The effect of hemodynamics, vessel wall compliance and hematocrit on ultrasonic Doppler power: an in vitro study

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.

Brain-Sparing in Intrauterine Growth Restriction: Considerations for the Neonatologist

Intrauterine growth restriction (IUGR) is most commonly caused by placental insufficiency, in response to which the fetus adapts its circulation to preserve oxygen and nutrient supply to the brain ('brain-sparing'). Currently, little is known about the postnatal course and consequences of this antenatal adaptation of the cerebral circulation. The altered cerebral haemodynamics may persist after birth, which would imply a different approach with regard to cerebral monitoring and clinical management of IUGR preterm neonates than their appropriately grown peers. Few studies are available with regard to this topic, and the small body of evidence shows controversy. This review discusses the cerebral circulatory adaptations of IUGR fetuses and appraises the available literature on their postnatal cerebral circulation with potential clinical consequences.

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.

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.

Fourier Analysis of the Envelope of the Ophthalmic Artery Blood Flow Velocity

The harmonic content of the envelope waveform of the blood flow velocity in the ophthalmic artery was analyzed in aging and arterial hypertension. The case-control study enrolled 98 healthy men (age: 44.0±15.6 years), 100 healthy women (age: 44.5±19.1 years), which is group 1, and overall 199 hypertensive patients with increased systolic and diastolic blood pressure (in millimeters of mercury) before registration of the blood flow velocity using pulsed Doppler sonography. Group 2 was sufficiently treated (≤140/≤90), group 3 (>140/≤90) and group 5 (>140/>90) were insufficiently treated, and group 4 (>140/≤90) and group 6 (>140/>90) were untreated. Cronbach-α reliability of the calculated spectral coefficient and SI (SI) was 0.88 and 0.93, respectively. In control subjects, the SI was influenced by age (men: 45.1%; women: 50.2%; P <0.001 each) and in women additionally by mean arterial pressure (13.1%; P <0.001). The SI differed in subjects >43 years of age (men: 0.37±0.11; women: 0.26±0.08; P <0.001 each) as compared with subjects ≤43 years of age (men: 0.60±0.18; women: 0.48±0.13). All of these changes were lacking for the resistance index. In both men and women with hypertension, the SI decreases, whereas the mean arterial pressure increases, but the resistance index did not change. The SI of the ophthalmic artery allows an assessment of the ocular circulation in consideration of age and arterial blood pressure in contrast to the resistance index.

Physical properties of tissues relevant to arterial ultrasound imaging and blood velocity measurement

A review was undertaken of physical phenomena and the values of associated physical quantities relevant to arterial ultrasound imaging and measurement. Arteries are multilayered anisotropic structures. However, the requirement to obtain elasticity measurements from the data available using ultrasound imaging necessitates the use of highly simplified constitutive models involving Young's modulus, E. Values of E are reported for healthy arteries and for the constituents of diseased arteries. It is widely assumed that arterial blood flow is Newtonian. However, recent studies suggest that non-Newtonian behavior has a strong influence on arterial flow, and the balance of published evidence suggests that non-Newtonian behavior is associated primarily with red cell deformation rather than with aggregation. Hence, modeling studies should account for red cell deformation and the shear thinning effect that this produces. Published literature in healthy adults gives an average hematocrit and high-shear viscosity of 0.44 +/- 0.03 and 3.9 +/- 0.6 mPa.s, respectively. Published data on the acoustic properties of arteries and blood is sufficiently consistent between papers to allow compilation and derivation of best-fit equations summarizing the behavior across a wide frequency range, which then may be used in future modeling studies. Best-fit equations were derived for the attenuation coefficient vs. frequency in whole arteries (R(2) = 0.995), plasma (R(2) = 0.963) and blood with hematocrit near 45% (R(2) = 0.999), and for the backscatter coefficient vs. frequency from blood with hematocrit near 45% (R(2) = 0.958).

Evaluation of quantified contrast-enhanced color and power Doppler ultrasonography for the assessment of vascularity and perfusion of naturally occurring tumors in dogs

OBJECTIVE

To investigate subjective and computerized methods of evaluation of color Doppler (CD) and power Doppler (PD) ultrasonographic images (obtained before and after administration of contrast medium) for quantitative assessment of vascularity and perfusion of various naturally occurring tumors in dogs.

SAMPLE POPULATION

34 tumors in 34 dogs.

PROCEDURE

Tumors in dogs were examined via CD and PD ultrasonography before and after i.v. injection of a microbubble contrast agent (pre- and postcontrast examinations, respectively). Images were digitized for subjective assessment of vessel density and vascular pattern and computer-aided assessment of parameters of vascularity (fractional area [FA]) and perfusion (color-weighted FA [CWFA] and mean color-weighted FA [CWFA] and mean color level).

