Ultrasound characterization of red blood cell aggregation with intervening attenuating tissue-mimicking phantoms

Monitoring Muscle Perfusion in Rodents During Short-Term Ischemia Using Power Doppler Ultrasound

OBJECTIVE

The aim of this work was to evaluate the reliability of power Doppler ultrasound (PD-US) measurements made without contrast enhancement to monitor temporal changes in peripheral blood perfusion.

METHODS

On the basis of pre-clinical rodent studies, we found that combinations of spatial registration and clutter filtering techniques applied to PD-US signals reproducibly tracked blood perfusion in skeletal muscle. Perfusion is monitored while modulating hindlimb blood flow. First, in invasive studies, PD-US measurements in deep muscle with laser speckle contrast imaging (LSCI) of superficial tissues made before, during and after short-term arterial clamping were compared. Then, in non-invasive studies, a pressure cuff was employed to generate longer-duration hindlimb ischemia. Here, B-mode imaging was also applied to measure flow-mediated dilation of the femoral artery while, simultaneously, PD-US was used to monitor downstream muscle perfusion to quantify reactive hyperemia. Measurements in adult male and female mice and rats, some with exercise conditioning, were included to explore biological variables.

RESULTS

PD-US methods are validated through comparisons with LSCI measurements. As expected, no significant differences were found between sexes or fitness levels in flow-mediated dilation or reactive hyperemia estimates, although post-ischemic perfusion was enhanced with exercise conditioning, suggesting there could be differences between the hyperemic responses of conduit and resistive vessels.

CONCLUSION

Overall, we found non-contrast PD-US imaging can reliably monitor relative spatiotemporal changes in muscle perfusion. This study supports the development of PD-US methods for monitoring perfusion changes in patients at risk for peripheral artery disease.

Evaluation of the Cell Concentration in Suspensions of Human Leukocytes by Ultrasound Imaging: The Influence of Size Dispersion and Cell Type

This work focuses on the use of ultrasound imaging to evaluate the cell concentration of dilute leukocyte suspensions in the range of 10-3000 cells/µL. First, numerical simulations were used to study the influence of the size dispersion and the leukocyte type on the performance of the concentration estimation algorithms, which were developed in previous works assuming single-sized scatterers. From this analysis, corrections to the mentioned algorithms were proposed and then the performance of these corrections was evaluated from experiments. For this, ultrasound images were captured from suspensions of lymphocytes, granulocytes, and their mixtures. These images were obtained using a 20 MHz single-channel scanning system. Results confirmed that concentration estimates provided by conventional algorithms were affected by the size dispersion of cells, leading to a remarkable underestimation of results. The proposed correction to compensate for cell size dispersion obtained from simulations improved the concentration estimation of these algorithms, for the cell suspensions tested, approaching the results to the reference optical characterization. Moreover, it was shown that these models provided a total leukocyte concentration from the ultrasound images which was independent of the relative populations of different white blood cell types.

Combining Spatial Registration With Clutter Filtering for Power-Doppler Imaging in Peripheral Perfusion Applications

Power-Doppler ultrasonic (PD-US) imaging is sensitive to echoes from blood cell motion in the microvasculature but generally nonspecific because of difficulties with filtering nonblood-echo sources. We are studying the potential for using PD-US imaging for routine assessments of peripheral blood perfusion without contrast media. The strategy developed is based on an experimentally verified computational model of tissue perfusion that simulates typical in vivo conditions. The model considers directed and diffuse blood perfusion states in a field of moving clutter and noise. A spatial registration method is applied to minimize tissue motion prior to clutter and noise filtering. The results show that in-plane clutter motion is effectively minimized. While out-of-plane motion remains a strong source of clutter-filter leakage, those registration errors are readily minimized by straightforward modification of scanning techniques and spatial averaging.

Statistical modeling of ultrasound signals related to the packing factor of wave scattering phenomena for structural characterization

The two-dimensional homodyned K-distribution has been widely used to model the echo envelope of ultrasound radio frequency (RF) signals in the field of medical ultrasonics. The main contribution of this work is to present a theoretical framework for supporting this model of the echo envelope and statistical models of the RF signals and their Hilbert transform in the case in which the scatterers' positions may be dependent. In doing so, the law of large numbers, Lyapounov's central limit theorem, and the Berry-Esseen theorem are being used. In particular, the proposed theoretical framework supports a previous conjecture relating the scatterer clustering parameter of the homodyned K-distribution to the packing factor W, which is related to the spatial organization of the scatterers, appearing in statistical physics or backscatter coefficient modeling. Simulations showed that the proposed modeling is valid for a number of scatterers and packing factors varying by steps of 2 from 1 to 21 and 1 to 11, respectively. The proposed framework allows, in principle, the detection of the structural information taking place at a scale smaller than the wavelength based solely on the statistical analysis of the RF signals or their echo envelope, although this goal was previously achieved based on the spectral analysis of ultrasound signals.

Quantitative ultrasound imaging of soft biological tissues: a primer for radiologists and medical physicists

Quantitative ultrasound (QUS) aims at quantifying interactions between ultrasound and biological tissues. QUS techniques extract fundamental physical properties of tissues based on interactions between ultrasound waves and tissue microstructure. These techniques provide quantitative information on sub-resolution properties that are not visible on grayscale (B-mode) imaging. Quantitative data may be represented either as a global measurement or as parametric maps overlaid on B-mode images. Recently, major ultrasound manufacturers have released speed of sound, attenuation, and backscatter packages for tissue characterization and imaging. Established and emerging clinical applications are currently limited and include liver fibrosis staging, liver steatosis grading, and breast cancer characterization. On the other hand, most biological tissues have been studied using experimental QUS methods, and quantitative datasets are available in the literature. This educational review addresses the general topic of biological soft tissue characterization using QUS, with a focus on disseminating technical concepts for clinicians and specialized QUS materials for medical physicists. Advanced but simplified technical descriptions are also provided in separate subsections identified as such. To understand QUS methods, this article reviews types of ultrasound waves, basic concepts of ultrasound wave propagation, ultrasound image formation, point spread function, constructive and destructive wave interferences, radiofrequency data processing, and a summary of different imaging modes. For each major QUS technique, topics include: concept, illustrations, clinical examples, pitfalls, and future directions.

