Assessment of blood coagulation under various flow conditions with ultrasound backscattering

A Review of Blood-mimicking Fluid Properties Using Doppler Ultrasound Applications

Doppler imaging ultrasound characterization and standardization requires blood that is called blood mimicking fluid for the exam. With recognized internal properties, acoustic and physical features of this artificial blood. Both acoustical and physical merits set in the International Electrotechnical Commission (IEC) scale are determined as regular values, where the components utilized in the artificial blood preparation must have values identical to the IEC values. An artificial blood is commercially available in the medical application and may not be suitable in the mode of ultrasonic device or for rate of new imaging technique. It is sometimes qualified to have the strength to produce sound features and simulate blood configuration for particular implementations. In the current review article, appropriate artificial blood components, fluids, and measurements are described that have been created using varied materials and processes that have modified for medical applications.

Optimized acoustic streaming generated at oblique incident angles to improve ultrasound thrombolysis effect

BACKGROUND

Combined with thrombolytic drugs and/or microbubbles (MBs), ultrasound (US) has been regarded as a useful tool for thrombolysis treatment by taking its advantages of non-invasive, non-ionization, low cost and accurate targeting of tissues deep in body. Recently, low-intensity pulsed ultrasound (LIPUS), which can cause fewer complications by stable cavitation and acoustic streaming other than more violent effects, has attracted broad attention.

PURPOSE

However, the thrombolysis effect in practice might not achieve expectation because there is not an ideal parallel multilayer structure between the skin and the targeted vessel. Therefore, the current work aims to better elucidate the influence of US incident angle on the generation of acoustic streaming and thrombolysis effect.

METHODS

Systemic numerical and experimental studies, viz., finite element modeling (FEM), particle image velocimetry (PIV) and in vitro thrombolysis measurements, were performed to estimate the acoustical/streaming field pattern, maximum flow velocity and shear stress on the surface of thrombus, as well as the lysis rate generated at different conditions. These methods aim at verifying the hypothesis that streaming-induced vortices can further accelerate the dissolution of the thrombus and optimized thrombolysis effected can be achieved by adjusting US incident angles.

RESULTS

The pool data results showed that the variation trends of the flow velocity and shear stress obtained from FEM simulation and PIV experiments are qualitatively consistent with each other. There exists an optimal incident angle that can maximize the flow velocity and shear stress on the surface of thrombus, so that superior stirring and mixing effect can be generated. Furthermore, as the flow velocity and shear stress on thrombus surface are both highly correlated with the thrombolysis effect (the correlation coefficient R1 = 0.988, R2 = 0.958, respectively), the peak value of lysis rate (increase by at least 5.02%) also occurred at 10°.

CONCLUSIONS

The current results demonstrated that, with appropriately determined incident angle, higher thrombolysis rate could be achieved without increasing the driving pressure. It may shed the light on future US thrombolysis planning strategy that, if combined with other advanced technologies (e.g., machine-learning-based image analysis and image-guided adaptive US emission modulation), more efficient thrombolytic effect could be realized while minimizing undesired side-effects caused by excessively high pressure. This article is protected by copyright. All rights reserved.

Ultrasound-Guided Intravascular Sonothrombolysis With a Dual Mode Ultrasound Catheter: In Vitro Study

Thromboembolism in vessels often leads to stroke or heart attack and even sudden death unless brought under control. Sonothrombolysis based on ultrasound contrast agents has shown promising outcome in effective treatment of thromboembolism. Intravascular sonothrombolysis transducer was reported recently for unprecedented sonothrombolysis in vitro. However, it is necessary to provide an imaging guide during thrombolysis in clinical applications for optimal treatment efficiency. In this article, a dual mode ultrasound catheter was developed by combining a 16-MHz high-frequency element (imaging transducer) and a 220-kHz low-frequency element (treatment transducer) for sonothrombolysis in vitro. The treatment transducer was designed with a 20-layer PZT-5A stack with the aperture size of 1.2×1.2 mm², and the imaging transducer with the aperture size of 1.2×1.2 mm² was attached in front of the treatment transducer. Both transducers were assembled into a customized 2-lm 10-Fr catheter. In vitro experiment was carried out using a bovine blood clot. Imaging tests were conducted, showing that the backscattering signals can be obtained with a high signal-to-noise ratio (SNR) for the 16-MHz imaging transducer. Sonothrombolysis was performed successfully that the volume of clot was reduced significantly after the 30-min treatment. The size changes of clot were observed clearly using the 16-MHz M-mode imaging during the thrombolysis. The findings suggest that the proposed ultrasound-guided intravascular sonothrombolysis can be enhanced since the position of treatment transducer can be adjusted with the target at the clot due to the imaging guide.

