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    Diabetes Status is Associated With Plantar Soft Tissue Stiffness Measured Using Ultrasound Reverberant Shear Wave Elastography Approach
    (SAGE Publishing, 2020-10-23)
    Introduction: The purpose of this study was to investigate the association between the mechanical properties of plantar soft tissue and diabetes status. Method: 51 (M/F: 21/30) participants with prediabetes onset (fasting blood sugar [FBS] level > 100 mg/dL), age >18 years, and no lower limb amputation were recruited after ethical approval was granted from Pontificia Universidad Catolica del Peru ethical review board. Ultrasound reverberant shear wave elastography was used to assess the soft tissue stiffness at the 1st metatarsal head (MTH), 3rd MTH, and the heel at both feet. Results: Spearman’s rank-order correlation (rho) test indicated a significant ( P < .05) positive correlations between FBS level and the plantar soft tissue shear wave speed at the 1st MTH: rho = 0.402 (@400 Hz), rho = 0.373 (@450 Hz), rho = 0.474 (@500 Hz), rho= 0.395 (@550 Hz), and rho = 0.326 (@600 Hz) in the left foot and rho = 0.364 (@450 Hz) in the right foot. Mann-Whitney U test indicated a significantly ( P < .05) higher shear wave speed in the plantar soft tissue with the following effect sizes (r) at the 1st MTH of the left foot at all tested frequencies: r = 0.297 (@450 Hz), r = 0.345 (@500 Hz), r = 0.322 (@550 Hz), and r = 0.275 (@600 Hz), and at the 1st MTH of right foot r = 0.286 (@400 Hz) in diabetes as compared with the age and body mass index matched prediabetes group. Conclusion: An association between fasting blood sugar level and the stiffness of the plantar soft tissue with higher values of shear wave speed in diabetes versus prediabetes group was observed. This indicated that the proposed approach can improve the assessment of the severity of diabetic foot complications with potential implications in patient stratification.
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    Plantar soft tissue characterization using reverberant shear wave elastography: a proof-of-concept study
    (Elsevier, 2021-10-25)
    Plantar soft tissue stiffness provides relevant information on biomechanical characteristics of the foot. Therefore, appropriate monitoring of foot elasticity could be useful for diagnosis, treatment or health care of people with complex pathologies such as a diabetic foot. In this work, the reliability of reverberant shear wave elastography (RSWE) applied to plantar soft tissue was investigated. Shear wave speed (SWS) measurements were estimated at the plantar soft tissue at the first metatarsal head, the third metatarsal head and the heel from both feet in five healthy volunteers. Experiments were repeated for a test–retest analysis with and without the use of gel pad using a mechanical excitation frequency range between 400 and 600 Hz. Statistical analysis was performed to evaluate the reliability of the SWS estimations. In addition, the results were compared against those obtained with a commercially available shear wave-based elastography technique, supersonic imaging (SSI). The results indicate a low coefficient of variation for test–retest experiments with gel pad (median: 5.59%) and without gel pad (median: 5.83%). Additionally, the values of the SWS measurements increase at higher frequencies (median values: 2.11 m/s at 400 Hz, 2.16 m/s at 450 Hz, 2.24 m/s at 500 Hz, 2.21 m/s at 550 Hz and 2.31 m/s at 600 Hz), consistent with previous reports at lower frequencies. The SWSs at the plantar soft tissue at the first metatarsal head, third metatarsal head and heel were found be significantly (p<0.05) different, with median values of 2.42, 2.16 and 2.03 m/s, respectively which indicates the ability of the method to differentiate between shear wave speeds at different anatomical locations. The results indicated better elastographic signal-to-noise ratios with RSWE compared to SSI because of the artifacts presented in the SWS generation. These preliminary results indicate that the RSWE approach can be used to estimate the plantar soft tissue elasticity, which may have great potential to better evaluate changes in biomechanical characteristics of the foot.
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    In vivo assessment of corneal biomechanics under a localized cross-linking treatment using confocal air-coupled optical coherence elastography
    (Optica Publishing Group (formerly OSA), 2022-05-01)
    The localized application of the riboflavin/UV-A collagen cross-linking (UV-CXL) corneal treatment has been proposed to concentrate the stiffening process only in the compromised regions of the cornea by limiting the epithelium removal and irradiation area. However, current clinical screening devices dedicated to measuring corneal biomechanics cannot provide maps nor spatial-dependent changes of elasticity in corneas when treated locally with UV-CXL. In this study, we leverage our previously reported confocal air-coupled ultrasonic optical coherence elastography (ACUS-OCE) probe to study local changes of corneal elasticity in three cases: untreated, half-CXL-treated, and full-CXL-treated in vivo rabbit corneas (n = 8). We found a significant increase of the shear modulus in the half-treated (>450%) and full-treated (>650%) corneal regions when compared to the non-treated cases. Therefore, the ACUS-OCE technology possesses a great potential in detecting spatially-dependent mechanical properties of the cornea at multiple meridians and generating elastography maps that are clinically relevant for patient-specific treatment planning and monitoring of UV-CXL procedures.
