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Kalayeh K, Fowlkes JB, Yeras S, Chen A, Daignault-Newton S, Schultz WW, Sack BS. A Comparative Study of Commercially Available Ultrasound Contrast Agents for Sub-harmonic-Aided Pressure Estimation (SHAPE) in a Bladder Phantom. ULTRASOUND IN MEDICINE & BIOLOGY 2024:S0301-5629(24)00226-6. [PMID: 39054243 DOI: 10.1016/j.ultrasmedbio.2024.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/14/2024] [Accepted: 05/19/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE The goal of this study was to evaluate the performance of different commercial ultrasound contrast microbubbles (MBs) when measuring bladder phantom pressure with sub-harmonic-aided pressure estimation (SHAPE) methodology. We hypothesized that SHAPE performance is dependent on MB formulation. This study aimed to advance the SHAPE application for bladder pressure measurements in humans. METHODS Using a previously designed and built bladder phantom, we tested four different commercial agents: Definity, Lumason, Sonazoid and Optison. A standard clinical cystometrogram (CMG) system was used to infuse a MB-saline mixture into the bladder phantom to measure pressure. Ultrasound imaging was performed using the GE Healthcare LOGIQ E10 scanner. RESULTS All agents showed a predicted inverse linear relationship between change in pressure and SHAPE signal. However, they differ from each other in terms of stability, linear correlation, sensitivity to pressure and error. Generally, Definity and Lumason showed the highest performance during the SHAPE-based bladder phantom pressure assessments. CONCLUSION Our results show that the SHAPE signal decreases as bladder phantom pressures increases, regardless of the agent or CMG phase, suggesting the possibility of using SHAPE for measuring bladder pressure without a catheter. However, the efficacy of SHAPE in measuring pressure varies by MB formulation. These observations support using Lumason and Definity in a human subject feasibility study as we advance toward a catheter-free solution for measuring voiding bladder pressure via SHAPE.
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Affiliation(s)
- Kourosh Kalayeh
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - J Brian Fowlkes
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Sophia Yeras
- College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI, USA
| | - Amy Chen
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI, USA
| | | | - William W Schultz
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Bryan S Sack
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.
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Zhang L, Dong YF, Chen Y, Li XG, Wang YH, Wang Y, Ge ZT, Wang X, Cai S, Yang X, Zhu QL, Li JC. Impact of Microbubble Degradation and Flow Velocity on Subharmonic-aided Pressure Estimation (SHAPE): An Experimental Investigation. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:1020-1027. [PMID: 38594125 DOI: 10.1016/j.ultrasmedbio.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/12/2024] [Accepted: 03/21/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE This study aimed to investigate the impact of microbubble degradation and flow velocity on Sub-Harmonic Aided Pressure Estimation (SHAPE), and to explore the correlation between subharmonic amplitude and pressure as a single factor. METHODS We develop an open-loop vascular phantom platform system and utilize a commercial ultrasound machine and microbubbles for subharmonic imaging. Subharmonic amplitude was measured continuously at constant pressure and flow velocity to assess the impact of microbubble degradation. Flow velocity was varied within a range of 4-14 cm/s at constant pressure to investigate its relationship to subharmonic amplitude. Furthermore, pressure was varied within a range of 10-110 mm Hg at constant flow velocity to assess its isolated effect on subharmonic amplitude. RESULTS Under constant pressure and flow velocity, subharmonic amplitude exhibited a continuous decrease at an average rate of 0.221 dB/min, signifying ongoing microbubble degradation during the experimental procedures. Subharmonic amplitude demonstrated a positive correlation with flow velocity, with a variation ratio of 0.423 dB/(cm/s). Under controlled conditions of microbubble degradation and flow velocity, a strong negative linear correlation was observed between pressure and subharmonic amplitude across different Mechanical Index (MI) settings (all R2 > 0.90). The sensitivity of SHAPE was determined to be 0.025 dB/mmHg at an MI of 0.04. CONCLUSION The assessment of SHAPE sensitivity is affected by microbubble degradation and flow velocity. Excluding the aforementioned influencing factors, a strong linear negative correlation between pressure and subharmonic amplitude was still evident, albeit with a sensitivity coefficient lower than previously reported values.
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Affiliation(s)
- Li Zhang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yi-Fan Dong
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yao Chen
- Department of Ultrasound, GE Healthcare Medical System (China), Shanghai, China
| | - Xiao-Gang Li
- Biobank Facility, National Infrastructures for Translational Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Ya-Hong Wang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Ying Wang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zhi-Tong Ge
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xin Wang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Sheng Cai
- Department of Health Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiao Yang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Qing-Li Zhu
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jian-Chu Li
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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Merouani S, Dehane A, Hamdaoui O, Yasui K, Ashokkumar M. Review on the impacts of external pressure on sonochemistry. ULTRASONICS SONOCHEMISTRY 2024; 106:106893. [PMID: 38705083 PMCID: PMC11074972 DOI: 10.1016/j.ultsonch.2024.106893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 04/28/2024] [Accepted: 04/29/2024] [Indexed: 05/07/2024]
Abstract
The impact of hydrostatic pressure, commonly known as ambient or external pressure, on the phenomenon of sonochemistry and/or sonoluminescence has been extensively investigated through a multitude of experimental and computational studies, all of which have emphasized the crucial role played by this particular parameter. Numerous previous studies have successfully demonstrated the existence of an optimal static pressure for the occurrence of sonoluminescence and multi-bubble or single-bubble sonochemistry. However, despite these findings, a universally accepted value for this critical pressure has not yet been established. In addition, it has been found that the cavitation effect is completely inhibited when the static pressure is either too high or too low. This comprehensive review aims to delve into the primary experimental results and elucidate their significance in relation to hydrostatic pressure. We will then conduct an analysis of numerical calculations, focusing specifically on the influence of external pressure on single bubble sonochemistry. By delving into these calculations, we will be able to gain a deeper understanding of the experimental results and effectively interpret their implications.
