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van Helvert M, Ruisch J, de Bakker JMK, Saris AECM, de Korte CL, Versluis M, Groot Jebbink E, Reijnen MMPJ. High-Frame-Rate Ultrasound Velocimetry in the Healthy Femoral Bifurcation: A Comparative Study Against 4-D Flow Magnetic Resonance Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2024:S0301-5629(24)00218-7. [PMID: 39244482 DOI: 10.1016/j.ultrasmedbio.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 09/09/2024]
Abstract
OBJECTIVE Local flow dynamics impact atherosclerosis yet are difficult to quantify with conventional ultrasound techniques. This study investigates the performance of ultrasound vector flow imaging (US-VFI) with and without ultrasound contrast agents in the healthy femoral bifurcation. METHODS High-frame-rate ultrasound data with incremental acoustic outputs were acquired in the femoral bifurcations of 20 healthy subjects before (50V) and after contrast injection (2V, 5V and 10V). 2-D blood-velocity profiles were obtained through native blood speckle tracking (BST) and contrast tracking (echo particle image velocimetry [echoPIV]). As a reference, 4-D flow magnetic resonance imaging (4-D flow MRI) was acquired. Contrast-to-background ratio and vector correlation were used to assess the quality of the US-VFI acquisitions. Spatiotemporal velocity profiles were extracted, from which peak velocities (PSV) were compared between the modalities. Furthermore, root-mean-square error analysis was performed. RESULTS US-VFI was successful in 99% of the cases and optimal VFI quality was established with the 10V echoPIV and BST settings. A good correspondence between 10V echoPIV and BST was found, with a mean PSV difference of -0.5 cm/s (limits of agreement: -14.1-13.2). Both US-VFI techniques compared well with 4-D flow MRI, with a mean PSV difference of 1.4 cm/s (-18.7-21.6) between 10V echoPIV and MRI, and 0.3 cm/s (-23.8-24.4) between BST and MRI. Similar complex flow patterns among all modalities were observed. CONCLUSION 2-D blood-flow quantification of femoral bifurcation is feasible with echoPIV and BST. Both modalities showed good agreement compared to 4-D flow MRI. For the femoral tract the administration of contrast was not needed to increase the echogenicity of the blood for optimal image quality.
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Affiliation(s)
- Majorie van Helvert
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands; Department of Vascular Surgery, Rijnstate Hospital, Arnhem, The Netherlands; Physics of Fluids Group, TechMed Centre, University of Twente, Enschede, The Netherlands.
| | - Janna Ruisch
- Department of Vascular Surgery, Rijnstate Hospital, Arnhem, The Netherlands; Medical Ultrasound Imaging Centre, Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Joosje M K de Bakker
- Medical Ultrasound Imaging Centre, Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Anne E C M Saris
- Medical Ultrasound Imaging Centre, Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Chris L de Korte
- Physics of Fluids Group, TechMed Centre, University of Twente, Enschede, The Netherlands; Medical Ultrasound Imaging Centre, Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Michel Versluis
- Physics of Fluids Group, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Erik Groot Jebbink
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands; Department of Vascular Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - Michel M P J Reijnen
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands; Department of Vascular Surgery, Rijnstate Hospital, Arnhem, The Netherlands
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2
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Jevsikov J, Ng T, Lane ES, Alajrami E, Naidoo P, Fernandes P, Sehmi JS, Alzetani M, Demetrescu CD, Azarmehr N, Serej ND, Stowell CC, Shun-Shin MJ, Francis DP, Zolgharni M. Automated mitral inflow Doppler peak velocity measurement using deep learning. Comput Biol Med 2024; 171:108192. [PMID: 38417384 DOI: 10.1016/j.compbiomed.2024.108192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/01/2024] [Accepted: 02/18/2024] [Indexed: 03/01/2024]
Abstract
Doppler echocardiography is a widely utilised non-invasive imaging modality for assessing the functionality of heart valves, including the mitral valve. Manual assessments of Doppler traces by clinicians introduce variability, prompting the need for automated solutions. This study introduces an innovative deep learning model for automated detection of peak velocity measurements from mitral inflow Doppler images, independent from Electrocardiogram information. A dataset of Doppler images annotated by multiple expert cardiologists was established, serving as a robust benchmark. The model leverages heatmap regression networks, achieving 96% detection accuracy. The model discrepancy with the expert consensus falls comfortably within the range of inter- and intra-observer variability in measuring Doppler peak velocities. The dataset and models are open-source, fostering further research and clinical application.
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Affiliation(s)
- Jevgeni Jevsikov
- School of Computing and Engineering, University of West London, United Kingdom; National Heart and Lung Institute, Imperial College London, United Kingdom.
| | - Tiffany Ng
- National Heart and Lung Institute, Imperial College London, United Kingdom
| | - Elisabeth S Lane
- School of Computing and Engineering, University of West London, United Kingdom
| | - Eman Alajrami
- School of Computing and Engineering, University of West London, United Kingdom
| | - Preshen Naidoo
- School of Computing and Engineering, University of West London, United Kingdom
| | - Patricia Fernandes
- School of Computing and Engineering, University of West London, United Kingdom
| | - Joban S Sehmi
- West Hertfordshire Hospitals NHS Trust, Wafford, United Kingdom
| | - Maysaa Alzetani
- Luton & Dunstable University Hospital, Bedfordshire, United Kingdom
| | | | - Neda Azarmehr
- School of Computing and Engineering, University of West London, United Kingdom
| | - Nasim Dadashi Serej
- School of Computing and Engineering, University of West London, United Kingdom
| | | | | | - Darrel P Francis
- National Heart and Lung Institute, Imperial College London, United Kingdom
| | - Massoud Zolgharni
- School of Computing and Engineering, University of West London, United Kingdom; National Heart and Lung Institute, Imperial College London, United Kingdom
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3
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Flodin J, Wallenius P, Guo L, Persson NK, Ackermann P. Wearable Neuromuscular Electrical Stimulation on Quadriceps Muscle Can Increase Venous Flow. Ann Biomed Eng 2023; 51:2873-2882. [PMID: 37598135 PMCID: PMC10632221 DOI: 10.1007/s10439-023-03349-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 08/09/2023] [Indexed: 08/21/2023]
Abstract
Neuromuscular electrical stimulation (NMES) of the quadriceps (Q) may increase venous blood flow to reduce the risk of venous thromboembolism. This study assessed whether Q-NMES pants could increase peak venous velocity (PVV) in the femoral vein using Doppler ultrasound and minimize discomfort. On 15 healthy subjects, Q-NMES using textile electrodes integrated in pants was applied with increasing intensity (mA) until the first visible muscle contraction [measurement level (ML)-I] and with an additional increase of six NMES levels (ML II). Discomfort using a numeric rating scale (NRS, 0-10) and PVV were used to assess different NMES parameters: frequency (1, 36, 66 Hz), ramp-up/-down time (RUD) (0, 1 s), plateau time (1.5, 4, and 6 s), and on:off duty cycle (1:1, 1:2, 1:3, 1:4). Q-NMES pants significantly increased PVV from baseline with 93% at ML I and 173% at ML II. Frequencies 36 Hz and 66 Hz and no RUD resulted in significantly higher PVV at both MLs compared to 1 Hz and 1 s RUD, respectively. Plateau time, and duty cycle did not significantly change PVV. Discomfort was only significantly higher with increasing intensity and frequency. Q-NMES pants produces intensity-dependent 2-3-fold increases of venous blood flow with minimal discomfort. The superior NMES parameters were a frequency of 36 Hz, 0 s RUD, and intensity at ML II. Textile-based NMES wearables are promising for non-episodic venous thromboembolism prevention.
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Affiliation(s)
- Johanna Flodin
- Integrative Orthopedic Laboratory, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
- Department of Trauma, Acute Surgery and Orthopaedics, Karolinska University Hospital, 171 76, Stockholm, Sweden.
| | - Philip Wallenius
- Integrative Orthopedic Laboratory, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Trauma, Acute Surgery and Orthopaedics, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Li Guo
- Polymeric E-textiles Research Group, Swedish School of Textiles, Smart Textiles, University of Borås, Borås, Sweden
| | - Nils-Krister Persson
- Polymeric E-textiles Research Group, Swedish School of Textiles, Smart Textiles, University of Borås, Borås, Sweden
| | - Paul Ackermann
- Integrative Orthopedic Laboratory, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Trauma, Acute Surgery and Orthopaedics, Karolinska University Hospital, 171 76, Stockholm, Sweden
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4
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Russ MK, Lafata NM, Robertson SH, Samei E. Pulsed wave Doppler ultrasound: Accuracy, variability, and impact of acquisition parameters on flow measurements. Med Phys 2023; 50:6704-6713. [PMID: 37793117 DOI: 10.1002/mp.16774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 08/22/2023] [Accepted: 09/15/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Pulsed wave Doppler ultrasound is a useful modality for assessing vascular health as it quantifies blood flow characteristics. To facilitate accurate diagnosis, accuracy and consistency of this modality should be assessed through Doppler quality assurance (QA). PURPOSE The purpose of this study was to characterize the accuracy, reproducibility, and inter-scanner variability of ultrasound flow velocity measurements via a flow phantom, with a focus on the effect of systematic acquisition parameters on measured flow velocity accuracy. METHODS Using a manufacturer-calibrated flow phantom, pulsed wave measurements were acquired on five clinical systems (iU22, Philips) with three models of transducers, including both linear and curvilinear models. The peak and mean flow velocities were estimated by vendor-supplied spectral analysis tools. To investigate intra- and inter-scanner variability, measurements were repeated using each scanner-transducer pair under a standardized set of conditions. Inter-scanner variability was assessed using ANOVA. Flow velocity accuracy was investigated by mean absolute percentage error. The impacts of receive gain, measurement depth, and beam steering on measured flow velocity accuracy were examined by varying each parameter over its available range and comparing to the ground truth flow velocity. RESULTS Inter-scanner variability was statistically significant for peak flow measurements made using both linear and curvilinear transducers, though absolute differences in measured velocity were small. Inter-scanner variability was not statistically significant for mean flow velocity. Receive gain, measurement depth, and beam steering were all found to impact the accuracy of measured flow characteristics for linear transducers. Accuracy of the flow measurements made with the curvilinear transducer demonstrated high consistency to changes in receive gain at a constant depth, though were impacted by increasing the measurement depth. CONCLUSIONS Carefully and consistently selected acquisition and set-up parameters are essential in order to establish a reliable and meaningful QA program.
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Affiliation(s)
- Megan K Russ
- Clinical Imaging Physics Group, Duke University Health System, Durham, North Carolina, USA
- Department of Radiology, Duke University, Durham, North Carolina, USA
| | - Nicole M Lafata
- Clinical Imaging Physics Group, Duke University Health System, Durham, North Carolina, USA
- Department of Radiology, Duke University, Durham, North Carolina, USA
| | - Scott H Robertson
- Clinical Imaging Physics Group, Duke University Health System, Durham, North Carolina, USA
- Department of Radiology, Duke University, Durham, North Carolina, USA
| | - Ehsan Samei
- Clinical Imaging Physics Group, Duke University Health System, Durham, North Carolina, USA
- Department of Radiology, Duke University, Durham, North Carolina, USA
- Center for Virtual Imaging Trials, Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University, Durham, North Carolina, USA
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina, USA
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Dubs L, Charitatos V, Buoso S, Wegener S, Winklhofer S, Alkadhi H, Kurtcuoglu V. Assessment of extracranial carotid artery disease using digital twins - A pilot study. Neuroimage Clin 2023; 38:103435. [PMID: 37245493 PMCID: PMC10238877 DOI: 10.1016/j.nicl.2023.103435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/05/2023] [Accepted: 05/12/2023] [Indexed: 05/30/2023]
Abstract
To improve risk stratification in extracranial internal carotid artery disease (CAD), patients who would benefit maximally from revascularization must be identified. In cardiology, the fractional flow reserve (FFR) has become a reference standard for evaluating the functional severity of coronary artery stenosis, and noninvasive surrogates thereof relying on computational fluid dynamics (CFD) have been developed. Here, we present a CFD-based workflow using digital twins of patients' carotid bifurcations derived from computed tomography angiography for the noninvasive functional assessment of CAD. We reconstructed patient-specific digital twins of 37 carotid bifurcations. We implemented a CFD model using common carotid artery peak systolic velocity (PSV) acquired with Doppler ultrasound (DUS) as inlet boundary condition and a two-element Windkessel model as oulet boundary condition. The agreement between CFD and DUS on the PSV in the internal carotid artery (ICA) was then compared. The relative error for the agreement between DUS and CFD was 9% ± 20% and the intraclass correlation coefficient was 0.88. Furthermore, hyperemic simulations in a physiological range were feasible and unmasked markedly different pressure drops along two ICA stenoses with similar degree of narrowing under comparable ICA blood flow. Hereby, we lay the foundation for prospective studies on noninvasive CFD-based derivation of metrics similar to the FFR for the assessment of CAD.
