Nonlinear stress-strain relationships in tissue and their effect on the contrast-to-noise ratio in elastograms.

The practice of elastography is generally limited to small applied compressions (typically 1%), under the assumption of a linear stress-strain relationship in biological tissue. However, the recent reports of larger applied compressions and precompression levels to increase the strain contrast violate the above assumption. The nonlinear stress-strain relationships in different breast tissue types significantly alter the contrast in elastography, especially for large applied compression. The moduli of normal fibrous and glandular breast tissue (along with cancerous lesions) are strain-dependent, with tissue stiffness increasing with applied compression. In this paper, we illustrate that the strain-dependence of the modulus has a significant impact on the elastographic contrast and on the contrast-to-noise ratio, and may even cause a reversal of the contrast in certain situations. This paper also emphasizes the effect of the precompression strain level on the strain contrast.