Mapping the longitudinal wall stiffness heterogeneities within intact canine aortas using Pulse Wave Imaging (PWI) ex vivo

Avoiding tensional equilibrium in cells migrating on a matrix with cell-scale stiffness-heterogeneity

Intracellular stresses affect various cell functions, including proliferation, differentiation and movement, which are dynamically modulated in migrating cells through continuous cell-shaping and remodeling of the cytoskeletal architecture induced by spatiotemporal interactions with extracellular matrix stiffness. When cells migrate on a matrix with cell-scale stiffness-heterogeneity, which is a common situation in living tissues, what intracellular stress dynamics (ISD) emerge? In this study, to explore this issue, finite element method-based traction force microscopy was applied to cells migrating on microelastically patterned gels. Two model systems of microelastically patterned gels (stiff/soft stripe and stiff triangular patterns) were designed to characterize the effects of a spatial constraint on cell-shaping and of the presence of different types of cues to induce competing cellular taxis (usual and reverse durotaxis) on the ISD, respectively. As the main result, the prolonged fluctuation of traction stress on a whole-cell scale was markedly enhanced on single cell-size triangular stiff patterns compared with homogeneous gels. Such ISD enhancement was found to be derived from the interplay between the nomadic migration of cells to regions with different degrees of stiffness and domain shape-dependent traction force dynamics, which should be an essential factor for keeping cells far from tensional equilibrium.

Regional pulse wave velocity and stress in aneurysmal arch-shaped aorta

The pulse wave velocity (PWV) has been shown to be associated with the properties of blood vessel and a cardiovascular risk factor such as aneurysm. The global PWV estimation is applied in conventional clinical diagnosis. However, the geometry of blood vessel changes along the wave traveling path and the global PWV estimation may not always detect regional wall changes resulting from cardiovascular diseases. In this study, a fluid structure interaction (FSI) analysis was applied on arch-shaped aortas with and without aneurysm aimed at determining the effects of the number of aneurysm, aneurysm size and the modulus ratio (aneurysm to wall modulus) on the pulse wave propagation and velocity. The characterization for each stage of aneurysmal aorta was simulated by progressively increasing aortic stiffness and aneurysm size. The pulse wave propagations and velocities were estimated from the two-dimensional spatial-temporal plot of the normalized wall displacement based on elastic deformation. The descending forward and arch reflected PWVs of aneurysmal aortic arch models were found up to 9.7% and 122.8%, respectively, deviate from the PWV of non-aneurysmal aortic arch model. The PWV patterns and magnitudes can be used to distinguish the characterization of the normal and aneurysmal aortic walls and shown to be relevant regional markers utilized in clinical diagnosis.

Noninvasive Evaluation of Varying Pulse Pressures in vivo Using Brachial Sphymomanometry, Applanation Tonometry, and Pulse Wave Ultrasound Manometry

The routine assessment and monitoring of hypertension may benefit from the evaluation of arterial pulse pressure (PP) at more central locations (e.g. the aorta) rather solely at the brachial artery. Pulse Wave Ultrasound Manometry (PWUM) was previously developed by our group to provide direct, noninvasive aortic PP measurements using ultrasound elasticity imaging. Using PWUM, radial applanation tonometry, and brachial sphygmomanometry, this study investigated the feasibility of noninvasively obtaining direct PP measurements at multiple arterial locations in normotensive, pre-hypertensive, and hypertensive human subjects. Two-way ANOVA indicated a significantly higher aortic PP in the hypertensive subjects, while radial and brachial PP were not significantly different among the subject groups. No strong correlation (r² < 0.45) was observed between aortic and radial/brachial PP in normal and pre-hypertensive subjects, suggesting that increases in PP throughout the arterial tree may not be uniform in relatively compliant arteries. However, there was a relatively strong positive correlation between aortic PP and both radial and brachial PP in hypertensive subjects (r² = 0.68 and 0.87, respectively). PWUM provides a low-cost, non-invasive, and direct means of measuring the pulse pressure in large central arteries such as the aorta. When used in conjunction with peripheral measurement devices, PWUM allows for the routine screening of hypertension and monitoring of BP-lowering drugs based on the PP from multiple arterial sites.

