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Leary OP, Shaaya EA, Chernysh AA, Seidler M, Sastry RA, Persad-Paisley E, Zhu M, Gokaslan ZL, Oyelese AA, Beland MD, Fridley JS. Microbubble Contrast-Enhanced Transcutaneous Ultrasound Enables Real-Time Spinal Cord Perfusion Monitoring Following Posterior Cervical Decompression. World Neurosurg 2024:S1878-8750(24)01035-0. [PMID: 38901475 DOI: 10.1016/j.wneu.2024.06.077] [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: 05/06/2024] [Revised: 06/14/2024] [Accepted: 06/15/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Ultrasound imaging is inexpensive, portable, and widely available. The development of a real-time transcutaneous spinal cord perfusion monitoring system would allow more precise targeting of mean arterial pressure goals following acute spinal cord injury (SCI). There has been no prior demonstration of successful real-time cord perfusion monitoring in humans. METHODS Four adult patients who had undergone posterior cervical decompression and instrumentation at a single center were enrolled into this prospective feasibility study. All participants had undergone cervical laminectomies spanning ≥2 contiguous levels ≥2 months prior to inclusion with no history of SCI. The first 2 underwent transcutaneous ultrasound without contrast and the second 2 underwent contrast-enhanced ultrasound (CEUS) with intravenously injected microbubble contrast. RESULTS Using noncontrast ultrasound with or without Doppler (n = 2), the dura, spinal cord, and vertebral bodies were apparent however ultrasonography was insufficient to discern intramedullary perfusion or clear white-gray matter differentiation. With application of microbubble contrast (n = 2), it was possible to quantify differential spinal cord perfusion within and between cross-sectional regions of the cord. Further, it was possible to quantify spinal cord hemodynamic perfusion using CEUS by measuring peak signal intensity and the time to peak signal intensity after microbubble contrast injection. Time-intensity curves were generated and area under the curves were calculated as a marker of tissue perfusion. CONCLUSIONS CEUS is a viable platform for monitoring real-time cord perfusion in patients who have undergone prior cervical laminectomies. Further development has the potential to change clinical management acute SCI by tailoring treatments to measured tissue perfusion parameters.
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Affiliation(s)
- Owen P Leary
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
| | - Elias A Shaaya
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Alexander A Chernysh
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Michael Seidler
- Department of Diagnostic Imaging, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Rahul A Sastry
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Elijah Persad-Paisley
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Michelle Zhu
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Adetokunbo A Oyelese
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Michael D Beland
- Department of Diagnostic Imaging, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Jared S Fridley
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
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Saway BF, Courtney J, Barley J, Frankel B, Hofstetter C, Kalhorn S. Contrast enhanced ultrasound for traumatic spinal cord injury: an overview of current and future applications. Spinal Cord Ser Cases 2024; 10:31. [PMID: 38664470 PMCID: PMC11045808 DOI: 10.1038/s41394-024-00644-3] [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: 01/03/2024] [Revised: 04/08/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVE Contrast-enhanced ultrasound (CEUS) is an imaging modality that has only recently seen neurosurgical application. CEUS uses inert microbubbles to intraoperatively visualize vasculature and perfusion of the brain and spinal cord in real time. Observation and augmentation of spinal cord perfusion is vital component of the management of traumatic spinal cord injury, yet there are limited imaging modalities to evaluate spinal cord perfusion. CEUS provides an intraoperative imaging tool to evaluate spinal cord perfusion in real time. The objective of this review is to evaluate the current literature on the various applications and benefits of CEUS in traumatic spinal cord injury. SETTING South Carolina, USA. METHODS This review was written according to the PRISMA 2020 guidelines. RESULTS 143 articles were found in our literature search, with 46 of them being unique. After excluding articles for relevance to CEUS and spinal cord injury, we were left with 10 papers. Studies in animal models have shown CEUS to be an effective non-invasive imaging modality that can detect perfusion changes of injured spinal cords in real time. CONCLUSION This imaging modality can provide object perfusion data of the nidus of injury, surrounding penumbra and healthy neural tissue in a traumatized spinal cord. Investigation in its use in humans is ongoing and remains promising to be an effective diagnostic and prognostic tool for those suffering from spinal cord injury.