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Affiliation(s)
- Linus Dubs
- University of Zurich, Institute of Physiology, The Interface Group, Winterthurerstrasse 190, 8057 Zürich, Switzerland.
| | - Vasileios Charitatos
- University of Zurich, Institute of Physiology, The Interface Group, Winterthurerstrasse 190, 8057 Zürich, Switzerland; University Hospital Zurich, University of Zurich, Institute of Diagnostic and Interventional Radiology, Rämistrasse 100, 8091 Zürich, Switzerland.
| | - Stefano Buoso
- University of Zurich, Institute of Physiology, The Interface Group, Winterthurerstrasse 190, 8057 Zürich, Switzerland; ETH Zurich, Institute for Biomedical Engineering, Gloriastrasse 35, 8092 Zürich, Switzerland.
| | - Susanne Wegener
- University Hospital Zurich, University of Zurich, Clinical Neuroscience Center, Department of Neurology, Frauenklinikstrasse 10, 8091 Zürich, Switzerland.
| | - Sebastian Winklhofer
- University Hospital Zurich, University of Zurich, Clinical Neuroscience Center, Department of Neuroradiology, Frauenklinikstrasse 10, 8091 Zürich, Switzerland.
| | - Hatem Alkadhi
- University Hospital Zurich, University of Zurich, Institute of Diagnostic and Interventional Radiology, Rämistrasse 100, 8091 Zürich, Switzerland.
| | - Vartan Kurtcuoglu
- University of Zurich, Institute of Physiology, The Interface Group, Winterthurerstrasse 190, 8057 Zürich, Switzerland.
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Lane ES, Jevsikov J, Shun-Shin MJ, Dhutia N, Matoorian N, Cole GD, Francis DP, Zolgharni M. Automated multi-beat tissue Doppler echocardiography analysis using deep neural networks. Med Biol Eng Comput 2023; 61:911-926. [PMID: 36631666 DOI: 10.1007/s11517-022-02753-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 12/24/2022] [Indexed: 01/13/2023]
Abstract
Tissue Doppler imaging is an essential echocardiographic technique for the non-invasive assessment of myocardial blood velocity. Image acquisition and interpretation are performed by trained operators who visually localise landmarks representing Doppler peak velocities. Current clinical guidelines recommend averaging measurements over several heartbeats. However, this manual process is both time-consuming and disruptive to workflow. An automated system for accurate beat isolation and landmark identification would be highly desirable. A dataset of tissue Doppler images was annotated by three cardiologist experts, providing a gold standard and allowing for observer variability comparisons. Deep neural networks were trained for fully automated predictions on multiple heartbeats and tested on tissue Doppler strips of arbitrary length. Automated measurements of peak Doppler velocities show good Bland-Altman agreement (average standard deviation of 0.40 cm/s) with consensus expert values; less than the inter-observer variability (0.65 cm/s). Performance is akin to individual experts (standard deviation of 0.40 to 0.75 cm/s). Our approach allows for > 26 times as many heartbeats to be analysed, compared to a manual approach. The proposed automated models can accurately and reliably make measurements on tissue Doppler images spanning several heartbeats, with performance indistinguishable from that of human experts, but with significantly shorter processing time. HIGHLIGHTS: • Novel approach successfully identifies heartbeats from Tissue Doppler Images • Accurately measures peak velocities on several heartbeats • Framework is fast and can make predictions on arbitrary length images • Patient dataset and models made public for future benchmark studies.
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Affiliation(s)
- Elisabeth S Lane
- School of Computing and Engineering, University of West London, St Mary's Rd, Ealing, London, W5 5RF, UK.
| | - Jevgeni Jevsikov
- School of Computing and Engineering, University of West London, St Mary's Rd, Ealing, London, W5 5RF, UK
| | | | - Niti Dhutia
- New York University Abu Dhabi, Saadiyat Island, Abu Dhabi, United Arab Emirates
| | - Nasser Matoorian
- School of Computing and Engineering, University of West London, St Mary's Rd, Ealing, London, W5 5RF, UK
| | - Graham D Cole
- National Heart and Lung Institute, Imperial College, London, UK
| | | | - Massoud Zolgharni
- School of Computing and Engineering, University of West London, St Mary's Rd, Ealing, London, W5 5RF, UK
- National Heart and Lung Institute, Imperial College, London, UK
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van Houte J, Raaijmaakers AE, Mooi FJ, Meijs LPB, de Boer EC, Suriani I, Houterman S, Montenij LJ, Bouwman AR. Evaluating corrected carotid flow time as a non-invasive parameter for trending cardiac output and stroke volume in cardiac surgery patients. J Ultrasound 2023; 26:89-97. [PMID: 35397758 PMCID: PMC10063698 DOI: 10.1007/s40477-022-00678-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/16/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE The corrected carotid flow time (ccFT) is derived from a pulsed-wave Doppler signal at the common carotid artery. Several equations are currently used to calculate ccFT. Its ability to assess the intravascular volume status non-invasively has recently been investigated. The purpose of this study was to evaluate the correlation and trending ability of ccFT with invasive cardiac output (CO) and stroke volume (SV) measurements. METHODS Eighteen cardiac surgery patients were included in this prospective observational study. ccFT measurements were obtained at three time points: after induction of anesthesia (T1), after a passive leg raise (T2), and post-bypass (T3). Simultaneously, CO and SV were measured by calibrated pulse contour analysis. Three different equations (Bazett, Chambers, and Wodey) were used to calculate ccFT. The correlation and percentage change in time (concordance) between ccFT and CO and between ccFT and SV were evaluated. RESULTS Mean ccFT values differed significantly for the three equations (p < 0.001). The correlation between ccFT and CO and between ccFT and SV was highest for Bazett's (ρ = 0.43, p < 0.0001) and Wodey's (ρ = 0.33, p < 0.0001) equations, respectively. Concordance between ΔccFT and ΔCO and between ΔccFT and ΔSV was highest for Bazett's (100%) and Wodey's (82%) equations, respectively. Subgroup analysis demonstrated that correlation and concordance between SV and ccFT improved when assessed within limited heart rate (HR) ranges. CONCLUSION The use of different ccFT equations leads to variable correlation and concordance rates between ccFT and CO/SV measurements. Bazett's equation acceptably tracked CO changes in time, while the trending capability of SV was poor.
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Affiliation(s)
- Joris van Houte
- Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands.
- Department of Intensive Care, Catharina Hospital, Eindhoven, The Netherlands.
- Department of Anesthesiology and Intensive Care, Catharina Hospital, P.O. Box 1350, 5602 ZA, Eindhoven, The Netherlands.
| | - Anniek E Raaijmaakers
- Deparment of Anesthesiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Frederik J Mooi
- Deparment of Anesthesiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Loek P B Meijs
- Department of Intensive Care, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Esmée C de Boer
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Irene Suriani
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Saskia Houterman
- Department of Education and Research, Catharina Hospital, Eindhoven, The Netherlands
| | - Leon J Montenij
- Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands
- Department of Intensive Care, Catharina Hospital, Eindhoven, The Netherlands
| | - Arthur R Bouwman
- Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands
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Suriani I, van Houte J, de Boer EC, van Knippenberg L, Manzari S, Mischi M, Bouwman RA. Carotid Doppler ultrasound for non-invasive haemodynamic monitoring: a narrative review. Physiol Meas 2023; 43. [PMID: 36179705 DOI: 10.1088/1361-6579/ac96cb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/30/2022] [Indexed: 11/11/2022]
Abstract
Objective.Accurate haemodynamic monitoring is the cornerstone in the management of critically ill patients. It guides the optimization of tissue and organ perfusion in order to prevent multiple organ failure. In the past decades, carotid Doppler ultrasound (CDU) has been explored as a non-invasive alternative for long-established invasive haemodynamic monitoring techniques. Considering the large heterogeneity in reported studies, we conducted a review of the literature to clarify the current status of CDU as a haemodynamic monitoring tool.Approach.In this article, firstly an overview is given of the equipment and workflow required to perform a CDU exam in clinical practice, the limitations and technical challenges potentially faced by the CDU sonographer, and the cerebrovascular mechanisms that may influence CDU measurement outcomes. The following chapter describes alternative techniques for non-invasive haemodynamic monitoring, detailing advantages and limitations compared to CDU. Next, a comprehensive review of the literature regarding the use of CDU for haemodynamic monitoring is presented. Furthermore, feasibility aspects, training requirements and technical developments of CDU are addressed.Main results.Based on the outcomes of these studies, we assess the applicability of CDU-derived parameters within three clinical domains (cardiac output, volume status, and fluid responsiveness), and amongst different patient groups. Finally, recommendations are provided to improve the quality and standardization of future research and clinical practice in this field.Significance.Although CDU is not yet interchangeable with invasive 'gold standard' cardiac output monitoring, the present work shows that certain CDU-derived parameters prove promising in the context of functional haemodynamic monitoring.
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Affiliation(s)
- Irene Suriani
- Eindhoven University of Technology, Groene Loper 3, 5612 AE Eindhoven, The Netherlands
| | - Joris van Houte
- Catharina Hospital Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands
| | - Esmée C de Boer
- Eindhoven University of Technology, Groene Loper 3, 5612 AE Eindhoven, The Netherlands
| | - Luuk van Knippenberg
- Eindhoven University of Technology, Groene Loper 3, 5612 AE Eindhoven, The Netherlands
| | - Sabina Manzari
- Philips Research High Tech Campus 34, 5656 AE Eindhoven, The Netherlands
| | - Massimo Mischi
- Eindhoven University of Technology, Groene Loper 3, 5612 AE Eindhoven, The Netherlands
| | - R Arthur Bouwman
- Eindhoven University of Technology, Groene Loper 3, 5612 AE Eindhoven, The Netherlands.,Catharina Hospital Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands
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9
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Jin L, Tong LY, Sha L, Cao MM, Shen CQ, Du LF, Li ZJ. Handheld versus conventional ultrasound for assessing carotid artery in routine volunteers. Clin Hemorheol Microcirc 2022; 82:255-263. [PMID: 35848014 DOI: 10.3233/ch-221521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIM Carotid ultrasound is a key tool for the diagnosis and evaluation of cardio disease, and the measurement of carotid intima-media thickness (CIMT) and hemodynamic parameters is of paramount importance for the imaging method. The aim of this study was to evaluate the feasibility and accuracy of handheld ultrasound devices for measuring carotid parameters. METHODS We performed a carotid ultrasound on 25 participants using a handheld ultrasound device and a conventional ultrasound machine. For each participant, max and mean CIMT of common carotid artery (CCA) and peak systolic velocity (PSV), end diastolic velocity (EDV) and resistive index (RI) of CCA, bilateral external carotid artery (ECA), internal carotid artery (ICA) and the vertebral artery were measured. Agreement and repeatability were evaluated by linear regression and Bland-Altman analysis. RESULTS We found a good repeatability and consistent of handheld ultrasound device in measuring mean CIMT (r = 0.68, P < 0.01). Furthermore, there was a moderate to good agreement between handheld and conventional ultrasound systems in measuring max IMT, mean IMT, PSV, EDV and RI of CCA (0.73, 0.79, 0.52, 0.58 and 0.84, respectively). CONCLUSION Handheld ultrasound devices were able to provide carotid IMT and hemodynamic parameters measurements similar to those of conventional ultrasound. Such capabilities of handheld ultrasound devices might be useful for the primary assessment of carotid in clinical work.
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Affiliation(s)
- Lin Jin
- Department of Ultrasound, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Lan-Yue Tong
- Department of Ultrasound, Shanghai General Hospital Jiading Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lei Sha
- Department of Ultrasound, Shanghai General Hospital Jiading Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Meng-Meng Cao
- Department of Ultrasound, Shanghai General Hospital Jiading Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Cui-Qin Shen
- Department of Ultrasound, Shanghai General Hospital Jiading Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lian-Fang Du
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhao-Jun Li
- Department of Ultrasound, Shanghai General Hospital Jiading Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Department of Ultrasound, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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10
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Shaikh F, Kenny JE, Awan O, Markovic D, Friedman O, He T, Singh S, Yan P, Qadir N, Barjaktarevic I. Measuring the accuracy of cardiac output using POCUS: the introduction of artificial intelligence into routine care. Ultrasound J 2022; 14:47. [DOI: 10.1186/s13089-022-00301-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background
Shock management requires quick and reliable means to monitor the hemodynamic effects of fluid resuscitation. Point-of-care ultrasound (POCUS) is a relatively quick and non-invasive imaging technique capable of capturing cardiac output (CO) variations in acute settings. However, POCUS is plagued by variable operator skill and interpretation. Artificial intelligence may assist healthcare professionals obtain more objective and precise measurements during ultrasound imaging, thus increasing usability among users with varying experience. In this feasibility study, we compared the performance of novice POCUS users in measuring CO with manual techniques to a novel automation-assisted technique that provides real-time feedback to correct image acquisition for optimal aortic outflow velocity measurement.
Methods
28 junior critical care trainees with limited experience in POCUS performed manual and automation-assisted CO measurements on a single healthy volunteer. CO measurements were obtained using left ventricular outflow tract (LVOT) velocity time integral (VTI) and LVOT diameter. Measurements obtained by study subjects were compared to those taken by board-certified echocardiographers. Comparative analyses were performed using Spearman’s rank correlation and Bland–Altman matched-pairs analysis.