Estimating the neovascularity of human finger tendon through high frequency ultrasound micro-Doppler imaging

OBJECTIVE

Neovascularization of injured tendons prolongs the proliferative phase of healing, but prolonged neovascularization may cause improper healing and pain. Currently, ultrasound Doppler imaging is used for measuring the neovascularization of injured tendons (e.g., Achilles tendon). However, the resolution of state-of-the-art clinical ultrasound machines is insufficient for visualizing the neovascularization in finger tendons. In this study, a high-resolution micro-Doppler imaging (HFDI) based on 40-MHz ultrafast ultrasound imaging was proposed for visualizing the neovascularization in injured finger tendons during multiple rehabilitation phases.

METHOD

The vessel visibility was enhanced through a block-wise singular value decomposition filter and several curvilinear structure enhancement strategies, including the bowler-hat transform and Hessian-based vessel enhancement filtering. HFDI was verified through small animal kidney and spleen imaging because the related vessel structure patterns of mice are well studied. Five patients with finger tendon injuries underwent HFDI examination at various rehabilitation phases after surgery (weeks 1156), and finger function evaluations were performed for comparisons.

RESULTS

The results of small animal experiments revealed that the proposed HFDI provides excellent microvasculature imaging performance; the contrast-to-noise ratio of HFDI was approximately 15 dB higher than that of the conventional singular value decomposition filter, and the minimum detectable vessel size for mouse kidney was 35 m without the use of contrast agent. In the human study, neovascularization was clearly observed in injured finger tendons during the early phase of healing (weeks 1121), but it regressed from week 52 to 56. Finger rehabilitation appears to help reduce neovascularization; neovascular density decreased by approximately 1.8%8.0% in participants after 4 weeks of rehabilitation.

CONCLUSION

The experimental results verified the performance of HFDI for microvasculature imaging and its potential for injured finger tendon evaluations.

Control of fibrinolytic drug injection via real-time ultrasonic monitoring of blood coagulation

In the present study, we investigated the capabilities of a novel ultrasonic approach for real-time control of fibrinolysis under flow conditions. Ultrasonic monitoring was performed in a specially designed experimental in vitro system. Fibrinolytic agents were automatically injected at ultrasonically determined stages of the blood clotting. The following clots dissolution in the system was investigated by means of ultrasonic monitoring. It was shown, that clots resistance to fibrinolysis significantly increases during the first 5 minutes since the formation of primary micro-clots. The efficiency of clot lysis strongly depends on the concentration of the fibrinolytic agent as well as the delay of its injection moment. The ultrasonic method was able to detect the coagulation at early stages, when timely pharmacological intervention can still prevent the formation of macroscopic clots in the experimental system. This result serves as evidence that ultrasonic methods may provide new opportunities for real-time monitoring and the early pharmacological correction of thrombotic complications in clinical practice.

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.

Effect of fibrinogen on blood coagulation detected by optical coherence tomography

Our previous work demonstrated that an optical coherence tomography (OCT) technique and the parameter 1/e light penetration depth (d1/e) were able to characterize the whole blood coagulation process in contrast to existing optical tests that are performed on plasma samples. To evaluate the feasibility of the technique for quantifying the effect of fibrinogen (Fbg) on blood coagulation, a dynamic study of d1/e of blood in various Fbg concentrations was performed in static state. Two groups of blood samples of hematocrit (HCT) in 35, 45, and 55% were reconstituted of red blood cells with: 1) treated plasma with its intrinsic Fbg removed and commercial Fbg added (0-8 g L(-1)); and 2) native plasma with commercial Fbg added (0-8 g L(-1)). The results revealed a typical behavior due to coagulation induced by calcium ions and the clotting time is Fbg concentration-dependent. The clotting time was decreased by the increasing amount of Fbg in both groups. Besides, the blood of lower HCT with various levels of Fbg took shorter time to coagulate than that of higher HCT. Consequently, the OCT method is a useful and promising tool for the detection of blood-coagulation processes induced with different Fbg levels.

