A unified approach to modeling the backscattered Doppler ultrasound from blood

An examination of point-particle Lagrangian simulations for assessing time-resolved hydroacoustic particle flux measurements in sediment-laden flows

Accurate modelling and prediction of sediment transport in aquatic environments is essential for sustainable coastal and riverine management. Current capabilities rely on physical process-based numerical models and fine-scale sediment flux measurements. High-resolution hydroacoustic instrumentation has emerged as a promising tool for such measurements. However, challenges arise due to the inherent complexity of ultrasound scattering processes. This study introduces a numerical modelling using a point-particle approach to simulate the echoes backscattered by such instrumentation in sediment-laden flow conditions. The model considers geometric, statistical, particle cloud, and flow-induced effects on sediment velocity, concentration, and flux estimates using an acoustic concentration and velocity profiler as a reference. The model performance is assessed here under unidirectional constant flow conditions in terms of velocity, concentration, and time-resolved sediment flux estimates for a large range of the particles' advection speed and sampled volume sizes. Application to the estimation of the measurement accuracy of sediment flux in these flows is also considered, with a final error on the flux seen to be partially controlled by the residence time of particles within the sampled volumes. The proposed model provides insights into scattering processes and offers a tool for investigating robust sediment flux estimation techniques in various flow conditions.

FLUST: A fast, open source framework for ultrasound blood flow simulations

BACKGROUND AND OBJECTIVE

Ultrasound based blood velocity estimation is a continuously developing frontier, where the vast number of possible acquisition setups and velocity estimators makes it challenging to assess which combination is better suited for a given imaging application. FLUST, the Flow-Line based Ultrasound Simulation Tool, may be used to address this challenge, providing a common platform for evaluation of velocity estimation schemes on in silico data. However, the FLUST approach had some limitations in its original form, including reduced robustness for phase sensitive setups and the need for manual selection of integrity parameters. In addition, implementation of the technique and therefore also documentation of signal integrity was left to potential users of the approach.

METHODS

In this work, several improvements to the FLUST technique are proposed and investigated, and a robust, open source simulation framework developed. The software supports several transducer types and acquisition setups, in addition to a range of different flow phantoms. The main goal of this work is to offer a robust, computationally cheap and user-friendly framework to simulate ultrasound data from stationary blood velocity fields and thereby facilitate design and evaluation of estimation schemes, including acquisition design, velocity estimation and other post-processing steps.

RESULTS

The technical improvements proposed in this work resulted in reduced interpolation errors, reduced variability in signal power, and also automatic selection of spatial and temporal discretization parameters. Results are presented illustrating the challenges and the effectiveness of the solutions. The integrity of the improved simulation framework is validated in an extensive study, with results indicating that speckle statistics, spatial and temporal correlation and frequency content all correspond well with theoretical predictions. Finally, an illustrative example shows how FLUST may be used throughout the design and optimization process of a velocity estimator.

CONCLUSIONS

The FLUST framework is available as a part of the UltraSound ToolBox (USTB), and the results in this paper demonstrate that it can be used as an efficient and reliable tool for the development and validation of ultrasound-based velocity estimation schemes.

Functional Ultrasound Speckle Decorrelation-Based Velocimetry of the Brain

A high-speed, contrast-free, quantitative ultrasound velocimetry (vUS) for blood flow velocity imaging throughout the rodent brain is developed based on the normalized first-order temporal autocorrelation function of the ultrasound field signal. vUS is able to quantify blood flow velocity in both transverse and axial directions, and is validated with numerical simulation, phantom experiments, and in vivo measurements. The functional imaging ability of vUS is demonstrated by monitoring the blood flow velocity changes during whisker stimulation in awake mice. Compared to existing Power-Doppler- and Color-Doppler-based functional ultrasound imaging techniques, vUS shows quantitative accuracy in estimating both axial and transverse flow speeds and resistance to acoustic attenuation and high-frequency noise.

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.

A Review of Suspension-Scattered Particles Used in Blood-Mimicking Fluid for Doppler Ultrasound Imaging

Doppler ultrasound imaging system description and calibration need blood-mimicking fluids (BMFs) for the test target of medical ultrasound diagnostic tools, with known interior features and acoustic and physical properties of this fluid (BMF). Physical and acoustical properties determined in the International Electrotechnical Commission (IEC) standard are specified as constant values, the materials used in the BMF preparation should have values similar to the IEC standard values. However, BMF is ready-made commercially from a field of medical usage, which may not be appropriate in the layout of ultrasound system or for an estimate of novel imaging mechanism. It is often eligible to have the capability to make sound properties and mimic blood arrangement for specific applications. In this review, sufficient BMF materials, liquids, and measures are described which have been generated by utilizing diverse operation mechanism and materials that have sculptured a range of biological systems.

Structure Function Estimated From Histological Tissue Sections

Ultrasonic scattering is determined by not only the properties of individual scatterers but also the correlation among scatterer positions. The role of scatterer spatial correlation is significant for dense medium, but has not been fully understood. The effect of scatterer spatial correlation may be modeled by the structure function as a frequency-dependent factor in the backscatter coefficient (BSC) expression. The structure function has been previously estimated from the BSC data. The aim of this study is to estimate the structure function from histology to test if the acoustically estimated structure function is indeed caused by the scatterer spatial distribution. Hematoxylin and eosin stained histological sections from dense cell pellet biophantoms were digitized. The scatterer positions were determined manually from the histological images. The structure function was calculated from the extracted scatterer positions. The structure function obtained from histology showed reasonable agreement in the shape but not in the amplitude, compared with the structure function previously estimated from the backscattered data. Fitting a polydisperse structure function model to the histologically estimated structure function yielded relatively accurate cell radius estimates ([Formula: see text]). Furthermore, two types of mouse tumors that have similar cell size and shape but distinct cell spatial distributions were studied, where the backscattered data were shown to be related to the cell spatial distribution through the structure function estimated from histology. In conclusion, the agreement between acoustically estimated and histologically estimated structure functions suggests that the acoustically estimated structure function is related to the scatterer spatial distribution.

