Using doppler signal power to detect changes in vessel size: a feasibility study using a wall-less flow phantom

Relative blood flow changes measured using calibrated frequency-weighted Doppler power at different hematocrit levels

In theory, the power of a trans-cranial Doppler signal may be used to measure changes in blood flow and vessel diameter in addition to velocity. In this study, a flow index (FI) of relative changes in blood flow was derived from frequency-weighted Doppler power signals. The FI, plotted against velocity, was calibrated to the zero intercept with absent flow to reduce the effects of non-uniform vessel insonation. An area index was also calculated. FIs were compared with actual flow in four silicone tubes of different diameter at increasing flow rates and increasing hematocrit (Hct) in a closed-loop phantom model. FI values were strongly correlated with actual flow, at constant Hct, but varied substantially with changes in Hct. Percentage changes in area indexes, relative to the 4-mm tube, were strongly correlated with tube cross-sectional area. The implications of these results for in vivo use are discussed.

Objective selection of high-frequency power Doppler wall filter cutoff velocity for regions of interest containing multiple small vessels

High-frequency (> 20 MHz) power Doppler ultrasound is frequently used to quantify vascularity in preclinical studies of small animal angiogenic models, but quantitative images can be difficult to obtain in the presence of flow artifacts. To improve flow quantification, color pixel density (CPD) can be plotted as a function of wall filter cutoff velocity to produce a wall-filter selection curve that can be used to estimate actual vascular volume fraction. A mathematical model based on receiver operating characteristic statistics is developed to study the behavior of wall-filter selection curves. The model is compared to experimental data acquired with a 30-MHz transducer and a custom-designed multiple-vessel flow phantom capable of mimicking a range of blood vessel sizes (200-300 microm), blood flow velocities (1-10 mm/s), and blood vessel orientations. At high flow rates, wall-filter selection curves for multiple-vessel regions include a plateau whose CPD corresponds with the total vascular volume fraction. Conversely, the vascular volume fraction of a subset of vessels is obtained at low flow rates. Detection of the volume fraction of all vessels is ensured when a plateau is > 0.5 mm/s in length and begins at a wall filter cutoff < 2 mm/s.

Doppler ultrasound compatible plastic material for use in rigid flow models

A technique for the rapid but accurate fabrication of multiple flow phantoms with variations in vascular geometry would be desirable in the investigation of carotid atherosclerosis. This study demonstrates the feasibility and efficacy of implementing numerically controlled direct-machining of vascular geometries into Doppler ultrasound (DUS)-compatible plastic for the easy fabrication of DUS flow phantoms. Candidate plastics were tested for longitudinal speed of sound (SoS) and acoustic attenuation at the diagnostic frequency of 5 MHz. Teflon was found to have the most appropriate SoS (1376 +/- 40 m s(-1) compared with 1540 m s(-1) in soft tissue) and thus was selected to construct a carotid bifurcation flow model with moderate eccentric stenosis. The vessel geometry was machined directly into Teflon using a numerically controlled milling technique. Geometric accuracy of the phantom lumen was verified using nondestructive micro-computed tomography. Although Teflon displayed a higher attenuation coefficient than other tested materials, Doppler data acquired in the Teflon flow model indicated that sufficient signal power was delivered throughout the depth of the vessel and provided comparable velocity profiles to that obtained in the tissue-mimicking phantom. Our results indicate that Teflon provides the best combination of machinability and DUS compatibility, making it an appropriate choice for the fabrication of rigid DUS flow models using a direct-machining method.

Validation of a sensitivity performance index test protocol and evaluation of colour Doppler sensitivity for a range of ultrasound scanners