Estimation of the concentration of particles in suspension based on envelope statistics of ultrasound backscattering

This work deals with the development of a methodology to evaluate the concentration in cell or particle suspensions from ultrasound images. The novelty of the method is based on two goals: first, it should be valid when the energy reaching the scatterers is unknown and cannot be measured or calibrated. In addition, it should be robust against echo overlap which may occur due to high scatterer concentration. Both characteristics are especially valuable in quantitative ultrasound analysis in the clinical context. In this regard, the present work considers the ability of envelope statistics models to characterize ultrasound images. Envelope statistical analysis are based on the examination of the physical properties of a medium through the study of the statistical distribution of the backscattered signal envelop. A review of the statistical distributions typically used to characterize scattering mediums was conducted. The main parameters of the distribution were estimated from simulations of signals backscattered by particle suspensions. Then, the ability of these parameters to characterize the suspension concentration was analyzed and the µ parameter from the Homodyned-K distribution resulted as the most suitable parameter for the task. Simulations were also used to study the impact of noise, signal amplitude variability and dispersion of particle sizes on the estimation method. The efficiency of the algorithm on experimental measurements was also evaluated. To this end, two sets of ultrasound images were obtained from suspensions of 7 µm and 12 µm polystyrene particles in water, using a 20 MHz focused transducer. The methodology proved to be efficient to quantify the concentration of particle suspensions in the range between 5 and 3000 particles/µl, achieving similar results for both particle sizes and for different signal-to-noise ratios.

A New Methodology for the Assessment of Very Low Concentrations of Cells in Serous Body Fluids Based on the Count of Ultrasound Echoes Backscattered From Cells

A methodology for the assessment of cell concentration, in the range 5-100 cells/ [Formula: see text], suitable for in vivo analysis of serous body fluids is presented in this work. This methodology is based on the quantitative analysis of ultrasound images obtained from cell suspensions and considers applicability criteria, such as short analysis times, moderate frequency, and absolute concentration estimation, all necessary to deal with the variability of tissues among different patients. Numerical simulations provided the framework to analyze the impact of echo overlapping and the polydispersion of scatterer sizes on the cell concentration estimation. The cell concentration range that can be analyzed as a function of the transducer and emitted waveform used was also discussed. Experiments were conducted to evaluate the performance of the method using 7- [Formula: see text] and 12- [Formula: see text] polystyrene particles in water suspensions in the 5-100 particles/ [Formula: see text] range. A single scanning focused transducer working at a central frequency of 20 MHz was used to obtain ultrasound images. The method proposed to estimate the concentration proved to be robust for different particle sizes and variations of gain acquisition settings. The effect of tissues placed in the ultrasound path between the probe and the sample was also investigated using 3-mm-thick tissue mimics. Under this situation, the algorithm was robust for the concentration analysis of 12 [Formula: see text] particle suspensions, yet significant deviations were obtained for the smallest particles.

Pilot clinical study of quantitative ultrasound spectroscopy measurements of erythrocyte aggregation within superficial veins

BACKGROUND:

An enhanced inflammatory response is a trigger to the production of blood macromolecules involved in abnormally high levels of erythrocyte aggregation.

OBJECTIVE:

This study aimed at demonstrating for the first time the clinical feasibility of a non-invasive ultrasound-based erythrocyte aggregation quantitative measurement method for potential application in critical care medicine.

METHODS:

Erythrocyte aggregation was evaluated using modeling of the backscatter coefficient with the Structure Factor Size and Attenuation Estimator (SFSAE). SFSAE spectral parameters W (packing factor) and D (mean aggregate diameter) were measured within the antebrachial vein of the forearm and tibial vein of the leg in 50 healthy participants at natural flow and reduced flow controlled by a pressurized bracelet. Blood samples were also collected to measure erythrocyte aggregation ex vivo with an erythroaggregometer (parameter S₁₀).

RESULTS:

W and Din vivo measurements were positively correlated with the ex vivoS₁₀ index for both measurement sites and shear rates (correlations between 0.35–0.81, p < 0.05). Measurement at low shear rate was found to increase the sensitivity and reliability of this non-invasive measurement method.

CONCLUSIONS:

We behold that the SFSAE method presents systemic measures of the erythrocyte aggregation level, since results on upper and lower limbs were highly correlated.

Ultrasonic backscattering and microstructure in sheared concentrated suspensions

Quantitative ultrasound techniques based on the parametrization of the backscatter coefficient (BSC) are used to characterize concentrated particle suspensions. Specifically, a scattering model is fit to the measured BSC and the fit parameters can provide local suspension properties. The scattering models generally assume an isotropic microstructure (i.e., spatial organization) of the scatterers, whereas the sheared concentrated suspensions can develop an anisotropic microstructure. This paper studied the influence of the shear-induced anisotropic microstructure of concentrated suspensions on the ultrasonic backscattering. Experiments were conducted on suspensions of polymethylmetacrylate spheres (5.8 μm in radius) sheared in a Couette flow device to obtain anisotropic microstructure and then mixed by hand to obtain isotropic microstructure. Experimental structure factors that are related to the spatial distribution of sphere positions were obtained by comparing the BSCs of one concentrated and one diluted suspension. Finally, Stokesian dynamics numerical simulations of sheared concentrated suspensions are used to determine the pair correlation function, which is linked to the Fourier transform of the structure factor. The experimental structure factors are found to be in good agreement with numerical simulations. The numerical simulation demonstrates that the angular-dependent BSCs and structure factors are caused by the shear-induced anisotropic microstructure within the suspension.