Heterogeneous Tissue Characterization Using Ultrasound: A Comparison of Fractal Analysis Backscatter Models on Liver Tumors

Assessment of tumor tissue heterogeneity via ultrasound has recently been suggested as a method for predicting early response to treatment. The ultrasound backscattering characteristics can assist in better understanding the tumor texture by highlighting the local concentration and spatial arrangement of tissue scatterers. However, it is challenging to quantify the various tissue heterogeneities ranging from fine to coarse of the echo envelope peaks in tumor texture. Local parametric fractal features extracted via maximum likelihood estimation from five well-known statistical model families are evaluated for the purpose of ultrasound tissue characterization. The fractal dimension (self-similarity measure) was used to characterize the spatial distribution of scatterers, whereas the lacunarity (sparsity measure) was applied to determine scatterer number density. Performance was assessed based on 608 cross-sectional clinical ultrasound radiofrequency images of liver tumors (230 and 378 representing respondent and non-respondent cases, respectively). Cross-validation via leave-one-tumor-out and with different k-fold methodologies using a Bayesian classifier was employed for validation. The fractal properties of the backscattered echoes based on the Nakagami model (Nkg) and its extend four-parameter Nakagami-generalized inverse Gaussian (NIG) distribution achieved best results-with nearly similar performance-in characterizing liver tumor tissue. The accuracy, sensitivity and specificity of Nkg/NIG were 85.6%/86.3%, 94.0%/96.0% and 73.0%/71.0%, respectively. Other statistical models, such as the Rician, Rayleigh and K-distribution, were found to not be as effective in characterizing subtle changes in tissue texture as an indication of response to treatment. Employing the most relevant and practical statistical model could have potential consequences for the design of an early and effective clinical therapy.

Unifying Concepts of Statistical and Spectral Quantitative Ultrasound Techniques

Quantitative ultrasound (QUS) techniques using radiofrequency (RF) backscattered signals have been used for tissue characterization of numerous organ systems. One approach is to use the magnitude and frequency dependence of backscatter echoes to quantify tissue structures. Another approach is to use first-order statistical properties of the echo envelope as a signature of the tissue microstructure. We propose a unification of these QUS concepts. For this purpose, a mixture of homodyned K-distributions is introduced to model the echo envelope, together with an estimation method and a physical interpretation of its parameters based on the echo signal spectrum. In particular, the total, coherent and diffuse signal powers related to the proposed mixture model are expressed explicitly in terms of the structure factor previously studied to describe the backscatter coefficient (BSC). Then, this approach is illustrated in the context of red blood cell (RBC) aggregation. It is experimentally shown that the total, coherent and diffuse signal powers are determined by a structural parameter of the spectral Structure Factor Size and Attenuation Estimator. A two-way repeated measures ANOVA test showed that attenuation (p-value of 0.077) and attenuation compensation (p-value of 0.527) had no significant effect on the diffuse to total power ratio. These results constitute a further step in understanding the physical meaning of first-order statistics of ultrasound images and their relations to QUS techniques. The proposed unifying concepts should be applicable to other biological tissues than blood considering that the structure factor can theoretically model any spatial distribution of scatterers.

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.

Forward problem study of an effective medium model for ultrasound blood characterization

The structure factor model (SFM) is a scattering model developed to simulate the backscattering coefficient (BSC) of aggregated red blood cells (RBCs). However, the SFM can hardly be implemented to estimate the structural aggregate parameters in the framework of an inverse problem formulation. A scattering model called the effective medium theory combined with the SFM (EMTSFM) is thus proposed to approximate the SFM. The EMTSFM assumes that aggregates of RBCs can be treated as individual homogeneous scatterers, which have effective properties determined by the acoustical characteristics and concentration of RBCs within aggregates. The EMTSFM parameterizes the BSC by three indices: the aggregate radius, the concentration of RBCs with- in aggregates (the aggregate compactness), and the systemic hematocrit. The goodness of fit of the EMTSFM approximation in comparison with the SFM was then examined. Based on a 2-D study, the EMTSFM was found to approximate the SFM with relative errors less than 30% for a product of the wavenumber times the mean aggregate radius krΛκ <; 1.32. The main contribution of this work is the parameterization of the BSC with the RBC aggregate compactness, which is of relevance in clinical hemorheology because it reflects the binding energy between RBCs.

Newtonian viscous effects in ultrasonic emboli removal from blood

We have modeled the removal of emboli from cardiopulmonary bypass circuits via acoustic radiation force. Unless removed, emboli can result in cognitive deficit for those undergoing heart surgery with the use of extracorporeal circuits. There are a variety of mathematical formulations in the literature describing acoustic radiation force, but a lingering question that remains is how important viscosity of the blood and/or embolus is to the process. We implemented both inviscid and viscous models for acoustic radiation force on a sphere immersed in a fluid. We found that for this specific application, the inviscid model seems to be sufficient for predicting acoustic force upon emboli when compared with the chosen viscous model. Thus, the much simpler inviscid model could be used to optimize experimental techniques for ultrasonic emboli removal.

In vitro verification of multiple-receiver Doppler ultrasound for velocity estimation improvement

The coherent scattering effect, which introduces noise in Doppler-derived velocity estimates, is caused by constructive and destructive interference of sound waves scattered from multiple particles. Because the phase relationship between signals scattered from different particles depends on the orientation of the receiver, the error in a given velocity estimate depends on the receiver location. To examine this dependence, the velocity of a steady uniform flow was measured simultaneously with a transceiver and three receivers, and the cross-correlation coefficients between velocity estimates for pairs of crystals were calculated. The velocity estimates were nearly independent, with cross-correlation coefficients of approximately 0.2. This result agrees with our previously published numerical simulation studies which demonstrated that the coherent scattering noise in receivers separated by 5 degrees or more was nearly uncorrelated. Consequently, the contribution of coherent scattering noise can be reduced by averaging out noise in signals obtained from multiple receivers.

Basic considerations in the use of coded excitation for color flow imaging applications

Coded excitation is now a well-established technique in medical ultrasound for B-mode imaging applications. It enables a gain in depth of penetration, without sacrificing the spatial resolution and maintaining an acceptable peak intensity for patient safety. The rationale of this technique for velocity estimation applications still has to be formulated in more precise terms. In particular, differences in the situation that arise in color flow imaging (CFI) applications from typical B-mode imaging conditions, such as signal-to-noise ratio conditions, pulsing strategy, and safety requirements, need to be specifically addressed to assess more quantitatively the potential of this technique. This paper discusses the potential improvement in sensitivity, resolution, and statistical performance provided by coded excitation for CFI applications from theoretical considerations and simulations.