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Affiliation(s)
- Brian Fabian Saway
- Medical University of South Carolina, Department of Neurosurgery, Charleston, SC, 29425, USA.
| | - James Courtney
- Florida State University College of Medicine, Tallahassee, FL, 32303, USA
| | - Jessica Barley
- Medical University of South Carolina, Department of Neurosurgery, Charleston, SC, 29425, USA
| | - Bruce Frankel
- Southern Illinois University School of Medicine, Department of Neurosurgery, Springfield, IL, 62702, USA
| | | | - Stephen Kalhorn
- Medical University of South Carolina, Department of Neurosurgery, Charleston, SC, 29425, USA
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3
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Liang X, Wang X, Chen Y, He D, Li L, Chen G, Li J, Li J, Liu S, Xu Z. Predictive value of intraoperative contrast-enhanced ultrasound in functional recovery of non-traumatic cervical spinal cord injury. Eur Radiol 2024; 34:2297-2309. [PMID: 37707550 DOI: 10.1007/s00330-023-10221-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 07/05/2023] [Accepted: 07/15/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVES To evaluate the ability of intraoperative CEUS to predict neurological recovery in patients with degenerative cervical myelopathy (DCM). METHODS Twenty-six patients with DCM who underwent laminoplasty and intraoperative ultrasound (IOUS) were included in this prospective study. The modified Japanese Orthopaedic Association (mJOA) scores and MRI were assessed before surgery and 12 months postoperatively. The anteroposterior diameter (APD), maximum spinal cord compression (MSCC), and area of signal changes in the cord at the compressed and normal levels were measured and compared using MRI and IOUS. Conventional blood flow and CEUS indices (time to peak, ascending slope, peak intensity (PI), and area under the curve (AUC)) at different levels during IOUS were calculated and analysed. Correlations between all indicators and the neurological recovery rate were evaluated. RESULTS All patients underwent IOUS and intraoperative CEUS, and the total recovery rate was 50.7 ± 33.3%. APD and MSCC improved significantly (p < 0.01). The recovery rate of the hyperechoic lesion group was significantly worse than that of the isoechoic group (p = 0.016). 22 patients were analysed by contrast analysis software. PI was higher in the compressed zone than in the normal zone (24.58 ± 3.19 versus 22.43 ± 2.39, p = 0.019). ΔPI compress-normal and ΔAUC compress-normal of the hyperechoic lesion group were significantly higher than those of the isoechoic group (median 2.19 versus 0.55, p = 0.017; 135.7 versus 21.54, p = 0.014, respectively), and both indices were moderately negatively correlated with the recovery rate (r = - 0.463, p = 0.030; r = - 0.466, p = 0.029). CONCLUSIONS Signal changes and microvascular perfusion evaluated using CEUS during surgery are valuable predictors of cervical myelopathy prognosis. CLINICAL RELEVANCE STATEMENT In the spinal cord compression area of degenerative cervical myelopathy, especially in the hyperechoic lesions, intraoperative CEUS showed more significant contrast agent perfusion than in the normal area, and the degree was negatively correlated with the neurological prognosis. KEY POINTS • Recovery rates in patients with hyperechoic findings were lower than those of patients without lesions detected during intraoperative ultrasound. • The peak intensity of CEUS was higher in compressed zones than in the normal parts of the spinal cord. • Quantitative CEUS comparisons of the peak intensity and area under the curve at the compressed and normal levels of the spinal cord revealed differences that were inversely correlated to the recovery rate.
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Affiliation(s)
- Xuankun Liang
- Department of Medical Ultrasonics, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - Xianxiang Wang
- Department of Medical Ultrasonics, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - Yanfang Chen
- Outpatient Office, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - Danni He
- Department of Medical Ultrasonics, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - Lujing Li
- Department of Medical Ultrasonics, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - Guoliang Chen
- Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - Jiachun Li
- Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - Jie Li
- Department of Medical Ultrasonics, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - Shaoyu Liu
- Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China.
| | - Zuofeng Xu
- Department of Medical Ultrasonics, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China.
