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Prostate tumors can have a higher mechanical hardness than the surrounding tissue. During the digital rectal exam this can be used not only to detect the hypertrophy but also localized hardenings. The examination by digital palpation is inaccurate and even in combination with PSAvalue and a transrectal ultrasonic examination the result is often not reliable. Ultrasound strain imaging is able to measure and visualize the elastic properties of a tissue region and hence is an adequate supplement for commonly used diagnostic procedures. We have developed a real time system for elastographic mechanical tissue assessment of the prostate which can be used for the transrectal ultrasonic examination for navigation and diagnosis. During the examination a sequence of ultrasonic images is acquired while the organ is slightly compressed by the ultrasound probe. Using a numerical analysis of image pairs of the acquired sequence the tissue strain is calculated which represents the spatial elasticity distribution of a specific cross-section of the organ and which are able to distinguish hard areas in the tissue. We present results from several patients. which show, that real time strain imaging is able to detect tumor-like areas which are inconspicuous in the bmode image. The results correspond to the histological specimens. After the evaluation of 130 patients using a prospective study we found the specificity for cancer detection to be approximately 84% and a sensitivity of approximately 76 %. Furthermore the tumor location and extend was correctly predicted in most of the investigated patients using our real time strain imaging. SIGNAL PROCESSING Strain imaging was first described by Ophir in 1991 [1], but could not easily be clinically applied so far, because the described method had no real time capability. To use it in a clinical setting we invented a time efficient algorithm, called “phase root seeking” [2], which in a current system is able to calculate up to 30 strain images per second using a conventional desktop PC. Similar to [1], time shifts are estimated using a discrete number of windows at discrete depths. The time shift τm,k of the k-th window of two A-lines centered around tk = k∆T is estimated by the following iterative formula L k m k m , 1 , 0 , , − τ = τ (1)

Real Time Strain Imaging — a new Ultrasonic Method for Cancer Detection: First Study Results