Reflection from bound microbubbles at high ultrasound frequencies

Targeted contrast agents and ultrasound imaging are now used in combination for the assessment and tracking of biomarkers in animal models in vivo. These applications have triggered interest in the understanding and prediction of the ultrasound echoes from contrast agents attached to cells. This study describes the reflection enhancement due to microbubbles bound on a gelatin surface. The reflection enhancement was measured using ultrasound pulses at high frequency (40 MHz) and low pressure (38 kPa peak-negativepressure) allowing a linear approximation to be applied. The observed reflection coefficient increased with the number of microbubbles, until reaching saturation at 0.9 when the surface coverage fraction was 35%. A multiple scattering model assuming that the targeted microbubbles are confined within an infinitesimally thin layer appeared suitable in predicting the reflection coefficient even at very high surface densities. These results could permit the optimization of the sensitivity of highfrequency ultrasound to targeted contrast agents.

Determining the relationship between three-dimensional power Doppler data and true blood flow characteristics: an in-vitro flow phantom experiment

OBJECTIVES

Three-dimensional (3D) ultrasound can be used to acquire power Doppler data which can be quantified to give an objective impression about blood flow within a tissue or organ. Proprietary software can be used to calculate three indices of vascularity: vascularization index (VI), flow index (FI) and vascularization flow index (VFI). Although these indices appear to have a predictive value in the clinical setting and can be shown to vary between different patient populations and over time within the same population, their relationship with true in-vivo blood flow characteristics has not been established. The objective was to examine the effect of flow rate, vessel number, attenuation and erythrocyte density on these indices.

METHODS

A computer-driven flow phantom was used to continuously pump a nylon particle-based blood mimic (Orgasol(trade mark)) around a closed system through three different ultrasound test tanks. These tanks were designed specifically for these experiments and contained C-Flex(trade mark) tubing, in a variety of arrangements, encased in an agar-based tissue mimic. The test tanks were insonated with a modified 3D transvaginal 4-8-MHz ultrasound transducer and 3D power Doppler data were then acquired over a graduated series of flow rates, depths and blood mimic concentrations. Regression analysis was used to determine the resulting relationships.

RESULTS

The VI increased linearly with an increase in flow rate (P < 0.05), whereas the FI increased in a cubic manner with a more rapid initial increase (P < 0.05). The VI demonstrated a similar linear increase with an increase in the erythrocyte mimic density (P < 0.05), whereas the FI increased markedly with a small change in erythrocyte mimic density and then plateaued (P < 0.01). There was a significant reduction in each index as the distance between the transducer and vessel increased (P < 0.05). Patterns similar to those seen in relation to the change in flow rate were evident, with a more linear relationship between depth and the VI and VFI than between depth and the FI, although the FI remained relatively constant and was not significantly affected by distance from the transducer until a depth of 55 mm was reached. Although a positive linear relationship was seen between vessel number and VI and VFI (P < 0.05) the FI demonstrated a very different and complex, cubic relationship (P < 0.001), increasing linearly until a maximum of three vessels were present when it decreased, and no overall correlation was seen (P > 0.05).

CONCLUSIONS

The VI, FI and VFI are all significantly affected by volume flow, attenuation, vessel number and erythrocyte density, but in different ways. The VI and VFI seem to have a more predictable relationship, whereas the FI often demonstrates a more complex cubic relationship that is not always logical. Further work is required to establish the effect of other confounding parameters before valid conclusions may be made and a better understanding of 3D power Doppler ultrasound imaging achieved.

Ultrasonic observation of blood disturbance in a stenosed tube: effects of flow acceleration and turbulence downstream

Red blood cell (RBC) aggregation is known to be highly dependent on hemodynamic parameters such as shear rate, flow turbulence and flow acceleration under pulsatile flow. The effects of all three hemodynamic parameters on RBC aggregation and echogenicity of porcine whole blood were investigated downstream of an eccentric stenosis in a mock flow loop using B-mode images with Doppler spectrograms of a commercial ultrasonic system. A hyperechoic parabolic profile appeared downstream during flow acceleration, yielding another piece of evidence suggesting that the enhancement of rouleaux formation may be caused by flow acceleration. It was also found that echogenicity increased locally at a distance of three tube diameters downstream from the stenosis. The local increase of echogenicity is thought to be mainly due to flow turbulence. The hypoechoic "black hole" was also seen at the center of the tube downstream of the stenosis where blood flow was disturbed, and this may be caused by the compound effect of flow turbulence and shear rate.

Model for the ultrasound reflection from micro-beads and cells distributed in layers on a uniform surface

A model predicting the reflection of ultrasound from multiple layers of small scattering spheres is developed. Predictions of the reflection coefficient, which takes into account the interferences between the different sphere layers, are compared to measurements performed in the 10-80 MHz and 15-35 MHz frequency range with layers of glass beads and spherical acute myeloid leukemia (AML) cells, respectively. For both types of scatterers, the reflection coefficient increases as a function of their density on the surface for less than three superimposed layers, at which point it saturates at 0.38 for glass beads and 0.02 for AML cells. Above three layers, oscillations of the reflection coefficient due to constructive or destructive interference between layers are observed experimentally and are accurately predicted by the model. The use of such a model could lead to a better understanding of the structures observed in layered tissue images.

Statistical distributions of potential interest in ultrasound speckle analysis

Compound statistical modelling of the uncompressed envelope of the backscattered signal has received much interest recently. In this note, a comprehensive collection of models is derived for the uncompressed envelope of the backscattered signal by compounding the Nakagami distribution with 13 flexible families. The corresponding estimation procedures are derived by the method of moments and the method of maximum likelihood. The sensitivity of the models to their various parameters is examined. It is expected that this work could serve as a useful reference and lead to improved modelling of the uncompressed envelope of the backscattered signal.