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Hersh AM, Weber-Levine C, Jiang K, Theodore N. Spinal Cord Injury: Emerging Technologies. Neurosurg Clin N Am 2024; 35:243-251. [PMID: 38423740 DOI: 10.1016/j.nec.2023.10.001] [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] [Indexed: 03/02/2024]
Abstract
The mainstay of treatment for spinal cord injury includes decompressive laminectomy and elevation of mean arterial pressure. However, outcomes often remain poor. Extensive research and ongoing clinical trials seek to design new treatment options for spinal cord injury, including stem cell therapy, scaffolds, brain-spine interfaces, exoskeletons, epidural electrical stimulation, ultrasound, and cerebrospinal fluid drainage. Some of these treatments are targeted at the initial acute window of injury, during which secondary damage occurs; others are designed to help patients living with chronic injuries.
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Affiliation(s)
- Andrew M Hersh
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-113, Baltimore, MD 21287, USA. https://twitter.com/AndrewMHersh
| | - Carly Weber-Levine
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-113, Baltimore, MD 21287, USA
| | - Kelly Jiang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-113, Baltimore, MD 21287, USA. https://twitter.com/kellyjjiang
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-113, Baltimore, MD 21287, USA; Orthopaedic Surgery & Biomedical Engineering, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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5
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Routkevitch D, Soulé Z, Kats N, Baca E, Hersh AM, Kempski-Leadingham KM, Menta AK, Bhimreddy M, Jiang K, Davidar AD, Smit C, Theodore N, Thakor NV, Manbachi A. Non-contrast ultrasound image analysis for spatial and temporal distribution of blood flow after spinal cord injury. Sci Rep 2024; 14:714. [PMID: 38184676 PMCID: PMC10771432 DOI: 10.1038/s41598-024-51281-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 01/03/2024] [Indexed: 01/08/2024] Open
Abstract
Ultrasound technology can provide high-resolution imaging of blood flow following spinal cord injury (SCI). Blood flow imaging may improve critical care management of SCI, yet its duration is limited clinically by the amount of contrast agent injection required for high-resolution, continuous monitoring. In this study, we aim to establish non-contrast ultrasound as a clinically translatable imaging technique for spinal cord blood flow via comparison to contrast-based methods and by measuring the spatial distribution of blood flow after SCI. A rodent model of contusion SCI at the T12 spinal level was carried out using three different impact forces. We compared images of spinal cord blood flow taken using both non-contrast and contrast-enhanced ultrasound. Subsequently, we processed the images as a function of distance from injury, yielding the distribution of blood flow through space after SCI, and found the following. (1) Both non-contrast and contrast-enhanced imaging methods resulted in similar blood flow distributions (Spearman's ρ = 0.55, p < 0.0001). (2) We found an area of decreased flow at the injury epicenter, or umbra (p < 0.0001). Unexpectedly, we found increased flow at the periphery, or penumbra (rostral, p < 0.05; caudal, p < 0.01), following SCI. However, distal flow remained unchanged, in what is presumably unaffected tissue. (3) Finally, tracking blood flow in the injury zones over time revealed interesting dynamic changes. After an initial decrease, blood flow in the penumbra increased during the first 10 min after injury, while blood flow in the umbra and distal tissue remained constant over time. These results demonstrate the viability of non-contrast ultrasound as a clinical monitoring tool. Furthermore, our surprising observations of increased flow in the injury periphery pose interesting new questions about how the spinal cord vasculature reacts to SCI, with potentially increased significance of the penumbra.
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Affiliation(s)
- Denis Routkevitch
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- HEPIUS Innovation Laboratory, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Zoe Soulé
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Nicholas Kats
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Emily Baca
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Andrew M Hersh
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- HEPIUS Innovation Laboratory, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Kelley M Kempski-Leadingham
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- HEPIUS Innovation Laboratory, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Arjun K Menta
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- HEPIUS Innovation Laboratory, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Meghana Bhimreddy
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- HEPIUS Innovation Laboratory, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Kelly Jiang
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- HEPIUS Innovation Laboratory, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - A Daniel Davidar
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- HEPIUS Innovation Laboratory, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Constantin Smit
- HEPIUS Innovation Laboratory, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Nicholas Theodore
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- HEPIUS Innovation Laboratory, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Nitish V Thakor
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- HEPIUS Innovation Laboratory, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Amir Manbachi
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA.
