Ultrasound scattering from blood with hematocrits up to 100%

Specification and Evaluation of Plasticizer Migration Simulants for Human Blood Products: A Delphi Study

Potentially toxic plasticizers are commonly added to polyvinyl chloride medical devices for transfusion in order to improve their flexibility and workability. As the plasticizers are not chemically bonded to the PVC, they can be released into labile blood products (LBPs) during storage. Ideally, LBPs would be used in laboratory studies of plasticizer migration from the medical device. However, short supply (i.e., limited stocks of human blood in collection centres) has prompted the development of specific simulants for each type of LBP in the evaluation of new transfusion devices. We performed a Delphi study with a multidisciplinary panel of 24 experts. In the first (qualitative) phase, the panel developed consensus definitions of the specification criteria to be met by each migration simulant. Next, we reviewed the literature on techniques for simulating the migration of plasticizers into LBPs. A questionnaire was elaborated and sent out to the experts, and the replies were synthesized in order to obtain a consensus. The qualitative study established specifications for each biological matrix (whole blood, red blood cell concentrate, plasma, and platelet concentrate) and defined the criteria required for a suitable LBP simulant. Ten criteria were suggested: physical and chemical characteristics, opacity, form, stability, composition, ability to mimic a particular clinical situation, ease and safety of use, a simulant–plastic interaction correlated with blood, and compatibility with analytical methods. The questionnaire data revealed a consensus on the use of natural products (such as pig’s blood) to mimic the four LBPs. Opinions diverged with regard to synthetic products. However, an isotonic solution and a rheological property modifier were considered to be of value in the design of synthetic simulants. Consensus reached by the Delphi group could be used as a database for the development of simulants used to assess the migration of plasticizers from PVC bags into LBPs.

Quantitative colour Doppler and greyscale ultrasound for evaluating prostate cancer

Introduction

Although transrectal ultrasound is routinely performed for imaging prostate lesions, colour Doppler imaging visualizing vascularity is not commonly used for diagnosis. The goal of this study was to measure vascular and echogenic differences between malignant and benign lesions of the prostate by quantitative colour Doppler and greyscale transrectal ultrasound.

Methods

Greyscale and colour Doppler ultrasound images of the prostate were acquired in 16 subjects with biopsy-proven malignant or benign lesions. Echogenicity and microvascular flow velocity of each lesion were measured by quantitative image analysis. Flow velocity was measured over several cardiac cycles and the velocity-time waveform was used to determine microvascular pulsatility index and microvascular resistivity index. The Wilcoxon rank sum test was used to compare the malignant and benign groups.

Results

Median microvascular flow velocity of the malignant lesions was 1.25 cm/s compared to 0.36 cm/s for the benign lesions. Median pulsatility and resistive indices of the malignant lesions were 1.55 and 0.68, respectively versus 6.38 and 1.0 for the benign lesions. Malignant lesions were more hypoechoic relative to the surrounding tissue, with median echogenicity of 0.24 compared to 0.76 for the benign lesions. The differences between the malignant and benign groups for each measurement were significant (p < 0.01).

Conclusion

Marked differences were observed in flow velocity, microvascular pulsatility, microvascular resistance, and echogenicity of prostate cancer measured with quantitative colour Doppler and greyscale ultrasound imaging. Vascular differences measured together with echogenicity have the combined potential to characterize malignant and benign prostate lesions.

Spectrum analysis for assessing red blood cell aggregation using high-frequency ultrasound array transducer

The purpose of this study is to investigate a spectrum analysis technique for detecting and monitoring red blood cell (RBC) aggregation using a high-frequency array transducer. To assess the feasibility of this approach, the backscattered radio-frequency signal from non-aggregated and aggregated RBC samples with two hematocrit levels were acquired by using a 30-MHz linear array transducer and analyzed in frequency domain. Three parameters such as spectral slope, midband fit and Y intercept were extracted in a static condition. Fresh porcine blood was used and degrees of aggregation were changed by diluting plasma concentration. From the experiments, it was demonstrated that the spectral slope related to a size of scatterer progressively declined as the level of aggregation increased; its mean values at hematocrit of 40% were 1.10 and -0.22 dB/MHz for RBCs suspended in isotonic phosphate buffered saline and solution with 70% plasma concentrations, respectively. For the midband fit and Y intercept, the mean values were increased by 9.1 and 46.4 dB, respectively. These results indicated that the spectrum analysis technique is useful for monitoring RBC aggregation and can be potentially developed for assessing aggregation in clinical applications.