Quantitative ultrasound imaging of cell-laden hydrogels and printed constructs

In the present work we have revisited the application of quantitative ultrasound imaging (QUI) to cellular hydrogels, by using the reference phantom method (RPM) in combination with a local attenuation compensation algorithm. The investigated biological samples consisted of cell-laden collagen hydrogels with PC12 neural cells. These cell-laden hydrogels were used to calibrate the integrated backscattering coefficient (IBC) as a function of cell density, which was then used to generate parametric images of local cell density. The image resolution used for QUI and its impact on the relative IBC error was also investigated. Another important contribution of our work was the monitoring of PC12 cell proliferation. The cell number estimates obtained via the calibrated IBC compared well with data obtained using a conventional quantitative method, the MTS assay. Evaluation of spectral changes as a function of culture time also provided additional information on the cell cluster size, which was found to be in close agreement with that observed by microscopy. Last but not least, we also applied QUI on a 3D printed cellular construct in order to illustrate its capabilities for the evaluation of bioprinted structures. STATEMENT OF SIGNIFICANCE: While there is intensive research in the areas of polymer science, biology, and 3D bio-printing, there exists a gap in available characterisation tools for the non-destructive inspection of biological constructs in the three-dimensional domain, on the macroscopic scale, and with fast data acquisition times. Quantitative ultrasound imaging is a suitable characterization technique for providing essential information on the development of tissue engineered constructs. These results provide a detailed and comprehensive guide on the capabilities and limitations of the technique.

Low Variance Estimation of Backscatter Quantitative Ultrasound Parameters Using Dynamic Programming

One of the main limitations of ultrasound imaging is that image quality and interpretation depend on the skill of the user and the experience of the clinician. Quantitative ultrasound (QUS) methods provide objective, system-independent estimates of tissue properties, such as acoustic attenuation and backscattering properties of tissue, which are valuable as objective tools for both diagnosis and intervention. Accurate and precise estimation of these properties requires correct compensation for intervening tissue attenuation. Prior attempts to estimate intervening-tissue attenuation based on minimizing cost functions that compared backscattered echo data to models have resulted in limited precision and accuracy. To overcome these limitations, in this paper, we incorporate the prior information of piecewise continuity of QUS parameters as a regularization term into our cost function. We further propose to calculate this cost function using dynamic programming (DP), a computationally efficient optimization algorithm that finds the global optimum. Our results on tissue-mimicking phantoms show that DP substantially outperforms a published least squares method in terms of both estimation bias and variance.

Ultrasound scattering by aggregated red blood cells in patients with diabetes

PURPOSE

To develop methods for noninvasively and quantitatively measuring blood glucose levels.

METHODS

In the present study, we evaluated the degree of red blood cell (RBC) aggregation at a low shear rate robustly by introducing two new parameters determined from changes in the scattering power spectrum of the echoes from the intravascular lumen before and after cessation of blood flow. We also considered the clinical significance of these parameters and the change in sizes estimated by the conventional method by comparing them with the blood glucose level obtained just before the ultrasonic measurements. We performed the measurements in one healthy subject and 11 diabetic patients.

RESULTS

A correlation was found between one of the proposed parameters and the blood glucose level. However, the p value was not very high, and one of the reasons for the decline of the correlation will be that some factors other than blood glucose also affect RBC aggregation.

CONCLUSION

The proposed method has potential for clinical application after elucidation of the various factors affecting RBC aggregation.

Quantitative Measurement of Erythrocyte Aggregation as a Systemic Inflammatory Marker by Ultrasound Imaging: A Systematic Review

This systematic review is aimed at answering two questions: (i) Is erythrocyte aggregation a useful biomarker in assessing systemic inflammation? (ii) Does quantitative ultrasound imaging provide the non-invasive option to measure erythrocyte aggregation in real time? The search was executed through bibliographic electronic databases CINAHL, EMB Review, EMBASE, MEDLINE, PubMed and the grey literature. The majority of studies correlated elevated erythrocyte aggregation with inflammatory blood markers for several pathologic states. Some studies used "erythrocyte aggregation" as an established marker of systemic inflammation. There were limited but promising articles regarding the use of quantitative ultrasound spectroscopy to monitor erythrocyte aggregation. Similarly, there were limited studies that used other ultrasound techniques to measure systemic inflammation. The quantitative measurement of erythrocyte aggregation has the potential to be a routine clinical marker of inflammation as it can reflect the cumulative inflammatory dynamics in vivo, is relatively simple to measure, is cost-effective and has a rapid turnaround time. Technologies like quantitative ultrasound spectroscopy that can measure erythrocyte aggregation non-invasively and in real time may offer the advantage of continuous monitoring of the inflammation state and, thus, may help in rapid decision making in a critical care setup.

Estimation of polydispersity in aggregating red blood cells by quantitative ultrasound backscatter analysis

Quantitative ultrasound techniques based on the backscatter coefficient (BSC) have been commonly used to characterize red blood cell (RBC) aggregation. Specifically, a scattering model is fitted to measured BSC and estimated parameters can provide a meaningful description of the RBC aggregates' structure (i.e., aggregate size and compactness). In most cases, scattering models assumed monodisperse RBC aggregates. This study proposes the Effective Medium Theory combined with the polydisperse Structure Factor Model (EMTSFM) to incorporate the polydispersity of aggregate size. From the measured BSC, this model allows estimating three structural parameters: the mean radius of the aggregate size distribution, the width of the distribution, and the compactness of the aggregates. Two successive experiments were conducted: a first experiment on blood sheared in a Couette flow device coupled with an ultrasonic probe, and a second experiment, on the same blood sample, sheared in a plane-plane rheometer coupled to a light microscope. Results demonstrated that the polydisperse EMTSFM provided the best fit to the BSC data when compared to the classical monodisperse models for the higher levels of aggregation at hematocrits between 10% and 40%. Fitting the polydisperse model yielded aggregate size distributions that were consistent with direct light microscope observations at low hematocrits.

