Novel estimation of the electrical bioimpedance using the local polynomial method. Application to in vivo real-time myocardium tissue impedance characterization during the cardiac cycle

The Use of Virtual Tissue Constructs That Include Morphological Variability to Assess the Potential of Electrical Impedance Spectroscopy to Differentiate between Thyroid and Parathyroid Tissues during Surgery

Electrical impedance spectroscopy (EIS) has been proposed as a promising noninvasive method to differentiate healthy thyroid from parathyroid tissues during thyroidectomy. However, previously reported similarities in the in vivo measured spectra of these tissues during a pilot study suggest that this separation may not be straightforward. We utilise computational modelling as a method to elucidate the distinguishing characteristics in the EIS signal and explore the features of the tissue that contribute to the observed electrical behaviour. Firstly, multiscale finite element models (or 'virtual tissue constructs') of thyroid and parathyroid tissues were developed and verified against in vivo tissue measurements. A global sensitivity analysis was performed to investigate the impact of physiological micro-, meso- and macroscale tissue morphological features of both tissue types on the computed macroscale EIS spectra and explore the separability of the two tissue types. Our results suggest that the presence of a surface fascia layer could obstruct tissue differentiation, but an analysis of the separability of simulated spectra without the surface fascia layer suggests that differentiation of the two tissue types should be possible if this layer is completely removed by the surgeon. Comprehensive in vivo measurements are required to fully determine the potential for EIS as a method in distinguishing between thyroid and parathyroid tissues.

A review of bio-impedance devices

Bio-impedance measurement analysis primarily refers to a safe and a non-invasive technique to analyze the electrical changes in living tissues on the application of low-value alternating current. It finds applications both in the biomedical and the agricultural fields. This paper concisely reviews the origin and measurement approaches for concepts and fundamentals of bio-impedance followed by a critical review on bio-impedance portable devices with main emphasis on the embedded system approach which is in demand due to its miniature size and present lifestyle preference of monitoring health in real time. The paper also provides a comprehensive review of various bio-impedance circuits with emphasis on the measurement and calibration techniques.

Smart needle to diagnose metastatic lymph node using electrical impedance spectroscopy

OBJECTIVES

The cause of cervical lymphadenopathy varies from inflammation to malignancy. Accurate and prompt diagnosis is crucial as delayed detection of malignant lymph node can lead to a worse prognosis. To improve the diagnostic accuracy of metastatic lymph node, electrical spectroscopy was employed to study human normal and metastatic lymph nodes using a hypodermic needle with fine interdigitated electrodes on its tip (EoN).

SUBJECTS AND METHODS

The electrical impedance of samples collected from 8 patients were analyzed in the sweeping frequency range from 1 Hz to 1 MHz. To align the impedance level data of the patients, normalized impedance was employed.

RESULTS

The optimal frequency exhibiting the best discrimination results between the normal and cancerous tissues was introduced based on a discrimination index. A high sensitivity (86.2%) and specificity (88.9%) were obtained, which implied that the EoN holds the potential to improve the in vivo diagnostic accuracy of metastatic lymph node during biopsy and surgery.

CONCLUSION

EoN has a promising potential to be utilized in real-time in actual clinical trials without a need for any pre/post-treatment during FNA or surgery. We believe that the EoN could reduce unnecessary operations with its associated morbidity.

A Novel Passive Method for the Assessment of Skin-Electrode Contact Impedance in Intraoperative Neurophysiological Monitoring Systems

Intraoperative Neurophysiological Monitoring is a set of monitoring techniques consisting of reading electrical activity generated by the nervous system structures during surgeries. In order to guarantee signal quality, contact impedance between the sensing electrodes and the patient’s skin needs to be as low as possible. Hence, monitoring this impedance while signals are measured is an important feature of current medical devices. The most commonly used technique involves injection of a known current and measurement of the voltage drop in the contact interface. This method poses several problems, such as power consumption (critical in battery-powered systems), frequency dependency and regulation issues, which are overcome by using a passive method. The fundamentals of the method proposed in this paper are based on the utilization of the variation suffered by the input random signal when a known resistance is connected in parallel to the input terminals of the low-noise amplifier (LNA) of the analog front-end of the acquisition system. Controlling the connection of the resistors and computing the root mean square of the LNA output voltage has been proved to be a useful tool to assess that the contact impedance is suitably low, allowing the user to know if the neural measurements obtained are valid.