Changes in backscattered ultrasonic envelope statistics as a function of thrombus age: an in vitro study

It is necessary to determine the age of thrombi in planning clinical treatment for thrombolysis. Ultrasound imaging can potentially be used to evaluate thrombus age in real time. The backscattered signals from thrombi may contain useful information regarding their age. On the basis of the randomness of ultrasound backscattering, this study explored changes in backscattered US statistics as a function of thrombus age. Porcine blood samples were used for the in vitro induction of fresh thrombi (day 0) with hematocrits ranging from 0%-40% and aged thrombi (days 0-8) with a hematocrit of 40%. Each thrombus was imaged using a pulse-echo ultrasound scanner equipped with a 7.5-MHz linear array transducer to acquire raw backscattered signals for B-mode and Nakagami imaging, by which the backscattered statistics were visualized. Hematoxylin and eosin staining and scanning electron microscopy were used to observe the histology of fresh and aged thrombi. The results indicated that a decrease in the number of red blood cells in the thrombus caused by the aging effect was observed in the in vitro model, indicating that the proposed model could simulate the structural changes in the thrombus during aging. Compared with fresh thrombi with various hematocrits, the aged thrombi exhibited a trend toward more substantial decreases in the Nakagami parameter with increasing thrombus age (the Nakagami parameter decreased from 1.1 to 0.6 as thrombus age increased from day 0 to day 8), indicating that thrombus aging causes the backscattered statistics to follow a pre-Rayleigh distribution to a high degree. This finding may be applied to the determination of thrombus age using conventional ultrasound imaging in the future.

Discrimination between newly formed and aged thrombi using empirical mode decomposition of ultrasound B-scan image

Ultrasound imaging is a first-line diagnostic method for screening the thrombus. During thrombus aging, the proportion of red blood cells (RBCs) in the thrombus decreases and therefore the signal intensity of B-scan can be used to detect the thrombus age. To avoid the effect of system gain on the measurements, this study proposed using the empirical mode decomposition (EMD) of ultrasound image as a strategy to classify newly formed and aged thrombi. Porcine blood samples were used for the in vitro induction of fresh and aged thrombi (at hematocrits of 40%). Each thrombus was imaged using an ultrasound scanner at different gains (15, 20, and 30 dB). Then, EMD of ultrasound signals was performed to obtain the first and second intrinsic mode functions (IMFs), which were further used to calculate the IMF-based echogenicity ratio (IER). The results showed that the performance of using signal amplitude of B-scan to reflect the thrombus age depends on gain. However, the IER is less affected by the gain in discriminating between fresh and aged thrombi. In the future, ultrasound B-scan combined with the EMD may be used to identify the thrombus age for the establishment of thrombolytic treatment planning.

Assessing blood coagulation status with laser speckle rheology

We have developed and investigated a novel optical approach, Laser Speckle Rheology (LSR), to evaluate a patient's coagulation status by measuring the viscoelastic properties of blood during coagulation. In LSR, a blood sample is illuminated with laser light and temporal speckle intensity fluctuations are measured using a high-speed CMOS camera. During blood coagulation, changes in the viscoelastic properties of the clot restrict Brownian displacements of light scattering centers within the sample, altering the rate of speckle intensity fluctuations. As a result, blood coagulation status can be measured by relating the time scale of speckle intensity fluctuations with clinically relevant coagulation metrics including clotting time and fibrinogen content. Our results report a close correlation between coagulation metrics measured using LSR and conventional coagulation results of activated partial thromboplastin time, prothrombin time and functional fibrinogen levels, creating the unique opportunity to evaluate a patient's coagulation status in real-time at the point of care.