A model for reflectivity enhancement due to surface bound submicrometer particles

Submicrometer particles filled with liquid perfluorocarbon have been shown to increase the ultrasound reflectivity of surfaces onto which they bind and, consequently, are seen as potential targeted contrast agents. The objective of this study is to explain the reflectivity enhancement as a result of the presence of randomly distributed particles on a surface. A model is presented where the diffraction-weighted scattering of all particles is summed over the exposed surface. Experiments were performed at frequencies ranging from 15 MHz to 60 MHz, with glass microbeads and perfluorohexane particles deposited on the surface of agar and Aqualene, a rubber closely matched to water, to confirm the validity of the model. Results showed that the model predicts the surface density and the frequency dependence of the reflectivity enhancement up to a density corresponding to twice the maximum packing of spheres on a surface (200% confluence fraction) for glass beads and a fifth (20% confluence fraction) for perfluorohexane particles. This suggests the possibility of predicting signal enhancement due to a bound contrast agent in simple geometries.

Doppler ultrasound spectral enhancement using the Gabor transform-based spectral subtraction

Most of the important clinical indices of blood flow are estimated from the spectrograms of Doppler ultrasound (US) signals. Any noise may degrade the readability of the spectrogram and the precision of the clinical indiCes, so the spectral enhancement plays an important role in Doppler US signal processing. A new Doppler US spectral enhancement method is proposed in this paper and implemented in three main steps: the Gabor transform is used to compute the Gabor coefficients of a Doppler US signal, the spectral subtraction is performed on the magnitude of the Gabor coefficients, and the Gabor expansion with the spectral subtracted Gabor coefficients is used to reconstruct the denoised Doppler US signal. The different analysis and synthesis windows are examined in the Gabor transform and expansion. The signal-to-noise ratio (SNR) improvement together with the overall enhancement of spectrograms are examined on the simulated Doppler US signals from a femoral artery. The results show the denoising method based on the orthogonal-like Gabor expansion achieves the best denoising performance. The experiments on some clinical Doppler US signals from umbilical arteries confirm the superior denoising performance of the new method.

Microembolic signal characterization using adaptive chirplet expansion

The adaptive chirplet expansion (ACE) is proposed to characterize high-intensity, transient signals from circulating microemboli. The nonnegative adaptive spectrogram based on the ACE gives a compact representation of the microembolic signal (MES) in joint-time, frequency domain. The mean instantaneous power (MIP) and mean instantaneous frequency (MIF) of MES are estimated from the adaptive spectrogram. Then, several important characteristics of MES, such as embolus-to-blood ratio (EBR), half width maximum (HWM), and embolic signal onset (ESO), are computed from the MIP, and the frequency modulation is examined in the MIF. To validate the new method, we improved the simulation model of the audio Doppler ultrasound signal. Some MESs together with a Doppler ultrasound signal from carotid blood flow are simulated in the simulation study. As a comparison, the adaptive Gabor expansion (AGE) also is implemented on these simulated signals. The experimental results of the simulation study show that the new method, based on the ACE, outperforms the AGE-based method in MES characterization. The consistent conclusion has been confirmed by the clinical study on some clinical MESs.

Rheology and ultrasound scattering from aggregated red cell suspensions in shear flow

The shear flow dynamics of reversible red cell aggregates in dense suspensions were investigated by ultrasound scattering, to study the shear disruption processes of Rayleigh clusters and examine the effective mean field approximation used in microrheological models. In a first section, a rheo-acoustical model, in the Rayleigh scattering regime, is proposed to describe the shear stress dependence of the low frequency scattered power in relation to structural parameters. The fractal scattering regime characterizing the anisotropic scattering from flocs of size larger than the ultrasound wavelength is further discussed. In the second section, we report flow-dependent changes in the low-frequency scattering coefficient in a plane-plane flow geometry to analyze the shear disruption processes of hardened or deformable red cell aggregates in neutral dextran polymer solution. Rheo-acoustical experiments are examined on the basis of the rheo-acoustical model and the effective medium approximation. The ability of ultrasound scattering technique to determine the critical disaggregation shear stress and to give quantitative information on particle surface adhesive energy is analyzed. Lastly, the shear-thinning behavior of weakly aggregated hardened or deformable red cells is described.

Effect of red cell clustering and anisotropy on ultrasound blood backscatter: a Monte Carlo study

When flowing at a low shear rate, blood appears hyperechogenic on ultrasound B-scans. The formation of red blood cell (RBC) aggregates that also alters blood viscosity is the microscopic mechanism explaining this acoustical phenomenon. In this study, Monte Carlo simulations were performed to predict how RBC clustering increases ultrasound scattering by blood. A bidimensional Gibbs-Markov random point process parameterized by the adhesion energy epsilon and an anisotropy index nu was used to describe RBC positions for a hematocrit H = 40%. The frequency dependence of the backscattering coefficient chi(f) was computed using Born approximation. The backscattering coefficient chi0 at 5 MHz and the spectral slopes n(x) and n(y) (chi alpha f(nx) or f(ny)) measured, respectively, when the insonification is parallel and perpendicular with the RBC cluster axis were then extracted. Under isotropic conditions, chi0 increased up to 7 dB with epsilon and n(x) = n(y) decreased from 4.2 to 3.4. Under anisotropic conditions, the backscattering was stronger perpendicularly to aggregate axis, resulting in n(x) < n(y). The anisotropy in scattering appeared more pronounced when epsilon or nu increased. These two dimensional results generally predict that low-frequency blood backscatter is related to cluster dimension, and higher-frequency properties are affected by finer morphological features as anisotropy. This numerically establishes that ultrasound backscatter spectroscopy on a large frequency range is pertinent to characterize in situ hemorheology.

Volume scattering of distributed microbubbles and its influence on blood flow estimation

In recent years, microbubble contrast agents have become a potential adjunct in Doppler ultrasound diagnosis. In this paper, we show that volume scattering makes the effective band in Doppler spectrum shift downward after injection of microbubbles. Because the insonified volume comprises a collection of distributed microbubbles, the statistical properties such as the autocorrelation function and ensemble average power spectrum of the echoes from a collection of distributed microbubbles were derived first. It can be observed that, beyond a critical frequency, the theoretical volume backscattering cross section derived from the ensemble average power spectrum of microbubbles decreases with frequency. On the contrary, the volume backscattering cross section of red cells increases with frequency. Using two-dimensional (2-D) Fourier transform, the variation in Doppler spectrum caused by different volume backscattering cross section can be demonstrated, and the consequential downward shifts of the estimated Doppler parameters (e.g., the mean and maximum Doppler shifts, and the variance of Doppler power spectrum) after microbubble injection are shown. In addition, it can be observed that the variation gets larger as the transmitted bandwidth increases. And, the variations in Doppler parameters estimated with experimental data are presented to verify the theoretical deviations.

