Cyclic changes in blood echogenicity under pulsatile flow are frequency dependent

Contrast Agent-Free Assessment of Blood Flow and Wall Shear Stress in the Rabbit Aorta using Ultrasound Image Velocimetry

Blood flow velocity and wall shear stress (WSS) influence and are influenced by vascular disease. Their measurement is consequently useful in the laboratory and clinic. Contrast-enhanced ultrasound image velocimetry (UIV) can estimate them accurately but the need to inject contrast agents limits utility. Singular value decomposition and high-frame-rate imaging may render contrast agents dispensable. Here we determined whether contrast agent-free UIV can measure flow and WSS. In simulation, accurate measurements were achieved with a signal-to-noise ratio of 13.5 dB or higher. Signal intensity in the rabbit aorta increased monotonically with mechanical index; it was lowest during stagnant flow and uneven across the vessel. In vivo measurements with contrast-free and contrast-enhanced UIV differed by 4.4% and 1.9% for velocity magnitude and angle and by 9.47% for WSS. Bland-Altman analysis of waveforms revealed good agreement between contrast-free and contrast-enhanced UIV. In five rabbits, the root-mean-square errors were as low as 0.022 m/s (0.81%) and 0.11 Pa (1.7%). This study indicates that with an optimised protocol, UIV can assess flow and WSS without contrast agents. Unlike contrast-enhanced UIV, contrast-free UIV could be routinely employed.

In vitro photoacoustic spectroscopy of pulsatile blood flow: Probing the interrelationship between red blood cell aggregation and oxygen saturation

We investigate the optical wavelength dependence in quantitative photoacoustic (QPA) assessment of red blood cell (RBC) aggregation and oxygen saturation (sO₂ ) during pulsatile blood flow. Experimentally, the pulsatile flow was imaged with a 700 to 900 nm laser using the VevoLAZR. Theoretically, the photoacoustic (PA) signals were computed based on a Green's function integrated with a Monte Carlo simulation of radiant fluence. The pulsatile flow created periodic conditions of RBC aggregation/nonaggregation, altering the aggregate size, and, in turn, the sO₂ . The dynamic range, DR (a metric of change in PA power) from 700 to 900 nm for nonaggregated RBCs, was 5 dB for both experiment and theory. A significant difference in the DR for aggregated RBCs was 1.5 dB between experiment and theory. Comparing the DR at different wavelengths, the DR from nonaggregated to aggregated RBCs at 700 nm was significantly smaller than that at 900 nm for both experiment (4.0 dB < 7.1 dB) and theory (5.3 dB < 9.0 dB). These results demonstrate that RBC aggregation simultaneously affects the absorber size and the absorption coefficient in photoacoustic imaging (PAI) of pulsatile blood flow. This investigation elucidates how QPA spectroscopy can be used for probing hemodynamics and oxygen transport by PAI of blood flow.

Quantitative Measurement of Erythrocyte Aggregation as a Systemic Inflammatory Marker by Ultrasound Imaging: A Systematic Review

This systematic review is aimed at answering two questions: (i) Is erythrocyte aggregation a useful biomarker in assessing systemic inflammation? (ii) Does quantitative ultrasound imaging provide the non-invasive option to measure erythrocyte aggregation in real time? The search was executed through bibliographic electronic databases CINAHL, EMB Review, EMBASE, MEDLINE, PubMed and the grey literature. The majority of studies correlated elevated erythrocyte aggregation with inflammatory blood markers for several pathologic states. Some studies used "erythrocyte aggregation" as an established marker of systemic inflammation. There were limited but promising articles regarding the use of quantitative ultrasound spectroscopy to monitor erythrocyte aggregation. Similarly, there were limited studies that used other ultrasound techniques to measure systemic inflammation. The quantitative measurement of erythrocyte aggregation has the potential to be a routine clinical marker of inflammation as it can reflect the cumulative inflammatory dynamics in vivo, is relatively simple to measure, is cost-effective and has a rapid turnaround time. Technologies like quantitative ultrasound spectroscopy that can measure erythrocyte aggregation non-invasively and in real time may offer the advantage of continuous monitoring of the inflammation state and, thus, may help in rapid decision making in a critical care setup.

