Ultrasonic backscatter from flowing whole blood. II: Dependence on frequency and fibrinogen concentration

Effect of Clutter Filter in High-Frame-Rate Ultrasonic Backscatter Coefficient Analysis

High-frame-rate imaging with a clutter filter can clearly visualize blood flow signals and provide more efficient discrimination with tissue signals. In vitro studies using clutter-less phantom and high-frequency ultrasound suggested a possibility of evaluating the red blood cell (RBC) aggregation by analyzing the frequency dependence of the backscatter coefficient (BSC). However, in in vivo applications, clutter filtering is required to visualize echoes from the RBC. This study initially evaluated the effect of the clutter filter for ultrasonic BSC analysis for in vitro and preliminary in vivo data to characterize hemorheology. Coherently compounded plane wave imaging at a frame rate of 2 kHz was carried out in high-frame-rate imaging. Two samples of RBCs suspended by saline and autologous plasma for in vitro data were circulated in two types of flow phantoms without or with clutter signals. The singular value decomposition was applied to suppress the clutter signal in the flow phantom. The BSC was calculated using the reference phantom method, and it was parametrized by spectral slope and mid-band fit (MBF) between 4-12 MHz. The velocity distribution was estimated by the block matching method, and the shear rate was estimated by the least squares approximation of the slope near the wall. Consequently, the spectral slope of the saline sample was always around four (Rayleigh scattering), independently of the shear rate, because the RBCs did not aggregate in the solution. Conversely, the spectral slope of the plasma sample was lower than four at low shear rates but approached four by increasing the shear rate, because the aggregations were presumably dissolved by the high shear rate. Moreover, the MBF of the plasma sample decreased from -36 to -49 dB in both flow phantoms with increasing shear rates, from approximately 10 to 100 s^-1. The variation in the spectral slope and MBF in the saline sample was comparable to the results of in vivo cases in healthy human jugular veins when the tissue and blood flow signals could be separated.

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

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

Power Spectrum Consistency among Systems and Transducers

Use of the reference phantom method for computing acoustic attenuation and backscatter is widespread. However, clinical application of these methods has been limited by the need to acquire reference phantom data. We determined that the data acquired from 11 transducers of the same model and five clinical ultrasound systems of the same model produce equivalent estimates of reference phantom power spectra. We describe that the contribution to power spectral density variance among systems and transducers equals that from speckle variance with 59 uncorrelated echo signals. Thus, when the number of uncorrelated lines of data is small, speckle variance will dominate the power spectral density estimate variance introduced by different systems and transducers. These results suggest that, at least for this particular transducer and imaging system combination, one set of reference phantom calibration data is highly representative of the average among equivalent transducers and systems that are in good working order.

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.

High frequency ultrasound imaging and simulations of sea urchin oocytes

High frequency ultrasound backscatter signals from sea urchin oocytes were measured using a 40 MHz transducer and compared to numerical simulations. The Faran scattering model was used to calculate the ultrasound scattered from single oocytes in suspension. The urchin oocytes are non-nucleated with uniform size and biomechanical properties; the backscatter from each cell is similar and easy to simulate, unlike typical nucleated mammalian cells. The time domain signal measured from single oocytes in suspension showed two distinct peaks, and the power spectrum was periodic with minima spaced approximately 10 MHz apart. Good agreement to the Faran scattering model was observed. Measurements from tightly packed oocyte cell pellets showed similar periodic features in the power spectra, which was a result of the uniform size and consistent biomechanical properties of the cells. Numerical simulations that calculated the ultrasound scattered from individual oocytes within a three dimensional volume showed good agreement to the measured signals and B-scan images. A cepstral analysis of the signal was used to calculate the size of the cells, which was 78.7 μm (measured) and 81.4 μm (simulated). This work supports the single scattering approximation, where ultrasound is discretely scattered from single cells within a bulk homogeneous sample, and that multiple scattering has a negligible effect. This technique can be applied towards understanding the complex scattering behaviour from heterogeneous tissues.