Quantitative assessment on the orientation and distribution of carbon fibers in a conductive polymer composite using high-frequency ultrasound

Conductive polymer composites, typically fabricated from a mix of conductive fillers and a polymer substrate, are commonly applied as bipolar plates in a fuel cell stack. Electrical conductivity is a crucial property that greatly depends on the distribution and orientation of the fillers. In this study, a 50-MHz ultrasound imaging system and analysis techniques capable of nondestructively assessing the properties of carbon fibers (CFs) in conductive polymer composites were developed. Composite materials containing a mix of polycarbonate substrates and 0 to 0.3 wt% of CFs were prepared using an injection molding technique. Ultrasonic A-line signals and C-scan images were acquired from each composite sample in regions at a depth of 0.15 mm beneath the sample surface (region A) and those at a depth of 0.3 mm (region B). The integrated backscatter (IB) and the Nakagami statistical parameter were calculated to quantitatively assess the samples. The area ratio, defined as the percentage of areas composed of CF images normalized by that of the whole C-scan image, was applied to further quantify the orientation of CFs perpendicular to the sample surface. Corresponding to the increase in CF concentrations from 0.1 to 0.3 wt%, the average IB and Nakagami parameter (m) of the composite samples increased from -78.10 ± 2.20 (mean ± standard deviation) to -72.66 ± 1.40 dB and from 0.024 ± 0.012 to 0.048 ± 0.011, respectively. The corresponding area ratios were respectively estimated to be 0.78 ± 0.35%, 2.33 ± 0.66%, and 2.20 ± 0.60% in region A of the samples; those of CFs with a perpendicular orientation were 0.04 ± 0.03%, 0.08 ± 0.02%, and 0.12 ± 0.05%. The area ratios in region B of the samples were calculated to be 1.19 ± 0.54%, 2.81 ± 0.42%, and 2.64 ± 0.76%, and those of CFs with a perpendicular orientation were 0.07 ± 0.04%, 0.12 ± 0.04%, and 0.14 ± 0.03%. According to the results of the orientations and ultrasonic images, CFs tended to distribute more uniformly in the deeper regions of the samples. This study validates that the distribution and orientation of CFs in conductive polymer composites could be sensitively and quantitatively assessed by high-frequency ultrasound in conjunction with current analysis methods.

Assessing the viscoelastic properties of thrombus using a solid-sphere-based instantaneous force approach

The viscoelastic properties of thrombus play a significant role when the clot closes a leak in a vessel of the blood circulation. The common method used to measure the viscoelastic properties of a clot employs a rheometer but this might be unsuitable due to the clot fiber network being broken up by excessive deformation. This study assessed the feasibility of using a novel acoustic method to assess the viscoelastic properties of blood clots. This method is based on monitoring the motion of a solid sphere in a blood clot induced by an applied instantaneous force. Experiments were performed in which a solid sphere was displaced by a 1 MHz single-element focused transducer, with a 20 MHz single-element focused transducer used to track this displacement. The spatiotemporal behavior of the sphere displacement was used to determine the viscoelastic properties of the clot. The experimental system was calibrated by measuring the viscoelastic modulus of gelatin using different types of solid spheres embedded in the phantoms and, then, the shear modulus and viscosity of porcine blood clots with hematocrits of 0% (plasma), 20% and 40% were assessed. The viscoelastic modulus of each clot sample was also measured directly by a rheometer for comparison. The results showed that the shear modulus increased from 173 ± 52 (mean ± SD) Pa for 40%-hematocrit blood clots to 619.5 ± 80.5 Pa for plasma blood clots, while the viscosity decreased from 0.32 ± 0.07 Pa∙s to 0.16 ± 0.06 Pa∙s, respectively, which indicated that the concentration of red blood cells and the amount of fibrinogen are the main determinants of the clot viscoelastic properties.

Optical coherence tomography to investigate optical properties of blood during coagulation

This study investigates the optical properties of human blood during the coagulation process under statics using optical coherence tomography (OCT). OCT signal slope (OCTSS) and 1∕e light penetration depth (d(1∕e)) were obtained from the profiles of reflectance versus depth. Results showed that both OCTSS and d(1∕e) were able to sensitively differentiate various stages of blood properties during coagulating. After 1 h clotting, OCTSS decreased by 47.0%, 15.0%, 13.7%, and 8.5% and d(1∕e) increased by 34.7%, 29.4%, 24.3%, and 22.9% for the blood samples at HCT of 25%, 35%, 45%, and 55%, respectively. The slope of d(1∕e) versus time (S(r), ×10(-4) mm∕s), associated with clot formation rate decreased from 6.0 ± 0.3, 3.7 ± 0.5 to 2.3 ± 0.4 with the increasing of HCT from 35%, 45%, to 55%. The clotting time (t(c)) from the d(1∕e) evolution curves was estimated to be 1969 ± 92 s, 375 ± 12 s, 455 ± 11 s, and 865 ± 47 s for the blood of 25%, 35%, 45%, and 55%. This study demonstrates that the parameters (t(c) and S(r)) from the variations in d(1∕e) had better sensitivity and smaller standard deviation. Furthermore, blood hematocrit affecting backscattering properties of blood during coagulation was capable of being discerned by OCT parameters. It is concluded that OCT is a potential technique to quantify and follow the liquid-gel transition of blood during clotting.