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
- HEPIUS Innovation Laboratory, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA.
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA.
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
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6
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Tang S, Weiner B, Taraballi F, Haase C, Stetco E, Mehta SM, Shajudeen P, Hogan M, De Rosa E, Horner PJ, Grande-Allen KJ, Shi Z, Karmonik C, Tasciotti E, Righetti R. Assessment of spinal cord injury using ultrasound elastography in a rabbit model in vivo. Sci Rep 2023; 13:15323. [PMID: 37714920 PMCID: PMC10504274 DOI: 10.1038/s41598-023-41172-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 08/23/2023] [Indexed: 09/17/2023] Open
Abstract
The effect of the mechanical micro-environment on spinal cord injury (SCI) and treatment effectiveness remains unclear. Currently, there are limited imaging methods that can directly assess the localized mechanical behavior of spinal cords in vivo. In this study, we apply new ultrasound elastography (USE) techniques to assess SCI in vivo at the site of the injury and at the time of one week post injury, in a rabbit animal model. Eleven rabbits underwent laminectomy procedures. Among them, spinal cords of five rabbits were injured during the procedure. The other six rabbits were used as control. Two neurological statuses were achieved: non-paralysis and paralysis. Ultrasound data were collected one week post-surgery and processed to compute strain ratios. Histologic analysis, mechanical testing, magnetic resonance imaging (MRI), computerized tomography and MRI diffusion tensor imaging (DTI) were performed to validate USE results. Strain ratios computed via USE were found to be significantly different in paralyzed versus non-paralyzed rabbits. The myelomalacia histologic score and spinal cord Young's modulus evaluated in selected animals were in good qualitative agreement with USE assessment. It is feasible to use USE to assess changes in the spinal cord of the presented animal model. In the future, with more experimental data available, USE may provide new quantitative tools for improving SCI diagnosis and prognosis.
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Affiliation(s)
- Songyuan Tang
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX, USA
| | - Bradley Weiner
- Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Francesca Taraballi
- Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
- Department of Orthopedics and Sports Medicine, Center for Musculoskeletal Regeneration, Houston Methodist Hospital, Houston, TX, USA
| | - Candice Haase
- Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
- Department of Orthopedics and Sports Medicine, Center for Musculoskeletal Regeneration, Houston Methodist Hospital, Houston, TX, USA
| | - Eliana Stetco
- Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
- Department of Orthopedics and Sports Medicine, Center for Musculoskeletal Regeneration, Houston Methodist Hospital, Houston, TX, USA
| | | | - Peer Shajudeen
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX, USA
| | - Matthew Hogan
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, USA
| | - Enrica De Rosa
- Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
- Department of Orthopedics and Sports Medicine, Center for Musculoskeletal Regeneration, Houston Methodist Hospital, Houston, TX, USA
| | - Philip J Horner
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, USA
| | | | - Zhaoyue Shi
- Translational Imaging Center, Houston Methodist Research Institute, Houston, TX, USA
| | - Christof Karmonik
- Translational Imaging Center, Houston Methodist Research Institute, Houston, TX, USA
| | - Ennio Tasciotti
- Department of Human Sciences and Promotion of Quality of Life, San Raffaele Roma Open University and IRCCS San Raffaele Pisana, 00166, Rome, Italy
| | - Raffaella Righetti
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX, USA.
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7
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Khaing ZZ, Chandrasekaran A, Katta A, Reed MJ. The Brain and Spinal Microvasculature in Normal Aging. J Gerontol A Biol Sci Med Sci 2023; 78:1309-1319. [PMID: 37093786 PMCID: PMC10395569 DOI: 10.1093/gerona/glad107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Indexed: 04/25/2023] Open
Abstract
Changes in the brain and spinal cord microvasculature during normal aging contribute to the "sensitive" nature of aged central nervous system tissue to ischemic insults. In this review, we will examine alterations in the central nervous system microvasculature during normal aging, which we define as aging without a dominant pathology such as neurodegenerative processes, vascular injury or disease, or trauma. We will also discuss newer technologies to improve the study of central nervous system microvascular structure and function. Microvasculature within the brain and spinal cord will be discussed separately as anatomy and physiology differ between these compartments. Lastly, we will identify critical areas for future studies as well as key unanswered questions.