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

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

Pitfalls of Doppler Measurements for Arterial Blood Flow Quantification in Small Animal Research: A Study Based on Virtual Ultrasound Imaging

High-resolution Doppler is a popular tool for evaluating cardiovascular physiology in mutant mice, though its 1-D nature and spectral broadening processes complicate interpretation of the measurement. Hence, it is crucial for pre-clinical researchers to know how error sources in Doppler assessments reveal themselves in the murine arterial system. Therefore, we performed virtual Doppler experiments in a computer model of an aneurysmatic murine aorta with full control of the imaging and insonified fluid dynamics. We observed significant variability in Doppler performance and derived vascular indices depending on the interrogated flow, operator settings and signal processing. In particular, we found that (i) Doppler spectra in the upper aortic branches and celiac artery exhibited more broadening because of complex out-of-beam flow paths; (ii) mean frequency tracking outperforms tracking of the outer envelope, but is sensitive to errors in angle correction; and (iii) imaging depths deviating much from the elevation focus suffer from decreased spectral quality.

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.

Experimental application of ultrafast imaging to spectral tissue characterization

Ultrasound ultrafast imaging (UI) allows acquisition of thousands of frames per second with a sustained image quality at any depth in the field of view. Therefore, it would be ideally suited to obtain good statistical sampling of fast-moving tissues using spectral-based techniques to derive the backscatter coefficient (BSC) and associated quantitative parameters. In UI, an image is formed by insonifying the medium with plane waves steered at different angles, beamforming them and compounding the resulting radiofrequency images. We aimed at validating, experimentally, the effect of these beamforming protocols on the BSC, under both isotropic and anisotropic conditions. Using UI techniques with a linear array transducer (5-14 MHz), we estimated the BSCs of tissue-mimicking phantoms and flowing porcine blood at depths up to 35 mm with a frame rate reaching 514 Hz. UI-based data were compared with those obtained using single-element transducers and conventional focusing imaging. Results revealed that UI compounded images can produce valid estimates of BSCs and effective scatterer size (errors less than 2.2 ± 0.8 and 0.26 ± 0.2 dB for blood and phantom experiments, respectively). This work also describes the use of pre-compounded UI images (i.e., steered images) to assess the angular dependency of circulating red blood cells. We have concluded that UI data sets can be used for BSC spectral tissue analysis and anisotropy characterization.

Measurement of the Doppler power of flowing blood using ultrasound Doppler devices

Measurement of the Doppler power of signals backscattered from flowing blood (henceforth referred to as the Doppler power of flowing blood) and the echogenicity of flowing blood have been used widely to assess the degree of red blood cell (RBC) aggregation for more than 20 y. Many studies have used Doppler flowmeters based on an analogue circuit design to obtain the Doppler shifts in the signals backscattered from flowing blood; however, some recent studies have mentioned that the analogue Doppler flowmeter exhibits a frequency-response problem whereby the backscattered energy is lost at higher Doppler shift frequencies. Therefore, the measured Doppler power of flowing blood and evaluations of RBC aggregation obtained using an analogue Doppler device may be inaccurate. To overcome this problem, the present study implemented a field-programmable gate array-based digital pulsed-wave Doppler flowmeter to measure the Doppler power of flowing blood, in the aim of providing more accurate assessments of RBC aggregation. A clinical duplex ultrasound imaging system that can acquire pulsed-wave Doppler spectrograms is now available, but its usefulness for estimating the ultrasound scattering properties of blood is still in doubt. Therefore, the echogenicity and Doppler power of flowing blood under the same flow conditions were measured using a laboratory pulser-receiver system and a clinical ultrasound system, respectively, for comparisons. The experiments were carried out using porcine blood under steady laminar flow with both RBC suspensions and whole blood. The experimental results indicated that a clinical ultrasound system used to measure the Doppler spectrograms is not suitable for quantifying Doppler power. However, the Doppler power measured using a digital Doppler flowmeter can reveal the relationship between backscattering signals and the properties of blood cells because the effects of frequency response are eliminated. The measurements of the Doppler power and echogenicity of flowing blood were compared with those obtained in several previous studies.