Effects of the container on structure function with impedance map analysis of dense scattering media

Quantitative ultrasound (QUS) can be used to estimate acoustic properties of tissue microstructure. In one approach to QUS, the backscatter coefficient (BSC) is utilized to quantify and classify tissue state. From the BSC, parametric models can be constructed to relate the frequency-dependent BSC to geometrical properties of the underlying tissue. However, most of these parametric models are based on analytic expressions (e.g., Gaussian function) and not on actual tissue morphology. Impedance map analysis has been proposed to help identify sources of ultrasonic scattering in tissues and to develop improved models of scattering. Previously, two-dimensional impedance maps (2DZMs) were demonstrated to provide tissue models of three-dimensional (3D) structures for sparse scattering media. In the current study, 2DZMs analysis of dense scatterer media combining the structure function with impedance map analysis was studied through a series of simulations. The simulation analysis demonstrated that the correlation coefficient and power spectrum could be estimated for a dense collection of spheres using 2DZMs. The current finding implies that 2DZMs can capture information about the 3D spatial positions of scatterers in addition to information about the size and shape of the scatterers for a dense scattering media, which is expected to be encountered in many tissues.

Analysis of Two Quantitative Ultrasound Approaches

There are two well-known ultrasonic approaches to extract sets of quantitative parameters: Lizzi-Feleppa (LF) parameters: slope, intercept, and midband; and quantitative ultrasound (QUS)-derived parameters: effective scatterer diameter (ESD) and effective acoustic concentration (EAC). In this study, the relation between the LF and QUS-derived parameters is studied theoretically and experimentally on ex vivo mouse livers. As expected from the theory, LF slope is correlated to ESD ([Formula: see text]), and from experimental data, LF midband is correlated to EAC ([Formula: see text]). However, LF intercept is not correlated to ESD ([Formula: see text]) nor EAC ([Formula: see text]). The unexpected correlation observed between LF slope and EAC ([Formula: see text]) results likely from the high correlation between ESD and EAC due to the inversion process. For a liver fat percentage estimation, an important potential medical application, the parameters presenting the better correlation are EAC ([Formula: see text]) and LF midband ([Formula: see text]).

Protocol for Robust In Vivo Measurements of Erythrocyte Aggregation Using Ultrasound Spectroscopy

Erythrocyte aggregation is a non-specific marker of acute and chronic inflammation. Although it is usual to evaluate this phenomenon from blood samples analyzed in laboratory instruments, in vivo real-time assessment of aggregation is possible with spectral ultrasound techniques. However, variable blood flow can affect the interpretation of acoustic measures. Therefore, flow standardization is required. Two techniques of flow standardization were evaluated with porcine and equine blood samples in Couette flow. These techniques consisted in either stopping the flow or reducing it. Then, the sensibility and repeatability of the retained method were evaluated in 11 human volunteers. We observed that stopping the flow compromised interpretation and repeatability. Conversely, maintaining a low flow provided repeatable measures and could distinguish between normal and high extents of erythrocyte aggregation. Agreement was observed between in vivo and ex vivo measures of the phenomenon (R² = 82.7%, p value < 0.0001). These results support the feasibility of assessing in vivo erythrocyte aggregation in humans by quantitative ultrasound means.

Computational Biomechanics of Human Red Blood Cells in Hematological Disorders

We review recent advances in multiscale modeling of the biomechanical characteristics of red blood cells (RBCs) in hematological diseases, and their relevance to the structure and dynamics of defective RBCs. We highlight examples of successful simulations of blood disorders including malaria and other hereditary disorders, such as sickle-cell anemia, spherocytosis, and elliptocytosis.

Monitoring Microwave Ablation of Ex Vivo Bovine Liver Using Ultrasonic Attenuation Imaging

Thermal ablation of soft tissue changes the tissue microstructure and, consequently, induces changes in its acoustic properties. Although B-mode ultrasound provides high-resolution and high-frame-rate images of ablative therapeutic procedures, it is not particularly effective at delineating boundaries of ablated regions because of poor contrast in echogenicity between ablated and surrounding normal tissue. Quantitative ultrasound techniques can provide quantitative estimates of acoustic properties, such as backscatter and attenuation coefficients, and differentiate ablated and unablated regions more effectively, with the potential for monitoring minimally invasive thermal therapies. In this study, a previously introduced attenuation estimation method was used to create quantitative attenuation coefficient maps for 11 microwave ablation procedures performed on refrigerated ex vivo bovine liver. The attenuation images correlate well with the pathologic images of the ablated region. The mean attenuation coefficient for regions of interest drawn inside and outside the ablated zones were 0.9 (±0.2) and 0.45 (±0.15) dB/cm/MHz, respectively. These estimates agree with reported values in the literature and establish the usefulness of non-invasive attenuation imaging for monitoring therapeutic procedures in the liver.

Lower Bound on Estimation Variance of the Ultrasonic Attenuation Coefficient Using the Spectral-Difference Reference-phantom Method

Ultrasonic attenuation is one of the primary parameters of interest in Quantitative Ultrasound (QUS). Non-invasive monitoring of tissue attenuation can provide valuable diagnostic and prognostic information to the physician. The Reference Phantom Method (RPM) was introduced as a way of mitigating some of the system-related effects and biases to facilitate clinical QUS applications. In this paper, under the assumption of diffuse scattering, a probabilistic model of the backscattered signal spectrum is used to derive a theoretical lower bound on the estimation variance of the attenuation coefficient using the Spectral-Difference RPM. The theoretical lower bound is compared to simulated and experimental attenuation estimation statistics in tissue-mimicking (TM) phantoms. Estimation standard deviation (STD) of the sample attenuation in a region of interest (ROI) of the TM phantom is measured for various combinations of processing parameters, including Radio-Frequency (RF) data block length (i.e., window length) from 3 to 17 mm, RF data block width from 10 to 100 A-lines, and number of RF data blocks per attenuation estimation ROI from 3 to 10. In addition to the Spectral-Difference RPM, local attenuation estimation for simulated and experimental data sets was also performed using a modified implementation of the Spectral Fit Method (SFM). Estimation statistics of the SFM are compared to theoretical variance predictions from the literature.1 Measured STD curves are observed to lie above the theoretical lower bound curves, thus experimentally verifying the validity of the derived bounds. This theoretical framework benefits tissue characterization efforts by isolating processing parameter ranges that could provide required precision levels in estimation of the ultrasonic attenuation coefficient using Spectral Difference methods.