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Affiliation(s)
- Zin Z Khaing
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | | | - Anjali Katta
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - May J Reed
- Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, Washington, USA
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8
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Yu J, Dong H, Ta D, Xie R, Xu K. Super-resolution Ultrasound Microvascular Angiography for Spinal Cord Penumbra Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2023:S0301-5629(23)00202-8. [PMID: 37451953 DOI: 10.1016/j.ultrasmedbio.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 06/02/2023] [Accepted: 06/09/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE After spinal cord injury (SCI) or ischemia, timely intervention in the penumbra, such as recanalization and tissue reperfusion, is essential for preservation of its function. However, limited by imaging resolution and micro-blood flow sensitivity, golden standard angiography modalities, including magnetic resonance angiography (MRA) and digital subtraction angiography (DSA), are still not applicable for spinal cord microvascular imaging. Regarding spinal cord penumbra, to the best of authors' knowledge, currently, there is no efficient in vivo imaging modality for its evaluation. With tens-of-micrometer resolution and deep penetration, advanced ultrasound localization microscopy (ULM) could potentially meet the needs of emergent diagnosis and long-term monitoring of spinal cord penumbra. METHODS ULM microvasculature imaging was performed on rats with all laminae removed to obtain the blood supply in major spinal cord segments (C5-L5). For adult rats with spinal cord penumbra induced by compression injury (1 s, 10 s and 15 s), ULM imaging was conducted. The corresponding angiography results are investigated in terms of microvessel saturation, morphology, and flow velocity. The Basso/Beattie/Bresnahan (BBB) locomotor rating scale and hematoxylin and eosin staining were utilized for model validation and comparison. RESULTS The feasibility of ULM enabling spinal cord penumbra imaging and development monitoring was demonstrated. The focal injury core and penumbra can be clearly identified using the proposed method. Significant difference of perfusion can be observed after 1 s, 10 s and 15 s compression. Quantitative results show a high correlation between in vivo ultrasonic angiography, BBB functional evaluation and ex vivo histology assessment under different compression duration. CONCLUSION It is demonstrated that the super-resolution ULM micro-vasculature imaging can be used to evaluate the penumbra in spinal cord at acute and early stage of chronic phase, providing an efficient modality for micro-hemodynamics monitoring of the spinal cord.
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Affiliation(s)
- Junjin Yu
- Center for Biomedical Engineering, Fudan University, Shanghai, China; State Key Laboratory of Integrated Chips and Systems, Fudan University, Shanghai, China
| | - Haoru Dong
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Dean Ta
- Center for Biomedical Engineering, Fudan University, Shanghai, China; State Key Laboratory of Integrated Chips and Systems, Fudan University, Shanghai, China
| | - Rong Xie
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Kailiang Xu
- Center for Biomedical Engineering, Fudan University, Shanghai, China; State Key Laboratory of Integrated Chips and Systems, Fudan University, Shanghai, China.
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9
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Routkevitch D, Hersh AM, Kempski KM, Kerensky M, Theodore N, Thakor NV, Manbachi A. FlowMorph: Morphological Segmentation of Ultrasound-Monitored Spinal Cord Microcirculation. IEEE BIOMEDICAL CIRCUITS AND SYSTEMS CONFERENCE : HEALTHCARE TECHNOLOGY : [PROCEEDINGS]. IEEE BIOMEDICAL CIRCUITS AND SYSTEMS CONFERENCE 2022; 2022:610-614. [PMID: 36695674 PMCID: PMC9870043 DOI: 10.1109/biocas54905.2022.9948639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Imaging of spinal cord microvasculature holds great potential in directing critical care management of spinal cord injury (SCI). Traditionally, contrast agents are preferred for imaging of the spinal cord vasculature, which is disadvantageous for long-term monitoring of injury. Here, we present FlowMorph, an algorithm that uses mathematical morphology techniques to segment non-contrast Doppler-based videos of rat spinal cord. Using the segmentation, it measures single-vessel parameters such as flow velocity, rate, and radius, with visible cardiac cycles in individual vessels showcasing the spatiotemporal resolution. The segmentation outlines vessels well with little extraneous labeling, and outlines are smooth through time. Radius measurements of perforating vessels are similar to what is seen in the literature through other methods. Verification of the algorithm through comparison to manual measurement and in vitro microphantom standards highlights points of future improvement. This method will be vital for future work studying the vascular effects of SCI and can be adopted to other species as well.