Intrinsic elastography and its dependence on arterial flow volume

We propose a new estimation method of tissues stiffness from deformation induced by arterial pulsation. The new method was named Intrinsic Elastography (IE). Under two assumptions that the deformation induced by pulsation propagates throughout the body, and the propagation velocity (PV) is closely related to the mechanical properties of tissues, the IE can evaluate the tissue stiffness based on the PV. However, this method has an issue that the observed PVs change with the changes of amounts of the flow. In this paper, we propose the new estimation method in order to estimate true shear elasticity in spite of the changes. The results was compared to the results of SWI. The results was almost identical to the result of SWI, or showed the similar results.

FSI Simulations of Pulse Wave Propagation in Human Abdominal Aortic Aneurysm: The Effects of Sac Geometry and Stiffness

This study aims to quantify the effects of geometry and stiffness of aneurysms on the pulse wave velocity (PWV) and propagation in fluid–solid interaction (FSI) simulations of arterial pulsatile flow. Spatiotemporal maps of both the wall displacement and fluid velocity were generated in order to obtain the pulse wave propagation through fluid and solid media, and to examine the interactions between the two waves. The results indicate that the presence of abdominal aortic aneurysm (AAA) sac and variations in the sac modulus affect the propagation of the pulse waves both qualitatively (eg, patterns of change of forward and reflective waves) and quantitatively (eg, decreasing of PWV within the sac and its increase beyond the sac as the sac stiffness increases). The sac region is particularly identified on the spatiotemporal maps with a region of disruption in the wave propagation with multiple short-traveling forward/reflected waves, which is caused by the change in boundary conditions within the saccular region. The change in sac stiffness, however, is more pronounced on the wall displacement spatiotemporal maps compared to those of fluid velocity. We conclude that the existence of the sac can be identified based on the solid and fluid pulse waves, while the sac properties can also be estimated. This study demonstrates the initial findings in numerical simulations of FSI dynamics during arterial pulsations that can be used as reference for experimental and in vivo studies. Future studies are needed to demonstrate the feasibility of the method in identifying very mild sacs, which cannot be detected from medical imaging, where the material property degradation exists under early disease initiation.

An inverse approach to determining spatially varying arterial compliance using ultrasound imaging

The mechanical properties of arteries are implicated in a wide variety of cardiovascular diseases, many of which are expected to involve a strong spatial variation in properties that can be depicted by diagnostic imaging. A pulse wave inverse problem (PWIP) is presented, which can produce spatially resolved estimates of vessel compliance from ultrasound measurements of the vessel wall displacements. The 1D equations governing pulse wave propagation in a flexible tube are parameterized by the spatially varying properties, discrete cosine transform components of the inlet pressure boundary conditions, viscous loss constant and a resistance outlet boundary condition. Gradient descent optimization is used to fit displacements from the model to the measured data by updating the model parameters. Inversion of simulated data showed that the PWIP can accurately recover the correct compliance distribution and inlet pressure under realistic conditions, even under high simulated measurement noise conditions. Silicone phantoms with known compliance contrast were imaged with a clinical ultrasound system. The PWIP produced spatially and quantitatively accurate maps of the phantom compliance compared to independent static property estimates, and the known locations of stiff inclusions (which were as small as 7 mm). The PWIP is necessary for these phantom experiments as the spatiotemporal resolution, measurement noise and compliance contrast does not allow accurate tracking of the pulse wave velocity using traditional approaches (e.g. 50% upstroke markers). Results from simulations indicate reflections generated from material interfaces may negatively affect wave velocity estimates, whereas these reflections are accounted for in the PWIP and do not cause problems.