Results
Adequate image acquisition was 100% feasible. The correlation between manual and automated VTI values was not significant (p = 0.11) and means from both groups underestimated the mean values obtained by board-certified echocardiographers. Automated measurements of VTI in the trainee cohort were found to have more reproducibility, narrower measurement range (6.2 vs. 10.3 cm), and reduced standard deviation (1.98 vs. 2.33 cm) compared to manual measurements. The coefficient of variation across raters was 11.5%, 13.6% and 15.4% for board-certified echocardiographers, automated, and manual VTI tracing, respectively.
Conclusions
Our study demonstrates that novel automation-assisted VTI is feasible and can decrease variability while increasing precision in CO measurement. These results support the use of artificial intelligence-augmented image acquisition in routine critical care ultrasound and may have a role for evaluating the response of CO to hemodynamic interventions. Further investigations into artificial intelligence-assisted ultrasound systems in clinical settings are warranted.
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11
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Shen Y, van der Harst JJ, Wei Y, Bokkers RPH, van Dijk JMC, Uyttenboogaart M. Validation of a cerebral hemodynamic model with personalized calibration in patients with aneurysmal subarachnoid hemorrhage. Front Bioeng Biotechnol 2022; 10:1031600. [PMID: 36507259 PMCID: PMC9732662 DOI: 10.3389/fbioe.2022.1031600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022] Open
Abstract
This study aims to validate a numerical model developed for assessing personalized circle of Willis (CoW) hemodynamics under pathological conditions. Based on 66 computed tomography angiography images, investigations were obtained from 43 acute aneurysmal subarachnoid hemorrhage (aSAH) patients from a local neurovascular center. The mean flow velocity of each artery in the CoW measured using transcranial Doppler (TCD) and simulated by the numerical model was obtained for comparison. The intraclass correlation coefficient (ICC) over all cerebral arteries for TCD and the numerical model was 0.88 (N = 561; 95% CI 0.84-0.90). In a subgroup of patients who had developed delayed cerebral ischemia (DCI), the ICC had decreased to 0.72 but remained constant with respect to changes in blood pressure, Fisher grade, and location of ruptured aneurysm. Our numerical model showed good agreement with TCD in assessing the flow velocity in the CoW of patients with aSAH. In conclusion, the proposed model can satisfactorily reproduce the cerebral hemodynamics under aSAH conditions by personalizing the numerical model with TCD measurements. Clinical trial registration: [http://www.trialregister.nl/], identifier [NL8114].
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Affiliation(s)
- Yuanyuan Shen
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - J. Joep van der Harst
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Yanji Wei
- Eastern Institute for Advanced Study, Yongriver Institute of Technology, Ningbo, China
| | - Reinoud P. H. Bokkers
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - J. Marc C. van Dijk
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Maarten Uyttenboogaart
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands,Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands,*Correspondence: Maarten Uyttenboogaart,
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12
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Yuhn C, Oshima M, Chen Y, Hayakawa M, Yamada S. Uncertainty quantification in cerebral circulation simulations focusing on the collateral flow: Surrogate model approach with machine learning. PLoS Comput Biol 2022; 18:e1009996. [PMID: 35867968 PMCID: PMC9307280 DOI: 10.1371/journal.pcbi.1009996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/07/2022] [Indexed: 11/18/2022] Open
Abstract
Collateral circulation in the circle of Willis (CoW), closely associated with disease mechanisms and treatment outcomes, can be effectively investigated using one-dimensional–zero-dimensional hemodynamic simulations. As the entire cardiovascular system is considered in the simulation, it captures the systemic effects of local arterial changes, thus reproducing collateral circulation that reflects biological phenomena. The simulation facilitates rapid assessment of clinically relevant hemodynamic quantities under patient-specific conditions by incorporating clinical data. During patient-specific simulations, the impact of clinical data uncertainty on the simulated quantities should be quantified to obtain reliable results. However, as uncertainty quantification (UQ) is time-consuming and computationally expensive, its implementation in time-sensitive clinical applications is considered impractical. Therefore, we constructed a surrogate model based on machine learning using simulation data. The model accurately predicts the flow rate and pressure in the CoW in a few milliseconds. This reduced computation time enables the UQ execution with 100 000 predictions in a few minutes on a single CPU core and in less than a minute on a GPU. We performed UQ to predict the risk of cerebral hyperperfusion (CH), a life-threatening condition that can occur after carotid artery stenosis surgery if collateral circulation fails to function appropriately. We predicted the statistics of the postoperative flow rate increase in the CoW, which is a measure of CH, considering the uncertainties of arterial diameters, stenosis parameters, and flow rates measured using the patients’ clinical data. A sensitivity analysis was performed to clarify the impact of each uncertain parameter on the flow rate increase. Results indicated that CH occurred when two conditions were satisfied simultaneously: severe stenosis and when arteries of small diameter serve as the collateral pathway to the cerebral artery on the stenosis side. These findings elucidate the biological aspects of cerebral circulation in terms of the relationship between collateral flow and CH.
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Affiliation(s)
- Changyoung Yuhn
- Department of Mechanical Engineering, The University of Tokyo, Meguro-ku, Tokyo, Japan
| | - Marie Oshima
- Interfaculty Initiative in Information Studies, The University of Tokyo, Meguro-ku, Tokyo, Japan
- * E-mail:
| | - Yan Chen
- Interfaculty Initiative in Information Studies, The University of Tokyo, Meguro-ku, Tokyo, Japan
| | - Motoharu Hayakawa
- Department of Neurosurgery, Fujita Health University, Toyoake, Aichi, Japan
| | - Shigeki Yamada
- Interfaculty Initiative in Information Studies, The University of Tokyo, Meguro-ku, Tokyo, Japan
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
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13
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Lefebvre TL, Brown E, Hacker L, Else T, Oraiopoulou ME, Tomaszewski MR, Jena R, Bohndiek SE. The Potential of Photoacoustic Imaging in Radiation Oncology. Front Oncol 2022; 12:803777. [PMID: 35311156 PMCID: PMC8928467 DOI: 10.3389/fonc.2022.803777] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/07/2022] [Indexed: 12/16/2022] Open
Abstract
Radiotherapy is recognized globally as a mainstay of treatment in most solid tumors and is essential in both curative and palliative settings. Ionizing radiation is frequently combined with surgery, either preoperatively or postoperatively, and with systemic chemotherapy. Recent advances in imaging have enabled precise targeting of solid lesions yet substantial intratumoral heterogeneity means that treatment planning and monitoring remains a clinical challenge as therapy response can take weeks to manifest on conventional imaging and early indications of progression can be misleading. Photoacoustic imaging (PAI) is an emerging modality for molecular imaging of cancer, enabling non-invasive assessment of endogenous tissue chromophores with optical contrast at unprecedented spatio-temporal resolution. Preclinical studies in mouse models have shown that PAI could be used to assess response to radiotherapy and chemoradiotherapy based on changes in the tumor vascular architecture and blood oxygen saturation, which are closely linked to tumor hypoxia. Given the strong relationship between hypoxia and radio-resistance, PAI assessment of the tumor microenvironment has the potential to be applied longitudinally during radiotherapy to detect resistance at much earlier time-points than currently achieved by size measurements and tailor treatments based on tumor oxygen availability and vascular heterogeneity. Here, we review the current state-of-the-art in PAI in the context of radiotherapy research. Based on these studies, we identify promising applications of PAI in radiation oncology and discuss the future potential and outstanding challenges in the development of translational PAI biomarkers of early response to radiotherapy.
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Affiliation(s)
- Thierry L. Lefebvre
- Department of Physics, University of Cambridge, Cambridge, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Emma Brown
- Department of Physics, University of Cambridge, Cambridge, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Lina Hacker
- Department of Physics, University of Cambridge, Cambridge, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Thomas Else
- Department of Physics, University of Cambridge, Cambridge, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Mariam-Eleni Oraiopoulou
- Department of Physics, University of Cambridge, Cambridge, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Michal R. Tomaszewski
- Department of Cancer Physiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Rajesh Jena
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Sarah E. Bohndiek
- Department of Physics, University of Cambridge, Cambridge, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
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14
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István L, Czakó C, Benyó F, Élő Á, Mihály Z, Sótonyi P, Varga A, Nagy ZZ, Kovács I. The effect of systemic factors on retinal blood flow in patients with carotid stenosis: an optical coherence tomography angiography study. GeroScience 2022; 44:389-401. [PMID: 34837589 PMCID: PMC8810958 DOI: 10.1007/s11357-021-00492-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/16/2021] [Indexed: 12/17/2022] Open
Abstract
Carotid artery stenosis (CAS) is among the leading causes of mortality and permanent disabilities in the Western world. CAS is a consequence of systemic atherosclerotic disease affecting the majority of the aging population. Optical coherence tomography angiography (OCTA) is a novel imaging technique for visualizing retinal blood flow. It is a noninvasive, fast method for qualitative and quantitative assessment of the microcirculation. Cerebral and retinal circulation share similar anatomy, physiology, and embryology; thus, retinal microvasculature provides a unique opportunity to study the pathogenesis of cerebral small vessel disease in vivo. In this study, we aimed to analyze the effect of systemic risk factors on retinal blood flow in the eyes of patients with significant carotid artery stenosis using OCT angiography. A total of 112 eyes of 56 patients with significant carotid stenosis were included in the study. We found that several systemic factors, such as decreased estimated glomerular filtration rate (eGFR), hypertension, and carotid occlusion have a significant negative effect on retinal blood flow, while statin use and carotid surgery substantially improve ocular microcirculation. Neither diabetes, clopidogrel or acetylsalicylic acid use, BMI, serum lipid level, nor thrombocyte count showed a significant effect on ocular blood flow. Our results demonstrate that a systematic connection does exist between certain systemic risk factors and retinal blood flow in this patient population. OCTA could help in the assessment of cerebral circulation of patients with CAS due to its ability to detect subtle changes in retinal microcirculation that is considered to represent changes in intracranial blood flow.
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Affiliation(s)
- Lilla István
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary
| | - Cecilia Czakó
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary
| | - Fruzsina Benyó
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary
| | - Ágnes Élő
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary
| | - Zsuzsa Mihály
- Department of Vascular & Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Péter Sótonyi
- Department of Vascular & Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Andrea Varga
- Department of Vascular & Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Zoltán Zsolt Nagy
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary
| | - Illés Kovács
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary.
- Department of Ophthalmology, Weill Cornell Medical College, New York, USA.
- Department of Clinical Ophthalmology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary.
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15
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Nguyen TQ, Traberg MS, Olesen JB, Moshavegh R, Møller-Sørensen PH, Lönn L, Jensen JA, Nielsen MB, Hansen KL. Pressure Difference Estimation in Non-stenotic Carotid Bifurcation Phantoms Using Vector Flow Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:346-357. [PMID: 34763906 DOI: 10.1016/j.ultrasmedbio.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 08/21/2021] [Accepted: 10/03/2021] [Indexed: 06/13/2023]
Abstract
Local pressure differences estimated using vector flow imaging (VFI) and direct catheterization in seven carotid bifurcation phantoms were compared with simulated pressure fields. VFI correlated strongly with simulated peak pressure differences (r = 0.99, p < 0.00001), with an average overestimation of 12.3 Pa (28.6%). The range between the lowest and highest pressure difference of VFI underestimated simulations by 4.6 Pa (8.06%; r = 0.99, p < 0.0001). The catheter method exhibited no correlation (r = -0.09, p = 0.85). Ten repeated measurements on one phantom revealed a small standard deviation (SD) for VFI (SD = 8.4%, mean estimated SD = 11.5%), but not for the catheter method (SD = 785.6%). An in vivo peak systolic pressure difference of 97.9 Pa (estimated SD = 30%) was measured using VFI in one healthy individual. This study indicates that VFI pressure difference estimation is feasible in phantoms and in vivo and realistic estimates of the SD can be attained from the data.
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Affiliation(s)
- Tin-Quoc Nguyen
- Department of Diagnostic Radiology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Marie Sand Traberg
- Center for Fast Ultrasound Imaging, Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | | | | | | | - Lars Lönn
- Department of Diagnostic Radiology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Arendt Jensen
- Center for Fast Ultrasound Imaging, Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Michael Bachmann Nielsen
- Center for Fast Ultrasound Imaging, Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Kristoffer Lindskov Hansen
- Center for Fast Ultrasound Imaging, Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
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16
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Kenny JÉS, Barjaktarevic I, Mackenzie DC, Rola P, Haycock K, Eibl AM, Eibl JK. Inferring the Frank-Starling Curve From Simultaneous Venous and Arterial Doppler: Measurements From a Wireless, Wearable Ultrasound Patch. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 3:676995. [PMID: 35047930 PMCID: PMC8757733 DOI: 10.3389/fmedt.2021.676995] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 03/30/2021] [Indexed: 12/12/2022] Open
Abstract
The Frank–Starling relationship is a fundamental concept in cardiovascular physiology, relating change in cardiac filling to its output. Historically, this relationship has been measured by physiologists and clinicians using invasive monitoring tools, relating right atrial pressure (Pra) to stroke volume (SV) because the Pra-SV slope has therapeutic implications. For example, a critically ill patient with a flattened Pra-SV slope may have low Pra yet fail to increase SV following additional cardiac filling (e.g., intravenous fluids). Provocative maneuvers such as the passive leg raise (PLR) have been proposed to identify these “fluid non-responders”; however, simultaneously measuring cardiac filling and output via non-invasive methods like ultrasound is cumbersome during a PLR. In this Hypothesis and Theory submission, we suggest that a wearable Doppler ultrasound can infer the Pra-SV relationship by simultaneously capturing jugular venous and carotid arterial Doppler in real time. We propose that this method would confirm that low cardiac filling may associate with poor response to additional volume. Additionally, simultaneous assessment of venous filling and arterial output could help interpret and compare provocative maneuvers like the PLR because change in cardiac filling can be confirmed. If our hypothesis is confirmed with future investigation, wearable monitors capable of monitoring both variables of the Frank–Starling relation could be helpful in the ICU and other less acute patient settings.