Estimation of polydispersity in aggregating red blood cells by quantitative ultrasound backscatter analysis

Quantitative ultrasound techniques based on the backscatter coefficient (BSC) have been commonly used to characterize red blood cell (RBC) aggregation. Specifically, a scattering model is fitted to measured BSC and estimated parameters can provide a meaningful description of the RBC aggregates' structure (i.e., aggregate size and compactness). In most cases, scattering models assumed monodisperse RBC aggregates. This study proposes the Effective Medium Theory combined with the polydisperse Structure Factor Model (EMTSFM) to incorporate the polydispersity of aggregate size. From the measured BSC, this model allows estimating three structural parameters: the mean radius of the aggregate size distribution, the width of the distribution, and the compactness of the aggregates. Two successive experiments were conducted: a first experiment on blood sheared in a Couette flow device coupled with an ultrasonic probe, and a second experiment, on the same blood sample, sheared in a plane-plane rheometer coupled to a light microscope. Results demonstrated that the polydisperse EMTSFM provided the best fit to the BSC data when compared to the classical monodisperse models for the higher levels of aggregation at hematocrits between 10% and 40%. Fitting the polydisperse model yielded aggregate size distributions that were consistent with direct light microscope observations at low hematocrits.

Protocol for Robust In Vivo Measurements of Erythrocyte Aggregation Using Ultrasound Spectroscopy

Erythrocyte aggregation is a non-specific marker of acute and chronic inflammation. Although it is usual to evaluate this phenomenon from blood samples analyzed in laboratory instruments, in vivo real-time assessment of aggregation is possible with spectral ultrasound techniques. However, variable blood flow can affect the interpretation of acoustic measures. Therefore, flow standardization is required. Two techniques of flow standardization were evaluated with porcine and equine blood samples in Couette flow. These techniques consisted in either stopping the flow or reducing it. Then, the sensibility and repeatability of the retained method were evaluated in 11 human volunteers. We observed that stopping the flow compromised interpretation and repeatability. Conversely, maintaining a low flow provided repeatable measures and could distinguish between normal and high extents of erythrocyte aggregation. Agreement was observed between in vivo and ex vivo measures of the phenomenon (R² = 82.7%, p value < 0.0001). These results support the feasibility of assessing in vivo erythrocyte aggregation in humans by quantitative ultrasound means.

Measurement of the Doppler power of flowing blood using ultrasound Doppler devices

Measurement of the Doppler power of signals backscattered from flowing blood (henceforth referred to as the Doppler power of flowing blood) and the echogenicity of flowing blood have been used widely to assess the degree of red blood cell (RBC) aggregation for more than 20 y. Many studies have used Doppler flowmeters based on an analogue circuit design to obtain the Doppler shifts in the signals backscattered from flowing blood; however, some recent studies have mentioned that the analogue Doppler flowmeter exhibits a frequency-response problem whereby the backscattered energy is lost at higher Doppler shift frequencies. Therefore, the measured Doppler power of flowing blood and evaluations of RBC aggregation obtained using an analogue Doppler device may be inaccurate. To overcome this problem, the present study implemented a field-programmable gate array-based digital pulsed-wave Doppler flowmeter to measure the Doppler power of flowing blood, in the aim of providing more accurate assessments of RBC aggregation. A clinical duplex ultrasound imaging system that can acquire pulsed-wave Doppler spectrograms is now available, but its usefulness for estimating the ultrasound scattering properties of blood is still in doubt. Therefore, the echogenicity and Doppler power of flowing blood under the same flow conditions were measured using a laboratory pulser-receiver system and a clinical ultrasound system, respectively, for comparisons. The experiments were carried out using porcine blood under steady laminar flow with both RBC suspensions and whole blood. The experimental results indicated that a clinical ultrasound system used to measure the Doppler spectrograms is not suitable for quantifying Doppler power. However, the Doppler power measured using a digital Doppler flowmeter can reveal the relationship between backscattering signals and the properties of blood cells because the effects of frequency response are eliminated. The measurements of the Doppler power and echogenicity of flowing blood were compared with those obtained in several previous studies.

Multiple-site hemodynamic analysis of Doppler ultrasound with an adaptive color relation classifier for arteriovenous access occlusion evaluation

This study proposes multiple-site hemodynamic analysis of Doppler ultrasound with an adaptive color relation classifier for arteriovenous access occlusion evaluation in routine examinations. The hemodynamic analysis is used to express the properties of blood flow through a vital access or a tube, using dimensionless numbers. An acoustic measurement is carried out to detect the peak-systolic and peak-diastolic velocities of blood flow from the arterial anastomosis sites (A) to the venous anastomosis sites (V). The ratio of the supracritical Reynolds (Re(supra)) number and the resistive (Res) index quantitates the degrees of stenosis (DOS) at multiple measurement sites. Then, an adaptive color relation classifier is designed as a nonlinear estimate model to survey the occlusion level in monthly examinations. For 30 long-term follow-up patients, the experimental results show the proposed screening model efficiently evaluates access occlusion.