Comparison of Different Pulse Waveforms for Local Pulse Wave Velocity Measurement in Healthy and Hypertensive Common Carotid Arteries in Vivo

Pulse wave velocity (PWV), a measurement of arterial stiffness, can be estimated locally by determining the time delay of the pulse waveforms for a known distance as measured in an ultrasound image. Our aim was to compare three ultrasound-based methods for estimation of local PWV based on the measurement of diameter distension waveforms, displacement waveforms of the anterior wall and displacement waveforms of the posterior wall, respectively, in human common carotid arteries in vivo. The local PWVs at both systolic foot (PWVsf) and dicrotic notch (PWVdn) were estimated from ultrasound radiofrequency data of 25 healthy and 24 hypertensive patients for each method. PWV estimation using the distension waveform method was found to have the highest precision in both groups. Both PWVsf and PWVdn were significantly higher in the hypertensive group compared with the healthy group using the distension waveform method (PWVsf: 6.08 ± 1.70 m/s vs. 4.75 ± 0.92 m/s, p = 0.000014; PWVdn: 7.83 ± 2.26 m/s vs. 5.21 ± 0.95 m/s, p < 0.000001), whereas there was no significant difference at a significance level of 0.01 between the two groups when the anterior or posterior wall waveform method was used. Thus, the difference in arterial stiffness between the two groups could be discriminated well by the distension waveform method. The local PWV estimated using distension waveforms might be a promising index for arterial stiffness characterization and hypertension management.

High frame rate and high line density ultrasound imaging for local pulse wave velocity estimation using motion matching: A feasibility study on vessel phantoms

Pulse wave imaging (PWI) is an ultrasound-based method to visualize the propagation of pulse wave and to quantitatively estimate regional pulse wave velocity (PWV) of the arteries within the imaging field of view (FOV). To guarantee the reliability of PWV measurement, high frame rate imaging is required, which can be achieved by reducing the line density of ultrasound imaging or transmitting plane wave at the expense of spatial resolution and/or signal-to-noise ratio (SNR). In this study, a composite, full-view imaging method using motion matching was proposed with both high temporal and spatial resolution. Ultrasound radiofrequency (RF) data of 4 sub-sectors, each with 34 beams, including a common beam, were acquired successively to achieve a frame rate of ∼507 Hz at an imaging depth of 35 mm. The acceleration profiles of the vessel wall estimated from the common beam were used to reconstruct the full-view (38-mm width, 128-beam) image sequence. The feasibility of mapping local PWV variation along the artery using PWI technique was preliminarily validated on both homogeneous and inhomogeneous polyvinyl alcohol (PVA) cryogel vessel phantoms. Regional PWVs for the three homogeneous phantoms measured by the proposed method were in accordance with the sparse imaging method (38-mm width, 32-beam) and plane wave imaging method. Local PWV was estimated using the above-mentioned three methods on 3 inhomogeneous phantoms, and good agreement was obtained in both the softer (1.91±0.24 m/s, 1.97±0.27 m/s and 1.78±0.28 m/s) and the stiffer region (4.17±0.46 m/s, 3.99±0.53 m/s and 4.27±0.49 m/s) of the phantoms. In addition to the improved spatial resolution, higher precision of local PWV estimation in low SNR circumstances was also obtained by the proposed method as compared with the sparse imaging method. The proposed method might be helpful in disease detections through mapping the local PWV of the vascular wall.

Piecewise Pulse Wave Imaging (pPWI) for Detection and Monitoring of Focal Vascular Disease in Murine Aortas and Carotids In Vivo