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    Viscoelastic characterization of in vivo human dermis using high-frequency ultrasonic crawling wave elastography
    (Institute of Electrical and Electronics Engineers Inc., 2022-01-01)
    High-frequency (center frequency of 18MHz) ultrasound was combined with crawling wave elastography to characterize skin viscoelastic properties in two anatomical sites (i.e., thigh and forearm) in humans in the range of 200-400 Hz. The Voigt model was used to obtain shear elasticity and shear viscosity estimates. The forearm's mean shear elasticity and shear viscosity were 6 kPa and 5.5 Pa.s, respectively, exhibiting significantly higher values than in the thigh (3.4 kPa and 3.2 Pa.s, respectively, p < 0.05). These results suggest that skin viscoelastic properties can be estimated in vivo using high-frequency crawling wave elastography and show translation potential for future application in the clinical screening of skin disorders.
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    Characterisation of the Soft Tissue Viscous and Elastic Properties Using Ultrasound Elastography and Rheological Models: Validation and Applications in Plantar Soft Tissue Assessment
    (Institute of Physics, 2023-05-21)
    Objective. The mechanical behaviour of soft tissue is influenced by its elastic and viscous characteristics. Therefore, the aim of this study was to develop a validated method to characterise the viscoelastic properties of soft tissues based on ultrasound elastography data. Approach. Plantar soft tissue was chosen as the tissue of interest, and gelatine-phantoms replicating its mechanical properties were manufactured for validation of the protocol. Both plantar soft tissue and the phantom were scanned using Reverberant shear wave ultrasound (US) elastography at 400-600 Hz. Shear wave speed was estimated using the US particle velocity data. The viscoelastic parameters were extracted by fitting the Young’s modulus as a function of frequency derived from the constitutive equations of the eight rheological models (four classic and their fractional-derivative versions) to the shear wave dispersion data. Furthermore, stress-time functions derived from the eight rheological models were fitted to the phantom stress-relaxation data. Main results. The viscoelastic parameters estimated using elastography data based on the fractional-derivative (FD) models, compared to the classic models, were closer to those quantified using the mechanical test. In addition, the FD-Maxwell and FD-Kelvin-Voigt models showed to more effectively replicate the viscoelastic behaviour of the plantar soft tissue with minimum number of model parameters ( R 2 = 0.72 for both models) . Hence the FD-KV and FD-Maxwell models can more effectively quantify the viscoelastic characteristics of the soft tissue compared to other models. Significance. In this study, a method for mechanical characterisation of the viscoelastic properties of soft tissue in ultrasound elastography was developed and fully validated. An investigation into the most valid rheological model and its applications in plantar soft tissue assessment were also presented. This proposed approach for the characterisation of viscous and elastic mechanical properties of soft tissue has implications in assessing the soft tissue function where those can be used as markers for diagnosis or prognosis of tissue status.
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    Optimizing harmonic shear wave elastography over three distinct frequency regimes
    (IOP Publishing, 2026-05-01)
    Objective. To investigate how excitation frequency and source configuration influence shear wave propagation in bounded soft tissues, and to establish practical guidelines for optimizing shear wave elastography across different operating regimes. Approach. We analyze shear wave propagation using theoretical modeling, numerical simulations, and experimental observations across a wide range of frequencies and source configurations. The study identifies distinct propagation regimes based on the relationship between wavelength, attenuation, and geometry, and evaluates their impact on shear wave behavior. Main results . We demonstrate that shear wave fields exhibit three distinct regimes—quasistatic, modal, and free-space—each associated with different propagation characteristics and limitations for inverse reconstruction. We further show that optimized source configurations can significantly enhance shear wave dominance while minimizing compressional components, leading to order-of-magnitude improvements in signal-to-noise ratio and spatial resolution at higher frequencies. Significance . These findings provide a unified framework for understanding frequency-dependent wave behavior in elastography and highlight that frequency selection is a critical determinant of both wave physics and reconstruction validity. The proposed guidelines offer practical insight for translating experimental optimization strategies into clinically relevant settings.
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