Comparison of new ultrasound index with laser reference and viscosity indexes for erythrocyte aggregation quantification

We have previously established new ultrasonic indexes for erythrocyte aggregation using a Couette device, and validated them toward the Rayleigh's theory and reproducibility. Two hydrodynamic protocols were applied on various suspensions and their aggregation degrees were characterized by: 1. for the decreasing shear rates protocol: the power P(US) at the nominal frequency of the transducer used; 2. for the kinetic protocol: aggregation times (latency and half-rise times), variation between initial disaggregated state (Vo) and final aggregated state (V(inf)) and AI(US), which is the integral of the kinetic curve over time. The objective of the present study was to demonstrate the ability of these indexes to characterize the aggregation dynamics of suspensions with various levels of aggregation induced by concentrations of dextran 70 kD (Dx) of 10, 20 and 40 g/L added to washed red cells resuspended in saline solution. The results showed a maximum of backscattered power (P(US)) for Dx = 40 g/L with the decreasing shear rates protocol. We measured a final aggregation level (V(inf)), a minimal aggregation time (T(m)) and a maximal value of AI(US) for Dx = 40 g/L with the aggregation kinetics protocol. On the other hand, viscosity is increased with dextran concentration. These evolutions of the ultrasound (US) indexes and viscosity with dextran concentrations are consistent with literature reports. In addition, a particularly interesting phenomenon of US backscattering enhancement was observed for kinetics with no null final shear rate, which has never before been reported in such a precise manner. By another way, each of the dextran suspensions was tested on the laser erythroaggregometer that is presently considered as the "gold standard" method for erythrocyte characterization. The laser indexes (aggregation time T(a), aggregation indexes AI(10s) and AI(60s)), deduced from a kinetic protocol, have similar significance to the US ones. Statistical comparisons have been done between laser and ultrasonic indexes and significant correlations (0.001 < p < 0.01) were obtained. The set of results allowed us to conclude that ultrasonic indexes are suitable markers for the erythrocyte aggregation.

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.

Modifying the cosine model for nonstationary blood flow signal simulation

OBJECTIVE

The most important features of the Doppler signal are its nonstationary nature and randomness, which make simulating these kinds of signals difficult. Our intent was to create realistic simulations of these signals.

METHODS

We generated the Doppler signal for the carotid artery by using the cosine model. We also modified the cosine model to simulate the femoral Doppler signal for the whole cardiac cycle.

RESULTS

In auditory comparisons, the simulation results compared favorably with the original data. No appreciable differences were found between the real clinical signals and the simulations for the normal carotid and femoral arteries. However, the calculated normalized root mean square errors were high.

CONCLUSIONS

The cosine model is simple to implement and requires input of only the spectrum shape variation during a cardiac cycle. In addition, it is more informative than other modeling methods and therefore is preferred over other methods.

High-frequency backscatter and attenuation measurements of porcine erythrocyte suspensions between 30-90 MHz

There are now diagnostic ultrasonic imaging devices that operate at very high frequencies (VHF) of 20 MHz and beyond for clinical applications in ophthalmology, dermatology and vascular surgery. To be able to better interpret these images and to further the development of these devices, knowledge of ultrasonic attenuation and scattering of biologic tissues, such as blood, in the high-frequency range is crucial. VHF attenuation and backscatter experiments were made on porcine red blood cell (RBC) suspensions, for which much data on attenuation and backscatter can be found in the literature in the lower frequency range. Attenuation and backscatter at hematocrits of 6%, 10%, 15%, 20%, 25% and 30% from 30 to 90 MHz were measured using a modified substitution method that allows the utilization of focused transducers. The results show that the attenuation coefficient from all suspensions increased linearly with frequency and the backscatter coefficient for low hematocrit suspensions was found to have a maximum between 10% and 15%. At higher hematocrits, a decrease in the frequency-dependence was observed, possibly indicating that Rayleigh scattering is no longer valid because the wavelength in the VHF range is comparable to the size of a porcine RBC.

Simulation of ultrasound backscattering by red cell aggregates: effect of shear rate and anisotropy

Tissue characterization using ultrasound (US) scattering allows extraction of relevant cellular biophysical information noninvasively. Characterization of the level of red blood cell (RBC) aggregation is one of the proposed application. In the current paper, it is hypothesized that the microstructure of the RBCs is a main determinant of the US backscattered power. A simulation model was developed to study the effect of various RBC configurations on the backscattered power. It is an iterative dynamical model that considers the effect of the adhesive and repulsive forces between RBCs, and the effect of the flow. The method is shown to be efficient to model polydispersity in size, shape, and orientation of the aggregates due to the flow, and to relate these variations to the US backscattering properties. Three levels of aggregability at shear rates varying between 0.05 and 10 s(-1) were modeled at 40% hematocrit. The simulated backscattered power increased with a decrease in the shear rate or an increase in the RBC aggregability. Angular dependence of the backscattered power was observed. It is the first attempt to model the US power backscattered by RBC aggregates polydisperse in size and shape due to the shearing of the flow.

New approach for modelling ultrasound blood backscatter signal

The ultrasound (US) scattered signal from blood has been treated as a random signal by many investigators. However, the degree of randomness of a medium is a relative term that can change considerably with the resolution of the sensor. In this study, the backscattered signal from blood has been looked at as a chaotic signal. By this treatment, according to Taken's theorem, a single variable (e.g., amplitude of the blood-backscattered signal) can be used to reconstruct the nonlinear dynamics of the blood-scattered signal. Multilayer perceptron neural network architecture, with error back-propagation, has been formulated and used as a basis for building and testing the chaotic model of the backscattered signal. This chaotic model is used successfully as a short-term predictor of the backscattered signal from blood-mimicking fluid (BMF) flowing in a vascular flow phantom under pulsatile flow. This modelling approach can be useful, for example, in detecting blood-borne emboli.