Atherosclerosis and Abdominal Aortic Aneurysms (AAAs) are two common vascular diseases associated with mechanical changes in the arterial wall. Pulse Wave Imaging (PWI), a technique developed by our group to assess and quantify the mechanical properties of the aortic wall in vivo, may provide valuable diagnostic information. This work implements piecewise PWI (pPWI), an enhanced version of PWI designed for focal vascular diseases. Localized, sub-regional PWVs and PWI moduli ( EPWI ) were estimated within 2-4 mm wall segments of murine normal, atherosclerotic and aneurysmal arteries. Overall, stiffness was found to increase in the atherosclerotic cases. The mean sub-regional PWV was found to be 2.57±0.18 m/s for the normal aortas (n = 7) with a corresponding mean EPWI of 43.82±5.86 kPa. A significant increase ( (p ≤ 0.001)) in the group means of the sub-regional PWVs was found between the normal aortas and the aortas of mice on high-fat diet for 20 ( 3.30±0.36 m/s) and 30 weeks ( 3.56±0.29 m/s). The mean of the sub-regional PWVs ( 1.57±0.78 m/s) and EPWI values ( 19.23±15.47 kPa) decreased significantly in the aneurysmal aortas (p ≤ 0.05) . Furthermore, the mean coefficient of determination (r(2)) of the normal aortas was significantly higher (p ≤ 0.05) than those of the aneurysmal and atherosclerotic cases. These findings demonstrated that pPWI may be able to provide useful biomarkers for monitoring focal vascular diseases.

Quantification of regional aortic stiffness using MR elastography: A phantom and ex-vivo porcine aorta study

MR Elastography (MRE) is a noninvasive technique for measuring tissue stiffness that has been used to assess the average stiffness of the abdominal aorta. The utility of aortic MRE would be improved if it could provide information about local variations in aortic stiffness. We hypothesize that regional variations in aortic stiffness can also be measured with MRE and the purpose of this work was to demonstrate that MRE can measure regional stiffness variations in a vascular phantom and in ex vivo porcine aortas. A vascular phantom was fabricated, containing two silicone tubes embedded in gel. A segment of one of the tubes was modified to increase its stiffness. MRE was performed on the phantom with a continuous flow of water through the tubes. The stiffness distribution along the modified tube was measured and compared to the reference tube. MRE was also performed in porcine aortas embedded in gel with segments treated with saline or formalin for 4 days. The stiffness difference between saline- and formalin-treated aortic segments was measured by MRE and mechanical tests. A positive correlation was found between the regional stiffnesses measured by MRE and mechanical tests. The results indicate that MRE can be used to evaluate the local stiffness distribution in silicone tubes and ex vivo porcine aortas. It may therefore be possible to apply MRE to measure regional stiffness variations of the aorta in vivo.

Performance assessment of Pulse Wave Imaging using conventional ultrasound in canine aortas ex vivo and normal human arteries in vivo

The propagation behavior of the arterial pulse wave may provide valuable diagnostic information for cardiovascular pathology. Pulse Wave Imaging (PWI) is a noninvasive, ultrasound imaging-based technique capable of mapping multiple wall motion waveforms along a short arterial segment over a single cardiac cycle, allowing for the regional pulse wave velocity (PWV) and propagation uniformity to be evaluated. The purpose of this study was to improve the clinical utility of PWI using a conventional ultrasound system. The tradeoff between PWI spatial and temporal resolution was evaluated using an ex vivo canine aorta (n = 2) setup to assess the effects of varying image acquisition and signal processing parameters on the measurement of the PWV and the pulse wave propagation uniformity r². PWI was also performed on the carotid arteries and abdominal aortas of 10 healthy volunteers (24.8 ± 3.3 y.o.) to determine the waveform tracking feature that would yield the most precise PWV measurements and highest r² values in vivo. The ex vivo results indicated that the highest precision for measuring PWVs ~ 2.5 - 3.5 m/s was achieved using 24-48 scan lines within a 38 mm image plane width (i.e. 0.63 - 1.26 lines/mm). The in vivo results indicated that tracking the 50% upstroke of the waveform would consistently yield the most precise PWV measurements and minimize the error in the propagation uniformity measurement. Such findings may help establish the optimal image acquisition and signal processing parameters that may improve the reliability of PWI as a clinical measurement tool.

