Realistic Ultrasound Simulations of Healthy and Osteoarthritic Cartilage.

Osteoarthritis (OA) causes irreversible cartilage damage, highlighting the need for early and sensitive assessment. Current imaging modalities are limited in detecting early-stage changes. Ultrasound (US) provides a non-invasive and accessible alternative, but its clinical adoption is limited by the lack of standardized protocols and reliable cartilage assessment. Simulations can be used to address these challenges by enabling system design, acquisition optimization and validation by providing ground truth when in vivo ground truth is unavailable. The aim of this study is to develop an in silico framework for realistic US imaging of healthy and OA cartilage by combining accurate acoustic wave modeling with a 2D microstructural cartilage phantom. The model was calibrated to healthy cartilage using first-order speckle statistics and extended to simulate degeneration through changes in structural and acoustic properties. As a proof-of-concept study, simulations were evaluated against limited ex vivo US data from healthy and OA cartilage and compared with literature data. The simulations reproduced key OA-related features and trends, including changes in reflection coefficient (R), integrated reflection coefficient (IRC), apparent integrated backscatter (AIB), and gray level distributions. These findings demonstrate the feasibility of using microstructure-based tissue phantoms to model healthy and OA cartilage. The framework provides a platform for systematic investigation of cartilage microstructure and US-derived features and may support future generation of synthetic datasets for data-driven and AI-based OA assessment.