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Affiliation(s)
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care, Department of Medicine, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA, United States
| | - David C Mackenzie
- Department of Emergency Medicine, Maine Medical Center, Portland, Maine.,Tufts University School of Medicine, Boston, MA, United States
| | - Philippe Rola
- Division of Intensive Care, Santa Cabrini Hospital, Montreal, QC, Canada
| | - Korbin Haycock
- Department of Emergency Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, United States
| | - Andrew M Eibl
- Health Sciences North Research Institute, Sudbury, ON, Canada
| | - Joseph K Eibl
- Health Sciences North Research Institute, Sudbury, ON, Canada.,Northern Ontario School of Medicine, Sudbury, ON, Canada
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17
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Ambrogio S, Ansell J, Gabriel E, Aneju G, Newman B, Negoita M, Fedele F, Ramnarine KV. Pulsed Wave Doppler Measurements of Maximum Velocity: Dependence on Sample Volume Size. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:68-77. [PMID: 34607758 DOI: 10.1016/j.ultrasmedbio.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/20/2021] [Accepted: 09/04/2021] [Indexed: 06/13/2023]
Abstract
Pulsed wave (PW) Doppler ultrasound is routinely used in the clinic to assess blood flow. Our annual Doppler quality assurance tests revealed unexpectedly large errors in measurement of maximum velocity, exceeding our tolerance (error >20%), when using certain scanners with small Doppler sample volume dimensions. The aim of this study was to assess the dependence of maximum velocity estimates on PW Doppler sample volume size. A flow phantom with known steady flow was used to acquire maximum velocity estimates (maximum velocities of 24, 39 and 85 cm/s and sample volume range of 0.3-20 mm) with a variety of transducers and scanners in clinical use (51 probes from 4 manufacturers). Selected acoustic outputs were characterized using free-field hydrophone measurements. All maximum velocity estimates were within our tolerance for sample volume sizes ≥1.5 mm, although maximum velocity estimates typically increased with decreasing sample volume size. Errors exceeding our tolerance were commonly found for one manufacturer when using smaller sample volumes, resulting in up to 75% overestimation. Although intrinsic spectral broadening based on transit time considerations may help explain our findings, the sample volume dependence raises potential clinical concerns that users should be aware of and which manufacturers should consider addressing.
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Affiliation(s)
- Simone Ambrogio
- Medical Physics Department, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Jane Ansell
- Medical Physics Department, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Elizabeth Gabriel
- Medical Physics Department, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Grace Aneju
- Medical Physics Department, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Benedict Newman
- Medical Physics Department, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Madalina Negoita
- Medical Physics Department, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Fiammetta Fedele
- Medical Physics Department, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Kumar V Ramnarine
- Medical Physics Department, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
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18
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Kenny JÉS, Clarke G, Myers M, Elfarnawany M, Eibl AM, Eibl JK, Nalla B, Atoui R. A Wireless Wearable Doppler Ultrasound Detects Changing Stroke Volume: Proof-of-Principle Comparison with Trans-Esophageal Echocardiography during Coronary Bypass Surgery. Bioengineering (Basel) 2021; 8:203. [PMID: 34940356 PMCID: PMC8698882 DOI: 10.3390/bioengineering8120203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/30/2021] [Accepted: 12/07/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND A novel, wireless, ultrasound biosensor that adheres to the neck and measures real-time Doppler of the carotid artery may be a useful functional hemodynamic monitor. A unique experimental set-up during elective coronary artery bypass surgery is described as a means to compare the wearable Doppler to trans-esophageal echocardiography (TEE). METHODS A total of two representative patients were studied at baseline and during Trendelenburg position. Carotid Doppler spectra from the wearable ultrasound and TEE were synchronously captured. Areas under the receiver operator curve (AUROC) were performed to assess the accuracy of changing common carotid artery velocity time integral (ccVTI∆) at detecting a clinically significant change in stroke volume (SV∆). RESULTS Synchronously measuring and comparing Doppler spectra from the wearable ultrasound and TEE is feasible during Trendelenburg positioning. In two representative cardiac surgical patients, the ccVTI∆ accurately detected a clinically significant SV∆ with AUROCs of 0.89, 0.91, and 0.95 when single-beat, 3-consecutive beat and 10-consecutive beat averages were assessed, respectively. CONCLUSION In this proof-of-principle research communication, a wearable Doppler ultrasound system is successfully compared to TEE. Preliminary data suggests that the diagnostic accuracy of carotid Doppler ultrasonography at detecting clinically significant SV∆ is enhanced by averaging more cardiac cycles.
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Affiliation(s)
- Jon-Émile Stuart Kenny
- Health Sciences North Research Institute, Sudbury, ON P3E 2H2, Canada; (G.C.); (A.M.E.); (J.K.E.); (B.N.); (R.A.)
- Flosonics Medical, 325 Front Street, Toronto, ON M5V 2Y1, Canada; (M.M.); (M.E.)
| | - Geoffrey Clarke
- Health Sciences North Research Institute, Sudbury, ON P3E 2H2, Canada; (G.C.); (A.M.E.); (J.K.E.); (B.N.); (R.A.)
- Flosonics Medical, 325 Front Street, Toronto, ON M5V 2Y1, Canada; (M.M.); (M.E.)
| | - Matt Myers
- Flosonics Medical, 325 Front Street, Toronto, ON M5V 2Y1, Canada; (M.M.); (M.E.)
| | - Mai Elfarnawany
- Flosonics Medical, 325 Front Street, Toronto, ON M5V 2Y1, Canada; (M.M.); (M.E.)
| | - Andrew M. Eibl
- Health Sciences North Research Institute, Sudbury, ON P3E 2H2, Canada; (G.C.); (A.M.E.); (J.K.E.); (B.N.); (R.A.)
- Flosonics Medical, 325 Front Street, Toronto, ON M5V 2Y1, Canada; (M.M.); (M.E.)
| | - Joseph K. Eibl
- Health Sciences North Research Institute, Sudbury, ON P3E 2H2, Canada; (G.C.); (A.M.E.); (J.K.E.); (B.N.); (R.A.)
- Flosonics Medical, 325 Front Street, Toronto, ON M5V 2Y1, Canada; (M.M.); (M.E.)
- Northern Ontario School of Medicine, Sudbury, ON P3E 2C6, Canada
| | - Bhanu Nalla
- Health Sciences North Research Institute, Sudbury, ON P3E 2H2, Canada; (G.C.); (A.M.E.); (J.K.E.); (B.N.); (R.A.)
- Northern Ontario School of Medicine, Sudbury, ON P3E 2C6, Canada
| | - Rony Atoui
- Health Sciences North Research Institute, Sudbury, ON P3E 2H2, Canada; (G.C.); (A.M.E.); (J.K.E.); (B.N.); (R.A.)
- Northern Ontario School of Medicine, Sudbury, ON P3E 2C6, Canada
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19
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Carson J, Warrander L, Johnstone E, van Loon R. Personalising cardiovascular network models in pregnancy: A two-tiered parameter estimation approach. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3267. [PMID: 31799783 PMCID: PMC9286682 DOI: 10.1002/cnm.3267] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/07/2019] [Accepted: 09/07/2019] [Indexed: 05/26/2023]
Abstract
Uterine artery Doppler waveforms are often studied to determine whether a patient is at risk of developing pathologies such as pre-eclampsia. Many uterine waveform indices have been developed, which attempt to relate characteristics of the waveform with the physiological adaptation of the maternal cardiovascular system, and are often suggested to be an indicator of increased placenta resistance and arterial stiffness. Doppler waveforms of four patients, two of whom developed pre-eclampsia, are compared with a comprehensive closed-loop model of pregnancy. The closed-loop model has been previously validated but has been extended to include an improved parameter estimation technique that utilises systolic and diastolic blood pressure, cardiac output, heart rate, and pulse wave velocity measurements to adapt model resistances, compliances, blood volume, and the mean vessel areas in the main systemic arteries. The shape of the model-predicted uterine artery velocity waveforms showed good agreement with the characteristics observed in the patient Doppler waveforms. The personalised models obtained now allow a prediction of the uterine pressure waveforms in addition to the uterine velocity. This allows for a more detailed mechanistic analysis of the waveforms, eg, wave intensity analysis, to study existing clinical indices. The findings indicate that to accurately estimate arterial stiffness, both pulse pressure and pulse wave velocities are required. In addition, the results predict that patients who developed pre-eclampsia later in pregnancy have larger vessel areas in the main systemic arteries compared with the two patients who had normal pregnancy outcomes.
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Affiliation(s)
- Jason Carson
- Zienkiewicz Centre for Computational Engineering, College of EngineeringSwansea UniversitySwanseaUK
- Data Science Building, Swansea University Medical SchoolSwansea UniversitySwanseaUK
- HDR UK Wales and Northern IrelandHealth Data Research UKLondonUK
| | - Lynne Warrander
- Maternal and Fetal Health Research Centre, Division of Developmental Biology, Faculty of Medicine Biology and HealthUniversity of ManchesterManchesterUK
| | - Edward Johnstone
- Maternal and Fetal Health Research Centre, Division of Developmental Biology, Faculty of Medicine Biology and HealthUniversity of ManchesterManchesterUK
| | - Raoul van Loon
- Zienkiewicz Centre for Computational Engineering, College of EngineeringSwansea UniversitySwanseaUK
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20
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van Houte J, Mooi FJ, Montenij LJ, Meijs LPB, Suriani I, Conjaerts BCM, Houterman S, Bouwman AR. Correlation of Carotid Doppler Blood Flow With Invasive Cardiac Output Measurements in Cardiac Surgery Patients. J Cardiothorac Vasc Anesth 2021; 36:1081-1091. [PMID: 34756675 DOI: 10.1053/j.jvca.2021.09.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/15/2021] [Accepted: 09/27/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Carotid Doppler ultrasound has been a topic of recent interest, as it may be a promising noninvasive hemodynamic monitoring tool. In this study, the relation between carotid artery blood flow and invasive cardiac output (CO) was evaluated. DESIGN A prospective, observational study. SETTING A single-institution, tertiary referral hospital. PARTICIPANTS Eighteen elective cardiac surgery patients. INTERVENTIONS CO was measured by calibrated pulse contour analysis. Simultaneously, carotid artery pulsed-wave Doppler measurements were obtained in the operating room in three clinical settings: after induction of anesthesia (T1), after a passive leg raise maneuverer (T2), and at the end of surgery (T3). MEASUREMENTS AND MAIN RESULTS Correlation and trending between carotid artery blood flow and invasive CO were evaluated. Furthermore, two Bland-Altman plots were constructed to evaluate the level of agreement between carotid artery-derived CO and invasive CO measurements. Carotid artery blood flow correlated moderately with invasive CO (ρ = 0.67, 95% confidence interval 0.56-0.76, p < 0.05). Concordance between the percentage change of carotid artery blood flow and invasive CO from T1 to T3 was 72%. The level of agreement between carotid artery-derived CO and invasive CO was ±2.29; ±2.57 L/min, with a bias of 0.1; -0.54 L/min, and mean error of 50% and 48%, for the two Bland-Altman analyses, respectively. Intraexamination precision was acceptable. CONCLUSIONS In cardiac surgery patients, carotid artery blood flow correlated moderately with invasive CO measurements. However, the trending ability of carotid artery blood flow was poor, and carotid artery-derived CO tended not to be interchangeable with invasive CO.
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Affiliation(s)
- Joris van Houte
- Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands; Department of Intensive Care, Catharina Hospital, Eindhoven, The Netherlands.
| | - Frederik J Mooi
- Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Leon J Montenij
- Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands; Department of Intensive Care, Catharina Hospital, Eindhoven, The Netherlands
| | - Loek P B Meijs
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Irene Suriani
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Bente C M Conjaerts
- Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Saskia Houterman
- Department of Education and Research, Catharina Hospital, Eindhoven, The Netherlands
| | - Arthur R Bouwman
- Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands
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21
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Ultrasound of dialysis fistulae: Factors influencing Australian practice. SONOGRAPHY 2021. [DOI: 10.1002/sono.12288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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22
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Matera R, Ricci S. Automatic Measurement of the Carotid Blood Flow for Wearable Sensors: A Pilot Study. SENSORS 2021; 21:s21175877. [PMID: 34502768 PMCID: PMC8434437 DOI: 10.3390/s21175877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 01/09/2023]
Abstract
The assessment of the velocity of blood flowing in the carotid, in modern clinical practice, represents an important exam performed both in emergency situations and as part of scheduled screenings. It is typically performed by an expert sonographer who operates a complex and costly clinical echograph. Unfortunately, in developing countries, in rural areas, and even in crowded modern cities, the access to this exam can be limited by the lack of suitable personnel and ultrasound equipment. The recent availability of low-cost, handheld devices has contributed to solving part of the problem, but a wide access to the exam is still hampered by the lack of expert sonographers. In this work, an automated procedure is presented with the hope that, in the near future, it can be integrated into a low-cost, handheld instrument that is also suitable for self-measurement, for example, as can be done today with the finger oximeter. The operator should only place the probe on the neck, transversally with respect to the common tract of the carotid. The system, in real-time, automatically locates the vessel lumen, places the sample volume, and performs an angle-corrected velocity measurement of the common carotid artery peak velocity. In this study, the method was implemented for testing on the ULA-OP 256 scanner. Experiments on flow phantoms and volunteers show a performance in sample volume placement similar to that achieved by expert operators, and an accuracy and repeatability of 3.2% and 4.5%, respectively.