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Affiliation(s)
- Slimane Merouani
- Laboratory of Environmental Process Engineering, Department of Chemical Engineering, Faculty of Process Engineering, University Constantine 3 Salah Boubnider, P.O. Box 72, 25000 Constantine, Algeria
| | - Aissa Dehane
- Laboratory of Environmental Process Engineering, Department of Chemical Engineering, Faculty of Process Engineering, University Constantine 3 Salah Boubnider, P.O. Box 72, 25000 Constantine, Algeria
| | - Oualid Hamdaoui
- Chemical Engineering Department, College of Engineering, King Saud University, P.O. Box 800, 11421 Riyadh, Saudi Arabia.
| | - Kyuichi Yasui
- National Institute of Advanced Industrial Science and Technology, 2266-98 Anagahora, Shimoshidami, Moriyama-ku, Nagoya 463-8560, Japan
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Azami RH, Forsberg F, Eisenbrey JR, Sarkar K. Acoustic response and ambient pressure sensitivity characterization of SonoVue for noninvasive pressure estimation. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2024; 155:2636-2645. [PMID: 38629883 PMCID: PMC11026112 DOI: 10.1121/10.0025690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/21/2024] [Accepted: 03/27/2024] [Indexed: 04/20/2024]
Abstract
Subharmonic aided pressure estimation (SHAPE) is a noninvasive pressure measurement technique based on the pressure dependent subharmonic signal from contrast microbubbles. Here, SonoVue microbubble with a sulfur hexafluoride (SF6) core, was investigated for use in SHAPE. The study uses excitations of 25-700 kPa peak negative pressure (PNP) and 3 MHz frequency over eight pressurization cycles between atmospheric pressure and overpressures, ranging from 0 to 25 kPa (0 to 186 mm Hg). The SonoVue subharmonic response was characterized into two types. Unlike other microbubbles, SonoVue showed significant subharmonic signals at low excitations (PNPs, 25-400 kPa), denoted here as type I subharmonic. It linearly decreased with increasing overpressure (-0.52 dB/kPa at 100 kPa PNP). However, over multiple pressurization-depressurization cycles, type I subharmonic changed; its value at atmospheric pressure decreased over multiple cycles, and at later cycles, it recorded an increase in amplitude with overpressure (highest, +13 dB at 50 kPa PNP and 10 kPa overpressure). The subharmonic at higher excitations (PNP > 400 kPa), denoted here as type II subharmonic, showed a consistent decrease with the ambient pressure increase with strongest sensitivity of -0.4 dB/kPa at 500 kPa PNP.
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Affiliation(s)
- Roozbeh H Azami
- Department of Mechanical and Aerospace Engineering, The George Washington University, Washington, DC 20052, USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
| | - John R Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
| | - Kausik Sarkar
- Department of Mechanical and Aerospace Engineering, The George Washington University, Washington, DC 20052, USA
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Qiao X, Zhang R, Yu J, Yan Y, Bouakaz A, Su X, Liu J, Zong Y, Wan M. Noninvasive assessment of pressure distribution and fractional flow in middle cerebral artery using microbubbles and plane wave in vitro. ULTRASONICS 2024; 138:107244. [PMID: 38237398 DOI: 10.1016/j.ultras.2024.107244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/20/2023] [Accepted: 01/09/2024] [Indexed: 04/02/2024]
Abstract
Fractional flow has been proposed for quantifying the degree of functional stenosis in cerebral arteries. Herein, subharmonic aided pressure estimation (SHAPE) combined with plane wave (PW) transmission was employed to noninvasively estimate the pressure distribution and fractional flow in the middle cerebral artery (MCA) in vitro. Consequently, the effects of incident sound pressure (peak negative pressures of 86-653 kPa), pulse repetition frequency (PRF), number of pulses, and blood flow rate on the subharmonic pressure relationship were investigated. The radio frequency data were stored and beamformed offline, and the subharmonic amplitude over a 0.4 MHz bandwidth was extracted using a 12-cycle PW at 4 MHz. The optimal incident sound pressure was 217 kPa without skull (sensitivity = 0.09 dB/mmHg; r2 = 0.997) and 410 kPa with skull (median sensitivity = 0.06 dB/mmHg; median r2 = 0.981). The optimal PRF was 500 Hz, as this value affords the highest sensitivity (0.09 dB/mmHg; r2 = 0.976) and temporal resolution. In addition, the blood flow rate exhibited a lesser effect on the subharmonic pressure relationship in our experimental setup. Using the optimized parameters, the blood pressure distribution and fractional flow (FFs) were measured. As such, the FFs value was in high agreement with the value measured using the pressure sensor (FFm). The mean ± standard deviations of the FF difference (FFm - FFs) were 0.03 ± 0.06 without skull and 0.01 ± 0.05 with skull.
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Affiliation(s)
- Xiaoyang Qiao
- Xi'an Jiaotong University, College of Life Science and Technology, Xi'an, China
| | - Ruiyan Zhang
- Xi'an Jiaotong University, College of Life Science and Technology, Xi'an, China
| | - Jianjun Yu
- Xi'an Jiaotong University, College of Life Science and Technology, Xi'an, China
| | - Yadi Yan
- Xi'an Jiaotong University, College of Life Science and Technology, Xi'an, China
| | - Ayache Bouakaz
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - Xiao Su
- Xi'an Jiaotong University, College of Life Science and Technology, Xi'an, China
| | - Jiacheng Liu
- Xi'an Jiaotong University, College of Life Science and Technology, Xi'an, China
| | - Yujin Zong
- Xi'an Jiaotong University, College of Life Science and Technology, Xi'an, China.
| | - Mingxi Wan
- Xi'an Jiaotong University, College of Life Science and Technology, Xi'an, China.