A model based upon pseudo regular spacing of cells combined with the randomisation of the nuclei can explain the significant changes in high-frequency ultrasound signals during apoptosis

Recent ultrasound (US) experiments on packed myeloid leukaemia cells have shown that, at frequencies from 32 to 40 MHz, significant increases of signal amplitude were observed during apoptosis. This paper is an attempt to explain these signal increases based upon a simulation of the backscattered signals from the cells nuclei. The simulation is an expansion of work in which a condensed sample of cells, with fairly regular sizes, could be considered as an imperfect crystal. Thus, destructive interference could occur and this would be observed as a large reduced value of backscattered signals compared with the values obtained from a similar, but random, scattering source. This current paper explores the possibility that simple changes in the nuclei, such as their observed condensation or the small loss of nuclei scatterers from cells, could cause a significant increase in the observed backscattered signals. This model indicates that the greater backscattered signals can be explained by further randomisation of the average positions of the scattering sources in each cell. When these "microechoes" are added together, so that the destructive interference is reduced, a large increase in the signal is predicted. The simplified model strongly suggests that much of observed large increases of the backscattered signals could be simply explained by the randomisation of the position of the condensed nuclei during apoptosis, and the destruction of the nuclei could produce further signal amplitude changes due to disruption of the cloud of backscattered waves.

A point process approach to assess the frequency dependence of ultrasound backscattering by aggregating red blood cells

To study the shear-thinning rheological behavior of blood, an acoustical measurement of the erythrocyte aggregation level can be obtained by analyzing the frequency dependence of ultrasonic backscattering from blood. However, the relation that exists among the variables describing the aggregation level and the backscattering coefficient needs to be better clarified. To achieve this purpose, a three-dimensional random model, the Neyman-Scott point process, is proposed to simulate red cell clustering in aggregative conditions at a low hematocrit (H<5%). The frequency dependence of the backscattering coefficient of blood, in non-Rayleigh conditions, is analytically derived from the model, as a function of the size distribution of the aggregates and of their mass fractal dimension. Quantitative predictions of the backscatter increase due to red cell aggregation are given. The parametric model of backscatter enables two descriptive indices of red cell aggregation to be extracted from experimental data, the packing factor W and the size factor delta. Previously published backscatter measurements from porcine whole blood at 4.5% hematocrit, in the frequency range of 3.5 MHz-12.5 MHz, are used to study the shear-rate dependence of these two indices.

Statistics of the integrated backscatter estimate from a blood-mimicking fluid

This work evaluates the variance of the integrated backscatter (IBS) from moving blood [or blood-mimicking fluid (bmf)] as a way of determining the quality of the mean IBS estimate. The main motivation for this work comes from the fact that absolute IBS values from tissues adjacent to arterial blood can be found by normalizing the measured backscatter energy with the IBS of moving, deaggregated blood. The paper describes the parameters that control the statistics of the IBS estimate, which is calculated for the stochastic ultrasound backscatter signals from flowing blood. It further formulates how the measurement parameters should be specified so that an appropriately low blood IBS variance is ensured or, alternatively, a specified accuracy of the tissue IBS estimate is obtained. First, the paper provides an analytic formulation of the statistics of the IBS, based on a sequence of sampled echoes from a nonstationary Gaussian scattering medium. The analysis incorporates the correlation between the sample values as well as the correlation between the IBS of the individual echoes. The estimate of the mean IBS has been shown to be chi-squared distributed with a determinable order. With the degree of correlation between the samples and between the IBS of individual echoes specified, the number of measurements required to obtain an IBS estimate with a specified variance is readily calculated. Next, a sequence of synthetic echoes is produced and arranged as columns in a data matrix. The echoes are generated such that the second-order statistics along the rows and columns of the matrix match that of actually observed echoes. The actual variance of the mean IBS estimate for the synthetic echoes is calculated and compared with the variance determined from the analytic model, and a good agreement has been found. Finally, sequences of actual backscattered echoes from circulating blood-mimicking fluid are acquired and analyzed to determine the variance of their mean IBS estimate. Based on the measured second-order statistics of the rows and columns of the data matrix for the actual echoes, the observed variance of the mean IBS estimate was compared with the analytically determined variance and with good agreement. Thus, the paper has shown through modeling, simulations, and experiments how the variance of the IBS estimate of the blood backscatter signal can be quantified and reduced to a specified tolerable level.

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.

Influence of boundary conditions on a one-dimensional ultrasound backscattering model of blood

A simulation model of one-dimensional (1-D) ultrasound (US) propagation in blood was used to study the relation between the backscattering coefficient and hematocrit. In this model, an ultrasonic plane wave was propagated in plasma normal to randomly placed slabs of constant thickness whose acoustical properties are the same as red blood cells, and the corresponding intensity reflection coefficient was calculated. The simulation results were compared to the 1-D Percus-Yevick (P-Y) theory as presented in the literature. Previous investigators have reported a close agreement over a limited range of simulation parameters between their results and the P-Y theory. However, a more careful investigation using a wider range of parameters has revealed major discrepancies. It is shown that these arise from an inappropriate choice of boundary conditions. By averaging the material properties beyond the boundaries of the simulation, as suggested by earlier theoretical work, the results are now in excellent agreement with the P-Y theory over a wide range of simulation parameters.

In vivo measurements of ultrasonic backscattering in blood

Ultrasonic backscattering in blood including its dependence on the hematocrit, plasma proteins, shear rate, and flow disturbance, has been studied extensively theoretically and experimentally in vitro. However, much of the result has never been validated in vivo. To do so, backscattering measurements were made on pigs using a 10-MHz non-focused intravascular transducer in direct contact with blood. The probe was placed in either the abdominal aorta or the inferior vena cava. The backscattering coefficient (BSC) of blood flowing in these vessels as well as downstream from a stenosis was measured using an approach that was originally developed for measurements with focused transducers. With this approach, 6% porcine red cell saline suspensions prepared immediately after each in vivo measurement were used as the reference medium. Result from seven pigs at hematocrits ranging from 29 to 36% (31.9 +/- 2.5%) demonstrated that BSC of blood in the vena cava, (4.62 +/- 2.06) x 10(-5) cm-sr-1, is consistently higher than that in the aorta, (2.65 +/- 1.22) x 10(-5) cm-sr-1. The difference has been attributed to the lower shear rate and the formation of red cell aggregation in venous blood. These in vivo results are in agreement with those obtained in vitro. In response to stenoses created by ligating the aorta, backscattering of the blood measured downstream from the stenosis showed that the closer the site of measurement relative to the stenosis, the higher the backscatter, presumably resulting from the higher degree of flow disturbance. In vitro backscattering results on porcine whole blood were also acquired at 20 MHz with a Diasonics intravascular scanner.