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23
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István L, Czakó C, Élő Á, Mihály Z, Sótonyi P, Varga A, Ungvári Z, Csiszár A, Yabluchanskiy A, Conley S, Csipő T, Lipecz Á, Kovács I, Nagy ZZ. Imaging retinal microvascular manifestations of carotid artery disease in older adults: from diagnosis of ocular complications to understanding microvascular contributions to cognitive impairment. GeroScience 2021; 43:1703-1723. [PMID: 34100219 PMCID: PMC8492863 DOI: 10.1007/s11357-021-00392-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023] Open
Abstract
Carotid artery stenosis (CAS) is a consequence of systemic atherosclerotic disease affecting the aging populations of the Western world. CAS is frequently associated with cognitive impairment. However, the mechanisms contributing to the development of vascular cognitive impairment (VCI) associated with CAS are multifaceted and not fully understood. In addition to embolization and decreased blood flow due to the atherosclerotic lesion in the carotid artery, microcirculatory dysfunction in the cerebral circulation also plays a critical role in CAS-related VCI. To better understand the microvascular contributions to cognitive decline associated with CAS and evaluate microvascular protective effects of therapeutic interventions, it is essential to examine the structural and functional changes of the microvessels in the central nervous system (CNS). However, there are some limitations of in vivo brain vascular imaging modalities. The retinal microvasculature provides a unique opportunity to study pathogenesis of cerebral small vessel disease and VCI, because the cerebral circulation and the retinal circulation share similar anatomy, physiology and embryology. Similar microvascular pathologies may manifest in the brain and the retina, thus ocular examination can be used as a noninvasive screening tool to investigate pathological changes in the CNS associated with CAS. In this review, ocular signs of CAS and the retinal manifestations of CAS-associated microvascular dysfunction are discussed. The advantages and limitation of methods that are capable of imaging the ocular circulation (including funduscopy, fluorescein angiography, Doppler sonography, optical coherence tomography [OCT] and optical coherence tomography angiography [OCTA]) are discussed. The potential use of dynamic retinal vessel analysis (DVA), which allows for direct visualization of neurovascular coupling responses in the CNS, for understanding microvascular contributions to cognitive decline in CAS patients is also considered.
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Affiliation(s)
- Lilla István
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary
| | - Cecilia Czakó
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary
| | - Ágnes Élő
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary
| | - Zsuzsanna Mihály
- Department of Vascular & Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Péter Sótonyi
- Department of Vascular & Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Andrea Varga
- Department of Vascular & Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Zoltán Ungvári
- Department of Biochemistry and Molecular Biology, Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Theoretical Medicine Doctoral School/Departments of Medical Physics and Informatics & Cell Biology and Molecular Medicine, University of Szeged, Szeged, Hungary
| | - Anna Csiszár
- Department of Biochemistry and Molecular Biology, Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Theoretical Medicine Doctoral School/Departments of Medical Physics and Informatics & Cell Biology and Molecular Medicine, University of Szeged, Szeged, Hungary
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Andriy Yabluchanskiy
- Department of Biochemistry and Molecular Biology, Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Shannon Conley
- Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Tamás Csipő
- Department of Biochemistry and Molecular Biology, Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Ágnes Lipecz
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary
- Department of Biochemistry and Molecular Biology, Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Department of Ophthalmology, Josa Andras Hospital, Nyiregyhaza, Hungary
| | - Illés Kovács
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary.
- Department of Ophthalmology, Weill Cornell Medical College, New York City, NY, USA.
- Department of Clinical Ophtalmology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary.
| | - Zoltán Zsolt Nagy
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary
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Brandt AH, Olesen JB, Moshavegh R, Jensen JA, Nielsen MB, Hansen KL. Common Carotid Artery Volume Flow: A Comparison Study between Ultrasound Vector Flow Imaging and Phase Contrast Magnetic Resonance Imaging. Neurol Int 2021; 13:269-278. [PMID: 34201493 PMCID: PMC8293467 DOI: 10.3390/neurolint13030028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/19/2021] [Accepted: 06/20/2021] [Indexed: 11/16/2022] Open
Abstract
Volume flow estimation in the common carotid artery (CCA) can assess the absolute hemodynamic effect of a carotid stenosis. The aim of this study was to compare a commercial vector flow imaging (VFI) setup against the reference method magnetic resonance phase contrast angiography (MRA) for volume flow estimation in the CCA. Ten healthy volunteers were scanned with VFI and MRA over the CCA. VFI had an improved precision of 19.2% compared to MRA of 31.9% (p = 0.061). VFI estimated significantly lower volume flow than MRA (mean difference: 63.2 mL/min, p = 0.017), whilst the correlation between VFI and MRA was strong (R2 = 0.81, p < 0.0001). A Bland–Altman plot indicated a systematic bias. After bias correction, the percentage error was reduced from 41.0% to 25.2%. This study indicated that a VFI setup for volume flow estimation is precise and strongly correlated to MRA volume flow estimation, and after correcting for the systematic bias, VFI and MRA become interchangeable.
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Affiliation(s)
- Andreas Hjelm Brandt
- Department of Diagnostic Radiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark; (M.B.N.); (K.L.H.)
- Correspondence:
| | | | | | - Jørgen Arendt Jensen
- Center for Fast Ultrasound Imaging, Department of Health Technology, Technical University of Denmark, 2800 Lyngby, Denmark;
| | - Michael Bachmann Nielsen
- Department of Diagnostic Radiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark; (M.B.N.); (K.L.H.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Kristoffer Lindskov Hansen
- Department of Diagnostic Radiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark; (M.B.N.); (K.L.H.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
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25
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Carotid Doppler Measurement Variability in Functional Hemodynamic Monitoring: An Analysis of 17,822 Cardiac Cycles. Crit Care Explor 2021; 3:e0439. [PMID: 34136821 PMCID: PMC8202589 DOI: 10.1097/cce.0000000000000439] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Carotid Doppler ultrasound is used as a measure of fluid responsiveness, however, assessing change with statistical confidence requires an adequate beat sample size. The coefficient of variation helps quantify the number of cardiac cycles needed to adequately detect change during functional hemodynamic monitoring. DESIGN Prospective, observational, human model of hemorrhage and resuscitation. SETTING Human physiology laboratory at Mayo Clinic. SUBJECTS Healthy volunteers. INTERVENTIONS Lower body negative pressure. MEASUREMENTS AND MAIN RESULTS We measured the coefficient of variation of the carotid artery velocity time integral and corrected flow time during significant cardiac preload changes. Seventeen-thousand eight-hundred twenty-two cardiac cycles were analyzed. The median coefficient of variation of the carotid velocity time integral was 8.7% at baseline and 11.9% during lowest-tolerated lower body negative pressure stage. These values were 3.6% and 4.6%, respectively, for the corrected flow time. CONCLUSIONS The median coefficient of variation values measured in this large dataset indicates that at least 6 cardiac cycles should be averaged before and after an intervention when using the carotid artery as a functional hemodynamic measure.
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26
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Is Doppler Echocardiography Adequate for Surgical Planning of Single Ventricle Patients? Cardiovasc Eng Technol 2021; 12:606-617. [PMID: 33931807 DOI: 10.1007/s13239-021-00533-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 03/12/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Surgical planning has shown great potential for optimizing outcomes for patients affected by single ventricle (SV) malformations. Phase-contrast magnetic resonance imaging (PC-MRI) is the routine technique used for flow acquisition in the surgical planning paradigm. However, PC-MRI may suffer from possible artifacts in certain cases; furthermore, this technology may not be readily available for patients in low and lower-middle-income countries. Therefore, this study aims to investigate the effectiveness of using Doppler echocardiography (echo-Doppler) for flow acquisitions of SV surgical planning. METHODS This study included eight patients whose blood flow data was acquired by both PC-MRI and echo-Doppler. A virtual surgery platform was used to generate two surgical options for each patient: (1) a traditional Fontan conduit and (2) a Y-graft. Computational fluid dynamics (CFD) simulations were conducted using the two flow acquisitions to assess clinically relevant hemodynamic metrics: indexed power loss (iPL) and hepatic flow distribution (HFD). RESULTS Differences exist in flow data acquired by PC-MRI and echo-Doppler, but no statistical significance was obtained. Flow fields, therefore, exhibit discrepancies between simulations using flow acquisitions by PC-MRI and echo-Doppler. In virtual surgery, the two surgical options were ranked based on these metrics. No difference was observed in the ranking of surgical options between using different flow acquisitions. CONCLUSION Doppler echocardiography is an adequate alternative approach to acquire flow data for SV surgical planning. This finding encourages broader usage of SV surgical planning with echo-Doppler when MRI may present artifacts or is not available, especially in low and lower-middle-income countries.
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27
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Kenny JÉS, Eibl AM, Parrotta M, Long BF, Eibl JK. The Feasibility of a Novel Index From a Wireless Doppler Ultrasound Patch to Detect Decreasing Cardiac Output in Healthy Volunteers. Mil Med 2021; 186:751-756. [PMID: 33499507 PMCID: PMC7832258 DOI: 10.1093/milmed/usaa248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/17/2020] [Accepted: 08/18/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction Early hemorrhage is often missed by traditional vital signs because of physiological reserve, especially in the young and healthy. We have developed a novel, wearable, wireless Doppler ultrasound patch that tracks real-time blood velocity in the common carotid artery. Materials and Methods We studied eight healthy volunteers who decreased their cardiac output using a standardized Valsalva maneuver. In all eight, we simultaneously monitored the velocity time integral (VTI) of the common carotid artery (using the ultrasound patch) as well as the descending aorta (using a traditional pulsed wave duplex imaging system); the descending aortic VTI was used as a surrogate for left ventricular stroke volume (SV). Additionally, in a subset of four, we simultaneously measured SV using a noninvasive pulse contour analysis device. Results From baseline to peak effect of Valsalva, there was a statistically significant fall in descending aortic and common carotid VTI of 37% (P = 0.0005) and 23% (P < 0.0001), respectively. Both values returned to baseline on recovery. Additionally, a novel index from the carotid ultrasound patch (i.e., the heart rate divided by the carotid artery VTI) detected a 10% fall in aortic VTI with high sensitivity and specificity (100% and 100%, respectively); this novel index also accurately detected a 10% decrease in SV as measured by the noninvasive SV monitor. The mean arterial pressure, measured by the noninvasive pulse contour device, did not correctly detect the fall in SV. Conclusion In summary, a novel index from a wireless Doppler ultrasound patch may be more sensitive and specific for detecting decreased cardiac output than standard vital signs in healthy volunteers.
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Affiliation(s)
- Jon-Émile S Kenny
- Health Sciences North Research Institute, Sudbury, ON P3E 2H2, Canada
| | - Andrew M Eibl
- Health Sciences North Research Institute, Sudbury, ON P3E 2H2, Canada
| | - Matthew Parrotta
- Health Sciences North Research Institute, Sudbury, ON P3E 2H2, Canada
| | - Bradley F Long
- Health Sciences North Research Institute, Sudbury, ON P3E 2H2, Canada.,Northern Ontario School of Medicine, Sudbury ON P3E 2C6, Canada
| | - Joseph K Eibl
- Health Sciences North Research Institute, Sudbury, ON P3E 2H2, Canada.,Northern Ontario School of Medicine, Sudbury ON P3E 2C6, Canada
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28
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Kenny JÉS, Munding CE, Eibl JK, Eibl AM, Long BF, Boyes A, Yin J, Verrecchia P, Parrotta M, Gatzke R, Magnin PA, Burns PN, Foster FS, Demore CEM. A novel, hands-free ultrasound patch for continuous monitoring of quantitative Doppler in the carotid artery. Sci Rep 2021; 11:7780. [PMID: 33833288 PMCID: PMC8032670 DOI: 10.1038/s41598-021-87116-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 03/22/2021] [Indexed: 12/19/2022] Open
Abstract
Quantitative Doppler ultrasound of the carotid artery has been proposed as an instantaneous surrogate for monitoring rapid changes in left ventricular output. Tracking immediate changes in the arterial Doppler spectrogram has value in acute care settings such as the emergency department, operating room and critical care units. We report a novel, hands-free, continuous-wave Doppler ultrasound patch that adheres to the neck and tracks Doppler blood flow metrics in the common carotid artery using an automated algorithm. String and blood-mimicking test objects demonstrated that changes in velocity were accurately measured using both manually and automatically traced Doppler velocity waveforms. In a small usability study with 22 volunteer users (17 clinical, 5 lay), all users were able to locate the carotid Doppler signal on a volunteer subject, and, in a subsequent survey, agreed that the device was easy to use. To illustrate potential clinical applications of the device, the Doppler ultrasound patch was used on a healthy volunteer undergoing a passive leg raise (PLR) as well as on a congestive heart failure patient at resting baseline. The wearable carotid Doppler patch holds promise because of its ease-of-use, velocity measurement accuracy, and ability to continuously record Doppler spectrograms over many cardiac and respiratory cycles.