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Wang P, Tan C, Ji X, Bai J, Yu ACH, Qin P. Sensitivity improvement of subharmonic-based pressure measurement using phospholipid-coated monodisperse microbubbles. ULTRASONICS SONOCHEMISTRY 2024; 104:106830. [PMID: 38432151 PMCID: PMC10920959 DOI: 10.1016/j.ultsonch.2024.106830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/09/2024] [Accepted: 02/22/2024] [Indexed: 03/05/2024]
Abstract
The use of the subharmonic signal from microbubbles exposed to ultrasound is a promising safe and cost-effective approach for the non-invasive measurement of blood pressure. Achieving a high sensitivity of the subharmonic amplitude to the ambient overpressure is crucial for clinical applications. However, currently used microbubbles have a wide size distribution and diverse shell properties. This causes uncertainty in the response of the subharmonic amplitude to changes in ambient pressure, which limits the sensitivity. The aim of this study was to use monodisperse microbubbles to improve the sensitivity of subharmonic-based pressure measurements. With the same shell materials and gas core, we used a flow-focusing microfluidic chip and a mechanical agitation method to fabricate monodisperse (∼2.45-µm mean radius and 4.7 % polydisperse index) and polydisperse microbubbles (∼1.51-µm mean radius and 48.4 % polydisperse index), respectively. We varied the ultrasound parameters (i.e., the frequency, peak negative pressure (PNP) and pulse length), and found that there was an optimal excitation frequency (2.8 MHz) for achieving maximal subharmonic emission for monodisperse microbubbles, but not for polydisperse microbubbles. Three distinct regimes (occurrence, growth, and saturation) were identified in the response of the subharmonic amplitude to increasing PNP for both monodisperse and polydisperse microbubbles. For the polydisperse microbubbles, the subharmonic amplitude decreased either monotonically or non-monotonically with ambient overpressure, depending on the PNP. By contrast, for the monodisperse microbubbles, there was only a monotonic decrease at all PNPs. The maximum sensitivity (1.18 dB/kPa, R2 = 0.97) of the subharmonic amplitude to ambient overpressure for the monodisperse microbubbles was ∼6.5 times higher than that for the polydisperse microbubbles (0.18 dB/kPa, R2 = 0.88). These results show that monodisperse microbubbles can achieve a more consistent response of the subharmonic signal to changes in ambient overpressure and greatly improve the measurement sensitivity.
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Affiliation(s)
- Pengcheng Wang
- School of Sensing Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Chunjie Tan
- School of Sensing Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Xiang Ji
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Jingfeng Bai
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China.
| | - Alfred C H Yu
- Schlegel Research Institute for Aging, University of Waterloo, Waterloo, ON, N2L3G1, Canada
| | - Peng Qin
- School of Sensing Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China.
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7
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Forsberg F. Subharmonic-aided pressure estimation (SHAPE): on the cusp of clinical utility? Eur Radiol 2024; 34:755-757. [PMID: 37597028 DOI: 10.1007/s00330-023-10064-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 08/21/2023]
Affiliation(s)
- Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street, Philadelphia, PA, 19107, USA.
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Esposito C, Machado P, McDonald ME, Savage MP, Fischman D, Mehrotra P, Cohen IS, Ruggiero N, Walinsky P, Vishnevsky A, Dickie K, Davis M, Forsberg F, Dave JK. Evaluation of Intracardiac Pressures Using Subharmonic-aided Pressure Estimation with Sonazoid Microbubbles. Radiol Cardiothorac Imaging 2024; 6:e230153. [PMID: 38358329 PMCID: PMC10912883 DOI: 10.1148/ryct.230153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 12/13/2023] [Accepted: 01/10/2024] [Indexed: 02/16/2024]
Abstract
Purpose To investigate if the right ventricular (RV) systolic and left ventricular (LV) diastolic pressures can be obtained noninvasively using the subharmonic-aided pressure estimation (SHAPE) technique with Sonazoid microbubbles. Materials and Methods Individuals scheduled for a left and/or right heart catheterization were prospectively enrolled in this institutional review board-approved clinical trial from 2017 to 2020. A standard-of-care catheterization procedure was performed by advancing fluid-filled pressure catheters into the LV and aorta (n = 25) or RV (n = 22), and solid-state high-fidelity pressure catheters into the LV and aorta in a subset of participants (n = 18). Study participants received an infusion of Sonazoid microbubbles (GE HealthCare), and SHAPE data were acquired using a validated interface developed on a SonixTablet (BK Medical) US scanner, synchronously with the pressure catheter data. A conversion factor, derived using cuff-based pressure measurements with a SphygmoCor XCEL PWA (ATCOR) and subharmonic signal from the aorta, was used to convert the subharmonic signal into pressure values. Errors between the pressure measurements obtained using the SHAPE technique and pressure catheter were compared. Results The mean errors in pressure measurements obtained with the SHAPE technique relative to those of the fluid-filled pressure catheter were 1.6 mm Hg ± 1.5 [SD] (P = .85), 8.4 mm Hg ± 6.2 (P = .04), and 7.4 mm Hg ± 5.7 (P = .09) for RV systolic, LV minimum diastolic, and LV end-diastolic pressures, respectively. Relative to the measurements with the solid-state high-fidelity pressure catheter, the mean errors in LV minimum diastolic and LV end-diastolic pressures were 7.2 mm Hg ± 4.5 and 6.8 mm Hg ± 3.3 (P ≥ .44), respectively. Conclusion These results indicate that SHAPE with Sonazoid may have the potential to provide clinically relevant RV systolic and LV diastolic pressures. Keywords: Ultrasound-Contrast, Cardiac, Aorta, Left Ventricle, Right Ventricle ClinicalTrials.gov registration no.: NCT03245255 © RSNA, 2024.
