Dynamic elastography uses an imaging system to visualize the propagation of elastic waves, the speed of which is directly related to the elasticity felt by palpation. Very few studies have focused on X-ray elastography because of the technical challenges it poses: a planar image of an integration volume at a very slow sampling rate. We demonstrate that tracking a slow elastic wave guided along a one-dimensional structure could provide a possible solution. The recently discovered flexural pulse wave, which is naturally generated by heartbeats and propagates along arteries, is the perfect candidate for X-ray elastography. As it reflects the cardiovascular health of patients, arterial elasticity is a biomarker of high clinical interest. We first validate the method by measuring the elasticity in artery phantoms using X-ray. We then move on to data obtained in vivo on coronary arteries during a routine angiography examination. During coronary angiography, a catheter is used to inject an X-ray contrast dye into the patient’s aorta. X-rays are then taken as the dye spreads through the coronary arteries. It shows the movement of the coronary arteries for a few seconds and provides an opportunity to follow the natural flexural pulse waves. The obtained Young’s moduli for two patients are E = 38 ± 30 kPa and E = 36 ± 28 kPa, respectively. These preliminary results are expected to pave the way for X-ray elastography.

Arteriosclerosis is a major risk factor for cardiovascular disease and results in arterial vessel stiffening. Velocity estimation of the pulse wave sent by the heart and propagating into the arteries is a widely accepted biomarker. This symmetrical pulse wave propagates at a speed which is related to the Young's modulus through the Moens Korteweg (MK) equation. Recently, an antisymmetric flexural wave has been observed in vivo. Unlike the symmetrical wave, it is highly dispersive. This property offers promising applications for monitoring arterial stiffness and early detection of atheromatous plaque. However, as far as it is known, no equivalent of the MK equation exists for flexural pulse waves. To bridge this gap, a beam based theory was developed, and approximate analytical solutions were reached. An experiment in soft polymer artery phantoms was built to observe the dispersion of flexural waves. A good agreement was found between the analytical expression derived from beam theory and experiments. Moreover, numerical simulations validated wave speed dependence on the elastic and geometric parameters at low frequencies. Clinical applications, such as arterial age estimation and arterial pressure measurement, are foreseen.