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Affiliation(s)
- Jon-Émile S Kenny
- Health Sciences North Research Institute and the Northern Ontario School of Medicine, Sudbury, ON, Canada.
- Flosonics Medical, Sudbury, ON, Canada.
| | | | - Joseph K Eibl
- Health Sciences North Research Institute and the Northern Ontario School of Medicine, Sudbury, ON, Canada
- Flosonics Medical, Sudbury, ON, Canada
| | | | - Bradley F Long
- Health Sciences North Research Institute and the Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Aaron Boyes
- Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Jianhua Yin
- Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | | | | | | | | | - Peter N Burns
- Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - F Stuart Foster
- Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Christine E M Demore
- Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, ON, Canada.
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.
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Kenny JES, Cannesson M, Barjaktarevic I. Minimizing Measurement Variability in Carotid Ultrasound Evaluations. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:855-856. [PMID: 32833264 PMCID: PMC7902729 DOI: 10.1002/jum.15445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Jon-Emile S Kenny
- Health Sciences North Research Institute, Sudbury, Ontario, Canada
- Flosonics Medical, Sudbury, Ontario, Canada
| | - Maxime Cannesson
- Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Latham J, Hicks Y, Yang X, Setchi R, Rainer T. Stable Automatic Envelope Estimation for Noisy Doppler Ultrasound. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:465-481. [PMID: 32746225 DOI: 10.1109/tuffc.2020.3011823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Doppler ultrasound technology is widespread in clinical applications and is principally used for blood flow measurements in the heart, arteries, and veins. A commonly extracted parameter is the maximum velocity envelope. However, current methods of extracting it cannot produce stable envelopes in high noise conditions. This can limit clinical and research applications using the technology. In this article, a new method of automatic envelope estimation is presented. The method can handle challenging signals with high levels of noise and variable envelope shapes. Envelopes are extracted from a Doppler spectrogram image generated directly from the Doppler audio signal, making it less device-dependent than existing image-processing methods. The method's performance is assessed using simulated pulsatile flow, a flow phantom, and in vivo ascending aortic flow measurements and is compared with three state-of-the-art methods. The proposed method is the most accurate in noisy conditions, achieving, on average, for phantom data with signal-to-noise ratios (SNRs) below 10 dB, bias and standard deviation of 0.7% and 3.3% lower than the next-best performing method. In addition, a new method for beat segmentation is proposed. When combined, the two proposed methods exhibited the best performance using in vivo data, producing the least number of incorrectly segmented beats and 8.2% more correctly segmented beats than the next best performing method. The ability of the proposed methods to reliably extract timing indices for cardiac cycles across a range of signal quality is of particular significance for research and monitoring applications.
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31
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Kliewer MA, Dyke WB, Birch CW, Bagley AR. Respiratory Fluctuation of Peak Systolic Velocities in the Carotid Doppler Waveforms of Patients With Obstructive Airway Disease: Evidence of Pulsus Paradoxus With Experimental Validation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:359-367. [PMID: 32725845 DOI: 10.1002/jum.15410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/03/2020] [Accepted: 06/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To characterize fluctuations in peak systolic velocities (PSVs) in Doppler waveforms of the carotid artery in patients with and without obstructive airway disease and in volunteers subjected to incremental levels of airway resistance in an experimental model. METHODS The PSV variation in common carotid waveforms was measured in 100 patients who had had a carotid ultrasound examination and no respiratory or carotid disease. This was compared to that of patients who had this study during an admission for acute exacerbation of chronic obstructive pulmonary disease (COPD). The PSV variation was correlated with pulmonary function testing. In addition, 14 healthy volunteers were asked to breathe through 5 resistors. Simultaneous recordings were made of Doppler waveforms in the common carotid artery, cardiac activity, and respiration. Peak systolic velocity changes from inspiration to expiration were calculated. RESULTS Of the 100 patients without respiratory disease, the magnitude of the PSV variation averaged 6.3 cm/s. Of the 33 patients with COPD, the PSV variation averaged 16.5 cm/s. Nineteen of the 33 patients with COPD had concurrent pulmonary function testing; there was a statistically significant correlation between the PSV variation and forced vital capacity and forced expiratory volume indices. For the volunteers, mean velocity changes were 7.1, 6.6, 8.3, 15.1, and 16.1 cm/s for 0.00-, 2.15-, 3.27-, 3.58-, and 5.77-cm H2 O/L/s levels of breathing resistance, respectively. There was a statistically significant relationship between an increasing airway load and the decline in PSV during inspiration (P = .02). CONCLUSIONS The PSV variation is greater in patients with increased airway resistance. Similar changes are evident in volunteers breathing into resistors. These findings likely reflect pulsus paradoxus.
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Affiliation(s)
- Mark A Kliewer
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - William B Dyke
- University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | | | - Anjuli R Bagley
- Department of Radiology, University of Colorado-Denver, Aurora, Colorado, USA
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32
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Kenny JÉS. Functional Hemodynamic Monitoring With a Wireless Ultrasound Patch. J Cardiothorac Vasc Anesth 2021; 35:1509-1515. [PMID: 33597088 DOI: 10.1053/j.jvca.2021.01.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 01/19/2021] [Indexed: 02/07/2023]
Abstract
In this Emerging Technology Review, a novel, wireless, wearable Doppler ultrasound patch is described as a tool for resuscitation. The device is designed, foremost, as a functional hemodynamic monitor-a simple, fast, and consistent method for measuring hemodynamic change with preload variation. More generally, functional hemodynamic monitoring is a paradigm that helps predict stroke volume response to additional intravenous volume. Because Doppler ultrasound of the left ventricular outflow tract noninvasively measures stroke volume in realtime, it increasingly is deployed for this purpose. Nevertheless, Doppler ultrasound in this manner is cumbersome, especially when repeat assessments are needed. Accordingly, peripheral arteries have been studied and various measures from the common carotid artery Doppler signal act as windows to the left ventricle. Yet, handheld Doppler ultrasound of a peripheral artery is susceptible to human measurement error and statistical limitations from inadequate beat sample size. Therefore, a wearable Doppler ultrasound capable of continuous assessment minimizes measurement inconsistencies and smooths inherent physiologic variation by sampling many more cardiac cycles. Reaffirming clinical studies, the ultrasound patch tracks immediate SV change with excellent accuracy in healthy volunteers when cardiac preload is altered by various maneuvers. The wearable ultrasound also follows jugular venous Doppler, which qualitatively trends right atrial pressure. With further clinical research and the application of artificial intelligence, the monitoring modalities with this new technology are manifold.
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Kenny JS, Barjaktarevic I, Eibl AM, Parrotta M, Long BF, Eibl JK. A wearable carotid Doppler tracks changes in the descending aorta and stroke volume induced by end-inspiratory and end-expiratory occlusion: A pilot study. Health Sci Rep 2020; 3:e190. [PMID: 33033751 PMCID: PMC7534617 DOI: 10.1002/hsr2.190] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/28/2020] [Accepted: 08/18/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND AIMS To test the feasibility of a novel, wearable carotid Doppler ultrasound to track changes in cardiac output induced by end-inspiratory and end-expiratory occlusion tests. METHODS We observed the pattern of Doppler change of the common carotid artery during a simulated end-inspiratory and expiratory occlusion test (sEIOT/sEEOT) in 10, nonventilated, healthy subjects. Simultaneously, we measured the Doppler signal of the descending aorta using duplex ultrasound (Xario, Toshiba Medical Systems) and stroke volume (SV) using noninvasive pulse contour analysis (Clearsight, Edwards Lifesciences, Irvine, California). RESULTS During sEIOT, SV, maximum velocity time integral (VTI) of the descending aorta, and common carotid fell by 25.7% (P = .0131), 26.1% (P < .0001), and 18.5% (P < .0001), respectively. During sEEOT, SV, maximum VTI of the descending aorta, and common carotid rose by: 41.3% (P = .0051), 28.3% (P < .0001), and 41.6% (P < .0001), respectively. There was good correlation between change in aortic VTI and carotid VTI (r 2 = 0.79); SV and aortic VTI (r 2 = 0.82), and SV and carotid VTI (r 2 = 0.95).The coefficient of variation of the VTI measured by the Doppler patch was roughly 60% less than that of the duplex system. CONCLUSIONS The pattern of SV change induced by a sEIOT/sEEOT in nonmechanically ventilated volunteers is reflected in the common carotid artery and descending aorta. The VTI variability of the Doppler patch was less than that of the traditional, duplex Doppler.
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Affiliation(s)
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care, Department of MedicineDavid Geffen School of Medicine at UCLALos AngelesCalifornia
| | - Andrew M. Eibl
- Health Sciences North Research InstituteSudburyOntarioCanada
| | | | - Bradley F. Long
- Health Sciences North Research InstituteSudburyOntarioCanada
- Northern Ontario School of MedicineSudburyOntarioCanada
| | - Joseph K. Eibl
- Health Sciences North Research InstituteSudburyOntarioCanada
- Northern Ontario School of MedicineSudburyOntarioCanada
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Kenny JÉS, Barjaktarevic I. Timing and Measurement Variability Are Critical When Using Carotid Doppler to Infer Hemodynamics. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:3485-3486. [PMID: 32988668 DOI: 10.1016/j.ultrasmedbio.2020.08.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 08/14/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Jon-Émile S Kenny
- Health Sciences North Research Institute, Sudbury, ON, Canada; Flosonics Medical, Sudbury, ON, Canada.
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Kenny JÉS, Barjaktarevic I, Mackenzie DC, Eibl AM, Parrotta M, Long BF, Eibl JK. Diagnostic characteristics of 11 formulae for calculating corrected flow time as measured by a wearable Doppler patch. Intensive Care Med Exp 2020; 8:54. [PMID: 32940808 PMCID: PMC7498524 DOI: 10.1186/s40635-020-00339-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Change of the corrected flow time (Ftc) is a surrogate for tracking stroke volume (SV) in the intensive care unit. Multiple Ftc equations have been proposed; many have not had their diagnostic characteristics for detecting SV change reported. Further, little is known about the inherent Ftc variability induced by the respiratory cycle. MATERIALS AND METHODS Using a wearable Doppler ultrasound patch, we studied the clinical performance of 11 Ftc equations to detect a 10% change in SV measured by non-invasive pulse contour analysis; 26 healthy volunteers performed a standardized cardiac preload modifying maneuver. RESULTS One hundred changes in cardiac preload and 3890 carotid beats were analyzed. Most of the 11 Ftc equations studied had similar diagnostic attributes. Wodeys' and Chambers' formulae had identical results; a 2% change in Ftc detected a 10% change in SV with a sensitivity and specificity of 96% and 93%, respectively. Similarly, a 3% change in Ftc calculated by Bazett's formula displayed a sensitivity and specificity of 91% and 93%. FtcWodey had 100% concordance and an R2 of 0.75 with change in SV; these values were 99%, 0.76 and 98%, 0.71 for FtcChambers and FtcBazetts, respectively. As an exploratory analysis, we studied 3335 carotid beats for the dispersion of Ftc during quiet breathing using the equations of Wodey and Bazett. The coefficient of variation of Ftc during quiet breathing for these formulae were 0.06 and 0.07, respectively. CONCLUSIONS Most of the 11 different equations used to calculate carotid artery Ftc from a wearable Doppler ultrasound patch had similar thresholds and abilities to detect SV change in healthy volunteers. Variation in Ftc induced by the respiratory cycle is important; measuring a clinically significant change in Ftc with statistical confidence requires a large sample of beats.
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Affiliation(s)
- Jon-Émile S Kenny
- Health Sciences North Research Institute, Sudbury, ON, P3E 2H2, Canada.
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - David C Mackenzie
- Department of Emergency Medicine, Maine Medical Center, Portland, ME, USA.,Tufts University School of Medicine, Boston, MA, USA
| | - Andrew M Eibl
- Health Sciences North Research Institute, Sudbury, ON, P3E 2H2, Canada
| | - Matthew Parrotta
- Health Sciences North Research Institute, Sudbury, ON, P3E 2H2, Canada
| | - Bradley F Long
- Health Sciences North Research Institute, Sudbury, ON, P3E 2H2, Canada.,Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Joseph K Eibl
- Health Sciences North Research Institute, Sudbury, ON, P3E 2H2, Canada.,Northern Ontario School of Medicine, Sudbury, ON, Canada
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Zhang Y, Ge Z, Wang Y, Xu Z, Li J. Impact of different conditions of breath-holding on the results of renal artery Doppler sonography: A pilot study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:315-323. [PMID: 32363602 DOI: 10.1002/jcu.22843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 01/02/2020] [Accepted: 03/31/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To investigate the impact of different breath-holding conditions on the results of renal artery Doppler ultrasonography (RADS). METHODS In 45 healthy volunteers, we performed RADS examination during breath-holding while breathing naturally and after a deep inspiration. We measured and compared peak systolic flow velocity (PSV), end diastolic velocity (EDV), and resistance index (RI) of the right (RRA) and left (LRA) renal artery, and PSV, EDV, RI, acceleration time and acceleration index (AI) of the right and left interlobar arteries. RESULTS The RRA and LRA PSV were, respectively, 76 ± 13 cm/s and 77 ± 15 cm/s under natural breathing and 93 ± 18 cm/s and 89 ± 24 cm/s after deep inspiration (P ≤ .001). The RRA and LRA EDV were also greater at deep inspiration (P < .001 and P = .019, respectively). There was no significant difference in RRA or LRA RI. The PSV, RI, and AI of the right and left interlobar arteries were greater after deep inspiration (P ≤ .001), without difference in AI. CONCLUSION Breath-holding conditions may influence Doppler measurements of renal artery flow velocity and should be reported and taken into account.