RESULTS

With both analysis methods, more vessels were identified in precontrast PD ultrasonographic images than in precontrast CD ultrasonographic images. Moreover, compared with values for precontrast PD ultrasonography, FA, CWFA, and mean color level were higher for postcontrast PD ultrasonography. In postcontrast images, there was a significant association between vessel densities determined through subjective and computerized assessments. Although sample size was small, vascularity of squamous cell carcinomas was significantly greater than that of other tumor types. Ten of the 19 softer than issue that sarcomas had low vessel density with minor contrast enhancement. With increasing gross tumor volume, FA and CWFA decreased for all Doppler ultrasonographic methods.

CONCLUSIONS AND CLINICAL RELEVANCE

Higher values of the ultrasonographic parameters representing vascularity and perfusion of tumors in dogs were determined via PD ultrasonography after administration of contrast medium than via PD or CD ultrasonography without administration of contrast medium.

Cyclic and radial variation of the Doppler power from porcine whole blood

The Doppler power from porcine blood was observed in a mock flow loop to have cyclic and radial variation during a pulsatile cycle. It was found to decrease with shear rate under steady flow, except near the center of the tube at which other mechanisms such as the effects of radial distribution on the rouleaux might be involved. Under pulsatile flow, the timing of the peak of the Doppler power measured at the center of the tube became closer to the peak systole from 20 to 60 beats/minute (BPM), and the power and velocity peaks coincided at 60 BPM. The overall radial variation of the Doppler power during a whole pulsatile cycle was prominent due to the increase of shear rate from the center to 4.5 mm radial position within a tube of 6.35 mm radius. The cyclic variation of the Doppler power varied with the radial position, being relatively large at the center, reaching a minimum at an intermediate radial position, and increasing again near the wall. The peak of the Doppler power occurred at early systole near the tube wall and lagged the flow closer to the center. The "black hole" phenomenon was observed only over portions of the flow cycle. All these complex variations of the Doppler power across the tube over a cycle are thought to be the result of red cell aggregation, which can be affected by shear rate and acceleration.

Doppler power variation from porcine blood under steady and pulsatile flow

Although a number of recent studies have demonstrated that the echogenicity of blood varies as a function of time under pulsatile flow, the fundamental mechanisms responsible for it are still uncertain. To better understand this phenomenon, the Doppler power from porcine blood and polystyrene microsphere suspensions was measured at the center of the tube as functions of two crucial parameters, flow velocity and stroke rate (for pulsatile flow), under steady and pulsatile flow in a mock flow loop. In the present study, the experimental results were obtained with a 10-MHz pulsed Doppler system with a frequency response estimated more accurately by electronic injection, and validated by comparing to the radiofrequency (RF) signal acquired from the same Doppler instrument. The results show that the Doppler power from microspheres and porcine red blood cell (RBC) suspensions did not vary appreciably (< 2 dB), with either the speed or stroke rate (for pulsatile flow only) under steady and pulsatile flow. It was found that the Doppler power from porcine whole blood under steady flow decreased with the speed by approximately 13 dB from 3 to 33 cm/s and was only 3 dB higher than that from RBC suspension at 33 cm/s, suggesting minimal RBC aggregation in whole blood at this speed. The apparent cyclic variation from whole blood was observed at 20 and 40 beats/min (BPM). The cyclic variation became more obvious as the speed and stroke rate decreased. The mean Doppler power over a cycle increased as the peak speed decreased. The Doppler power reached a maximum near peak systole and a minimum at late diastole at the center of the tube. This pattern cannot be explained by RBC aggregation due to the shear rate alone, and may be attributed to acceleration and deceleration along with aggregation. The cyclic variation was not observed at 60 BPM, probably because of a lack of time for aggregation to occur.

Power Doppler-derived speckle tracking image of intraventricular flow in patients with anterior myocardial infarction: correlation with left ventricular thrombosis

The abnormal spatial distribution of intraventricular flow is superior to clinical and two-dimensional (2-D) echocardiographic variables in predicting left ventricular thrombosis after myocardial infarction. Echocardiography was prospectively performed in 79 patients within 72 h after anterior wall myocardial infarction onset and repeated before discharge. The apical rotating flow pattern in color flow map was recognized as abnormal. By power Doppler echocardiography, the moving blood could generate speckle tracking images to delineate the intraventricular flow. A swirling flow pattern indicating the compartmentalization of left ventricular blood flow with some blood stagnant in the apical dyssynergic area was identified. The flow pattern shown by the speckle tracking image was superior to the color-flow map in correlating with left ventricular thrombosis. It implicated that the more the detail in which we can describe the blood flow pathway, the more information we can realize.