超音波彈性影像技術已經徹底改變了對組織機械特性的非侵入性評估方式，為多種臨床應用提供了關鍵的診斷見解，壓縮彈性成像、聲輻射力脈衝（ARFI）成像以及剪切波彈性成像（SWEI）等技術如今已成為臨床實踐中的重要工具，特別是在評估肝纖維化和表徵乳腺病變等方面，這些方法通過測量施加力下的組織位移或剪切波（SWs）的傳播速度來判定組織的剛性，該剛性與病理學密切相關，然而，將這些傳統方法應用於肌肉骨骼組織時面臨著重大挑戰，骨骼肌和肌腱具有各向異性特性，這意味著其機械性質因其纖維的排列方向而異，這種各向異性破壞了SWEI中假設的組織各向同性性質，而該方法通常基於剪切波速度（SWV）計算楊氏模量，此外，肌肉纖維與產生力的軸線之間的角度（即肌纖維傾斜角）增加了測量剪切波傳播的複雜性，傳統方法難以捕捉肌肉在收縮和放鬆過程中剛性的動態變化，而小型、解剖結構複雜的肌腱進一步增加了獲取足夠分辨率和準確性的難度，因此，針對這些挑戰，需要專門的技術來全面評估肌肉骨骼組織的各向異性。
本論文探討了基於創新超音波技術的發展與應用，用於表徵肌肉骨骼組織（特別是骨骼肌和肌腱）的各向異性機械性質，這些組織對人類運動和功能至關重要，但由於其纖維排列和傾斜角的複雜性，對傳統彈性成像方法構成了挑戰，傳統方法通常假設各向同性，導致對肌肉和肌腱機械特性的評估不準確或不完整，限制了其診斷效用，為克服這些限制，本研究提出並驗證了四種創新的雙向剪切波成像（DDSWI）技術，旨在準確高效地評估組織的各向異性，基於線性彈性理論，該研究通過引入彈性張量來解決組織剛性隨方向變化的問題。
第一項研究提出了一種用於骨骼肌評估的DDSWI方法，通過同時在同一掃描平面上測量縱向和橫向SWV，解決了SWEI的局限性，消除了旋轉探頭方向的需求，該方法通過將外部振動器同軸安裝至超音波探頭上以產生橫向剪切波，結合聚焦聲輻射力（ARF）推動波束以生成縱向剪切波，超快成像技術捕捉了兩種剪切波的傳播，並通過橫向SWV與縱向SWV的比值（即各向異性比值）來量化組織的各向異性，使用模擬組織的實驗表明SWV測量具有高精度和低偏差的結果，對人體腓腸肌和肱二頭肌的活體研究顯示，不同纖維方向的機械性質存在顯著差異，該方法提供了實時的各向異性映射，是傳統旋轉技術的高效替代方案。
第二項研究針對如手部肌腱等小型複雜結構，引入了一種高頻3D DDSWI技術，該技術使用40 MHz的高頻超音波（HFUS），實現了縱向和橫向SWV的高分辨率成像，通過三軸電機平臺實現機械掃描，重建了SWV影像和各向異性比值的3D圖像，模擬組織研究證實該系統在捕捉雙向SWV方面的準確性與精度，而人體屈腕肌腱的活體研究揭示了不同手部姿勢下SWV和各向異性比值的變化，3D成像提供了肌腱機械性質和張力相關變化的詳細見解。
第三項研究解決了肌纖維傾斜角對肌肉各向異性評估的挑戰，此方法用傾斜超音速推動（TSP）波束取代了外部振動器，利用超音波推動技術在掃描平面內產生多個傾斜角度的SW，測量的SWV結合來自亮度模圖的2D傅立葉分析推導出的肌纖維傾斜角，並使用橢圓擬合計算出真實的縱向和橫向SWV，模擬驗證了橢圓擬合法的準確性，豬肌肉的體外實驗證實了該方法在不同傾斜角下的性能，人體腓腸肌的活體研究顯示，隨著肌肉動態變化，SWV和各向異性比值顯著變化，突出了該技術的臨床潛力。
第四項研究提出了一種用於評估羽狀肌性質的動態SW各向異性成像新方法，克服了傳統SWEI技術的局限性，設計了一種可穿戴的T型超音波探頭，具有雙正交線性陣列，可同時獲取縱向和橫向SWV，通過結合2D傅立葉變換分析肌纖維傾斜角，以及橢圓擬合方法計算真實各向異性SWV，該系統能更準確地表徵肌肉力學特性，進一步將探頭與光學追踪系統集成，用於運動過程中的動態評估，例如膝關節伸展，實驗結果顯示隨著膝關節角度的變化，SWV發生顯著變化，展示了該系統捕捉肌肉各向異性的動態能力。
本論文通過引入並驗證多種不同的DDSWI技術，推進了超音波彈性成像領域，解決了傳統方法的局限，實現了對肌肉和肌腱力學性質的準確、高效和動態表徵，這些發現對診斷和管理肌肉骨骼疾病具有重要意義，有助於早期發現損傷、監測組織癒合以及評估治療效果，未來的研究將著眼於將這些方法擴展至其他肌肉骨骼組織，探索其在不同患者群體中的臨床應用，並與多模態成像技術相結合，實現全面的肌肉骨骼評估，本研究為實現肌肉骨骼健康評估的精準化和特性化奠定了基礎。

Ultrasound elastography has transformed the non-invasive evaluation of tissue mechanical properties, offering critical diagnostic insights across numerous clinical applications. Techniques such as compression elastography, acoustic radiation force impulse (ARFI) imaging, and shear wave elasticity imaging (SWEI) are now staples in clinical practice, particularly for assessing liver fibrosis and characterizing breast lesions. These methods rely on either tissue displacement under applied forces or the propagation speed of shear waves (SWs) to determine tissue stiffness, which correlates with disease pathology. However, applying these conventional approaches to musculoskeletal tissues presents significant challenges. Skeletal muscles and tendons exhibit transverse isotropy, meaning their mechanical properties vary with direction due to the alignment of collagen fibers. This anisotropy undermines the assumption of tissue isotropy central to SWEI, which typically calculates Young’s modulus based on shear wave velocity (SWV). Additionally, the pennation angle—the angle between muscle fibers and the force-generating axis—introduces complexities in measuring SW propagation. Conventional methods also struggle to capture dynamic changes in muscle stiffness during contraction and relaxation, and small, anatomically complex tendons further complicate achieving sufficient resolution and accuracy. Specialized techniques are thus required to address these challenges and comprehensively evaluate musculoskeletal tissue anisotropy.