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Affiliation(s)
- Cara Esposito
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Priscilla Machado
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Maureen E. McDonald
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Michael P. Savage
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - David Fischman
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Praveen Mehrotra
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Ira S. Cohen
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Nicholas Ruggiero
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Paul Walinsky
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Alec Vishnevsky
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Kristopher Dickie
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Marguerite Davis
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Flemming Forsberg
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Jaydev K. Dave
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
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卢 慧, 王 云, 黄 来, 徐 岗, 周 娟, 虞 文, 李 飞. [Experimental study on high-frequency subharmonic scattering characteristics of ultrasound contrast agent microbubbles under low ambient pressure]. SHENG WU YI XUE GONG CHENG XUE ZA ZHI = JOURNAL OF BIOMEDICAL ENGINEERING = SHENGWU YIXUE GONGCHENGXUE ZAZHI 2023; 40:1209-1216. [PMID: 38151945 PMCID: PMC10753315 DOI: 10.7507/1001-5515.202304012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/29/2023] [Indexed: 12/29/2023]
Abstract
Correlation between nonlinear subharmonic scattering of ultrasound contrast agent microbubbles and ambient pressure is expected to be used for local brain tissue pressure monitoring. Although high-frequency ultrasound has achieved high-resolution imaging of intracranial microvessels, the research on high-frequency subharmonic scattering characteristics of microbubbles is insufficient at present, which restricts the research progress of estimating local brain tissue pressure based on high-frequency subharmonic scattering of microbubbles. Therefore, under the excitation of 10 MHz high-frequency ultrasound, the effects of different acoustic pressures and ambient pressures on the high-frequency subharmonic scattering characteristics of three different ultrasound contrast agents including SonoVue, Sonazoid and Huashengxian were investigated in this in vitro study. Results showed that the subharmonic scattering amplitudes of the three microbubbles increased with the increase of ambient pressure at the peak negative acoustic pressures of 696, 766 and 817 kPa, and there was a favorable linear correlation between subharmonic amplitude and ambient pressure. Under the above three acoustic pressures, the highest correlation coefficient of SonoVue was 0.948 ( P = 0.03), the highest sensitivity of pressure measurement was 0.248 dB/mm Hg and the minimum root mean square error (RMSE) was 2.64 mm Hg. Sonazoid's highest correlation coefficient was 0.982 ( P < 0.01), the highest sensitivity of pressure measurement was 0.052 dB/mm Hg and the minimum RMSE was 1.51 mm Hg. The highest correlation coefficient of Huashengxian was 0.969 ( P = 0.02), the highest sensitivity of pressure measurement was 0.098 dB/mm Hg and the minimum RMSE was 2.00 mm Hg. The above in vitro experimental results indicate that by selecting ultrasound contrast agent microbubbles and optimizing acoustic pressure, the correlation between high-frequency subharmonic scattering of microbubbles and ambient pressure can be improved, the sensitivity of pressure measurement can be upgraded, and the measurement error can be reduced to meet the clinical demand for local brain tissue pressure measurement, which provided an important experimental basis for subsequent research in vivo.
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Affiliation(s)
- 慧敏 卢
- 南京大学 医学院附属鼓楼医院 重症医学科(南京 210008)Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, P. R. China
- 中国科学院 深圳先进技术研究院 劳特伯生物医学成像研究中心(广东深圳 518055)Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055, P. R. China
| | - 云 王
- 南京大学 医学院附属鼓楼医院 重症医学科(南京 210008)Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, P. R. China
- 中国科学院 深圳先进技术研究院 劳特伯生物医学成像研究中心(广东深圳 518055)Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055, P. R. China
| | - 来鑫 黄
- 南京大学 医学院附属鼓楼医院 重症医学科(南京 210008)Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, P. R. China
| | - 岗 徐
- 南京大学 医学院附属鼓楼医院 重症医学科(南京 210008)Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, P. R. China
| | - 娟 周
- 南京大学 医学院附属鼓楼医院 重症医学科(南京 210008)Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, P. R. China
| | - 文魁 虞
- 南京大学 医学院附属鼓楼医院 重症医学科(南京 210008)Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, P. R. China
| | - 飞 李
- 南京大学 医学院附属鼓楼医院 重症医学科(南京 210008)Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, P. R. China
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10
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Azami RH, Forsberg F, Eisenbrey JR, Sarkar K. Ambient Pressure Sensitivity of the Subharmonic Response of Coated Microbubbles: Effects of Acoustic Excitation Parameters. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1550-1560. [PMID: 37100673 PMCID: PMC10306329 DOI: 10.1016/j.ultrasmedbio.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/20/2023] [Accepted: 02/27/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE The sensitivity of the acoustic response of microbubbles, specifically a strong correlation between their subharmonic response and the ambient pressure, has motivated development of a non-invasive subharmonic-aided pressure estimation (SHAPE) method. However, this correlation has previously been found to vary depending on the microbubble type, the acoustic excitation and the hydrostatic pressure range. In this study, the ambient pressure sensitivity of microbubble response was investigated. METHODS The fundamental, subharmonic, second harmonic and ultraharmonic responses from an in-house lipid-coated microbubble were measured for excitations with peak negative pressures (PNPs) of 50-700 kPa and frequencies of 2, 3 and 4 MHz in the ambient overpressure range 0-25 kPa (0-187 mmHg) in an in vitro setup. RESULTS The subharmonic response typically has three stages-occurrence, growth and saturation-with increasing excitation PNP. We find distinct decreasing and increasing variations of the subharmonic signal with overpressure that are closely related to the threshold of subharmonic generation in a lipid-shelled microbubble. Above the excitation threshold, that is, in the growth-saturation phase, subharmonic signals decreased linearly with slopes as high as -0.56 dB/kPa with ambient pressure increase; below the threshold excitation (at atmospheric pressure), increasing overpressure triggers subharmonic generation, indicating a lowering of subharmonic threshold, and therefore leads to an increase in subharmonic with overpressure, the maximum enhancement being ∼11 dB for 15 kPa overpressure at 2 MHz and 100 kPa PNP. CONCLUSION This study indicates the possible development of novel and improved SHAPE methodologies.
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Affiliation(s)
- Roozbeh H Azami
- Department of Mechanical and Aerospace Engineering, George Washington University, Washington, DC, USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - John R Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kausik Sarkar
- Department of Mechanical and Aerospace Engineering, George Washington University, Washington, DC, USA.