In Vivo Estimation of Attenuation and Backscatter Coefficients From Human Thyroids

Fine-needle aspiration (FNA) remains the gold standard for the diagnosis of thyroid cancer. However, currently, a large number of FNA biopsies result in negative or undetermined diagnosis, which suggests that better noninvasive tools are needed for the clinical management of thyroid cancer. Spectral-based quantitative ultrasound (QUS) characterizations may offer a better diagnostic management as previously demonstrated in mouse cancer models ex vivo. As a first step toward understanding the potential of QUS markers for thyroid disease management, this paper deals with the spectral-based QUS estimation of healthy human thyroids in vivo. Twenty volunteers were inspected by a trained radiologist using two ultrasonic imaging systems, which allowed them to acquire radio-frequency data spanning the 3-16-MHz frequency range. Estimates of attenuation coefficient slope (ACS) using the spectral logarithmic difference method had an average value of [Formula: see text]) with a standard deviation of [Formula: see text]. Estimates of backscatter coefficient (BSC) using the reference-phantom method had an average value of [Formula: see text] over the useful frequency range. The intersubject variability when estimating BSCs was less than 1.5 dB over the analysis frequency range. Further, the effectiveness of three scattering models (i.e., fluid sphere, Gaussian, and exponential form factors) when fitting the experimentally estimated BSCs was assessed. The exponential form factor was found to provide the best overall goodness of fit ( R² = 0.917), followed by the Gaussian ( R² = 0.807) and the fluid-sphere models ( R² = 0.752). For all scattering models used in this study, average estimates of the effective scatterer diameter were between 44 and 56 μm. Overall, an excellent agreement in the estimated attenuation and BSCs with both scanners was exhibited.

Optimum Diffraction-Corrected Frequency-Shift Estimator of the Ultrasonic Attenuation Coefficient

The ultrasonic attenuation coefficient is an important parameter that has been studied extensively in Quantitative Ultrasound and Tissue Characterization. There are various methods described in the literature that estimate this parameter by measuring either spectral difference (i.e., decay) or spectral shift of the backscattered echo signal. Under ideal conditions, i.e., in the absence of abrupt changes in tissue backscattering, Spectral Difference methods can produce estimates with high accuracy and precision. On the other hand, diffraction-corrected Spectral Shift methods (e.g., the Hybrid method) are better suited for application in practical settings using clinical ultrasound scanners. However, current Spectral Shift methods use inefficient frequency shift estimators that ultimately degrade the quality of attenuation coefficient estimates. In this paper, a probabilistic model of the backscattered radiofrequency (RF) echo is used to derive the Cramér-Rao lower bound (CRLB) on estimation variance of the spectral centroid. Next, an efficient correlation-based shift estimator is presented that achieves the CRLB. Used in conjunction with a well-characterized reference phantom to correct for diffraction and other system-related effects, this estimator greatly improves the accuracy and precision of Spectral- Shift attenuation estimation. A theoretical analysis of this method is provided, and its performance is quantitatively compared with that of the Hybrid method using simulated and experimental phantom studies. A minimum of 3-fold reduction in the standard deviation of attenuation coefficient estimates is observed using the new method.

Review of Quantitative Ultrasound: Envelope Statistics and Backscatter Coefficient Imaging and Contributions to Diagnostic Ultrasound

Conventional medical imaging technologies, including ultrasound, have continued to improve over the years. For example, in oncology, medical imaging is characterized by high sensitivity, i.e., the ability to detect anomalous tissue features, but the ability to classify these tissue features from images often lacks specificity. As a result, a large number of biopsies of tissues with suspicious image findings are performed each year with a vast majority of these biopsies resulting in a negative finding. To improve specificity of cancer imaging, quantitative imaging techniques can play an important role. Conventional ultrasound B-mode imaging is mainly qualitative in nature. However, quantitative ultrasound (QUS) imaging can provide specific numbers related to tissue features that can increase the specificity of image findings leading to improvements in diagnostic ultrasound. QUS imaging can encompass a wide variety of techniques including spectral-based parameterization, elastography, shear wave imaging, flow estimation, and envelope statistics. Currently, spectral-based parameterization and envelope statistics are not available on most conventional clinical ultrasound machines. However, in recent years, QUS techniques involving spectral-based parameterization and envelope statistics have demonstrated success in many applications, providing additional diagnostic capabilities. Spectral-based techniques include the estimation of the backscatter coefficient (BSC), estimation of attenuation, and estimation of scatterer properties such as the correlation length associated with an effective scatterer diameter (ESD) and the effective acoustic concentration (EAC) of scatterers. Envelope statistics include the estimation of the number density of scatterers and quantification of coherent to incoherent signals produced from the tissue. Challenges for clinical application include correctly accounting for attenuation effects and transmission losses and implementation of QUS on clinical devices. Successful clinical and preclinical applications demonstrating the ability of QUS to improve medical diagnostics include characterization of the myocardium during the cardiac cycle, cancer detection, classification of solid tumors and lymph nodes, detection and quantification of fatty liver disease, and monitoring and assessment of therapy.

Unifying Concepts of Statistical and Spectral Quantitative Ultrasound Techniques

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

In vivo venous assessment of red blood cell aggregate sizes in diabetic patients with a quantitative cellular ultrasound imaging method: proof of concept

Background

Diabetic patients present higher level of red blood cell (RBC) aggregation contributing to the development of vascular complications. While it has been suggested that this hematology/rheology parameter could bring additional prognostic information for the management of those patients, RBC aggregation screening is not included as a clinical practice. Most medical centers are not equipped to measure properly this parameter, although sedimentation tests can bring some indication. Here, we aimed at evaluating the feasibility of using ultrasound to assess in-vivo hyper-aggregation in type 2 diabetic patients.

Research design and methods

Seventeen diabetic patients and 15 control subjects underwent ultrasound measurements of RBC aggregation in both cephalic and great saphenous veins. Non-invasive in-vivo ultrasound measurements were performed using a newly developed cellular imaging technique, the structure factor size and attenuation estimator (SFSAE). Comparisons with an ex-vivo gold standard rheometry technique were done, along with measurements of pro-aggregating plasma molecule concentrations.