The ability to detect flow is the most crucial aspect of an ultrasound (US) system because, if flow cannot be detected, no other aspect of performance matters. The objectives of this study were to validate a Doppler "sensitivity performance index," a figure of merit, and to determine if it could be used to differentiate colour Doppler sensitivity performance in scanners of varying complexity. The sensitivity performance index was developed to give a combined measure of related aspects of sensitivity, such as the lowest detectable velocity, the vessel size and the penetration depth. The colour Doppler sensitivity was evaluated objectively as the lowest detectable velocity signal from the deepest achievable point within the Doppler sensitivity phantom free from extraneous noise in a small diameter vessel (3.2 mm inner diameter). The effect of vessel size and mean velocity on the sensitivity performance index were investigated and it was found that the index was not proportional to vessel size, but this may be accounted for by considering the effect of the acoustic properties of the vessel material, the clutter filter and beam shape. The results obtained using flow phantoms with vessel sizes different from those used in this study are, therefore, not directly comparable to the results found in this study; however, a similar trend should be found in the results for the effect of control settings and a similar range of US scanners. It was found that the Doppler sensitivity performance index was a robust challenging test because none of the US scanners evaluated was capable of achieving the highest sensitivity performance index score, which would be limited by the lowest pump velocity and the deepest point of the vessel within the flow phantom. Therefore, this suggests that this method of determining Doppler sensitivity performance is valuable in the absence of other suitable methods, despite the fact that the relationship between the sensitivity performance index and vessel size is not proportional. Furthermore, use of the Doppler sensitivity performance index for the evaluation of a range of scanners demonstrated that curvilinear transducers have higher sensitivity performance indices than higher-frequency linear transducers, due to the higher achievable penetration depth. The effect of instrument settings was assessed for two transducers, the 4C3 curvilinear general-purpose transducer (Aspen) and the PVM375AT curvilinear general-purpose transducer (Nemio). The colour Doppler sensitivity performance was found to be significantly dependent on the clutter filter setting and the output power setting for both transducers tested. Users need to be aware of the effect of these settings on the colour Doppler sensitivity performance of their US scanner when interpreting the clinical significance of the colour Doppler information.

Non-invasive assessment of arterial distension waveforms using gradient-based hough transform and power Doppler ultrasound imaging

The peripheral arterial vessel often appears as an elliptic shape under the constraints of the surrounding tissues. In this study, the gradient-based Hough transform was used to detect the central location of the ellipse and the lumen area of the arterial vessel non-invasively using power Doppler imaging. Sequential ultrasound images were used to construct arterial distension waveforms in both the major- and minor-axis directions for a few cardiac cycles. The common carotid arteries (CCAs) for nine healthy male volunteers (mean age 24 years), in the sitting position, were investigated in vivo. The CCAs (n = 9) had a mean diameter of 5.83mm, and the pulsatile diameter distension was 13.7+/-1.9%. The brachial artery and dorsalis pedis artery for five healthy male volunteers (mean age 26 years), in the supine position, had mean diameters of 4.03mm and 2.83mm and distensions of 16.7+/-4.6% and 15.5+/-5.4%, respectively. The movement of the arterial centre location during the cardiac cycle reflected the asymmetry of the reaction forces produced by the surrounding soft tissues. The present method can obtain the response of vessel distension to pulse pressure, as well as the constrained conditions of the arteries.

Dynamic cerebral autoregulation is unaffected by aging

BACKGROUND AND PURPOSE

Normal aging is associated with marked changes in the cardiovascular and cerebrovascular systems. Although cerebral autoregulation (CA) is impaired in certain disease states, the effect of age per se on dynamic CA in humans is unknown and the focus of this study.

METHODS

Twenty-seven young subjects (</=40 years) and 27 older subjects (>/=55 years), matched for sex and systolic blood pressure (BP), underwent measurement of cerebral blood flow velocity by transcranial Doppler ultrasound and noninvasive beat-to-beat arterial BP measurement during induced and spontaneous dynamic BP stimuli. A standard dynamic autoregulatory index (ARI) was derived for each spontaneous and induced dynamic BP stimulus to include the step response, as well as cardiac baroreceptor sensitivity (BRS), for the 2 groups.

RESULTS

The mean age of the young group was 29+/-5 years, and that of the older group was 68+/-5 years. Cardiac BRS was reduced in the older group (8. 6+/-4.5 versus 16.9+/-8.8 ms/mm Hg; P:<0.0001). However, no age-related differences were demonstrated in step response plots or in ARI values for any pressor or depressor dynamic BP stimulus (P:=0. 62), with mean ARI values for all stimuli combined being 4.9+/-1.8 for the young group and 5.0+/-2.3 for the older group.

CONCLUSIONS

Although increasing age is associated with a decrease in cardiac BRS, dynamic CA, as assessed by step response analysis as well as cerebral blood flow responses to transient and induced BP stimuli, is unaffected by aging.