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Affiliation(s)
| | | | | | - Max Kerensky
- Johns Hopkins University,Baltimore,Maryland,21205
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10
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Bruce M, DeWees D, Harmon JN, Cates L, Khaing ZZ, Hofstetter CP. Blood Flow Changes Associated with Spinal Cord Injury Assessed by Non-linear Doppler Contrast-Enhanced Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1410-1419. [PMID: 35523621 PMCID: PMC9704544 DOI: 10.1016/j.ultrasmedbio.2022.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 05/23/2023]
Abstract
Contrast-enhanced ultrasound (CEUS) is clinically used to image the microcirculation at lower imaging frequencies (<2 MHz). Recently, plane-wave acquisitions and Doppler processing have revealed improved microbubble sensitivity, enabling CEUS use at higher frequencies (15 MHz) and the ability to image simultaneously blood flow in the micro- and macrocirculations. We used this approach to assess acute and chronic blood flow changes within contused spinal cord in a rodent spinal cord injury model. Immediately after spinal cord injury, we found significant differences in perfusion deficit between moderate and severe injuries (1.73 ± 0.1 mm2 vs. 3.2 ± 0.3 mm2, respectively), as well as a delay in microbubble arrival time in tissue adjacent to the injury site (0.97 ± 0.1 s vs. 1.54 ± 0.1 s, respectively). Acutely, morphological changes to central sulcal arteries were observed where vessels rostral to the contusion were displaced 4.8 ± 2.2° and 8.2 ± 3.1° anteriorly, and vessels caudal to the contusion 17.8 ± 3.9° and 24.2 ± 4.1° posteriorly, respectively, for moderate and severe injuries. Significant correlation of the acute perfusion deficit and arrival time were found with the chronic assessment of locomotive function and histological estimate of spared spinal cord tissue.
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Affiliation(s)
- Matthew Bruce
- Applied Physics Laboratory/Center for Industrial and Medical Ultrasound, University of Washington, Seattle, Washington, USA.
| | - Dane DeWees
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | - Jennifer N Harmon
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | - Lindsay Cates
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | - Zin Z Khaing
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
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11
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Beliard B, Ahmanna C, Tiran E, Kanté K, Deffieux T, Tanter M, Nothias F, Soares S, Pezet S. Ultrafast Doppler imaging and ultrasound localization microscopy reveal the complexity of vascular rearrangement in chronic spinal lesion. Sci Rep 2022; 12:6574. [PMID: 35449222 PMCID: PMC9023600 DOI: 10.1038/s41598-022-10250-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/30/2022] [Indexed: 12/16/2022] Open
Abstract
Acute spinal cord injury (SCI) leads to severe damage to the microvascular network. The process of spontaneous repair is accompanied by formation of new blood vessels; their functionality, however, presumably very important for functional recovery, has never been clearly established, as most studies so far used fixed tissues. Here, combining ultrafast Doppler imaging and ultrasound localization microscopy (ULM) on the same animals, we proceeded at a detailed analysis of structural and functional vascular alterations associated with the establishment of chronic SCI, both at macroscopic and microscopic scales. Using a standardized animal model of SCI, our results demonstrate striking hemodynamic alterations in several subparts of the spinal cord: a reduced blood velocity in the lesion site, and an asymmetrical hypoperfusion caudal but not rostral to the lesion. In addition, the worsening of many evaluated parameters at later time points suggests that the neoformed vascular network is not yet fully operational, and reveals ULM as an efficient in vivo readout for spinal cord vascular alterations. Finally, we show statistical correlations between the diverse biomarkers of vascular dysfunction and SCI severity. The imaging modality developed here will allow evaluating recovery of vascular function over time in pre-clinical models of SCI. Also, used on SCI patients in combination with other quantitative markers of neural tissue damage, it may help classifying lesion severity and predict possible treatment outcomes in patients.