Endocardial infarct scar recognition by myocardial electrical impedance is not influenced by changes in cardiac activation sequence

BACKGROUND

Measurement of myocardial electrical impedance can allow recognition of infarct scar and is theoretically not influenced by changes in cardiac activation sequence, but this is not known.

OBJECTIVES

The objectives of this study were to evaluate the ability of endocardial electrical impedance measurements to recognize areas of infarct scar and to assess the stability of the impedance data under changes in cardiac activation sequence.

METHODS

One-month-old myocardial infarction confirmed by cardiac magnetic resonance imaging was induced in 5 pigs submitted to coronary artery catheter balloon occlusion. Electroanatomic data and local electrical impedance (magnitude, phase angle, and amplitude of the systolic-diastolic impedance curve) were recorded at multiple endocardial sites in sinus rhythm and during right ventricular pacing. By merging the cardiac magnetic resonance and electroanatomic data, we classified each impedance measurement site either as healthy (bipolar amplitude ≥1.5 mV and maximum pixel intensity <40%) or scar (bipolar amplitude <1.5 mV and maximum pixel intensity ≥40%).

RESULTS

A total of 137 endocardial sites were studied. Compared to healthy tissue, areas of infarct scar showed 37.4% reduction in impedance magnitude (P < .001) and 21.5% decrease in phase angle (P < .001). The best predictive ability to detect infarct scar was achieved by the combination of the 4 impedance parameters (area under the receiver operating characteristic curve 0.96; 95% confidence interval 0.92-1.00). In contrast to voltage mapping, right ventricular pacing did not significantly modify the impedance data.

CONCLUSION

Endocardial catheter measurement of electrical impedance can identify infarct scar regions, and in contrast to voltage mapping, the impedance data are not affected by changes in cardiac activation sequence.

Design of current source for multi-frequency simultaneous electrical impedance tomography

Multi-frequency electrical impedance tomography has been evolving from the frequency-sweep approach to the multi-frequency simultaneous measurement technique which can reduce measuring time and will be increasingly attractive for time-varying biological applications. The accuracy and stability of the current source are the key factors determining the quality of the image reconstruction. This article presents a field programmable gate array-based current source for a multi-frequency simultaneous electrical impedance tomography system. A novel current source circuit was realized by combining the classic current mirror based on the feedback amplifier AD844 with a differential topology. The optimal phase offsets of harmonic sinusoids were obtained through the crest factor analysis. The output characteristics of this current source were evaluated by simulation and actual measurement. The results include the following: (1) the output impedance was compared with one of the Howland pump circuit in simulation, showing comparable performance at low frequencies. However, the proposed current source makes lower demands for resistor tolerance but performs even better at high frequencies. (2) The output impedance in actual measurement below 200 kHz is above 1.3 MΩ and can reach 250 KΩ up to 1 MHz. (3) An experiment based on a biological RC model has been implemented. The mean error for the demodulated impedance amplitude and phase are 0.192% and 0.139°, respectively. Therefore, the proposed current source is wideband, biocompatible, and high precision, which demonstrates great potential to work as a sub-system in the multi-frequency electrical impedance tomography system.