Improvement of ultrasound speckle image velocimetry using image enhancement techniques

Ultrasound-based techniques have been developed and widely used in noninvasive measurement of blood velocity. Speckle image velocimetry (SIV), which applies a cross-correlation algorithm to consecutive B-mode images of blood flow has often been employed owing to its better spatial resolution compared with conventional Doppler-based measurement techniques. The SIV technique utilizes speckles backscattered from red blood cell (RBC) aggregates as flow tracers. Hence, the intensity and size of such speckles are highly dependent on hemodynamic conditions. The grayscale intensity of speckle images varies along the radial direction of blood vessels because of the shear rate dependence of RBC aggregation. This inhomogeneous distribution of echo speckles decreases the signal-to-noise ratio (SNR) of a cross-correlation analysis and produces spurious results. In the present study, image-enhancement techniques such as contrast-limited adaptive histogram equalization (CLAHE), min/max technique, and subtraction of background image (SB) method were applied to speckle images to achieve a more accurate SIV measurement. A mechanical sector ultrasound scanner was used to obtain ultrasound speckle images from rat blood under steady and pulsatile flows. The effects of the image-enhancement techniques on SIV analysis were evaluated by comparing image intensities, velocities, and cross-correlation maps. The velocity profiles and wall shear rate (WSR) obtained from RBC suspension images were compared with the analytical solution for validation. In addition, the image-enhancement techniques were applied to in vivo measurement of blood flow in human vein. The experimental results of both in vitro and in vivo SIV measurements show that the intensity gradient in heterogeneous speckles has substantial influence on the cross-correlation analysis. The image-enhancement techniques used in this study can minimize errors encountered in ultrasound SIV measurement in which RBCs are used as flow tracers instead of exogenous contrast agents.

High spatial and temporal resolution observations of pulsatile changes in blood echogenicity in the common carotid artery of rats

Previous studies have found that ultrasound backscatter from blood in vascular flow systems varies under pulsatile flow, with the maximum values occurring during the systolic period. This phenomenon is of particular interest in hemorheology because it is contrary to the well-known fact that red blood cell (RBC) aggregation, which determines the intensity of ultrasound backscatter from blood, decreases at a high systolic shear rate. In the present study, a rat model was used to provide basic information on the characteristics of blood echogenicity in arterial blood flow to investigate the phenomenon of RBC aggregation under pulsatile flow. Blood echogenicity in the common carotid arteries of rats was measured using a high-frequency ultrasound imaging system with a 40-MHz probe. The electrocardiography-based kilohertz visualization reconstruction technique was employed to obtain high-temporal-resolution and high-spatial-resolution time-course B-mode cross-sectional and longitudinal images of the vessel. The experimental results indicate that blood echogenicity in rat carotid arteries varies during a cardiac cycle. Blood echogenicity tends to decrease during early systole and reaches its peak during late systole, followed by a slow decline thereafter. The time delay of the echogenicity peak from peak systole in the present results is the main difference from previous in vitro and in vivo observations of backscattering peaks during early systole, which may be caused by the very rapid heart rates and low RBC aggregation tendency of rats compared with humans and other mammalian species. The present study may provide useful information elucidating the characteristics of RBC aggregation in arterial blood flow.

The effect of flow acceleration on the cyclic variation of blood echogenicity under pulsatile flow

It has been shown that the echogenicity of blood varies during a flow cycle under pulsatile flow both in vitro and in vivo. In general, the echogenicity of flowing whole blood increases during the early systole phase and then reduces to a minimum at late diastole. While it has been postulated that this cyclic variation is associated with the dynamics of erythrocyte aggregation, the mechanisms underlying this increasing echogenicity with flow velocity remain uncertain. The effect of flow acceleration has also been proposed as an explanation for this phenomenon, but no specific experiments have been conducted to test this hypothesis. In addition, the influence of ultrasonic attenuation on the cyclic variation of echogenicity requires clarification. In the present study, a Couette flow system was designed to simulate blood flowing with different acceleration patterns, and the flow velocity, attenuation, and backscattering coefficient were measured synchronously from 20%- and 40%-hematocrit porcine whole blood and erythrocyte suspensions using 35-MHz ultrasound transducers. The results showed ultrasonic attenuation exerted only minor effects on the echogenicity of blood under pulsatile flow conditions. Cyclic variations of echogenicity were clearly observed for whole blood with a hematocrit of 40%, but no variations were apparent for erythrocyte suspensions. The echogenicity did not appear to be enhanced when instantaneous acceleration was applied to flowing blood in any case. These findings show that flow acceleration does not promote erythrocyte aggregation, even when a higher peak velocity is applied to the blood. Comparison of the results obtained with different accelerations revealed that the cyclic variation in echogenicity observed during pulsatile blood flow may be jointly attributable to the effect of shear rate and the distribution of erythrocyte on aggregation.

