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Noninvasive carotid artery elastography using multielement synthetic aperture imaging: Phantom and in vivo evaluation

Purpose: Vascular elastography can visualize the strain distribution in the carotid artery, which could be useful in assessing the propensity of advanced plaques to rupture. In our previous studies, we demonstrated that sparse synthetic aperture (SA) imaging can produce high quality vascular strain elastograms. However, the low output power of SA imaging may hamper its clinical utility. In this study, we hypothesize that multi‐element defocused emissions can overcome this limitation and improve the quality of the vascular strain elastograms. Methods: To assess the impact of attenuation on the elastographic performance of SA and (multi‐element synthetic aperture) MSA imaging, we conducted experiments using heterogeneous vessel phantoms with ideal (0.1 dB cm−1 MHz−1) and realistic (0.75 dB cm−1 MHz−1) attenuation. Further, we validated the results of the phantom study in vivo, on a healthy male volunteer. All echo imaging was performed at a transmit frequency of 5 MHz, using a commercially available ultrasound scanner (Sonix RP, Ultrasonix Medical Corp., Richmond, BC, Canada). Results: The results from the phantom results demonstrated that plaques were visible in all strain elastograms, but those produced using MSA imaging had less artifacts. MSA imaging improved the elastographic contrast to noise ratio (CNRe) of the vascular elastograms by 14.58 dB relative to SA imaging, and 9.1 dB relative to compounded plane wave (CPW) imaging. Further, the results demonstrated that the elastographic performance of MSA imaging improved with increase in (a) the number of transmit‐receive events and (b) the size of the transmit sub‐aperture, up to 13 elements. Using larger sub‐apertures degraded the elastographic performance. The results from the in vivo study were in good agreement with the phantom results. Specifically, using a defocused multi‐element transmit sub‐aperture for SA imaging improved the performance of vascular elastography. Conclusions: The results suggested that MSA imaging can produce reliable vascular stain elastograms. Future studies will involve using coded excitations to improve the CNRe and frame‐rate of the proposed technique for vascular elastography.