The power-velocity integral at the vena contracta: A new method for direct quantification of regurgitant volume flow

BACKGROUND

Noninvasive quantification of regurgitation is limited because Doppler measures velocity, not flow. Because backscattered Doppler power is proportional to sonified blood volume, power times velocity should be proportional to flow rate. Early studies, however, suggested that this held only for laminar flow, not for regurgitant jets, in which turbulence and fluid entrainment augment scatter. We therefore hypothesized that this Doppler power principle can be applied at the proximal vena contracta, where flow is laminar before entrainment, so that the power-times-velocity integral should vary linearly with flow rate and its time integral with stroke volume (SV).

METHODS AND RESULTS

This was tested in vitro with steady and pulsatile flow through 0.07- to 0.8-cm(2) orifices and in 36 hemodynamic stages in vivo, replacing the left atrium with a rigid chamber and column for direct visual recording of mitral regurgitant SV (MRSV). In 12 patients, MRSV was compared with MRI mitral inflow minus aortic outflow and in 11 patients with 3D echo left ventricular ejection volume-Doppler aortic forward SV. Vena contracta power in the narrow high-velocity spectrum from a broad measuring beam was calibrated against that from a narrow reference beam of known area. Calculated and actual flow rates and SV correlated well in vitro (r=0.99, 0.99; error=-1.6+/-2.5 mL/s, -2. 4+/-2.9 mL), in vivo (MRSV: r=0.98, error=0.04+/-0.87 mL), and in patients (MRSV: r=0.98, error=-2.8+/-4.5 mL).

CONCLUSIONS

The power-velocity integral at the vena contracta provides an accurate direct measurement of regurgitant flow, overcoming the limitations of existing Doppler techniques.

Rheo-acoustical study of the shear disruption of reversible aggregates. Ultrasound scattering from concentrated suspensions of red cell aggregates

Shear-induced disruption of reversible aggregates or clusters in a concentrated suspension is investigated by ultrasound backscattering in the low shear regime. Fractal aggregates are considered as non-Brownian scatterers much smaller than the wavelength with acoustic properties close to those of the surrounding liquid, so that the attenuation of the coherent field is weak and multiple scattering can be neglected. The concept of variance in local particle volume fraction is used to deduce a first-order expression of the ultrasound scattering cross section per unit volume for Rayleigh scatterers in a dense suspension. On the basis of a scaling law for the shear-induced disruption of aggregates, the shear stress dependence of the ultrasonic scattered intensity from a dense suspension of clusters is derived. In a second part, the shear breakup of hardened red blood cell aggregates is investigated in plane-plane flow geometry by ultrasound scattering. Rheo-acoustical experiments are analyzed within the framework of the self-consistent field approximation and the scaling laws currently used in microrheological models. Finally, the ability of ultrasonic, light reflectometry and viscometry methods to provide quantitative information about red blood cell aggregation and membrane adhesiveness is discussed.

On the relation between aggregation, packing and the backscattered ultrasound signal for whole blood

Previous studies have shown that the backscattered ultrasound (US) power from blood depends on the manner in which red blood cells (RBCs) are packed and, in particular, on spatial variations in the red blood cell number density (i.e., the RBC concentration variance). Experimental measurements have also shown that the backscattered US power depends on the degree of RBC aggregation, and it has been hypothesized that this is primarily due to the effect of RBC aggregation on the concentration variance. An initial simulation study of the relationship between RBC aggregation and packing statistics is presented, in which the effects of hematocrit, aggregate size, shape and size distribution on concentration variance are investigated. Both two-dimensional (2-D) and 3-D samples of aggregated and disaggregated RBCs were simulated; these enabled the concentration variance to be calculated. In agreement with theoretical predictions and experimental US results, the concentration variance for disaggregated RBCs is shown to be lowest at low and high hematocrits, and to peak at intermediate hematocrits. The concentration variance is shown to be particularly sensitive to changes in aggregate size and size distribution, and less sensitive to the shape of small aggregates. The results of this study provide a foundation for relating the state of aggregation in a blood sample to the manner in which RBCs are packed and, therefore, to the backscattered US power.

A system-based approach to modeling the ultrasound signal backscattered by red blood cells

A system-based model is proposed to describe and simulate the ultrasound signal backscattered by red blood cells (RBCs). The model is that of a space-invariant linear system that takes into consideration important biological tissue stochastic scattering properties as well as the characteristics of the ultrasound system. The formation of the ultrasound signal is described by a convolution integral involving a transducer transfer function, a scatterer prototype function, and a function representing the spatial arrangement of the scatterers. The RBCs are modeled as nonaggregating spherical scatterers, and the spatial distribution of the RBCs is determined using the Percus-Yevick packing factor. Computer simulations of the model are used to study the power backscattered by RBCs as a function of the hematocrit, the volume of the scatterers, and the frequency of the incident wave (2-500 MHz). Good agreement is obtained between the simulations and theoretical and experimental data for both Rayleigh and non-Rayleigh scattering conditions. In addition to these results, the renewal process theory is proposed to model the spatial arrangement of the scatterers. The study demonstrates that the system-based model is capable of accurately predicting important characteristics of the ultrasound signal backscattered by blood. The model is simple and flexible, and it appears to be superior to previous one- and two-dimensional simulation studies.