The acute effects of smoking on the cyclic variations in blood echogenicity of carotid artery

The objective of this research is to study the cyclic variations in echogenicity (CVE) as an acute response to smoking. CVEs, caused by the aggregation of red blood cells (RBC) were measured from the cross-sectional images of the common carotid artery using coded harmonic imaging of a commercial ultrasound system. The amplitude of the CVE (A(cve)) was analyzed among 28 smokers before and after smoking. A(cve) was increased in 22 smokers and decreased in six smokers after 1-2 cigarettes were smoked. Heart rate (HR) was also estimated from the ultrasonic images before and after smoking. The smokers were optimally divided into two clusters with respect to the change in A(cve) and the intrinsic characteristics of smokers (i.e., daily consumed cigarettes and smoking years) through a two-step cluster analysis (TSCA). The increase in A(cve) after smoking was significantly higher in the heavy smoker cluster compared with the light smoker cluster. The results suggest that the acute changes in A(cve) in response to smoking are different between heavy smokers and light smokers. This preliminary study demonstrates the potential application of coded harmonic ultrasound imaging to detect or characterize RBC aggregation. In addition, the results may be useful for understanding the acute physiologic changes caused by smoking.

Ultrasonic attenuation and backscatter from flowing whole blood are dependent on shear rate and hematocrit between 10 and 50 MHz

Ultrasonic backscatter has recently been used extensively to investigate erythrocyte aggregation, which is an inherent hematological phenomenon in the blood circulation system. The size of rouleaux can be estimated by measuring certain parameters of signals backscattered from flowing blood. However, most measurements of backscatter from blood use a constant value for the attenuation coefficient to compensate for the loss of ultrasound energy. This correction may be inaccurate because the attenuation varies with the blood properties, which prompted us to explore the effects of hemodynamic properties on ultrasonic attenuation and backscatter to better understand the blood rheological behaviors. Experiments were performed on porcine whole blood in a Couette flow apparatus. Ultrasonic attenuation and the backscattering coefficient of blood were measured at various frequencies (from 10 to 50 MHz), hematocrits (from 0 to 60%), and shear rates (from 0.1 to 200 s⁻¹). The results indicated that the attenuation and backscattering coefficients of blood are highly variable, depending in a complex manner on shear rate, hematocrit, and the measurement ultrasound frequency. The attenuation of blood decreased rapidly with increasing shear rates, eventually reaching a steady state asymptotically, and increased linearly with the hematocrit from 10 to 50 MHz at various shear rates, and also with the ultrasound frequency. The effect of erythrocyte aggregation means that the change in ultrasonic attenuation in blood with shear rate may be attributed to the absorption mechanism, which is enhanced by the increased blood viscosity at lower shear rates. Compensating the measured backscattering coefficients of blood for the shear-rate-dependent attenuation coefficient increased the accuracy of erythrocyte aggregation assessments. Together, the experimental results suggest that the shear-rate-dependent attenuation coefficient should be considered in future developments of ultrasonic technologies for characterizing blood rheology when the ultrasound frequency is higher than 20 MHz.

Cyclic and radial variation of the echogenicity of blood in human carotid arteries observed by harmonic imaging

To better understand the characteristics of erythrocyte aggregation in flowing blood, echogenicity variation in blood was observed both in vitro and in vivo. However, few noninvasive observations of blood echogenicity variation during the cardiac cycle in human arteries have been reported. In the present study, to reduce the dynamic range between the blood vessel lumen and the surrounding tissue, coded harmonic images were acquired from human carotid arteries using a GE LOGIQ 700 Expert system (GE, Milwaukee, WI, USA) with an M12L probe, which enabled the noninvasive detection of the cyclic and radial variation of echogenicity in arterial vessels. It was found that blood echogenicity increased during systole, reaching a maximum at peak systole and then decreased to a weak level during diastole. The echogenicity profiles of blood along the vessel diameter were found to be approximately parabolic in the cardiac cycle, except for the hypoechoic zone near the center of the vessel at peak systole. The present results for human carotid arteries corroborate previous in vitro observations that showed a cyclic and radial variation of blood echogenicity, which was thought to be caused by the enhancement of erythrocyte aggregation due to the combined effects of flow acceleration and shear rate during systole.