Results

In-vivo RBC aggregation was significantly higher in diabetic patients compared with controls for cephalic vein measurements, while a trend (p = 0.055) was noticed in the great saphenous vein. SFSAE measurements were correlated with gold standard in-vitro measures, fibrinogen and C-reactive protein plasma concentrations.

Conclusion

RBC aggregation can be measured in-vivo in diabetic patients using ultrasound. Prospective studies are needed to determine whether the SFSAE method could help clinicians in the early management of vascular complications in this patient population.

Experimental evaluation of spectral-based quantitative ultrasound imaging using plane wave compounding

Quantitative ultrasound (QUS) based on backscatter coefficient (BSC) estimation has shown potential for tissue characterization. Beamforming using plane wave compounding has advantages for echographic, Doppler, and elastographic imaging; however, to date, plane wave compounding has not been experimentally evaluated for the purpose of BSC estimation. In this study, two BSC-derived parameters (i.e., the BSC midband fit and intercept) were estimated from experimental data obtained using compound plane wave beamforming. For comparison, QUS parameters were also estimated from data obtained using both fixed focus and dynamic receive beamforming. An ultrasound imaging system equipped with a 9-MHz center frequency, 64-element array was used to collect data up to a depth of 45 mm. Two gelatin phantoms with randomly distributed 20-μm inclusions with a homogeneous scatterer concentration and a two-region scatterer concentration were used for assessing the precision and lateral resolution of QUS imaging, respectively. The use of plane wave compounding resulted in accurate QUS estimation (i.e., bias in the BSC parameters of less than 2 dB) and relatively constant lateral resolution (i.e., BSC midband fit 10% to 90% rise distance ranging between 1.0 and 1.5 mm) throughout a 45 mm field of view. Although both fixed focus and dynamic receive beamforming provided the same performance around the focal depth, the reduction in SNR away from the focus resulted in a reduced field of view in the homogeneous phantom (i.e., only 28 mm). The lateral resolution also degraded away from the focus, with up to a 2-fold and 10-fold increase in the rise distance at 20 mm beyond the focal depth for dynamic receive and fixed focus beamforming, respectively. These results suggest that plane wave compounding has the potential to improve the performance of spectral-based quantitative ultrasound over other conventional beamforming strategies.

Comparison of three scattering models for ultrasound blood characterization

Ultrasonic backscattered signals from blood contain frequency-dependent information that can be used to obtain quantitative parameters reflecting the aggregation level of red blood cells (RBCs). The approach is based on estimating structural aggregate parameters by fitting the spectrum of the backscattered radio-frequency echoes from blood to an estimated spectrum considering a theoretical scattering model. In this study, three scattering models were examined: a new implementation of the Gaussian model (GM), the structure factor size estimator (SFSE), and the new effective medium theory combined with the structure factor model (EMTSFM). The accuracy of the three scattering models in determining mean aggregate size and compactness was compared by 2-D and 3-D computer simulations in which RBC structural parameters were controlled. Two clustering conditions were studied: 1) the aggregate size varied and the aggregate compactness was fixed in both 2-D and 3-D cases, and 2) the aggregate size was fixed and the aggregate compactness varied in the 2-D case. For both clustering conditions, the EMTSFM was found to be more suitable than GM and SFSE for characterizing RBC aggregation.

Ultrasound monitoring of RBC aggregation as a real-time marker of the inflammatory response in a cardiopulmonary bypass swine model

OBJECTIVES

In many pathological conditions, including high-risk surgery, the severity of the inflammatory response is related to the patient outcome. However, determining the patient inflammatory state presents difficulties, as markers are obtained intermittently through blood testing with long delay. RBC aggregation is a surrogate marker of inflammation that can be quantified with the ultrasound Structure Factor Size and Attenuation Estimator. The latter is proposed as a real-time inflammation monitoring technique for patient care.

DESIGN

Ten swine underwent a 90-minute cardiopulmonary bypass, and surveillance was maintained during 120 minutes in the postbypass period. To promote the inflammatory reaction, lipopolysaccharide was administrated two times prior to surgery in six of those swine (lipopolysaccharide group). During the whole procedure, the Structure Factor Size and Attenuation Estimator cellular imaging method displayed a RBC aggregation index (W) computed from images acquired within the pump circuit and the femoral vein. Interleukin-6, interleukin-10, C-reactive protein, haptoglobin, immunoglobulin G, and fibrinogen concentrations were measured at specific periods.

MAIN RESULTS

Compared with controls, the lipopolysaccharide group exhibited higher W within the pump circuit (p < 0.05). In the femoral vein, W was gradually amplified in the lipopolysaccharide group during cardiopulmonary bypass and the postbypass period (p < 0.05), whereas interleukin levels were higher in the lipopolysaccharide group but only at the end of cardiopulmonary bypass and beginning of postbypass (p < 0.05).

CONCLUSIONS

Continuous RBC aggregation monitoring can characterize the evolving inflammatory response during and after cardiopulmonary bypass. The Structure Factor Size and Attenuation Estimator is proposed as a real-time noninvasive monitoring technique to anticipate inflammation-related complications during high-risk surgery or critical care situations. Because RBC aggregation promotes vascular resistance and thrombosis, W could also provide early information on vascular disorders in those clinical situations.