Electrical Impedance Myography and Its Applications in Neuromuscular Disorders

Electrical impedance myography (EIM) refers to the specific application of electrical bioimpedance techniques for the assessment of neuromuscular disorders. In EIM, a weak, high-frequency electrical current is applied to a muscle or muscle group of interest and the resulting voltages measured. Among its advantages, the technique can be used noninvasively across a variety of disorders and requires limited subject cooperation and evaluator training to obtain accurate and repeatable data. Studies in both animals and human subjects support its potential utility as a primary diagnostic tool, as well as a biomarker for clinical trial or individual patient use. This review begins by providing an overview of the current state and technological advances in electrical impedance myography and its specific application to the study of muscle. We then provide a summary of the clinical and preclinical applications of EIM for neuromuscular conditions, and conclude with an evaluation of ongoing research efforts and future developments.

Recognition of Fibrotic Infarct Density by the Pattern of Local Systolic-Diastolic Myocardial Electrical Impedance

Myocardial electrical impedance is a biophysical property of the heart that is influenced by the intrinsic structural characteristics of the tissue. Therefore, the structural derangements elicited in a chronic myocardial infarction should cause specific changes in the local systolic-diastolic myocardial impedance, but this is not known. This study aimed to characterize the local changes of systolic-diastolic myocardial impedance in a healed myocardial infarction model. Six pigs were successfully submitted to 150 min of left anterior descending (LAD) coronary artery occlusion followed by reperfusion. 4 weeks later, myocardial impedance spectroscopy (1–1000 kHz) was measured at different infarction sites. The electrocardiogram, left ventricular (LV) pressure, LV dP/dt, and aortic blood flow (ABF) were also recorded. A total of 59 LV tissue samples were obtained and histopathological studies were performed to quantify the percentage of fibrosis. Samples were categorized as normal myocardium (<10% fibrosis), heterogeneous scar (10–50%) and dense scar (>50%). Resistivity of normal myocardium depicted phasic changes during the cardiac cycle and its amplitude markedly decreased in dense scar (18 ± 2 Ω·cm vs. 10 ± 1 Ω·cm, at 41 kHz; P < 0.001, respectively). The mean phasic resistivity decreased progressively from normal to heterogeneous and dense scar regions (285 ± 10 Ω·cm, 225 ± 25 Ω·cm, and 162 ± 6 Ω·cm, at 41 kHz; P < 0.001 respectively). Moreover, myocardial resistivity and phase angle correlated significantly with the degree of local fibrosis (resistivity: r = 0.86 at 1 kHz, P < 0.001; phase angle: r = 0.84 at 41 kHz, P < 0.001). Myocardial infarcted regions with greater fibrotic content show lower mean impedance values and more depressed systolic-diastolic dynamic impedance changes. In conclusion, this study reveals that differences in the degree of myocardial fibrosis can be detected in vivo by local measurement of phasic systolic-diastolic bioimpedance spectrum. Once this new bioimpedance method could be used via a catheter-based device, it would be of potential clinical applicability for the recognition of fibrotic tissue to guide the ablation of atrial or ventricular arrhythmias.

A Robust System for Longitudinal Knee Joint Edema and Blood Flow Assessment Based on Vector Bioimpedance Measurements

We present a robust vector bioimpedance measurement system for longitudinal knee joint health assessment, capable of acquiring high resolution static (slowly varying over the course of hours to days) and dynamic (rapidly varying on the order of milli-seconds) bioresistance and bioreactance signals. Occupying an area of 78×90 mm(2) and consuming 0.25 W when supplied with ±5 V, the front-end achieves a dynamic range of 345 Ω and noise floor of 0.018 mΩrms (resistive) and 0.055 mΩrms (reactive) within a bandwidth of 0.1-20 Hz. A microcontroller allows real-time calibration to minimize errors due to environmental variability (e.g., temperature) that can be experienced outside of lab environments, and enables data storage on a micro secure digital card. The acquired signals are then processed using customized physiology-driven algorithms to extract musculoskeletal (edema) and cardiovascular (local blood volume pulse) features from the knee joint. In a feasibility study, we found statistically significant differences between the injured and contralateral static knee impedance measures for two subjects with recent unilateral knee injury compared to seven controls. Specifically, the impedance was lower for the injured knees, supporting the physiological expectations for increased edema and damaged cell membranes. In a second feasibility study, we demonstrate the sensitivity of the dynamic impedance measures with a cold-pressor test, with a 20 mΩ decrease in the pulsatile resistance associated with increased downstream peripheral vascular resistance. The proposed system will serve as a foundation for future efforts aimed at quantifying joint health status continuously during normal daily life.

