Impact of imaging cross-section on visualization of thyroid microvessels using ultrasound: Pilot study

Non-invasive, contrast-free microvascular imaging of human thyroids can be potentially beneficial in reducing the large number of benign biopsies of suspicious nodules. However, motion incurred by thyroid due to its proximity to the pulsating carotid artery significantly impacts the visualization of blood flow in small vessels. Singular value based spatiotemporal clutter filtering (SVD-STF) improves the performance of tissue rejection in the presence of motion. However, despite effective clutter filtering, motion in thyroid imaging can impact coherent integration of the Doppler ensemble and degrade the visualization of the underlying vasculature. Recently studies have demonstrated that motion correction using 2D normalized cross-correlation based speckle tracking can address this issue, however, only in-plane motion can be tracked and corrected. Given the natural anatomical orientation of the rigid trachea, thyroid and the pulsating carotid artery, we hypothesize that imaging of thyroid microvessels may be more reliable in the longitudinal view than in the transverse. Specifically, distal presence of rigid trachea can limit out-of-plane motion in the longitudinal view. We tested this hypothesis on 48 acquisitions obtained from 24 thyroid patients having at least one suspicious nodule. In each patient, ultrasound images of the thyroid were acquired in both longitudinal and transverse views. Compounded plane-wave imaging was used to acquire the ultrasound images at high frame-rate, which is important for contrast-free small vessel blood flow imaging. Thyroid motion was tracked using 2D normalized cross-correlation based speckle tracking. Tissue clutter was rejected using singular value decomposition based spatiotemporal clutter filtering. The clutter-filtered Doppler ensemble was motion corrected prior to slow-time power Doppler integration. Signal-to-noise and contrast-to-noise ratios were computed to assess the improvement in quality of the power Doppler images. Out-of-plane motion was detected by estimating normalized ensemble cross-correlation coefficient. The results demonstrated that motion associated with the thyroid due to the carotid artery was primarily in the lateral direction, which could be estimated and corrected using 2D speckle tracking. However, the motion in the transverse view displayed increased speckle decorrelation. The average ensemble cross-correlation coefficient of the thyroid ultrasound images were significantly higher (p < 0.05) in the longitudinal view than in the transverse view. The largest improvement in SNR and CNR of the estimated PD images upon motion correction was observed in the longitudinal view (12.95 ± 3.76 dB and 16.48 ± 4.6 dB) than in the transverse view (3.72 ± 0.894 dB and 6.217 ± 1.689 dB). These preliminary results show that motion encountered by the thyroid due to carotid pulsations can be effectively tracked and corrected in the longitudinal view relative to transverse, which is important for reliably visualizing the underlying blood flow.