Quantitative assessments of burn degree by high-frequency ultrasonic backscattering and statistical model

An accurate and quantitative modality to assess the burn degree is crucial for determining further treatments to be properly applied to burn injury patients. Ultrasounds with frequencies higher than 20 MHz have been applied to dermatological diagnosis due to its high resolution and noninvasive capability. Yet, it is still lacking a substantial means to sensitively correlate the burn degree and ultrasonic measurements quantitatively. Thus, a 50 MHz ultrasound system was developed and implemented to measure ultrasonic signals backscattered from the burned skin tissues. Various burn degrees were achieved by placing a 100 °C brass plate onto the dorsal skins of anesthetized rats for various durations ranged from 5 to 20 s. The burn degrees were correlated with ultrasonic parameters, including integrated backscatter (IB) and Nakagami parameter (m) calculated from ultrasonic signals acquired from the burned tissues of a 5 × 1.4 mm (width × depth) area. Results demonstrated that both IB and m decreased exponentially with the increase of burn degree. Specifically, an IB of -79.0 ± 2.4 (mean ± standard deviation) dB for normal skin tissues tended to decrease to -94.0 ± 1.3 dB for those burned for 20 s, while the corresponding Nakagami parameters tended to decrease from 0.76 ± 0.08 to 0.45 ± 0.04. The variation of both IB and m was partially associated with the change of properties of collagen fibers from the burned tissues verified by samples of tissue histological sections. Particularly, the m parameter may be more sensitive to differentiate burned skin due to the fact that it has a greater rate of change with respect to different burn durations. These ultrasonic parameters in conjunction with high-frequency B-mode and Nakagami images could have the potential to assess the burn degree quantitatively.

ARFI ultrasound for in vivo hemostasis assessment postcardiac catheterization, part I: preclinical studies

The world wide prevalence of cardiovascular disease leads to over seven million annual percutaneous coronary catheterization procedures, the majority of which exploit femoral artery access. Femoral puncture sites ('arteriotomies') can be associated with severe vessel complications after sheath removal if hemostasis is not properly achieved. Hemostasis onset is routinely determined by examination for bleeding at the skin puncture; however, clotting along the puncture path can obscure subcutaneous bleeding, and therefore hemostasis is blindly assessed. We hypothesize that hemostasis assessment can be un-blinded by Acoustic Radiation Force Impulse (ARFI) ultrasound. In this first of a two-part series, we present in vivo ARFI hemostasis imaging data obtained in relevant canine models of femoral artery puncture. Above arteriotomies, ARFI-induced displacements were large (3.5 to >5.0 microm) relative to surrounding soft tissue soon after needle removal, which was consistent with our expectation for pooled extravasated blood. ARFI-induced displacements above arteriotomies decreased in magnitude (to approximately 2 microm) some time after needle removal and suggested the onset of hemostasis. This preclinical investigation served as proof of concept and justification for a pilot human study, which is presented in part two of this series.

Acoustic determination of early stages of intravascular blood coagulation

The blood coagulation system (BCS) is a complex biological system playing a principal role in the maintenance of haemostasis. Insufficient activity of the BCS may lead to bleeding and blood loss (e.g. in the case of haemophilia). On the other hand, excessive activity may cause intravascular blood coagulation, thromboses and embolization. Most of the methods currently used for BCS monitoring suffer from the major disadvantage of being invasive. The purpose of the present work is to demonstrate the feasibility of using ultrasonic methods for non-invasive registration of the early stages of blood coagulation processes in intensive flows. With this purpose, a special experimental set-up was designed, facilitating the simultaneous detection of optical and acoustic signals during the clotting process. It was shown that (i) as microemboli appear in the flow during the early stage of blood coagulation, the intensity of the Doppler signal increases twofold, and (ii) microemboli formation in the early stages of blood clotting always reveals itself through an acoustic contrast. Both of these effects are well defined, so we hope that they may be used for non-invasive BCS monitoring in clinical practice.