High spatial and temporal resolution observations of pulsatile changes in blood echogenicity in the common carotid artery of rats

Previous studies have found that ultrasound backscatter from blood in vascular flow systems varies under pulsatile flow, with the maximum values occurring during the systolic period. This phenomenon is of particular interest in hemorheology because it is contrary to the well-known fact that red blood cell (RBC) aggregation, which determines the intensity of ultrasound backscatter from blood, decreases at a high systolic shear rate. In the present study, a rat model was used to provide basic information on the characteristics of blood echogenicity in arterial blood flow to investigate the phenomenon of RBC aggregation under pulsatile flow. Blood echogenicity in the common carotid arteries of rats was measured using a high-frequency ultrasound imaging system with a 40-MHz probe. The electrocardiography-based kilohertz visualization reconstruction technique was employed to obtain high-temporal-resolution and high-spatial-resolution time-course B-mode cross-sectional and longitudinal images of the vessel. The experimental results indicate that blood echogenicity in rat carotid arteries varies during a cardiac cycle. Blood echogenicity tends to decrease during early systole and reaches its peak during late systole, followed by a slow decline thereafter. The time delay of the echogenicity peak from peak systole in the present results is the main difference from previous in vitro and in vivo observations of backscattering peaks during early systole, which may be caused by the very rapid heart rates and low RBC aggregation tendency of rats compared with humans and other mammalian species. The present study may provide useful information elucidating the characteristics of RBC aggregation in arterial blood flow.

Multiscale modeling of blood flow: from single cells to blood rheology

Mesoscale simulations of blood flow, where the red blood cells are described as deformable closed shells with a membrane characterized by bending rigidity and stretching elasticity, have made much progress in recent years to predict the flow behavior of blood cells and other components in various flows. To numerically investigate blood flow and blood-related processes in complex geometries, a highly efficient simulation technique for the plasma and solutes is essential. In this review, we focus on the behavior of single and several cells in shear and microcapillary flows, the shear-thinning behavior of blood and its relation to the blood cell structure and interactions, margination of white blood cells and platelets, and modeling hematologic diseases and disorders. Comparisons of the simulation predictions with existing experimental results are made whenever possible, and generally very satisfactory agreement is obtained.

Ultrasound contrast plane wave imaging

BACKGROUND

Monitoring the accumulation of microbubbles within tissue vasculature with ultrasound allows both molecular and perfusion imaging. Unfortunately, conventional imaging with focused pulses can destroy a large fraction of the microbubbles it is trying to follow. Using coherent synthetic summation, ultrafast plane wave imaging could attain similar image quality, while reducing the peak acoustic pressure and bubble disruption.

METHOD

In these experiments, microbubbles were flowed in a wall-less vessel phantom. Images were obtained on a programmable clinical scanner with a set of line-per-line focused pulses for conventional contrast imaging and with compounded plane wave transmission adapted for nonlinear imaging. Imaging was performed between 14 and 650 kPa peak negative pressure at 7.5 MHz. The disruption of the microbubbles was evaluated by comparing the microbubble intensity before and after acquisition of a set of 100 images at various pressures.

RESULTS

The acoustic intensity required to disrupt 50% of the microbubbles was 24 times higher with plane-wave imaging compared with conventional focused pulses. Although both imaging approaches yield similar resolution, at the same disruption level, plane-wave imaging showed better contrast. In particular, at similar disruption ratio (50% after 100 images), contrast-pulse sequencing (CPS) performed with plane waves displayed an improvement of 11 dB compared with conventional nonlinear imaging.

CONCLUSION

In each resolution cell of the image, plane-wave imaging spread the spatial peak acoustic intensity over more pulses, reducing the peak pressure and, hence, preserving the microbubbles. This method could contribute to molecular imaging by allowing the continuous monitoring of the accumulation of microbubbles with improved contrast.

Experimental assessment of four ultrasound scattering models for characterizing concentrated tissue-mimicking phantoms

Tissue-mimicking phantoms with high scatterer concentrations were examined using quantitative ultrasound techniques based on four scattering models: The Gaussian model (GM), the Faran model (FM), the structure factor model (SFM), and the particle model (PM). Experiments were conducted using 10- and 17.5-MHz focused transducers on tissue-mimicking phantoms with scatterer concentrations ranging from 1% to 25%. Theoretical backscatter coefficients (BSCs) were first compared with the experimentally measured BSCs in the forward problem framework. The measured BSC versus scatterer concentration relationship was predicted satisfactorily by the SFM and the PM. The FM and the PM overestimated the BSC magnitude at actual concentrations greater than 2.5% and 10%, respectively. The SFM was the model that better matched the BSC magnitude at all the scatterer concentrations tested. Second, the four scattering models were compared in the inverse problem framework to estimate the scatterer size and concentration from the experimentally measured BSCs. The FM did not predict the concentration accurately at actual concentrations greater than 12.5%. The SFM and PM need to be associated with another quantitative parameter to differentiate between low and high concentrations. In that case, the SFM predicted the concentration satisfactorily with relative errors below 38% at actual concentrations ranging from 10% to 25%.

Quantitative ultrasound estimates from populations of scatterers with continuous size distributions: effects of the size estimator algorithm

Quantitative ultrasonic techniques using backscatter coefficients (BSCs) may fail to produce physically meaningful estimates of effective scatterer diameter (ESD) when the analysis media contains scatterers of different sizes. In this work, three different estimator algorithms were used to produce estimates of ESD. The performance of the three estimators was compared over different frequency bands using simulations and experiments with physical phantoms. All estimators produced ESD estimates by comparing the estimated BSCs with a scattering model based on the backscattering cross section of a single spherical fluid scatterer. The first estimator consisted of minimizing the average square deviation of the logarithmically compressed ratio between the estimated BSCs and the scattering model. The second and third estimators consisted of minimizing the mean square error between the estimated BSCs and a linear transformation of the scattering model with and without considering an intercept, respectively. Simulations were conducted over several analysis bandwidths between 1 and 40 MHz from populations of scatterers with either a uniform size distribution or a distribution based on the inverse cubic of the size. Diameters of the distributions ranged between [25, 100], [25, 50], [50, 100], and [50, 75] μm. Experimental results were obtained from two gelatin phantoms containing cross-linked dextran gel spheres ranging in diameter from 28 to 130 μm and 70 to 130 μm, respectively, and 5-, 7.5-, 10-, and 13-MHz focused transducers. Significant differences in the performances of the ESD estimator algorithms as a function of the analysis frequency were observed. Specifically, the third estimator exhibited potential to produce physically meaningful ESD estimates even for large ka values when using a single-size scattering model if sufficient analysis bandwidth was available.