Ultrasound characterization of red blood cell aggregation with intervening attenuating tissue-mimicking phantoms

The analysis of the ultrasonic frequency-dependent backscatter coefficient of aggregating red blood cells reveals information about blood structural properties. The difficulty in applying this technique in vivo is due to the frequency-dependent attenuation caused by intervening tissue layers that distorts the spectral content of signals backscattered by blood. An optimization method is proposed to simultaneously estimate tissue attenuation and blood structure properties, and was termed the structure factor size and attenuation estimator (SFSAE). An ultrasound scanner equipped with a wide-band 25 MHz probe was used to insonify porcine blood sheared in both Couette and tubular flow devices. Since skin is one of the most attenuating tissue layers during in vivo scanning, four skin-mimicking phantoms with different attenuation coefficients were introduced between the transducer and the blood flow. The SFSAE gave estimates with relative errors below 25% for attenuations between 0.115 and 0.411 dBMHz and kR<2.08 (k being the wave number and R the aggregate radius). The SFSAE can be useful to examine in vivo and in situ abnormal blood conditions suspected to promote pathophysiological cardiovascular consequences.

Cyclic variations of high-frequency ultrasonic backscattering from blood under pulsatile flow

It was shown previously that ultrasonic scattering from whole blood varies during the flow cycle under pulsatile flow both in vitro and in vivo. It has been postulated that the cyclic variations of the backscattering signal are associated with red blood cell (RBC) aggregation in flowing whole blood. To obtain a better understanding of the relationship between blood backscattering and RBC aggregation behavior for pulsatile flowing blood, the present study used high-frequency ultrasound to characterize blood properties. The backscattering signals from both whole blood and an RBC suspension at different peak flow velocities (from 10 to 30 cm/s) and hematocrits (20% and 40%) under pulsatile flow (stroke rate of 20 beats/min) were measured with 3 single-element transducers at frequencies of 10, 35, and 50 MHz in a mock flow loop. To avoid the frequency response problem of a Doppler flowmeter, the integrated backscatter (IB) and flow velocity as functions of time were calculated directly using RF signals from flowing blood. The experimental results showed that cyclic variations of the IB curve were clearly observed at a low flow velocity and a hematocrit of 40% when using 50 MHz ultrasound, and that these variations became weaker as the peak flow velocity increased. However, these cyclic variations were detected only at 10 cm/s when using 10 MHz ultrasound. These results demonstrate that a high flow velocity can stop the formation of rouleaux and that a high hematocrit can promote RBC aggregation to produce cyclic variations of the backscattering signal under pulsatile flow. In addition, slight cyclic variations of the IB curve for an RBC suspension were observed at 35 and 50 MHz. Furthermore, the peak of the IB curve from whole blood led the peak of the velocity waveform when using high-frequency ultrasound, which could be explained by the assumption that a rapid flow can promote RBC aggregation under pulsatile flow. Together, the experimental results showed that the sensitivity and resolution of detecting blood properties are higher for 50 MHz ultrasound than for 10 MHz ultrasound.

Monte Carlo study on ultrasound backscattering by three-dimensional distributions of red blood cells

A Monte Carlo study on ultrasound backscattering by red blood cells (RBCs) is presented for three-dimensional (3D) distributions of particles. The cells were treated as classical spherical particles and accordingly, the Boltzmann distribution was considered to describe probability distribution of energy states of a system composed of such particles. The well-known Metropolis algorithm can generate configurations according to that probability distribution and therefore, was employed in this study to simulate some realizations of both nonaggregating and aggregating RBCs. The study of nonaggregating particles was motivated to compare simulations with existing experimental results and consequently, to validate the model. In the case of aggregating RBCs, the interaction potential between cells was modeled with the Morse potential and the frequency-dependent backscattering coefficient (BSC) was investigated at different hematocrits (H, particle volume fractions). The impact of aggregation potential on the spectral slope (SS) was also evaluated. It is shown that BSC increased as the magnitude of aggregating potential was raised and the effect was more pronounced at higher hematocrits. Moreover, spectral slopes at nonaggregating and low aggregating conditions were found to be around 4, which is consistent with the Rayleigh scattering theory. However, it had diminished significantly, particularly at higher hematocrits as the magnitude of the attractive potential energy was raised. For instance, at H=40% SS dropped from 4.04 for nonaggregating particles to 3.62 at the highest aggregating potential considered in this study. Our results suggest that this 3D model is capable of reflecting the effects of RBC aggregation on BSC and SS.