A (zh) * 2024-03-13 2024-04-12 湖北神龙工程测试技术有限公司 一种基于人工智能的门窗性能检测方法

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