Early detection of acute transmural myocardial ischemia by the phasic systolic-diastolic changes of local tissue electrical impedance

Myocardial electrical impedance is influenced by the mechanical activity of the heart. Therefore, the ischemia-induced mechanical dysfunction may cause specific changes in the systolic-diastolic pattern of myocardial impedance, but this is not known. This study aimed to analyze the phasic changes of myocardial resistivity in normal and ischemic conditions. Myocardial resistivity was measured continuously during the cardiac cycle using 26 different simultaneous excitation frequencies (1 kHz-1 MHz) in 7 anesthetized open-chest pigs. Animals were submitted to 30 min regional ischemia by acute left anterior descending coronary artery occlusion. The electrocardiogram, left ventricular (LV) pressure, LV dP/dt, and aortic blood flow were recorded simultaneously. Baseline myocardial resistivity depicted a phasic pattern during the cardiac cycle with higher values at the preejection period (4.19 ± 1.09% increase above the mean, P < 0.001) and lower values during relaxation phase (5.01 ± 0.85% below the mean, P < 0.001). Acute coronary occlusion induced two effects on the phasic resistivity curve: 1) a prompt (5 min ischemia) holosystolic resistivity rise leading to a bell-shaped waveform and to a reduction of the area under the LV pressure-impedance curve (1,427 ± 335 vs. 757 ± 266 Ω·cm·mmHg, P < 0.01, 41 kHz) and 2) a subsequent (5-10 min ischemia) progressive mean resistivity rise (325 ± 23 vs. 438 ± 37 Ω·cm at 30 min, P < 0.01, 1 kHz). The structural and mechanical myocardial dysfunction induced by acute coronary occlusion can be recognized by specific changes in the systolic-diastolic myocardial resistivity curve. Therefore these changes may become a new indicator (surrogate) of evolving acute myocardial ischemia.

Design of tri-level excitation signals for broadband bioimpedance spectroscopy

Bioimpedance spectroscopy (BIS) measurement methods have been evolving from the traditional frequency-sweep approach to the multi-frequency simultaneous measurement technique which can drastically reduce measuring time and will be increasingly attractive for time-varying biological applications. Multi-frequency mixed (MFM) signals with sparsely distributed spectra are desirable for broadband BIS measurement. This paper proposes a synthesis method to design a series of tri-level MFM signals which contain only three values (+1, 0, -1), and has majority energy distributed on its (2(n))th primary harmonics. Tri-level MFM signals have both high energy efficiency and a low crest factor. An impedance measurement experiment excited by an 8th-order tri-level MFM signal on a RC three-element equivalent model has been performed, and the results on 8 primary harmonic frequencies ranging from 8 to 1024 kHz show a high accuracy with the mean amplitude relative error of 0.41% and mean phase absolute error of 0.18°, which has validated the feasibility of the tri-level MFM signals for broadband BIS measurement.

Multi-frequency simultaneous measurement of bioimpedance spectroscopy based on a low crest factor multisine excitation

Bioimpedance spectroscopy (BIS) is becoming a powerful diagnostic tool for a wide variety of medical applications, and the multi-frequency simultaneous (MFS) measurement of BIS can greatly reduce measurement time and record the transient physiological status of a living body compared with traditional frequency-sweep measurement technology. This paper adopts the Van der Ouderaa's multisine, which has 31 equidistant and flat amplitude spectra and a low crest factor of 1.405 as the broadband excitation, and realizes the MFS measurement of BIS by means of spectral analysis using the fast Fourier transform algorithm. The approach to implement the multisine based on a field-programmable gate array and a digital to analog converter is described in detail, and impedance measurement experiments are performed on three resistance-capitance three-element phantoms. Experimental results show a commendable accuracy with a mean relative error of 0.55% for the impedance amplitudes, and a mean absolute error of 0.20° for the impedance phases on the 31 frequencies ranging linearly from 32 to 992 kHz. This paper validates the feasibility of the MFS technology for BIS measurement based on the multisine excitation.