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Affiliation(s)
- Benoit Beliard
- Institute of Physics for Medicine Paris, Inserm U1273, ESPCI PSL Paris, CNRS UMR8361, PSL Research University - Paris, 17 rue Moreau, 75012, Paris, France
| | - Chaimae Ahmanna
- Neuroscience Paris Seine NPS, CNRS UMR8246, INSERM U1130, UM119, Institut de Biologie Paris Seine IBPS, Sorbonne Université Sciences, Campus UPMC, 75005, Paris, France
| | - Elodie Tiran
- Institute of Physics for Medicine Paris, Inserm U1273, ESPCI PSL Paris, CNRS UMR8361, PSL Research University - Paris, 17 rue Moreau, 75012, Paris, France
| | - Kadia Kanté
- Neuroscience Paris Seine NPS, CNRS UMR8246, INSERM U1130, UM119, Institut de Biologie Paris Seine IBPS, Sorbonne Université Sciences, Campus UPMC, 75005, Paris, France
| | - Thomas Deffieux
- Institute of Physics for Medicine Paris, Inserm U1273, ESPCI PSL Paris, CNRS UMR8361, PSL Research University - Paris, 17 rue Moreau, 75012, Paris, France
| | - Mickael Tanter
- Institute of Physics for Medicine Paris, Inserm U1273, ESPCI PSL Paris, CNRS UMR8361, PSL Research University - Paris, 17 rue Moreau, 75012, Paris, France
| | - Fatiha Nothias
- Neuroscience Paris Seine NPS, CNRS UMR8246, INSERM U1130, UM119, Institut de Biologie Paris Seine IBPS, Sorbonne Université Sciences, Campus UPMC, 75005, Paris, France
| | - Sylvia Soares
- Neuroscience Paris Seine NPS, CNRS UMR8246, INSERM U1130, UM119, Institut de Biologie Paris Seine IBPS, Sorbonne Université Sciences, Campus UPMC, 75005, Paris, France.
| | - Sophie Pezet
- Institute of Physics for Medicine Paris, Inserm U1273, ESPCI PSL Paris, CNRS UMR8361, PSL Research University - Paris, 17 rue Moreau, 75012, Paris, France.
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12
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Hwang BY, Mampre D, Ahmed AK, Suk I, Anderson WS, Manbachi A, Theodore N. Ultrasound in Traumatic Spinal Cord Injury: A Wide-Open Field. Neurosurgery 2021; 89:372-382. [PMID: 34098572 DOI: 10.1093/neuros/nyab177] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/19/2021] [Indexed: 02/02/2023] Open
Abstract
Traumatic spinal cord injury (SCI) is a common and devastating condition. In the absence of effective validated therapies, there is an urgent need for novel methods to achieve injury stabilization, regeneration, and functional restoration in SCI patients. Ultrasound is a versatile platform technology that can provide a foundation for viable diagnostic and therapeutic interventions in SCI. In particular, real-time perfusion and inflammatory biomarker monitoring, focal pharmaceutical delivery, and neuromodulation are capabilities that can be harnessed to advance our knowledge of SCI pathophysiology and to develop novel management and treatment options. Our review suggests that studies that evaluate the benefits and risks of ultrasound in SCI are severely lacking and our understanding of the technology's potential impact remains poorly understood. Although the complex anatomy and physiology of the spine and the spinal cord remain significant challenges, continued technological advances will help the field overcome the current barriers and bring ultrasound to the forefront of SCI research and development.
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Affiliation(s)
- Brian Y Hwang
- Division of Functional Neurosurgery, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David Mampre
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ian Suk
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - William S Anderson
- Division of Functional Neurosurgery, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Amir Manbachi
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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