Evaluation of thrombolysis by using ultrasonic imaging: an in vitro study

The hematocrit of a thrombus is a key factor associated with the susceptibility to thrombolysis. Ultrasonic imaging is currently the first-line screening tool for thrombus examinations. Different hematocrits result in different acoustical structures of thrombi, which alter the behavior of ultrasonic backscattering. This study explored the relationships among thrombolytic efficiencies, hematocrits, and ultrasonic parameters (the echo intensity and backscattered statistics). Porcine thrombi with different hematocrits, ranging from 0% to 50%, were induced in vitro. An ultrasonic scanner was used to scan thrombi and acquire raw image data for B-mode (echo intensity measurements) and Nakagami imaging (backscattered statistics analysis). Experiments on thrombolysis were performed using urokinase to explore the effect of the hematocrit on thrombolytic efficiency. Results showed that the weight loss ratio of thrombi exponentially decreased as the hematocrit increased from 0% to 50%. Compared with the echo intensity obtained from the conventional B-scan, the Nakagami parameter predicts the weight loss ratio, increasing from 0.6 to 1.2 as the weight loss ratio decreased from 0.67 to 0.26. The current findings suggest that using Nakagami imaging characterizing thrombi provides information of backscattered statistics, which may be associated with the thrombolytic efficiency.

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

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

Histology-based simulations of ultrasound imaging: methodology

Simulations of ultrasound (US) images based on histology may shed light on the process by which microscopic tissue features translate to a US image and may enable predictions of feature detectability as a function of US system parameters. This technical note describes how whole-slide hematoxylin and eosin-stained histology images can be used to generate maps of fractional change in bulk modulus, whose convolution with the impulse response of the US system yields simulated US images. The method is illustrated by two canine mastocytoma histology images, one with and the other without signs of intra-operative hemorrhaging. Quantitative comparisons of the envelope statistics with corresponding clinical US images provide preliminary validation of the method.

A tissue phantom for visualization and measurement of ultrasound-induced cavitation damage

Many ultrasound studies involve the use of tissue-mimicking materials to research phenomena in vitro and predict in vivo bioeffects. We have developed a tissue phantom to study cavitation-induced damage to tissue. The phantom consists of red blood cells suspended in an agarose hydrogel. The acoustic and mechanical properties of the gel phantom were found to be similar to soft tissue properties. The phantom's response to cavitation was evaluated using histotripsy. Histotripsy causes breakdown of tissue structures by the generation of controlled cavitation using short, focused, high-intensity ultrasound pulses. Histotripsy lesions were generated in the phantom and kidney tissue using a spherically focused 1-MHz transducer generating 15 cycle pulses, at a pulse repetition frequency of 100 Hz with a peak negative pressure of 14 MPa. Damage appeared clearly as increased optical transparency of the phantom due to rupture of individual red blood cells. The morphology of lesions generated in the phantom was very similar to that generated in kidney tissue at both macroscopic and cellular levels. Additionally, lesions in the phantom could be visualized as hypoechoic regions on a B-mode ultrasound image, similar to histotripsy lesions in tissue. High-speed imaging of the optically transparent phantom was used to show that damage coincides with the presence of cavitation. These results indicate that the phantom can accurately mimic the response of soft tissue to cavitation and provide a useful tool for studying damage induced by acoustic cavitation.

