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Tissue elasticity imaging by ultrasound echo is expected to be a powerful tool for tumor detection. However, elasticity imaging methods are not suitable for real-time processing because of the enormous computation time required. In this study, a strain distribution estimation algorithm with spatial differentiation of the displacement distribution using the combined autocorrelation method (CA) is implemented. The CA has the advantage of producing high-quality strain images with application to large displacements. Circuit implementation is realized using an structured function description language (SFL) after evaluation on a fixed-point design in SystemC. The designed parallel-pipelined CA architecture performs real-time processing at 30 fps on a Dini Group DNDVI DC board powered by Virtex-4 FX100 FPGA clocked at 100 MHz.