Effects of red blood cell aggregates dissociation on the estimation of ultrasound speckle image velocimetry

Ultrasound speckle image of blood is mainly attributed by red blood cells (RBCs) which tend to form RBC aggregates. RBC aggregates are separated into individual cells when the shear force is over a certain value. The dissociation of RBC aggregates has an influence on the performance of ultrasound speckle image velocimetry (SIV) technique in which a cross-correlation algorithm is applied to the speckle images to get the velocity field information. The present study aims to investigate the effect of the dissociation of RBC aggregates on the estimation quality of SIV technique. Ultrasound B-mode images were captured from the porcine blood circulating in a mock-up flow loop with varying flow rate. To verify the measurement performance of SIV technique, the centerline velocity measured by the SIV technique was compared with that measured by Doppler spectrograms. The dissociation of RBC aggregates was estimated by using decorrelation of speckle patterns in which the subsequent window was shifted as much as the speckle displacement to compensate decorrelation caused by in-plane loss of speckle patterns. The decorrelation of speckles is considerably increased according to shear rate. Its variations are different along the radial direction. Because the dissociation of RBC aggregates changes ultrasound speckles, the estimation quality of SIV technique is significantly correlated with the decorrelation of speckles. This degradation of measurement quality may be improved by increasing the data acquisition rate. This study would be useful for simultaneous measurement of hemodynamic and hemorheological information of blood flows using only speckle images.

In vivo observation of the hypo-echoic "black hole" phenomenon in rat arterial bloodstream: a preliminary Study

The "black hole," a hypo-echoic hole at the center of the bloodstream surrounded by a hyper-echoic zone in cross-sectional views, has been observed in ultrasound backscattering measurements of blood with red blood cell aggregation in in vitro studies. We investigated whether the phenomenon occurs in the in vivo arterial bloodstream of rats using a high-frequency ultrasound imaging system. Longitudinal and cross-sectional ultrasound images of the rat common carotid artery (CCA) and abdominal aorta were obtained using a 40-MHz ultrasound system. A high-frame-rate retrospective imaging mode was employed to precisely examine the dynamic changes in blood echogenicity in the arteries. When the imaging was performed with non-invasive scanning, blood echogenicity was very low in the CCA as compared with the surrounding tissues, exhibiting no hypo-echoic zone at the center of the vessel. Invasive imaging of the CCA by incising the skin and subcutaneous tissues at the imaging area provided clearer and brighter blood echo images, showing the "black hole" phenomenon near the center of the vessel in longitudinal view. The "black hole" was also observed in the abdominal aorta under direct imaging after laparotomy. The aortic "black hole" was clearly observed in both longitudinal and cross-sectional views. Although the "black hole" was always observed near the center of the arteries during the diastolic phase, it dissipated or was off-center along with the asymmetric arterial wall dilation at systole. In conclusion, we report the first in vivo observation of the hypo-echoic "black hole" caused by the radial variation of red blood cell aggregation in arterial bloodstream.

Predictive factors of left atrial spontaneous echo contrast in patients with rheumatic mitral valve stenosis: a retrospective study of 159 patients

Background

Mitral valve stenosis is a common manifestation of chronic rheumatic heart disease. The presence of spontaneous echo contrast in the left atrium and left atrial appendage has been reported to be an independent predictor of thrombo-embolic risk in patients with mitral stenosis. The objective of this study was to retrospectively investigate various clinical and echocardiographic variables to predict the spontaneous echo contrast in these patients.

Methodology

This is a bicentric retrospective study which includes 159 cases of symptomatic mitral stenosis from January 2011 to June 2012. All of the patients had transthoracic and transesophageal echocardiography. Patients who had significant mitral regurgitation (> Grade I), significant aortic valve disease, previous mitral valvulotomy and anticoagulation or antiplatelet therapy were excluded from the study. Our study population was divided into two groups based on the presence (Group I) or absence (Group II) of spontaneous echo contrast.

Result

Left atrial spontaneous contrast was present in 34.6% of cases. Patients in this group have more frequent atrial fibrillation (P = 0.001), larger left atrial area (P = 0.027) and diameter (P=0.023), smaller mitral valve area (P = 0.025), and higher mean transmitral diastolic gradient (p = 0.003) as compared to patients without spontaneous echo contrast. There were no significant differences in the mean age (p = 0.38), duration of symptoms (p = 0.4) and left ventricular ejection fraction (p = 0.7) between patients with and without spontaneous echo contrast. On multivariate analysis, only mitral valve area and transmitral diastolic gradient (OR: 18.753, 1.21, CI [1,838-191,332], [1,064-1,376], p: 0.013, 0.004, respectively) were found to be independently associated to the presence of spontaneous echo contrast.