Measurement of regional pulse-wave velocity using spatial compound imaging of the common carotid artery in vivo

Pulse-wave velocity (PWV) is an important index for diagnosing cardiovascular diseases. The pulse wave is volumetric change induced by heartbeat or inflowing blood, and significantly depends on the propagating path and stiffness of the artery. In this study, PWV of the propagating wave was visualized using spatial compound imaging with high temporal resolution. The frame rate was 1000 Hz, or a time interval of 1 ms. Subjects were four young healthy males and one young healthy female (n=5, age: 23.8±1.17 years old), and the measurement area was the right common carotid artery. PWVs in four phases (the four phases of heart valve opening and closing) were investigated during a cardiac cycle. In phase I, the heart pulsates. In phase II, the tricuspid and mitral valves close, and the aortic and pulmonic valves open. In phase III, the tricuspid and mitral valves open, and the aortic and pulmonic valves close. In phase IV, the propagating wave is reflected. PWVs in phases II and III were easily observed. PWVs were 3.52±1.11 m/s in phase I, 5.62±0.30 m/s in phase II, 7.94±0.85 m/s in phase III, and -4.60±0.99 m/s for the reflective wave. PWV was measured using Spatial Compound Imaging with high temporal resolution, and the PWV in each phase may be used as the index for diagnosing stages of arteriosclerosis progression.

Effects of parameters on the accuracy and precision of ultrasound-based local pulse wave velocity measurement: a simulation study

Quantification of arterial stiffness, such as pulse wave velocity (PWV), is increasingly used in the risk assessment of cardiovascular disease. Pulse wave imaging (PWI) is an emerging ultrasound-based technique to noninvasively measure the local PWV instead of the global PWV, as in conventional methods. In PWI, several key parameters, including the frame rate of ultrasound imaging, motion estimation rate (MER), number of scan lines, image width, PWV value, and sonographic signal-to-noise ratio (SNRs), play an important but still unclear role in the accuracy and precision of PWV measurement. In this study, computer simulations were performed to investigate the fundamental effects of these parameters on the PWV measurement. The pulse waveform was estimated by speckle tracking on ultrasound RF signals acquired at a frame rate of 2083 Hz from a location on the common carotid artery of a healthy subject. By applying different time delays on the estimated waveform based on specific PWI parameters, the pulse waveforms at others locations were simulated. Ultrasound RF signals of the artery during the pulse wave propagation were generated from a 2-D convolutional image formation model. The PWI technique was applied to estimate the PWV at different values of frame rate, MER, number of scan lines, image width, PWV, and SNRs. The performance of the PWV estimation was evaluated by measuring the relative error, coefficient of variation (CV) and coefficient of determination (R(2)). The results showed that PWVs could be correctly measured when the frame rate was higher than a certain value (i.e., minimum frame rate), below which the estimated error increased rapidly. The minimum frame rate required for PWV estimation was found to increase with the value of PWV. An optimal MER was found (i.e., about 200 Hz) and allowed better performance of PWV measurement. The CV of PWV estimation decreased and R(2) increased with number of scan lines and image width, indicating that the performance of the PWV estimation could be improved with a larger number of scan lines and image width. For a given sufficiently high frame rate, a higher PWV value was found to deteriorate the PWV estimation, as indicated by an increasing CV and decreasing R(2). The simulation results were in good agreement with the theoretical analysis. Finally, high-quality PWV estimation could be obtained as long as the SNRs was higher than about 30 dB. The quantitative effects of the key parameters obtained from this study might provide important guidelines for parameter optimization in ultrasound-based local PWV measurement in vivo.