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11
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Wang Y, Lu H, Huang L, Li D, Qiu W, Li L, Xu G, Su M, Zhou J, Li F. Noninvasive Estimation of Tumor Interstitial Fluid Pressure from Subharmonic Scattering of Ultrasound Contrast Microbubbles. BIOSENSORS 2023; 13:bios13050528. [PMID: 37232888 DOI: 10.3390/bios13050528] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/29/2023] [Accepted: 05/05/2023] [Indexed: 05/27/2023]
Abstract
The noninvasive estimation of interstitial fluid pressure (IFP) using ultrasound contrast agent (UCA) microbubbles as pressure sensors will provide tumor treatments and efficacy assessments with a promising tool. This study aimed to verify the efficacy of the optimal acoustic pressure in vitro in the prediction of tumor IFPs based on UCA microbubbles' subharmonic scattering. A customized ultrasound scanner was used to generate subharmonic signals from microbubbles' nonlinear oscillations, and the optimal acoustic pressure was determined in vitro when the subharmonic amplitude reached the most sensitive to hydrostatic pressure changes. This optimal acoustic pressure was then applied to predict IFPs in tumor-bearing mouse models, which were further compared with the reference IFPs measured using a standard tissue fluid pressure monitor. An inverse linear relationship and good correlation (r = -0.853, p < 0.001) existed between the subharmonic amplitude and tumor IFPs at the optimal acoustic pressure of 555 kPa, and pressure sensitivity was 1.019 dB/mmHg. No statistical differences were found between the pressures measured by the standard device and those estimated via the subharmonic amplitude, as confirmed by cross-validation (mean absolute errors from 2.00 to 3.09 mmHg, p > 0.05). Our findings demonstrated that in vitro optimized acoustic parameters for UCA microbubbles' subharmonic scattering can be applied for the noninvasive estimation of tumor IFPs.
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Affiliation(s)
- Yun Wang
- Department of Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Huimin Lu
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Laixin Huang
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Deyu Li
- Key Laboratory for Biomechanics and Mechanobiology of the Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China
| | - Weibao Qiu
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Lingling Li
- Department of Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Gang Xu
- Liver Transplant Center, Organ Transplant Center, West China Hospital of Sichuan University, Chengdu 610041, China
- Laboratory of Liver Transplantation, Key Laboratory of Transplant Engineering and Immunology, West China Hospital of Sichuan University, Chengdu 610093, China
| | - Min Su
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Jianhua Zhou
- Department of Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Fei Li
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
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Esposito C, Machado P, McDonald ME, Savage MP, Fischman D, Mehrotra P, Cohen IS, Ruggiero N, Walinsky P, Vishnevsky A, Dickie K, Davis M, Forsberg F, Dave JK. Noninvasive Evaluation of Cardiac Chamber Pressures Using Subharmonic-Aided Pressure Estimation With Definity Microbubbles. JACC Cardiovasc Imaging 2023; 16:224-235. [PMID: 36648035 DOI: 10.1016/j.jcmg.2022.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/04/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Noninvasive and accurate assessment of intracardiac pressures has remained an elusive goal of noninvasive cardiac imaging. OBJECTIVES The purpose of this study was to investigate if errors in intracardiac pressures obtained noninvasively using contrast microbubbles and the subharmonic-aided pressure estimation (SHAPE) technique are <5 mm Hg. METHODS In a nonrandomized institutional review board-approved clinical trial (NCT03243942), patients scheduled for a left-sided and/or right-sided heart catheterization procedure and providing written informed consent were included. A standard-of-care catheterization procedure was performed advancing clinically used pressure catheters into the left and/or right ventricles and/or the aorta. After pressure catheter placement, patients received an infusion of Definity microbubbles (n = 56; 2 vials diluted in 50 mL of saline; infusion rate: 4-10 mL/min) (Lantheus Medical Imaging). Then SHAPE data was acquired using a validated interface developed on a SonixTablet scanner (BK Medical Systems) synchronously with the pressure catheter data. A conversion factor (mm Hg/dB) was derived from SHAPE data and measurements with a SphygmoCor XCEL PWA device (ATCOR Medical) and was combined with SHAPE data from the left and/or the right ventricles to obtain clinically relevant systolic and diastolic ventricular pressures. RESULTS The mean value of absolute errors for left ventricular minimum and end diastolic pressures were 2.9 ± 2.0 and 1.7 ± 1.2 mm Hg (n = 26), respectively, and for right ventricular systolic pressures was 2.2 ± 1.5 mm Hg (n = 11). Two adverse events occurred during Definity infusion; both were resolved. CONCLUSIONS These results indicate that the SHAPE technique with Definity microbubbles is encouragingly efficacious for obtaining intracardiac pressures noninvasively and accurately. (Noninvasive, Subharmonic Intra-Cardiac Pressure Measurement; NCT03243942).
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Affiliation(s)
- Cara Esposito
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Priscilla Machado
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Maureen E McDonald
- Medical Imaging and Radiation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael P Savage
- Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - David Fischman
- Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Praveen Mehrotra
- Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ira S Cohen
- Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nicholas Ruggiero
- Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Paul Walinsky
- Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alec Vishnevsky
- Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Marguerite Davis
- Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jaydev K Dave
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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13
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Lu H, Xu G, Wang Y, Yang H, Li D, Huang L, Su M, Li C, Qiu W, Mao Y, Yu W, Li F. Correlation Between Portal Vein Pressure and Subharmonic Scattering Signals From SonoVue Microbubbles in Canines. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:203-211. [PMID: 36266141 DOI: 10.1016/j.ultrasmedbio.2022.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 06/16/2023]
Abstract
The current gold standard for the clinical diagnosis of portal hypertension (PH) is an invasive and indirect estimation of portal vein pressure (PVP). Therefore, the need for a non-invasive PVP measurement method is urgent. Subharmonic scattering of ultrasound contrast agent (UCA) microbubbles is under investigation in clinical research as a pressure indicator. However, the driving acoustic pressure must be optimized to improve the ambient pressure sensitivity of the subharmonic amplitude for different UCAs. In this study, for the first time, we obtained the relationship between the PVP and the amplitude of the subharmonic signal scattered from SonoVue microbubbles by using two canines to build the PH model. The results revealed a desirable linear correlation between the subharmonic amplitude and PVP (<20 mmHg) at the incident acoustic pressure of 453 kPa (r = -0.910, p < 0.005; sensitivity: -2.003 dB/mmHg); this was one order of magnitude higher in sensitivity than that of the in vitro case with a detectable pressure variation of approximately 1 mmHg. This indicates the feasibility of using UCA microbubbles to accurately measure low ambient pressures in vivo and further exhibits the potential of the method for non-invasive pressure estimation in clinical applications.