This dissertation explores the development and application of innovative ultrasound-based techniques for characterizing the anisotropic mechanical properties of musculoskeletal tissues, focusing on skeletal muscles and tendons. These tissues, critical for human movement and function, pose unique challenges for traditional elastography methods due to their anisotropic nature arising from complex fiber arrangements and pennation angles. Conventional approaches, which assume isotropy, often yield inaccurate and incomplete assessments of muscle and tendon mechanics, limiting their diagnostic utility. To overcome these limitations, this work introduces and validates four novel dual-direction shear wave imaging (DDSWI) techniques designed for accurate and efficient evaluation of tissue anisotropy. Building on linear elasticity theory, which links stress, strain, and material properties, the dissertation incorporates the elasticity tensor to address directional variations in tissue stiffness.
The first research proposes a DDSWI approach for skeletal muscle evaluation, addressing limitations of SWEI by simultaneously measuring longitudinal and transverse SWVs within the same scanning plane, thus eliminating the need for transducer rotation. This is achieved through an external vibrator attached to the ultrasound transducer, which generates longitudinal SWs, combined with focused acoustic radiation force (ARF) push beams for transverse SWs. Ultrafast imaging captures the propagation of both SW types, and the anisotropy ratio, defined as the ratio of transverse to longitudinal SWV, quantifies tissue anisotropy. Validation experiments using tissue-mimicking phantoms demonstrated high precision and low bias in SWV measurements. In-vivo studies on human gastrocnemius and biceps brachii muscles revealed distinct anisotropy ratios, highlighting variations in mechanical properties based on fiber orientation. This approach offers real-time anisotropy mapping and a more efficient alternative to traditional rotational techniques.
The second research introduces a high-frequency 3D DDSWI technique tailored for small, complex structures like hand tendons. Utilizing high-frequency ultrasound (HFUS) at 40 MHz, the technique achieves high-resolution imaging of transverse and longitudinal SWs generated by two external vibrators. A three-axis motor stage facilitates mechanical scanning, enabling 3D reconstruction of SWV maps and anisotropy ratios. Phantom studies confirmed the accuracy and precision of the system in capturing bidirectional SWVs, while in-vivo studies on human flexor carpi radialis tendons demonstrated variations in SWVs and anisotropy ratios across different hand postures. The 3D imaging approach revealed non-uniform SWV distributions, offering detailed insights into tendon mechanics and tension-dependent changes.
The third research addresses the challenges posed by pennation angles in muscle anisotropy evaluation. It replaces external vibrators with a tilted supersonic push (TSP) beam, generated using steered ultrasound pushing techniques. The TSP beam produces SWs at multiple tilted angles within the scan plane, eliminating the need for transducer rotation. SWVs measured at tilted angles are combined with pennation angles derived from 2D Fourier analysis of B-mode images, and elliptical fitting is used to calculate true longitudinal and transverse SWVs. Simulations verified the accuracy of the elliptical fitting method, and ex vivo experiments on porcine muscle validated its ability to recover anisotropic properties under various pennation angles. In-vivo studies on human gastrocnemius muscles in relaxed and stretched states demonstrated significant changes in SWVs and anisotropy ratios with muscle dynamics, underscoring the technique’s clinical potential.
The fourth research presents a novel approach to dynamic SW anisotropic imaging for evaluating pennate muscle properties, overcoming the limitations of conventional SWEI techniques. A wearable T-shaped ultrasound transducer was developed, featuring dual orthogonal linear arrays for simultaneous acquisition of longitudinal and transverse SWVs. By integrating a 2D Fourier Transform analysis to measure muscle pennation angles and an elliptical fitting approach to calculate true anisotropic SWVs, this system provides a more accurate characterization of muscle mechanics. The transducer was further combined with an optical tracking system to enable dynamic assessments during movement, such as knee extension. Experimental results demonstrated significant changes in SWVs with varying knee angles, highlighting the system’s ability to capture muscle anisotropy dynamically. This research offers a robust and non-invasive solution for muscle diagnostics, with potential applications in clinical evaluation, sports science, and rehabilitation.
This dissertation advances the field of ultrasound elastography by introducing and validating three DDSWI techniques for assessing musculoskeletal tissue anisotropy. These methods address the limitations of conventional elastography, enabling accurate, efficient, and dynamic characterization of muscle and tendon mechanics. The findings hold significant implications for diagnosing and managing musculoskeletal disorders, facilitating early detection of injuries, monitoring tissue healing, and evaluating treatment effectiveness. Future work will focus on extending these methods to other musculoskeletal tissues, exploring their clinical utility in diverse patient populations, and integrating them with multimodal imaging for comprehensive musculoskeletal assessment. This research lays a foundation for enhanced precision and characterization in musculoskeletal healthcare.

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