On the feasibility of imaging peripheral nerves using acoustic radiation force impulse imaging

Regional anesthesia is preferred over general anesthesia for many surgical procedures; however, challenges associated with poor image guidance limit its widespread acceptance as a viable alternative. In B-mode ultrasound images, the current standard for guidance, nerves can be difficult to visualize due to their similar acoustic impedance with surrounding tissues and needles must be aligned within the imaging plane at limited angles of approach that can impede successful peripheral nerve anesthesia. These challenges lead to inadequate regional anesthesia, necessitating intraoperative interventions, and can cause complications, including hemorrhage, intraneural injections and even nerve paralysis. ARFI imaging utilizes acoustic radiation force to generate images that portray relative tissue stiffness differences. Peripheral nerves are typically surrounded by many different tissue types (e.g., muscle, fat and fascia) that provide a mechanical basis for improved image contrast using ARFI imaging over conventional B-mode images. ARFI images of peripheral nerves and needles have been generated in cadaveric specimens and in humans in vivo. Contrast improvements of >600% have been achieved for distal sciatic nerve structures. The brachial plexus has been visualized with improved contrast over B-mode images in vivo during saline injection and ARFI images can delineate nerve bundle substructures to aid injection guidance. Physiologic motion during ARFI imaging of nerves near arterial structures has been successfully suppressed using ECG-triggered image acquisition and motion filters. This work demonstrates the feasibility of using ARFI imaging to improve the visualization of peripheral nerves during regional anesthesia procedures.