The theory and fundamentals of bioimpedance analysis in clinical status monitoring and diagnosis of diseases

Bioimpedance analysis is a noninvasive, low cost and a commonly used approach for body composition measurements and assessment of clinical condition. There are a variety of methods applied for interpretation of measured bioimpedance data and a wide range of utilizations of bioimpedance in body composition estimation and evaluation of clinical status. This paper reviews the main concepts of bioimpedance measurement techniques including the frequency based, the allocation based, bioimpedance vector analysis and the real time bioimpedance analysis systems. Commonly used prediction equations for body composition assessment and influence of anthropometric measurements, gender, ethnic groups, postures, measurements protocols and electrode artifacts in estimated values are also discussed. In addition, this paper also contributes to the deliberations of bioimpedance analysis assessment of abnormal loss in lean body mass and unbalanced shift in body fluids and to the summary of diagnostic usage in different kinds of conditions such as cardiac, pulmonary, renal, and neural and infection diseases.

Differentiation of the intracellular structure of slow- versus fast-twitch muscle fibers through evaluation of the dielectric properties of tissue

Slow-twitch (type 1) skeletal muscle fibers have markedly greater mitochondrial content than fast-twitch (type 2) fibers. Accordingly, we sought to determine whether the dielectric properties of these two fiber types differed, consistent with their distinct intracellular morphologies. The longitudinal and transverse dielectric spectrum of the ex vivo rat soleus (a predominantly type 1 muscle) and the superficial layers of rat gastrocnemius (predominantly type 2) (n = 15) were measured in the 1 kHz-10 MHz frequency range and modeled to a resistivity Cole-Cole function. Major differences were especially apparent in the dielectric spectrum in the 1 to 10 MHz range. Specifically, the gastrocnemius demonstrated a well-defined, higher center frequency than the soleus muscle, whereas the soleus muscle showed a greater difference in the modeled zero and infinite resistivities than the gastrocnemius. These findings are consistent with the fact that soleus tissue has larger and more numerous mitochondria than gastrocnemius. Evaluation of tissue at high frequency could provide a novel approach for assessing intracellular structure in health and disease.

Development of a stair-step multifrequency synchronized excitation signal for fast bioimpedance spectroscopy

Wideband excitation signal with finite prominent harmonic components is desirable for fast bioimpedance spectroscopy (BIS) measurements. This work introduces a simple method to synthesize and realize a type of periodical stair-step multifrequency synchronized (MFS) signal. The Fourier series analysis shows that the p-order MFS signal f(p, t) has constant 81.06% energy distributed equally on its p  2ⁿth primary harmonics. The synthesis principle is described firstly and then two examples of the 4-order and 5-order MFS signals, f(4, t) and f(5, t), are synthesized. The method to implement the MFS waveform based on a field-programmable gate array (FPGA) and a digital to analog converter (DAC) is also presented. Both the number and the frequencies of the expected primary harmonics can be adjusted as needed. An impedance measurement experiment on a RC three-element equivalent model is performed, and results show acceptable precision, which validates the feasibility of the MFS excitation.