Monitoring and staging abdominal aortic aneurysm disease with pulse wave imaging

The abdominal aortic aneurysm (AAA) is a silent and often deadly vascular disease caused by the localized weakening of the arterial wall. Previous work has indicated that local changes in wall stiffness can be detected with pulse wave imaging (PWI), which is a non-invasive technique for tracking the propagation of pulse waves along the aorta at high spatial and temporal resolutions. The aim of this study was to assess the capability of PWI to monitor and stage AAA progression in a murine model of the disease. ApoE/TIMP-1 knockout mice (N = 18) were given angiotensin II for 30 days via subcutaneously implanted osmotic pumps. The suprarenal sections of the abdominal aortas were imaged every 2-3 d after implantation using a 30-MHz VisualSonics Vevo 770 with 15-μm lateral resolution. Pulse wave propagation was monitored at an effective frame rate of 8 kHz by using retrospective electrocardiogram gating and by performing 1-D cross-correlation on the radiofrequency signals to obtain the displacements induced by the waves. In normal aortas, the pulse waves propagated at constant velocities (2.8 ± 0.9 m/s, r(2) = 0.89 ± 0.11), indicating that the composition of these vessels was relatively homogeneous. In the mice that developed AAAs (N = 10), the wave speeds in the aneurysm sac were 45% lower (1.6 ± 0.6 m/s) and were more variable (r(2) = 0.66 ± 0.23). Moreover, the wave-induced wall displacements were at least 80% lower within the sacs compared with the surrounding vessel. Finally, in mice that developed fissures (N = 5) or ruptures (N = 3) at the sites of their AAA, higher displacements directed out of the lumen and with no discernible wave pattern (r(2) < 0.20) were observed throughout the cardiac cycle. These findings indicate that PWI can be used to distinguish normal murine aortas from aneurysmal, fissured and ruptured ones. Hence, PWI could potentially be used to monitor and stage human aneurysms by providing information complementary to standard B-mode ultrasound.

3D-Printed Tissue-Mimicking Phantoms for Medical Imaging and Computational Validation Applications

Abdominal aortic aneurysm (AAA) is a permanent, irreversible dilation of the distal region of the aorta. Recent efforts have focused on improved AAA screening and biomechanics-based failure prediction. Idealized and patient-specific AAA phantoms are often employed to validate numerical models and imaging modalities. To produce such phantoms, the investment casting process is frequently used, reconstructing the 3D vessel geometry from computed tomography patient scans. In this study the alternative use of 3D printing to produce phantoms is investigated. The mechanical properties of flexible 3D-printed materials are benchmarked against proven elastomers. We demonstrate the utility of this process with particular application to the emerging imaging modality of ultrasound-based pulse wave imaging, a noninvasive diagnostic methodology being developed to obtain regional vascular wall stiffness properties, differentiating normal and pathologic tissue in vivo. Phantom wall displacements under pulsatile loading conditions were observed, showing good correlation to fluid-structure interaction simulations and regions of peak wall stress predicted by finite element analysis. 3D-printed phantoms show a strong potential to improve medical imaging and computational analysis, potentially helping bridge the gap between experimental and clinical diagnostic tools.

Quantification of Arterial Wall Inhomogeneity Size, Distribution, and Modulus Contrast Using FSI Numerical Pulse Wave Propagation

Changes in aortic wall material properties, such as stiffness, have been shown to accompany onset and progression of various cardiovascular pathologies. Pulse Wave velocity (PWV) and propagation along the aortic wall have been shown to depend on the wall stiffness (i.e. stiffer the wall, higher the PWV), and can potentially enhance the noninvasive diagnostic techniques. Conventional clinical methods involve a global examination of the pulse traveling between femoral and carotid arteries, to provide an average PWV estimate. Such methods may not prove effective in detecting wall focal changes as entailed by a range of cardiovascular diseases. A two-way-coupled fluid-structure interaction (FSI) simulation study of pulse wave propagation along inhomogeneous aortas with focal stiffening and softening has previously proved the model reliable. In this study, simulations are performed on inhomogeneous aortic walls with hard inclusions of different numbers, size and modulus in order to further characterize the effects of focal hardening on pulse wave propagation. Spatio-temporal maps of the wall displacement were used to analyze the regional pulse wave propagations and velocities. The findings showed that the quantitative markers -such as PWVs and r² s on the pre-inclusion forward, reflected and post-inclusion waves, and the width of the standing wave- as well as qualitative markers -such as diffracted reflection zone versus single reflection wave- allow the successful and reliable distinction between the changes in inclusion numbers, size and modulus. Future studies are needed to incorporate the wall softening and physiologically-relevant wall inhomogeneities such as those seen in calcifications or aneurysms.