Spectrum of Doppler ultrasound signals from nonstationary blood flow

A new formulation for the Doppler signal generation process in pulsatile flow has been developed enabling easier identification and quantification of the mechanisms involved in spectral broadening and the development of a simple estimation formula for the measured rms spectral width. The accuracy of the estimation formula was tested by comparing it with the spectral widths found by using conventional spectral estimation on simulated Doppler signals from pulsatile flow. The influence of acceleration, sample volume size, and time window duration on the Doppler spectral width was investigated for flow with blunt and parabolic velocity profiles passing through Gaussian-shaped sample volumes. Our results show that, for short duration windows, the spectral width is dominated by window broadening and that acceleration has a small effect on the spectral width. For long duration windows, the effect of acceleration must be taken into account. The size of the sample volume affects the spectral width of the Doppler signal in two ways: by intrinsic broadening and by the range of velocities passing through it. These effects act in opposite directions. The simple spectral width estimation formula was shown to have excellent agreement with widths calculated using the model and indicates the potential for correcting not only for window and nonstationarity broadening but also for intrinsic broadening.

Does the size of intracranial aneurysms change with intracranial pressure? Observations based on color "power" transcranial Doppler ultrasound

OBJECT

The authors sought to determine whether the increased pulsatility of aneurysms, compared with normal intracranial arteries, on color "power" transcranial Doppler (TCD) ultrasound was due to a true change in aneurysm size and whether aneurysm dimensions change with intracranial pressure (ICP).

METHODS

The authors studied nine patients who had suffered recent subarachnoid hemorrhages complicated by hydrocephalus requiring intraventricular cerebrospinal fluid drainage, in whom the presence of an aneurysm was confirmed on angiographic examination. Color "power" TCD studies of the intracranial arteries and aneurysm were obtained through the temporal bone window before and after insertion of the ventricular drain and then at different known ICPs. Of the nine patients studied, four were examined both before and after insertion of a ventricular drain. At high ICPs, aneurysms appeared very "pulsatile" and the maximum cross-sectional area was small, whereas at low ICPs, aneurysms appeared larger and were much less pulsatile. The normal arteries did not change significantly in terms of pulsatility or maximum cross-sectional area at different levels of ICP.

CONCLUSIONS

The change in aneurysm size visualized with the aid of color power TCD is likely to be real. Aneurysm dimensions vary with ICP levels; the lesions are larger and less pulsatile at low ICPs and smaller but more pulsatile at high ICPs.

Validation of a new blood-mimicking fluid for use in Doppler flow test objects

A blood-mimicking fluid (BMF) suitable for use in Doppler flow test objects is described and characterised. The BMF consists of 5 microns diameter nylon scattering particles suspended in a fluid base of water, glycerol, dextran and surfactant. The acoustical properties of various BMF preparations were measured under uniform flow to study the effects of particle size, particle concentration, surfactant concentration, flow rate and stability. The physical properties, (density, viscosity and particle size), and acoustical properties (velocity, backscatter and attenuation) of the BMF are within draft International Electrotechnical Commission requirements.

In vitro analysis of regurgitant fraction using Doppler power-weighted sum of velocities

The power-weighted sum of velocities (PWS) is the sum of each velocity component of the Doppler signal multiplied by its power. The purpose of this study was to determine (1) whether PWS is linearly related to volume flow and (2) whether PWS can predict the regurgitant fraction in an in vitro pulsatile flow system simulating aortic regurgitation. Doppler analysis of aortic flow was performed with an intact valve and two regurgitant valves. For each valve a linear relation between the forward flow PWS and forward flow volume was demonstrated, with excellent correlation (r = 0.99). For the valves with regurgitant orifices, the values for the PWS-derived regurgitant fraction were compared with measured regurgitant fraction. A fair correlation was demonstrated (r = 0.59), with low accuracy in prediction (error 44% +/- 24%). The PWS was inaccurate in predicting flow ratios in our in vitro system despite the strong relation with forward flow volume. The error incurred may be due to effects of filters that remove low velocity and low amplitude information.

Inhibition of red cell aggregation prevents spontaneous echocardiographic contrast formation in human blood

BACKGROUND

Spontaneous echocardiographic contrast (SEC) is a pattern of blood echogenicity that has been attributed to ultrasonic backscatter from blood cell aggregates that form under low shear conditions. Patients with left atrial SEC have an increased thromboembolic risk. This study examined the role of red cell and platelet aggregates in the pathogenesis of SEC in human blood and the effects on SEC of antithrombotic therapy and red cell disaggregatory agents.

METHODS AND RESULTS

Blood echogenicity was examined with the use of quantitative videodensitometry over a controlled range of flow velocities in an in vitro model characterized by nonlaminar flow conditions. One hundred ninety study samples were prepared from single fresh blood donations (40 to 120 mL) from 24 healthy volunteers and 11 patients. Whole blood echogenicity was unaltered by depletion of platelets, stimulation of platelet aggregation with adenosine diphosphate, or inhibition of platelet aggregation with aspirin. Low flow-related echogenicity increased with increasing hematocrit (P<.001) but was abolished when red cells were lysed selectively with saponin (P<.001). In the presence of red cells, low flow-related echogenicity increased with increasing fibrinogen concentration (P<.001) and with plasma paraproteins. Low flow-related echogenicity in whole blood was unaltered by heparin and warfarin but was reduced in a dose-dependent manner by dextran 40 (40 mg/mL, 70% reduction, P<.001) and poloxamer 188 (8 mg/mL, 47% reduction, P<.001), which inhibited red cell aggregation.

CONCLUSIONS

These results support protein-mediated red cell aggregation as the mechanism of SEC in human blood. Inhibition of red cell aggregation, indexed by resolution of SEC, may provide an alternative to anticoagulant and antiplatelet therapy to reduce cardiac thromboembolic risk.

An approach for measuring ultrasonic backscattering from biological tissues with focused transducers

When the standard substitution method is used with a focused transducer to measure the backscattering coefficient from biological tissues including blood, it yields erroneous results. Extending the backscattering measurements to frequencies beyond 15 MHz necessitates the use of focused transducers because of the worsened signal-to-noise ratio--caused by the increased attenuation and the smaller transducer aperture size--in order to make the measurements close to the transducer. An approach which allows the use of focused transducers in backscattering measurements has been developed. It has been used to measure the backscattering coefficient of red cell suspensions of hematocrit ranging from a few percent to 30% in the frequency range from 5 MHz to 30 MHz. The results at hematocrits below 20% agree well with those obtained with the standard substitution method, although they differ as the hematocrit is increased beyond 20%. The experimental results also show that the fourth-power dependence of backscatter on frequency is in general approximately valid for suspended erythrocytes of hematocrit between 6% and 30%.