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Affiliation(s)
- Huimin Lu
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, China; Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Gang Xu
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China; Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC and Chinese Academy of Medical Sciences, Beijing, China; Department of Liver Surgery and Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, China
| | - Yun Wang
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China; Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Huayu Yang
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC and Chinese Academy of Medical Sciences, Beijing, China
| | - Deyu Li
- Key Laboratory for Biomechanics and Mechanobiology of the Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Laixin Huang
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Min Su
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Changcan Li
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC and Chinese Academy of Medical Sciences, Beijing, China
| | - Weibao Qiu
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Yilei Mao
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC and Chinese Academy of Medical Sciences, Beijing, China.
| | - Wenkui Yu
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
| | - Fei Li
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
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14
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van Hoeve W, de Vargas Serrano M, Te Winkel L, Forsberg F, Dave JK, Sarkar K, Wessner CE, Eisenbrey JR. Improved Sensitivity of Ultrasound-Based Subharmonic Aided Pressure Estimation Using Monodisperse Microbubbles. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1781-1789. [PMID: 34724241 DOI: 10.1002/jum.15861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Subharmonic aided pressure estimation (SHAPE) has been shown effective for noninvasively measuring hydrostatic fluid pressures in a variety of clinical applications. The objective of this study was to explore potential improvements in SHAPE sensitivity using monodisperse microbubbles. METHODS Populations of monodisperse microbubbles were created using a commercially available microfluidics device (Solstice Pharmaceuticals). Size distributions were assessed using a Coulter Counter and stability of the distribution following fabrication was evaluated over 24 hours. Attenuation of the microbubble populations from 1 to 10 MHz was then quantified using single element transducers to identify each formulation's resonance frequency. Frequency spectra over increasing driving amplitudes were investigated to determine the nonlinear phases of subharmonic signal generation. SHAPE sensitivity was evaluated in a hydrostatic pressure-controlled water bath using a Logiq E10 scanner (GE Healthcare). RESULTS Monodisperse lipid microbubble suspensions ranging from 2.4 to 5.3 μm in diameter were successfully created and they showed no discernable change in size distribution over 24 hours following activation. Calculated resonance frequencies ranged from 2.1 to 6.3 MHz and showed excellent correlation with microbubble diameter (R2 > 0.99). When investigating microbubble frequency response, subharmonic signal occurrence was shown to begin at 150 kPa peak negative pressure, grow up to 225 kPa, and saturate at approximately 250 kPa. Using the Logiq E10, monodisperse bubbles demonstrated a SHAPE sensitivity of -0.17 dB/mmHg, which was nearly twice the sensitivity of the commercial polydisperse microbubble currently being used in clinical trials. CONCLUSIONS Monodisperse microbubbles have the potential to greatly improve the sensitivity of SHAPE for the noninvasive measurement of hydrostatic pressures.
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Affiliation(s)
| | | | | | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jaydev K Dave
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kausik Sarkar
- Department of Mechanical and Aerospace Engineering, The George Washington University, Washington, DC, USA
| | - Corinne E Wessner
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - John R Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
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15
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Qiao X, Wen Y, Yu J, Bouakaz A, Zong Y, Wan M. Noninvasive Pressure Estimation Based on the Subharmonic Response of SonoVue: Application to Intracranial Blood Pressure Assessment. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:957-966. [PMID: 34941508 DOI: 10.1109/tuffc.2021.3138100] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Intracranial blood pressure can directly reflect the status of blood vessels in real time. However, it can only be estimated invasively using a microcatheter during craniotomy. Subharmonic-aided pressure estimation (SHAPE) is a promising technique for estimating cardiac pressures but mainly uses Sonazoid, whereas SHAPE using SonoVue is still in the early stages of development. The aim of this study was to optimize transcranial SHAPE using SonoVue by investigating the relationship between subharmonic signals and middle cerebral artery pressure (MCAP) (20-160 mmHg) in vitro. We examined the effect of acoustic output levels (peak negative pressures (PNPs) of 238, 346, and 454 kPa), time in suspension (time from reconstituting the suspension to extracting it: 0-30 min), and exposure to gas-equilibrated saline (3 min, 1 h, or original gas completely replaced by air) on the subharmonic-pressure relationship. A mean subharmonic amplitude over a 0.4 MHz bandwidth was extracted using a 5 MHz 12-cycle pulse. A PNP of 346 kPa elicited the best subharmonic sensitivity for assessing hydrostatic pressures up to 0.24 dB/mmHg, possibly because compression-only behavior no longer occurs at this pressure. Moreover, the expansion force is not large enough to offset the effects of hydrostatic pressure. A linear monotonic relationship between the subharmonic amplitude and hydrostatic pressure was only observed for just prepared SonoVue. Excessive exposure to gas-equilibrated saline also affected the subharmonic-pressure relationship. Therefore, just prepared SonoVue should be used, and the duration of the pressure estimation process should be strictly controlled.
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16
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Fan Y, Li H, Fuster D. Time-delayed interactions on acoustically driven bubbly screens. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2021; 150:4219. [PMID: 34972303 DOI: 10.1121/10.0008905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/11/2021] [Indexed: 06/14/2023]
Abstract
The influence of the compressibility effects is discussed, including the time delays on the dynamics of acoustically excited bubbly screens. In the linear regime, it is shown that the proposed model for the infinite bubbly screen recovers the results predicted by the effective medium theory (EMT) up to the second order without introducing any fitting parameter when the wavelength is large compared to the inter-bubble distance. However, the effect of boundaries on the finite bubbly screens is shown to lead to the appearance of multiple local resonances and characteristic periodic structures, which limit the applicability of the EMT. In addition, a local resonance phenomenon in the liquid spacings between the bubbles is observed for both the infinite and finite bubbly screens with crystal structures, and these effects vanish as the crystal structure is perturbed. In the nonlinear regime, the current model is treated with time-delay effects as a delay differential equation, which is directly solved numerically. The appearance of an optimal distance for the subharmonic emission for the crystal structures is shown, and the accuracy of the EMT in the strong nonlinear regime is discussed.