Conclusion

Patients with severe rheumatic mitral stenosis in atrial fibrillation or sinus rhythm have a higher risk of developing spontaneous echo contrast. These patients might benefit from prophylactic anticoagulation. The long-term outcomes can be ascertained in a study over a longer period and with periodic follow-up.

The effect of flow acceleration on the cyclic variation of blood echogenicity under pulsatile flow

It has been shown that the echogenicity of blood varies during a flow cycle under pulsatile flow both in vitro and in vivo. In general, the echogenicity of flowing whole blood increases during the early systole phase and then reduces to a minimum at late diastole. While it has been postulated that this cyclic variation is associated with the dynamics of erythrocyte aggregation, the mechanisms underlying this increasing echogenicity with flow velocity remain uncertain. The effect of flow acceleration has also been proposed as an explanation for this phenomenon, but no specific experiments have been conducted to test this hypothesis. In addition, the influence of ultrasonic attenuation on the cyclic variation of echogenicity requires clarification. In the present study, a Couette flow system was designed to simulate blood flowing with different acceleration patterns, and the flow velocity, attenuation, and backscattering coefficient were measured synchronously from 20%- and 40%-hematocrit porcine whole blood and erythrocyte suspensions using 35-MHz ultrasound transducers. The results showed ultrasonic attenuation exerted only minor effects on the echogenicity of blood under pulsatile flow conditions. Cyclic variations of echogenicity were clearly observed for whole blood with a hematocrit of 40%, but no variations were apparent for erythrocyte suspensions. The echogenicity did not appear to be enhanced when instantaneous acceleration was applied to flowing blood in any case. These findings show that flow acceleration does not promote erythrocyte aggregation, even when a higher peak velocity is applied to the blood. Comparison of the results obtained with different accelerations revealed that the cyclic variation in echogenicity observed during pulsatile blood flow may be jointly attributable to the effect of shear rate and the distribution of erythrocyte on aggregation.

Improving image quality of diagnostic ultrasound by using the safe use time model with the dynamic safety factor and the effect of the exposure time on the image quality

Resolution and penetration are primary criteria for image quality of diagnostic ultrasound. In theory (and usually in practice), the maximum depth of imaging in a tissue increases as power (pressure) is increased. Alternatively, at a particular effective penetration, an increased power may be used to allow a higher ultrasound frequency for higher resolution and tissue contrast. Recently, Karagoz and Kartal proposed a safety parameter for thermal bioeffects of diagnostic ultrasound; that is, SUT (safe use time). The SUT model is constructed to determine how long one piece of tissue can be insonated safely according to a threshold exposure. Also, Karagoz and Kartal suggested that an increase in acoustic intensity beyond the current US Food and Drug Administration (FDA) limit of intensity can be theoretically possible by using SUT model while staying within the safe limit. The present study was motivated particularly by the goals of higher resolution and/or deeper penetration by using SUT model. The results presented here suggest that the safe use of higher exposure levels than currently allowed by the FDA may be possible for obtaining substantial improvements in penetration depth and/or resolution. Also, the study reveals that image quality can be functionally related to exposure time in addition to acoustic energy and frequency.

The acute effects of smoking on the cyclic variations in blood echogenicity of carotid artery

The objective of this research is to study the cyclic variations in echogenicity (CVE) as an acute response to smoking. CVEs, caused by the aggregation of red blood cells (RBC) were measured from the cross-sectional images of the common carotid artery using coded harmonic imaging of a commercial ultrasound system. The amplitude of the CVE (A(cve)) was analyzed among 28 smokers before and after smoking. A(cve) was increased in 22 smokers and decreased in six smokers after 1-2 cigarettes were smoked. Heart rate (HR) was also estimated from the ultrasonic images before and after smoking. The smokers were optimally divided into two clusters with respect to the change in A(cve) and the intrinsic characteristics of smokers (i.e., daily consumed cigarettes and smoking years) through a two-step cluster analysis (TSCA). The increase in A(cve) after smoking was significantly higher in the heavy smoker cluster compared with the light smoker cluster. The results suggest that the acute changes in A(cve) in response to smoking are different between heavy smokers and light smokers. This preliminary study demonstrates the potential application of coded harmonic ultrasound imaging to detect or characterize RBC aggregation. In addition, the results may be useful for understanding the acute physiologic changes caused by smoking.

