Reverberation clutter from subcutaneous tissue layers: simulation and in vivo demonstrations.

The degradation of ultrasonic image quality is typically attributed to aberration and reverberation. Although the sources and impact of aberration are well understood, very little is known about the source and impact of image degradation caused by reverberation. Reverberation is typically associated with multiple reflections at two interfaces along the same propagation path, as with the arterial wall or a metal sphere. However, the reverberation that results in image degradation includes more complex interaction between the propagating wave and the tissue. Simulations of wave propagation in realistic and simplified models of the abdominal wall are used to illustrate the characteristics of coherent and diffuse clutter generated by reverberation. In the realistic models, diffuse reverberation clutter is divided into that originating from the tissue interfaces and that originating from sub-resolution diffuse scatterers. In the simplified models, the magnitude of the reverberation clutter is observed as angle and density of the connective tissue are altered. The results suggest that multi-path scattering from the connective tissue/fat interfaces is a dominant component of reverberation clutter. Diffuse reverberation clutter is maximal when the connective tissue is near normal to the beam direction and increases with the density of connective tissue layers at these large angles. The presence of a thick fascial or fibrous layer at the distal boundary of the abdominal wall magnifies the amount of reverberation clutter. The simulations also illustrate that compression of the abdominal layer, a technique often used to mitigate clutter in overweight and obese patients, increases the decay of reverberation clutter with depth. In addition, rotation of the transducer or steering of the beam with respect to highly reflecting boundaries can reduce coherent clutter and transform it to diffuse clutter, which can be further reduced using coherence-based beamforming techniques. In vivo images of the human bladder illustrate some of the reverberation effects observed in simulation.