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Affiliation(s)
- Yixuan Zhang
- Department of Ultrasound, Peking Union Medical College Hospital, Beijing, China
| | - Zhitong Ge
- Department of Ultrasound, Peking Union Medical College Hospital, Beijing, China
| | - Yahong Wang
- Department of Ultrasound, Peking Union Medical College Hospital, Beijing, China
| | - Zhonghui Xu
- Department of Ultrasound, Peking Union Medical College Hospital, Beijing, China
| | - Jianchu Li
- Department of Ultrasound, Peking Union Medical College Hospital, Beijing, China
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Validation of four-dimensional flow cardiovascular magnetic resonance for aortic stenosis assessment. Sci Rep 2020; 10:10569. [PMID: 32601326 PMCID: PMC7324609 DOI: 10.1038/s41598-020-66659-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 05/18/2020] [Indexed: 11/18/2022] Open
Abstract
The management of patients with aortic stenosis (AS) crucially depends on accurate diagnosis. The main aim of this study were to validate the four-dimensional flow (4D flow) cardiovascular magnetic resonance (CMR) methods for AS assessment. Eighteen patients with clinically severe AS were recruited. All patients had pre-valve intervention 6MWT, echocardiography and CMR with 4D flow. Of these, ten patients had a surgical valve replacement, and eight patients had successful transcatheter aortic valve implantation (TAVI). TAVI patients had invasive pressure gradient assessments. A repeat assessment was performed at 3–4 months to assess the remodelling response. The peak pressure gradient by 4D flow was comparable to an invasive pressure gradient (54 ± 26 mmHG vs 50 ± 34 mmHg, P = 0.67). However, Doppler yielded significantly higher pressure gradient compared to invasive assessment (61 ± 32 mmHG vs 50 ± 34 mmHg, P = 0.0002). 6MWT was associated with 4D flow CMR derived pressure gradient (r = −0.45, P = 0.01) and EOA (r = 0.54, P < 0.01) but only with Doppler EOA (r = 0.45, P = 0.01). Left ventricular mass regression was better associated with 4D flow derived pressure gradient change (r = 0.64, P = 0.04). 4D flow CMR offers an alternative method for non-invasive assessment of AS. In addition, 4D flow derived valve metrics have a superior association to prognostically relevant 6MWT and LV mass regression than echocardiography.
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Gehron J, Schuster M, Rindler F, Bongert M, Böning A, Krombach G, Fiebich M, Grieshaber P. Watershed phenomena during extracorporeal life support and their clinical impact: a systematic in vitro investigation. ESC Heart Fail 2020; 7:1850-1861. [PMID: 32530129 PMCID: PMC7373893 DOI: 10.1002/ehf2.12751] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/13/2020] [Accepted: 04/20/2020] [Indexed: 11/27/2022] Open
Abstract
Aims Extracorporeal life support (ECLS) during acute cardiac failure restores haemodynamic stability and provides life‐saving cardiopulmonary support. Unfortunately, all common cannulation strategies and remaining pulmonary blood flow increase left‐ventricular afterload and may favour pulmonary congestion. The resulting disturbed pulmonary gas exchange and a residual left‐ventricular action can contribute to an inhomogeneous distribution of oxygenated blood into end organs. These complex flow interactions between native and artificial circulation cannot be investigated at the bedside: only an in vitro simulation can reveal the underlying activities. Using an in vitro mock circulation loop, we systematically investigated the impact of heart failure, extracorporeal support, and cannulation routes on the formation of flow phenomena and flow distribution in the arterial tree. Methods and results The mock circulation loop consisted of two flexible life‐sized vascular models (aorta and vena cava) driven by two paracorporeal assist devices, resistance elements, and compliance reservoirs to mimic the circulatory system. Several large‐bore antegrade and retrograde access ports allowed connection to an ECLS system for extracorporeal support. With four degrees of extracorporeal support—that for cardiac failure, early recovery, late recovery, and weaning—we investigated aortic blood flow velocity, blood flow, and mixing zones using colour‐coded Doppler ultrasound in the aorta and its corresponding branches. Full retrograde extracorporeal support (3–4 L/min) perfused major portions of the aorta but did not reach the supra‐aortic branches and ascending aorta, resulting in an area in the thoracic aorta demonstrating nearly stagnant blood flow velocities during cardiogenic shock and early recovery (0 ± 4 cm/s; −10 ± 15 cm/s, respectively) confined by two watersheds at the aortic isthmus and renal artery origin. Even increased ECLS flow was unable to shift the watershed towards the aortic arch. Antegrade support resulted in homogeneous flow distribution during all stages of cardiac failure but created a markedly negative flow vector in the ascending aorta during cardiogenic shock and early recovery with increased afterload. Conclusions Our systematic fluid‐mechanical analysis confirms the clinical assumption that despite restoring haemodynamic stability, extracorporeal support generates an inhomogeneous distribution of oxygenated blood with an inadequate supply to end organs and increased left‐ventricular afterload with absent ventricular unloading. End‐organ supply may be monitored by near‐infrared spectroscopy, but an obviously non‐controllable watershed emphasizes the need for additional measures: pre‐pulmonary oxygenation with a veno‐arterial‐venous ECLS configuration can allow a transpulmonary passage of oxygenated blood, providing improved end‐organ supply.
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Affiliation(s)
- Johannes Gehron
- Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Rudolf-Buchheim-Str. 7, 35392, Giessen, Germany
| | - Maximilian Schuster
- Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Rudolf-Buchheim-Str. 7, 35392, Giessen, Germany
| | - Florian Rindler
- Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Rudolf-Buchheim-Str. 7, 35392, Giessen, Germany
| | - Markus Bongert
- Research Center for Biomedical Technology (BMT), University of Applied Sciences and Arts, Dortmund, Germany
| | - Andreas Böning
- Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Rudolf-Buchheim-Str. 7, 35392, Giessen, Germany
| | - Gabriele Krombach
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Giessen, Germany
| | - Martin Fiebich
- Division of Life Science Engineering, University of Applied Sciences, Giessen, Germany
| | - Philippe Grieshaber
- Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Rudolf-Buchheim-Str. 7, 35392, Giessen, Germany
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AIUM Practice Parameter for the Performance of Vascular Ultrasound Examinations for Postoperative Assessment of Hemodialysis Access. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:E39-E48. [PMID: 32162362 DOI: 10.1002/jum.15262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Tse CTF, Keir PJ. External Compression and Partial Ischemia Decrease Human Finger Flexor Tendon and Subsynovial Connective Tissue Relative Motion. J Orthop Res 2020; 38:1038-1044. [PMID: 31793674 DOI: 10.1002/jor.24540] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 10/14/2019] [Indexed: 02/04/2023]
Abstract
Cumulative shear strain of the subsynovial connective tissue (SSCT) surrounding finger flexor tendons plays a significant role in the development and progression of carpal tunnel syndrome. Biomechanical risk factors can alter tendon-SSCT shear strain but the effects of external mechanical compression and localized ischemia have yet to be investigated. In a laboratory study with 19 healthy participants, color Doppler ultrasound imaging was used to quantify relative motion between the flexor digitorum superficialis tendon and SSCT during repetitive finger flexion-extension under various conditions of external mechanical compression (palmar and forearm compression), ischemia and different movement speeds (0.75 and 1.25 Hz). Forearm compression reduced tendon displacement (baseline = 28.5 ± 4.1 mm vs. forearm = 27.0 ± 4.6 mm; p = 0.043) and showed a trend for reduced SSCT displacement, while palmar compression had no significant effects on tendon-SSCT motion. Compared with baseline, partial ischemia decreased SSCT displacement (baseline = 22.9 ± 3.3 mm vs. ischemia = 22.0 ± 3.3 mm; p = 0.015), while tendon displacement remained unchanged. In all experimental conditions, faster movements elicited greater tendon-SSCT relative motion. Our findings suggest that palmar compression may not negatively impact tendon-SSCT relative motion, but forearm compression may require further investigation. Localized ischemia in the forearm may alter the gliding conditions within the carpal tunnel and affect tendon-SSCT relative motion, which bridges an important gap between blood flow in the carpal tunnel and shear injury risk. These findings contribute to the growing body of literature, supporting the role that cumulative tendon-SSCT shear injury may have on the pathomechanics of carpal tunnel syndrome. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:1038-1044, 2020.
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Affiliation(s)
- Calvin T F Tse
- Motion Analysis and Biofeedback Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter J Keir
- Occupational Biomechanics Laboratory, Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
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Karabiyik Y, Avdal J, Ekroll IK, Fiorentini S, Torp H, Lovstakken L. Data-Adaptive 2-D Tracking Doppler for High-Resolution Spectral Estimation. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2020; 67:3-12. [PMID: 31449012 DOI: 10.1109/tuffc.2019.2937281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Spectral broadening in pulsed-wave Doppler caused by the transit-time effect deteriorates the frequency resolution and may cause overestimation of maximum velocities in high-velocity blood flow regions and for large beam-to-flow angles. Data-adaptive spectral estimators have been shown to provide improved frequency resolution, especially for small ensemble lengths, but offer little or no improvement when the transit-time effect dominates. In this work, a method is presented that combines a data-adaptive spectral estimation method, the power spectral Capon, and 2-D tracking Doppler to enable improved frequency resolution for both high and low velocities. For each velocity, a time signal is extracted by tracking scatterers over time and space to decrease the transit-time effect, and power spectral Capon is used for spectral estimation. The method is evaluated using simulations, flow phantom recordings, and recordings from healthy and stenotic carotid arteries. Simulation results showed that the spectral width was decreased by 60% compared to 2-D tracking Doppler for velocities around 2.3 m/s using 12 time samples. The reduction was estimated to be 66% using the flow phantom results for 0.85-m/s mean velocity. A 5-dB SNR gain was observed from the in vivo results compared with Welch's method. Computer simulations confirm that in the presence of velocity gradients or out-of-plane motion, the proposed method can be used to reduce spectral broadening by requiring shorter observation windows.
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Polak JF, Alessi-Chinetti JM, Kremkau FW. Doppler Velocity Estimates of Internal Carotid Artery Stenosis: Angle Correction Parallel to the Color Doppler Lumen Versus Parallel to the Artery Wall. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3211-3218. [PMID: 31124163 DOI: 10.1002/jum.15029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 04/25/2019] [Accepted: 05/03/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES We compared internal carotid artery Doppler peak systolic velocities (PSVs) measured with angle correction parallel to the artery wall (// wall) on grayscale images and parallel to the direction of blood flow (// flow) on color Doppler images. METHODS We studied 25 internal carotid lesions with PSVs higher than 125 cm/s. The PSVs were measured in the same imaging plane, at the stenosis orifice (0 cm) and at 0.5 and 1 cm downstream by both methods. Linear regression and correlation analyses were used to study the effects of the angle correction method on changes in PSVs as a function of the differences in angle adjustment and distance from the stenosis. RESULTS The 23 patients studied included 9 women and 14 men. There was a mean difference in absolute PSVs ± SD of -17.2 ± 29.5 cm/s (P < .008) between methods at the stenosis. The difference in the PSVs was associated with the angle difference between the flow jet and the artery wall (P < .01). At 1 cm from the stenosis, // flow PSVs were more strongly correlated with PSVs at the stenosis (r = 0.61; 95% confidence interval, 0.28, 0.82; P = .001) than // wall PSVs (r = 0.39; 95% confidence interval, -0.003, 0.68; P = .052). CONCLUSIONS Blood flow velocity measurements made with angle correction parallel to the direction of the color Doppler blood flow lumen remain more consistent with the distance from the stenosis than blood flow velocity measurements made with angle correction parallel to the outer artery walls.