Minimally invasive in vivo human lung tissue bioimpedance measurements during the bronchoscopy procedure

Respiratory diseases, which include diseases of the lung, pleura, bronchial tree, trachea, upper respiratory tract and of the respiratory muscles and nerves, are a common and important cause of illness and death among the population. Experimental evidences have shown that tissue lesions have different electrical properties compared with normal tissue. Therefore, lung tissues lesions may be differentiated from lung normal tissue by comparing the tissue passive electrical properties. The manuscript reports a feasibility study for minimally invasive in vivo human lung tissue tetrapolar bioimpedance measurements using a catheter during the bronchoscopy procedure based on multisine Electrical Impedance Spectroscopy (EIS) at 10 kHz - 1 MHz.

Novel approach of processing electrical bioimpedance data using differential impedance analysis

The goal of this manuscript is to present a new methodology for real time analysis of time-varying electrical bioimpedance data. The approach assumes that the Fricke-Morse model of living tissues is meaningful and valid within the measured frequency range (10 kHz to 1 MHz). The parameters of this model are estimated in the whole frequency range with the presented method based on differential impedance analysis (DIA). The numerical accuracy of the developed approach has been validated and compared to complex nonlinear least square (CNLS) approach through simulations and also with experimental data from in vivo time-varying human lung tissue bioimpedance. The new developed method has demonstrated a promising performance for fast and easily interpretable information in real time.

A new measuring and identification approach for time-varying bioimpedance using multisine electrical impedance spectroscopy

The bioimpedance measurement/identification of time-varying biological systems Z(ω, t) by means of electrical impedance spectroscopy (EIS) is still a challenge today. This paper presents a novel measurement and identification approach, the so-called parametric-in-time approach, valid for time-varying (bio-)impedance systems with a (quasi) periodic character. The technique is based on multisine EIS. Contrary to the widely used nonparametric-in-time strategy, the (bio-)impedance Z(ω, t) is assumed to be time-variant during the measurement interval. Therefore, time-varying spectral analysis tools are required. This new parametric-in-time measuring/identification technique has experimentally been validated through three independent sets of in situ measurements of in vivo myocardial impedance. We show that the time-varying myocardial impedance Z(ω, t) is dominantly periodically time varying (PTV), denoted as ZPTV(ω, t). From the temporal analysis of ZPTV(ω, t), we demonstrate that it is possible to decompose ZPTV(ω, t) into a(n) (in)finite sum of fundamental (bio-)impedance spectra, the so-called harmonic impedance spectra (HIS) Zk(ω)s with [Formula: see text]. This is similar to the well-known Fourier series of a periodic signal, but now understood at the level of a periodic system's frequency response. The HIS Zk(ω)s for [Formula: see text] actually summarize in the bi-frequency (ω, k) domain all the temporal in-cycle information about the periodic changes of Z(ω, t). For the particular case k = 0 (i.e. on the ω-axis), Z0(ω) reflects the mean in-cycle behavior of the time-varying bioimpedance. Finally, the HIS Zk(ω)s are directly identified from noisy current and voltage myocardium measurements at the multisine measurement frequencies (i.e. nonparametric-in-frequency).

In-cycle myocardium tissue electrical impedance monitoring using broadband impedance spectroscopy

Measurements of myocardium tissue impedance during the cardiac cycle have information about the morphology of myocardium cells as well as cell membranes and intra/extra cellular spaces. Although the variation with time of the impedance cardiac signal has information about the myocardium tissue activity during the cardiac cycle, this information has been usually underestimated in the studies based on frequency-sweep Electrical Impedance Spectroscopy (EIS) technique. In these cases, the dynamic behavior was removed from the impedance by means of averaging. The originality of this research is to show the time evolution of in-vivo healthy myocardium tissue impedance during the cardiac cycle, being measured with a multisine excitation at 26 frequencies (1 kHz-1 MHz). The obtained parameters from fitting data to a Cole model are valid indicators to explain the time relation of the systolic and diastolic function with respect to the myocardium impedance time variation. This paper presents a successful application of broadband Impedance Spectroscopy for time-varying impedance monitoring. Furthermore, it can be extended to understand various unsolved problems in a wide range of biomedical and electrochemical applications, where the system dynamics are intended to be studied.