An increase in cellular size variance contributes to the increase in ultrasound backscatter during cell death

This study aims to explain the contribution of changes in cellular size variance (CSV) to increases in ultrasound-integrated backscatter (UIB) measured from cell samples undergoing cell death. A Monte Carlo algorithm was used to compare simulations of 2D distributions of cells, uniform (CSV = 0) versus heterogeneous (CSV > 0) and the same mean cellular size (M ). UIB increased in arrangements with heterogeneous cellular sizes from 3.6dB (M = 20 mum, CSV = 0 microm/CSV = 18 microm) to 5.6 dB (M =10 microm, CSV = 0 microm/CSV = 8 microm). Experimentally, UIB (10 to 30 MHz) was measured from cell samples of four tumor cell lines viable and undergoing cell death after radiotherapy and chemotherapy treatment. An increase of 3.8-7.5 dB (p < 0.001) in UIB was measured from three cell lines. No increase in UIB was measured from one cell line. An increase in CSV was found for all cell samples after cell death. The results suggest that an increase in CSV could have a significant contribution to the increases measured in UIB after cell death in cell samples exposed to anticancer therapies.

Ultrasonic backscatter from rat blood in aggregating media under in vitro rotational flow

Ultrasonic backscatter from flowing and static rat red blood cells (RBCs) in autologous plasma and in 360 kDa polyvinylpyrrolidone (PVP 360) solution was measured as a function of hematocrit. The flow speed was varied by a stirring magnet in a cylindrical chamber. The radio-frequency (RF) signals backscattered by RBC samples were measured over 5 min in a pulse-echo setup with a 5 MHz focused transducer. Although the intact rat blood has poor RBC aggregability, RBC aggregation of rat blood was enhanced by replacing its plasma with a higher molecular weight polymer solution. The experimental results showed that the nonlinear relationship between hematocrit and ultrasonic backscatter from rat RBCs in plasma and aggregating media is affected by flow speed, which may provide a unified insight into hematocrit dependence of RBC aggregation under flowing and static conditions.

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

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

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.

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.

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

The power of a Doppler signal is theoretically proportional to the volume of blood within the sample volume of an ultrasound (US) beam and, hence, may provide a means of detecting in vivo changes in the cross-sectional area of cerebral vessels, such as the middle cerebral artery. The purpose of this study was to examine the relationship between power and vessel size for signals recorded from a wall-less flow phantom. The results demonstrate the importance for the in vitro case of maximising the received signal power for each channel to obtain the true relationship between power and size, and show that a nonproportional relationship observed between the two parameters is primarily caused by high-pass filtering and nonuniform insonation. In addition, an investigation of the reproducibility of power values after transducer repositioning has shown that variation occurs even when extreme care is taken to maximise the received signal intensity. The implications of these results for the in vivo use of the Doppler signal power method are 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.

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%.

Particle and voxel approaches for simulating ultrasound backscattering from tissue

In modeling the backscattering of pulsed ultrasound from tissue, variations in compressibility are frequently approximated by assuming that an appropriate distribution of particles will produce a similar signal. For high particle densities, the computational burden can be large if simulations are conducted on a sample volume of realistic size. The approximate voxel approach offers the potential for greatly reduced computational burden, especially for three-dimensional simulations. One- and two-dimensional computer simulations were performed using both approaches with a realistic wideband Gaussian-shaped transmit signal. The mean squared errors of the simulated backscattered signals were compared to determine how the accuracy of the voxel approach depended on the scatterer concentration and voxel size selection. It is shown that the voxel approach can be used in place of the particle method with a high degree of accuracy, while considerably reducing computation time.

A computer model for simulating ultrasonic scattering in biological tissues with high scatterer concentration

Scattering of ultrasonic waves by biological tissues at different scatterer concentrations is investigated using one- and two-dimensional computer simulation models. The backscattered power as a function of scatterer concentrations is calculated using two types of incident waves, a Gaussian shaped pulse and a continuous wave (CW). The simulation results are in good agreement with the Percus-Yevick packing theory within the scatterer concentrations, from 0% to 100% in one-dimensional (1D) space, and 0% to 46% in two-dimensional (2D) space. In all cases, the simulation results from a pulsed incident wave show a much smaller standard deviation (SD) than those from an incident CW. The simulation can serve as a useful tool to verify scattering theories, simulate different experimental conditions, and to investigate the interaction between the scatterer properties and the scattering of ultrasonic waves. More importantly, the 2D simulation procedure serves as an initial step toward the final realization of a true three-dimensional (3D) simulation of ultrasonic scattering in biological tissues.