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Affiliation(s)
- Joseph F Polak
- Department of Radiology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Jean M Alessi-Chinetti
- Department of Vascular Diagnostic Laboratory, Tufts Medical Center, Boston, Massachusetts, USA
| | - Frederick W Kremkau
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Estimation of valvular resistance of segmented aortic valves using computational fluid dynamics. J Biomech 2019; 94:49-58. [DOI: 10.1016/j.jbiomech.2019.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/18/2019] [Accepted: 07/09/2019] [Indexed: 12/29/2022]
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A Blood Flow Volume Linear Inversion Model Based on Electromagnetic Sensor for Predicting the Rate of Arterial Stenosis. SENSORS 2019; 19:s19133006. [PMID: 31288428 PMCID: PMC6651440 DOI: 10.3390/s19133006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/05/2019] [Accepted: 07/05/2019] [Indexed: 11/16/2022]
Abstract
This paper presents a mathematical model of measuring blood flow based on electromagnetic induction for predicting the rate of arterial stenosis. Firstly, an electrode sensor was used to collect the induced potential differences from human skin surface in a uniform magnetic field. Then, the inversion matrix was constructed by the weight function theory and finite element method. Next, the blood flow volume inversion model was constructed by combining the induction potential differences and inversion matrix. Finally, the rate of arterial stenosis was predicted based on mathematical relationship between blood flow and the area of arterial stenosis. To verify the accuracy of the model, a uniform magnetic field distribution of Helmholtz coil and a 3D geometric model of the ulnar artery of the forearm with different rates of stenosis were established in COMSOL, a finite element analysis software. Simulation results showed that the inversion model had high accuracy in the measurement of blood flow and the prediction of rate of stenosis, and is of great significance for the early diagnosis of arterial stenosis and other vessel diseases.
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Verde L, De Pietro G. A neural network approach to classify carotid disorders from Heart Rate Variability analysis. Comput Biol Med 2019; 109:226-234. [DOI: 10.1016/j.compbiomed.2019.04.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/18/2019] [Accepted: 04/27/2019] [Indexed: 12/17/2022]
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Maternal Venous Hemodynamic Dysfunction in Proteinuric Gestational Hypertension: Evidence and Implications. J Clin Med 2019; 8:jcm8030335. [PMID: 30862007 PMCID: PMC6462953 DOI: 10.3390/jcm8030335] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 02/26/2019] [Accepted: 03/05/2019] [Indexed: 01/21/2023] Open
Abstract
This review summarizes current knowledge from experimental and clinical studies on renal function and venous hemodynamics in normal pregnancy, in gestational hypertension (GH) and in two types of preeclampsia: placental or early-onset preeclampsia (EPE) and maternal or late-onset (LPE) preeclampsia, presenting at <34 weeks and ≥34 weeks respectively. In addition, data from maternal venous Doppler studies are summarized, showing evidence for (1) the maternal circulation functioning closer to the upper limits of capacitance than in non-pregnant conditions, with intrinsic risks for volume overload, (2) abnormal venous Doppler measurements obtainable in preeclampsia, more pronounced in EPE than LPE, however not observed in GH, and (3) abnormal venous hemodynamic function installing gradually from first to third trimester within unique pathways of general circulatory deterioration in GH, EPE and LPE. These associations have important clinical implications in terms of screening, diagnosis, prevention and management of gestational hypertensive diseases. They invite for further hypothesis-driven research on the role of retrograde venous congestion in the etiology of preeclampsia-related organ dysfunctions and their absence in GH, and also challenge the generally accepted view of abnormal placentation as the primary cause of preeclampsia. The striking similarity between abnormal maternal venous Doppler flow patterns and those observed at the ductus venosus and other abdominal veins of the intra-uterine growth restricted fetus, also invites to explore the role of venous congestion in the intra-uterine programming of some adult diseases.
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Hansen PM, Hansen KL, Pedersen MM, Lange T, Lönn L, Jensen JA, Nielsen MB. Atherosclerotic Lesions in the Superficial Femoral Artery (SFA) Characterized with Velocity Ratios using Vector Velocity Ultrasound. Ultrasound Int Open 2018; 4:E79-E84. [PMID: 30250942 PMCID: PMC6143374 DOI: 10.1055/a-0637-2437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 04/13/2018] [Accepted: 05/12/2018] [Indexed: 12/19/2022] Open
Abstract
Purpose Atherosclerotic arteries are challenging to evaluate quantitatively using spectral Doppler ultrasound because of the turbulent flow conditions that occur in relation to the atherosclerotic stenoses. Vector velocity ultrasound is angle independent and provides flow information, which could potentially improve the diagnosis of arterial stenoses. The purpose of the study is to distinguish significant stenoses in the superficial femoral artery (> 50% diameter reduction) from non-significant stenoses based on velocity ratios derived from the commercially available vector velocity ultrasound technique Vector Flow Imaging (VFI). Materials and Methods Velocity ratios (intrastenotic blood flow velocity divided by pre- or poststenotic velocity) from a total of 16 atherosclerotic stenoses and plaques in the superficial femoral artery of 11 patients were obtained using VFI. The stenosis degree, expressed as percentage diameter reduction of the artery, was determined from digital subtraction angiography and compared to the velocity ratios. Results A velocity ratio of 2.5 was found to distinguish clinically relevant stenoses with>50% diameter reduction from clinically non-relevant stenoses with<50% diameter reduction and the difference was statistically significant. Conclusion The study indicates that VFI is a potential future tool for the evaluation of arterial stenoses.
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Affiliation(s)
- Peter Møller Hansen
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Mads Møller Pedersen
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Theis Lange
- Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark.,Center for Statistical Sciences, Peking University, Beijing, China
| | - Lars Lönn
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Vascular Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jørgen Arendt Jensen
- Center for Fast Ultrasound Imaging, Dept. of Elec. Eng., Technical University of Denmark, Lyngby, Denmark
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48
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Bechsgaard T, Hansen KL, Brandt A, Moshavegh R, Forman JL, Føgh P, Klitfod L, Bækgaard N, Lönn L, Jensen JA, Nielsen MB. Evaluation of Peak Reflux Velocities with Vector Flow Imaging and Spectral Doppler Ultrasound in Varicose Veins. Ultrasound Int Open 2018; 4:E91-E98. [PMID: 30276359 PMCID: PMC6162191 DOI: 10.1055/a-0643-4430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/24/2018] [Accepted: 05/17/2018] [Indexed: 10/29/2022] Open
Abstract
Purpose Spectral Doppler ultrasound (SDUS) is used for quantifying reflux in lower extremity varicose veins. The technique is angle-dependent opposed to the new angle-independent Vector Flow Imaging (VFI) method. The aim of this study was to compare peak reflux velocities obtained with VFI and SDUS in patients with chronic venous disease, i. e., pathological retrograde blood flow caused by incompetent venous valves. Materials and Methods 64 patients with chronic venous disease were scanned with VFI and SDUS in the great or the small saphenous vein, and reflux velocities were compared to three assessment tools for chronic venous disease. A flow rig was used to assess the accuracy and precision of the two methods. Results The mean peak reflux velocities differed significantly (VFI: 47.4 cm/s vs. SDUS: 62.0 cm/s, p<0.001). No difference in absolute precision (p=0.18) nor relative precision (p=0.79) was found. No correlation to disease severity, according to assessment tools, was found for peak reflux velocities obtained with either method. In vitro, VFI was more accurate but equally precise when compared to SDUS. Conclusion Both VFI and SDUS detected the pathologic retrograde flow in varicose veins but measured different reflux velocities with equal precision. VFI may play a role in evaluating venous disease in the future.
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Affiliation(s)
| | | | - Andreas Brandt
- Copenhagen University Hospital Rigshospitalet, Department of Diagnostic Radiology, 2100 Copenhagen Oe, Denmark
| | - Ramin Moshavegh
- The Technical University of Denmark, Department of Electrical Engineering Center for Fast Ultrasound Imaging, 2800 Kgs. Lyngby, Denmark
| | - Julie Lyng Forman
- Copenhagen University, Department of Public Health Section of Biostatistics, 1014 Copenhagen K, Denmark
| | - Pia Føgh
- Copenhagen University Hospital Rigshospitalet, Department of Vascular Surgery Herlev & Gentofte Hospital, 2900 Hellerup, Denmark
| | - Lotte Klitfod
- Copenhagen University Hospital Rigshospitalet, Department of Vascular Surgery Herlev & Gentofte Hospital, 2900 Hellerup, Denmark
| | - Niels Bækgaard
- Copenhagen University Hospital Rigshospitalet, Department of Vascular Surgery Herlev & Gentofte Hospital, 2900 Hellerup, Denmark
| | - Lars Lönn
- Rigshospitalet, Copenhagen, DK, Radiology, Copenhagen, Denmark
| | - Jørgen Arendt Jensen
- Technical University of Denmark, Department of Electrical Engineering Center for Fast Ultrasound Imaging, 2800 Kgs. Lyngby, Denmark
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49
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Bechsgaard T, Hansen KL, Brandt AH, Moshavegh R, Forman JL, Føgh P, Klitfod L, Bækgaard N, Lönn L, Nielsen MB, Jensen JA. Respiratory variability of peak velocities in the common femoral vein estimated with vector flow imaging and Doppler ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:1941-1950. [PMID: 29960752 DOI: 10.1016/j.ultrasmedbio.2018.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 04/26/2018] [Accepted: 05/04/2018] [Indexed: 06/08/2023]
Abstract
Respiratory variability of peak velocities (RVPV) in the common femoral vein measured with ultrasound can reveal venous outflow obstruction. Pulse wave (PW) Doppler is the gold standard for venous velocity estimation of the lower extremities. PW Doppler measurements are angle dependent, whereas vector flow imaging (VFI) can yield angle-independent measures. The hypothesis of the present study was that VFI can provide RVPV estimations without the angle dependency of PW Doppler for an improved venous disease assessment. Sixty-seven patients with symptomatic chronic venous disease were included in the study. On average, VFI measured a lower RVPV than PW Doppler (VFI: 14.11 cm/s; PW: 17.32 cm/s, p = 0.002) with a non-significant improved precision compared with PW Doppler (VFI: 21.09%; PW: 26.49%, p = 0.08). In a flow phantom, VFI had improved accuracy (p < 0.01) and equal precision compared with PW Doppler. The study indicated that VFI can characterize the hemodynamic fluctuations in the common femoral vein.
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Affiliation(s)
- Thor Bechsgaard
- Department of Diagnostic Radiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen Ø, Denmark.
| | - Kristoffer Lindskov Hansen
- Department of Diagnostic Radiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Andreas Hjelm Brandt
- Department of Diagnostic Radiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Ramin Moshavegh
- Center for Fast Ultrasound Imaging, Department of Electrical Engineering, Technical University of Denmark, Lyngby, Denmark
| | - Julie Lyng Forman
- Section of Biostatistics, Department of Public Health, Copenhagen University, Copenhagen K, Denmark
| | - Pia Føgh
- Department of Vascular Surgery, Rigshospitalet & Gentofte Hospital - Copenhagen University Hospital, Hellerup, Denmark
| | - Lotte Klitfod
- Department of Vascular Surgery, Rigshospitalet & Gentofte Hospital - Copenhagen University Hospital, Hellerup, Denmark
| | - Niels Bækgaard
- Department of Vascular Surgery, Rigshospitalet & Gentofte Hospital - Copenhagen University Hospital, Hellerup, Denmark
| | - Lars Lönn
- Department of Diagnostic Radiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Michael Bachmann Nielsen
- Department of Diagnostic Radiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Jørgen Arendt Jensen
- Center for Fast Ultrasound Imaging, Department of Electrical Engineering, Technical University of Denmark, Lyngby, Denmark
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50
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Brandt AH, Hansen KL, Ewertsen C, Holbek S, Olesen JB, Moshavegh R, Thomsen C, Jensen JA, Nielsen MB. A Comparison Study of Vector Velocity, Spectral Doppler and Magnetic Resonance of Blood Flow in the Common Carotid Artery. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:1751-1761. [PMID: 29804906 DOI: 10.1016/j.ultrasmedbio.2018.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/26/2018] [Accepted: 05/01/2018] [Indexed: 06/08/2023]
Abstract
Magnetic resonance phase contrast angiography (MRA) is the gold standard for blood flow evaluation. Spectral Doppler ultrasound (SDU) is the first clinical choice, although the method is angle dependent. Vector flow imaging (VFI) is an angle-independent ultrasound method. The aim of the study was to compare VFI- and SDU-estimated peak systolic velocities (PSV) of the common carotid artery (CCA) with PSV obtained by MRA. Furthermore, intra- and inter-observer agreement was determined. MRA estimates were significantly different from SDU estimates (left CCA: p < 0.001, right CCA: p < 0.001), but not from VFI estimates (left CCA: p = 0.28, right CCA: p = 0.18). VFI measured lower PSV in both CCAs compared with SDU (p < 0.001) with improved precision (VFI: left: 24%, right: 18%; SDU: left 38%, right: 23%). Intra- and inter-observer agreement was almost perfect for VFI and SDU (inter-observer correlation coefficient: VFI 0.88, SDU 0.91; intra-observer correlation coefficient: VFI 0.96, SDU 0.97). VFI is more accurate than SDU in evaluating PSV compared with MRA.
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Affiliation(s)
- Andreas Hjelm Brandt
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | | | - Caroline Ewertsen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Simon Holbek
- Center for Fast Ultrasound Imaging, Department of Electrical Engineering, Technical University of Denmark, Lyngby, Denmark
| | - Jacob Bjerring Olesen
- Center for Fast Ultrasound Imaging, Department of Electrical Engineering, Technical University of Denmark, Lyngby, Denmark
| | - Ramin Moshavegh
- Center for Fast Ultrasound Imaging, Department of Electrical Engineering, Technical University of Denmark, Lyngby, Denmark
| | - Carsten Thomsen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Radiology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - Jørgen Arendt Jensen
- Center for Fast Ultrasound Imaging, Department of Electrical Engineering, Technical University of Denmark, Lyngby, Denmark
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