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Affiliation(s)
- Yuzhe Fan
- Acoustic Science and Technology Laboratory, Harbin Engineering University, Harbin 150001, China
| | - Haisen Li
- Acoustic Science and Technology Laboratory, Harbin Engineering University, Harbin 150001, China
| | - Daniel Fuster
- Sorbonne Université, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7190, Institut Jean Le Rond D'Alembert, F-75005 Paris, France
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Xu G, Lu H, Yang H, Li D, Liu R, Su M, Jin B, Li C, Lv T, Du S, Yang J, Qiu W, Mao Y, Li F. Subharmonic Scattering of SonoVue Microbubbles Within 10-40-mmHg Overpressures In Vitro. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:3583-3591. [PMID: 34329162 DOI: 10.1109/tuffc.2021.3101694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Ultrasound contrast agent microbubbles are considered promising sensors to measure portal vein pressure noninvasively. In this study, we investigated the subharmonic scattering power and optimal incident acoustic pressure of SonoVue microbubbles (concentration: [Formula: see text]/mL 0.9% NaCl solution) in the ambient pressure range of 10-40 mmHg with 10-mmHg increments at a temperature of 25 °C. The results demonstrated that the subharmonic response of the SonoVue microbubbles existed in three stages: the first growth stage (40-300 kPa), saturation (300-400 kPa), and the second growth stage (400-540 kPa). In the first growth stage, the subharmonic amplitude increased with ambient pressure. However, while the ambient pressure increased, the subharmonic amplitude decreased in the second growth stage. The best correlation of the subharmonic amplitudes with the ambient pressures was obtained at a high incident acoustic pressure of 520 kPa (sensitivity: 0.15 dB/mmHg, r2 = 0.99 , and root-mean-square error = 0.49 mmHg), which indicated that the subharmonic signals in the second growth stage might be suitable for estimating low ambient pressures. The results presented in our study may pave the way for portal vein pressure estimation using SonoVue microbubbles as sensors in clinical applications.
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Shen X, Guo J, Fan N, Lai M, Huang L, Wang J, Li Q. Protective effect of ultrasound microbubble combined with gross saponins of tribulus terrestris on glaucomatous optic nerve damage. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1436. [PMID: 34733988 PMCID: PMC8506763 DOI: 10.21037/atm-21-4230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/09/2021] [Indexed: 11/06/2022]
Abstract
Background To investigate the protective effect of ultrasound microbubble combined with gross saponins of tribulus terrestris (GSTT) (a Chinese herb) on glaucomatous optic nerve damage. Methods Rabbits were randomly divided into five groups. Normal (Group A), high intraocular pressure (IOP, Group B), GSTT (Group C), GSTT + ultrasound (Group D), and GSTT + ultrasound + microbubble destruction (Group E). The high intraocular pressure eye (model eye) was compared to the normal eye (control eye) at 1, 2, and 4 weeks after model establishment. Rabbits were sacrificed 4 weeks later to measure the retina thickness using Cirrus OCT, slit lamp photograph, and fundus photography. The retina and optic nerve of rabbits in each group were collected and the stretched retina were prepared for retinal ganglion cell (RGC) counting, the optic nerve axon was measured, and a transmission electron microscopy was used. Results Retina thickness based on Cirrus OCT: mean retinal thickness in Group E was significantly greater than that in Group B, but still thinner than that in Group A. RGCs counts: RGCs counts in Group E were significantly higher than those in Groups B, C, and D but still lower than those in Group A. Quantitative analysis of optic nerve axons: In Group E, the number of optic nerves was increased, diameters of optic nerve axons were decreased, the percentage of optic nerve area occupied by axons was increased, and there were statistically significant differences compared to Groups B, C, and D. Content of GSTT in retina: The content of GSTT in Group E was significantly higher than that in other groups. Observation of the rabbit optic nerves: In Group E, the structure of the myelin sheath of the optic nerve was still intact but less ordered, and the microtubule and microfilament structures in the axons were clear. Conclusions Combination of the ultrasound microbubble and GSTT can improve the protective effect of GSTT on optic nerve damage in rabbits with ocular hypertension.