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

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

Predicting human blood viscosity in silico

The viscosity of blood has long been used as an indicator in the understanding and treatment of disease, and the advent of modern viscometers allows its measurement with ever-improving clinical convenience. However, these advances have not been matched by theoretical developments that can yield a quantitative understanding of blood's microrheology and its possible connection to relevant biomolecules (e.g., fibrinogen). Using coarse-grained molecular dynamics and two different red blood cell models, we accurately predict the dependence of blood viscosity on shear rate and hematocrit. We explicitly represent cell-cell interactions and identify the types and sizes of reversible rouleaux structures that yield a tremendous increase of blood viscosity at low shear rates. We also present the first quantitative estimates of the magnitude of adhesive forces between red cells. In addition, our simulations support the hypothesis, previously deduced from experiments, of yield stress as an indicator of cell aggregation. This non-Newtonian behavior is analyzed and related to the suspension's microstructure, deformation, and dynamics of single red blood cells. The most complex cell dynamics occurs in the intermediate shear rate regime, where individual cells experience severe deformation and transient folded conformations. The generality of these cell models together with single-cell measurements points to the future prediction of blood-viscosity anomalies and the corresponding microstructures associated with various diseases (e.g., malaria, AIDS, and diabetes mellitus). The models can easily be adapted to tune the properties of a much wider class of complex fluids including capsule and vesicle suspensions.

On the estimation of backscatter coefficients using single-element focused transducers

The ultimate goal of quantitative ultrasound (QUS) imaging methods based on backscatter coefficient (BSC) estimates is to obtain system-independent structural information about samples. In the current study, three BSC estimation methods were compared and evaluated using the same backscattered pressure datasets in order to assess their consistency. BSC estimates were obtained from two phantoms with embedded glass spheres and compared to theoretical BSCs calculated using size distributions estimated using optical microscopy. Effective scatterer diameter and concentration estimates of the glass spheres were also obtained from the estimated BSCs. One estimation method needed to be compensated by more than an order of magnitude in amplitude in order to produce BSCs comparable to the other two methods. All calibration methods introduced different frequency-dependent effects, which could have noticeable effects on the bias of QUS estimates derived from experimental BSCs. Although in most cases the experimental QUS estimates obtained with all three methods were observed to differ by less than 10%, larger differences are expected depending on both the pressure focusing gain of the transducer (proportional to the ratio of the square of the aperture radius to the product of the wavelength and focal length) and ka range used in the estimation.

A simulation study on photoacoustic signals from red blood cells

A two dimensional simulation study was performed to investigate the photoacoustic signal properties of non-aggregated and aggregated erythrocytes. Spatial distributions of non-aggregated blood samples were generated by employing a Monte Carlo method and aggregated blood samples were simulated using a hexagonal packing scheme. For the non-aggregating case photoacoustic signals demonstrated a monotonic rise with hematocrit. For the aggregating case it was found that spectral (<20 MHz) intensity increased (11 dB at 15.6 MHz) when the aggregate size increased. This study strongly suggests that the assessment of erythrocyte aggregation level in human blood might be possible by using a photoacoustic spectroscopic method.

Assessment of accuracy of the structure-factor-size-estimator method in determining red blood cell aggregate size from ultrasound spectral backscatter coefficient

A computer simulation study to produce ultrasonic backscatter coefficients (BSCs) from red blood cell (RBC) clusters is discussed. The simulation algorithm is suitable for generating non-overlapping, isotropic, and fairly identical RBC clusters. RBCs were stacked following the hexagonal close packing (HCP) structure to form a compact spherical aggregate. Such an aggregate was repeated and placed randomly under non-overlapping condition in the three-dimensional space to mimic an aggregated blood sample. BSCs were computed between 750 KHz and 200 MHz for samples of various cluster sizes at different hematocrits. Magnitudes of BSCs increased with mean aggregate sizes at low frequencies (<20 MHz). The accuracy of the structure-factor-size-estimator (SFSE) method in determining mean aggregate size and packing factor was also examined. A good correlation (R(2) ≥ 0.94) between the mean size of aggregates predicted by the SFSE and true size was found for each hematocrit. This study shows that for spherical aggregates there exists a region for each hematocrit where SFSE works most accurately. Typically, error of SFSE in estimating mean cluster size was <20% for dimensions between 14 and 17 μm at 40% hematocrit. This study suggests that the theoretical framework of SFSE is valid under the assumption of isotropic aggregates.

A local increase in red blood cell aggregation can trigger deep vein thrombosis: evidence based on quantitative cellular ultrasound imaging

BACKGROUND

Recurrent deep vein thrombosis (DVT) risk factors include a first idiopathic DVT, strongly suggesting the existence of undiagnosed and/or unidentified prothrombotic abnormalities.

OBJECTIVES

To evaluate the impact of locally increased red blood cell (RBC) aggregation on DVT pathogenesis in a rabbit model.

METHODS

DVT presence, flow and aggregation were measured in situ with ultrasound. Greatly enhanced aggregation was achieved by covalent linkage of Pluronic F98 to the RBC surface; coating with Pluronic F68, which very mildly enhances aggregation, was used as a coating control. On day 1, endothelial damage and a partial stenosis were surgically created on the left femoral vein whereas the right femoral vein was not manipulated.

RESULTS

A thrombus was formed within 30 min in six out of seven left femoral veins of animals receiving a 30% volume blood exchange with F98-coated RBC, whereas a thrombus occurred in only one out of seven veins in F68-transfused controls. In vivo imaging using quantitative ultrasound confirmed increased aggregation in the thrombosed veins of the F98 group compared with the F68 group and the contralateral vessel. For each group, five animals were followed for 2 weeks before being killed. In F98-transfused animals, lysis of clots occurred and the presence of chronic thrombi totally occluding the vein in three out of five animals was confirmed by histology. Conversely, in the F68 group, a single disorganized blood clot was observed in one out of five animals.

CONCLUSIONS

A marked increase in RBC aggregation promotes thrombosis in rabbit femoral veins, confirming a pathophysiological role of locally altered hemorheology in the onset of DVT.