Viscoelastic Strain Response (ViSR) Ultrasound in Pre-Clinical and Clinical Application

Viscoelastic Strain Response (ViSR) ultrasound is a novel acoustic radiation force (ARF)-based imaging method that noninvasively interrogates the viscoelastic properties of tissue by measuring the relaxation time constant for constant stress in the Voigt biomechanical model. The time constant is defined as the ratio of coefficient of viscosity to elastic modulus, so ViSR differentiates tissue with disparate viscosities and elasticities. ViSR ultrasound is performed by delivering two successive ARF impulses to a single region of exciation (ROE) and tracking the micrometer-scale displacements induced by the propagating longitudinal waves. ViSR does not rely on transverse wave propagation, which can be disrupted and difficult to track in heterogeneous and/or geometrically complex media. Another advantage to ViSR ultrasound is a large axial range relative to conventional ARF Impulse (ARFI) ultrasound. In this overview, ViSR methods are discussed and demonstrated in calibrated viscoelastic tissue mimicking materials. ViSR ultrasound is then applied to differentiating fatty and fibrous deposition in muscle in a golden retriever muscular dystrophy (GRMD) dog model and in boys with Duchenne muscular dystrophy (DMD) with correlation to standard physical testing. ViSR is also applied to delineating the structure and composition of atherosclerotic plaques in a hypercholesterolemic pig model with histochemical validation. ViSR’s key advantages and disadvantages are discussed in regard to its general clinical utility.