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Affiliation(s)
- Xiaoli Shen
- Department of Glaucoma, Shenzhen Eye Hospital, Shenzhen Eye Hospital Affiliated with Jinan University, School of Optometry, Shenzhen University, Shenzhen, China
| | - Junhong Guo
- Department of Glaucoma, Shenzhen Eye Hospital, Shenzhen Eye Hospital Affiliated with Jinan University, School of Optometry, Shenzhen University, Shenzhen, China
| | - Ning Fan
- Department of Glaucoma, Shenzhen Eye Hospital, Shenzhen Eye Hospital Affiliated with Jinan University, School of Optometry, Shenzhen University, Shenzhen, China
| | - Mingying Lai
- Department of Glaucoma, Shenzhen Eye Hospital, Shenzhen Eye Hospital Affiliated with Jinan University, School of Optometry, Shenzhen University, Shenzhen, China
| | - Lina Huang
- Department of Glaucoma, Shenzhen Eye Hospital, Shenzhen Eye Hospital Affiliated with Jinan University, School of Optometry, Shenzhen University, Shenzhen, China
| | - Jiantao Wang
- Department of Glaucoma, Shenzhen Eye Hospital, Shenzhen Eye Hospital Affiliated with Jinan University, School of Optometry, Shenzhen University, Shenzhen, China
| | - Qiang Li
- Department of Ophthalmology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
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Esposito C, Dickie K, Forsberg F, Dave JK. Developing an Interface and Investigating Optimal Parameters for Real-Time Intracardiac Subharmonic-Aided Pressure Estimation. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:579-585. [PMID: 32784134 PMCID: PMC7983258 DOI: 10.1109/tuffc.2020.3016264] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Thisstudy focuses on evaluating the real-time functionality of a customized interface and investigating the optimal parameters for intracardiac subharmonic-aided pressure estimation (SHAPE) utilizing Definity (Lantheus Medical Imaging Inc., North Billerica, MA, USA) and Sonazoid (GE Healthcare, Oslo, Norway) microbubbles. Pressure measurements within the chambers of the heart yield critical information for managing cardiovascular diseases. An alternative to current, invasive, clinical cardiac catheterization procedures is utilizing ultrasound contrast agents and SHAPE to noninvasively estimate intracardiac pressures. Therefore, this work developed a customized interface (on a SonixTablet, BK Ultrasound, Peabody, MA, USA) for real-time intracardiac SHAPE. In vitro, a Doppler flow phantom was utilized to mimic the dynamic pressure changes within the heart. Definity (15.0- [Formula: see text] microspheres corresponding to 0.1-0.15 mL) and Sonazoid (GE Healthcare; 0.4- [Formula: see text] microspheres corresponding to 0.05-0.15 mL) microbubbles were used. Data were acquired for varying transmit frequencies (2.5-4.0 MHz), and pulse shaping options (square wave and chirp down) to determine optimal transmit parameters. Simultaneously obtained radio frequency data and ambient pressure data were compared. For Definity, the chirp down pulse at 3.0 MHz yielded the highest correlation ( r = - 0.77 ± 0.2 ) between SHAPE and pressure catheter data. For Sonazoid, the square wave pulse at 2.5 MHz yielded the highest correlation ( r = - 0.72 ± 0.2 ). In conclusion, the real-time functionality of the customized interface has been verified, and the optimal parameters for utilizing Definity and Sonazoid for intracardiac SHAPE have been determined.
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Forsberg F, Gupta I, Machado P, Shaw CM, Fenkel JM, Wallace K, Eisenbrey JR. Contrast-Enhanced Subharmonic Aided Pressure Estimation (SHAPE) using Ultrasound Imaging with a Focus on Identifying Portal Hypertension. J Vis Exp 2020. [PMID: 33346203 DOI: 10.3791/62050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Noninvasive, accurate measurement of pressures within the human body has long been an important but elusive clinical goal. Contrast agents for ultrasound imaging are gas-filled, encapsulated microbubbles (diameter < 10 μm) that traverse the entire vasculature and enhance signals by up to 30 dB. These microbubbles also produce nonlinear oscillations at frequencies ranging from the subharmonic (half of the transmit frequency) to higher harmonics. The subharmonic amplitude has an inverse linear relationship with the ambient hydrostatic pressure. Here an ultrasound system capable of performing real-time, subharmonic aided pressure estimation (SHAPE) is presented. During ultrasound contrast agent infusion, an algorithm for optimizing acoustic outputs is activated. Following this calibration, subharmonic microbubble signals (i.e., SHAPE) have the highest sensitivity to pressure changes and can be used to noninvasively quantify pressure. The utility of the SHAPE procedure for identifying portal hypertension in the liver is the emphasis here, but the technique has applicability across many clinical scenarios.
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Affiliation(s)
| | - Ipshita Gupta
- Department of Radiology, Thomas Jefferson University; School of Biomedical Engineering, Sciences and Health Systems, Drexel University
| | | | | | - Jonathan M Fenkel
- Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University
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Gupta I, Eisenbrey JR, Machado P, Stanczak M, Wessner CE, Shaw CM, Gummadi S, Fenkel JM, Tan A, Miller C, Parent J, Schultz S, Soulen MC, Sehgal CM, Wallace K, Forsberg F. Diagnosing Portal Hypertension with Noninvasive Subharmonic Pressure Estimates from a US Contrast Agent. Radiology 2020; 298:104-111. [PMID: 33201789 DOI: 10.1148/radiol.2020202677] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background The current standard for assessing the severity of portal hypertension is the invasive acquisition of hepatic venous pressure gradient (HVPG). A noninvasive US-based technique called subharmonic-aided pressure estimation (SHAPE) could reduce risk and enable routine acquisition of these pressure estimates. Purpose To compare quantitative SHAPE to HVPG measurements to diagnose portal hypertension in participants undergoing a transjugular liver biopsy. Materials and Methods This was a prospective cross-sectional trial conducted at two hospitals between April 2015 and March 2019 (ClinicalTrials.gov identifier, NCT02489045). This trial enrolled participants who were scheduled for transjugular liver biopsy. After standard-of-care transjugular liver biopsy and HVPG pressure measurements, participants received an infusion of a US contrast agent and saline. During infusion, SHAPE data were collected from a portal vein and a hepatic vein, and the difference was compared with HVPG measurements. Correlations between data sets were determined by using the Pearson correlation coefficient, and statistical significance between groups was determined by using the Student t test. Receiver operating characteristic analysis was performed to determine the sensitivity and specificity of SHAPE. Results A total of 125 participants (mean age ± standard deviation, 59 years ± 12; 80 men) with complete data were included. Participants at increased risk for variceal hemorrhage (HVPG ≥12 mm Hg) had a higher mean SHAPE gradient compared with participants with lower HVPGs (0.79 dB ± 2.53 vs -4.95 dB ± 3.44; P < .001), which is equivalent to a sensitivity of 90% (13 of 14; 95% CI: 88, 94) and a specificity of 80% (79 of 99; 95% CI: 76, 84). The SHAPE gradient between the portal and hepatic veins was in good overall agreement with the HVPG measurements (r = 0.68). Conclusion Subharmonic-aided pressure estimation is an accurate noninvasive technique for detecting clinically significant portal hypertension. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Kiessling in this issue.
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Affiliation(s)
- Ipshita Gupta
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - John R Eisenbrey
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Priscilla Machado
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Maria Stanczak
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Corinne E Wessner
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Colette M Shaw
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Sriharsha Gummadi
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Jonathan M Fenkel
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Alison Tan
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Cynthia Miller
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Julia Parent
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Susan Schultz
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Michael C Soulen
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Chandra M Sehgal
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Kirk Wallace
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Flemming Forsberg
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
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