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.

Ultrasonic attenuation and backscatter from flowing whole blood are dependent on shear rate and hematocrit between 10 and 50 MHz

Ultrasonic backscatter has recently been used extensively to investigate erythrocyte aggregation, which is an inherent hematological phenomenon in the blood circulation system. The size of rouleaux can be estimated by measuring certain parameters of signals backscattered from flowing blood. However, most measurements of backscatter from blood use a constant value for the attenuation coefficient to compensate for the loss of ultrasound energy. This correction may be inaccurate because the attenuation varies with the blood properties, which prompted us to explore the effects of hemodynamic properties on ultrasonic attenuation and backscatter to better understand the blood rheological behaviors. Experiments were performed on porcine whole blood in a Couette flow apparatus. Ultrasonic attenuation and the backscattering coefficient of blood were measured at various frequencies (from 10 to 50 MHz), hematocrits (from 0 to 60%), and shear rates (from 0.1 to 200 s⁻¹). The results indicated that the attenuation and backscattering coefficients of blood are highly variable, depending in a complex manner on shear rate, hematocrit, and the measurement ultrasound frequency. The attenuation of blood decreased rapidly with increasing shear rates, eventually reaching a steady state asymptotically, and increased linearly with the hematocrit from 10 to 50 MHz at various shear rates, and also with the ultrasound frequency. The effect of erythrocyte aggregation means that the change in ultrasonic attenuation in blood with shear rate may be attributed to the absorption mechanism, which is enhanced by the increased blood viscosity at lower shear rates. Compensating the measured backscattering coefficients of blood for the shear-rate-dependent attenuation coefficient increased the accuracy of erythrocyte aggregation assessments. Together, the experimental results suggest that the shear-rate-dependent attenuation coefficient should be considered in future developments of ultrasonic technologies for characterizing blood rheology when the ultrasound frequency is higher than 20 MHz.

Measurement of the ultrasound attenuation and dispersion in whole human blood and its components from 0-70 MHz

The ultrasound attenuation coefficient and dispersion from 0-70 MHz in whole human blood and its components (red blood cells and plasma) at 37°C is reported. The measurements are made using a fixed path substitution technique that exploits optical mechanisms for the generation and detection of ultrasound. This allows the measurements to cover a broad frequency range with a single source and receiver. The measured attenuation coefficient and dispersion in solutions of red blood cells and physiological saline for total haemoglobin concentrations of 10, 15 and 20 g/dL are presented. The attenuation coefficient and dispersion in whole human blood taken from four healthy volunteers by venipuncture is also reported. The power law dependence of the attenuation coefficient is shown to vary across the measured frequency range. This is due to the varying frequency dependence of the different mechanisms responsible for the attenuation. The attenuation coefficient measured at high frequencies is found to be significantly higher than that predicted by historical power law parameters. A review of the attenuation mechanisms in blood along with previously reported experimental measurements is given. Values for the sound speed and density in the tested samples are also presented.

High-frequency attenuation and backscatter measurements of rat blood between 30 and 60 MHz

There has recently been a great deal of interest in noninvasive high-frequency ultrasound imaging of small animals such as rats due to their being the preferred animal model for gene therapy and cancer research. Improving the interpretation of the obtained images and furthering the development of the imaging devices require a detailed knowledge of the ultrasound attenuation and backscattering of biological tissue (e.g. blood) at high frequencies. In the present study, the attenuation and backscattering coefficients of the rat red blood cell (RBC) suspensions and whole blood with hematocrits ranging from 6% to 40% were measured between 30 and 60 MHz using a modified substitution approach. The acoustic parameters of porcine blood under the same conditions were also measured in order to compare differences in the blood properties between these two animals. For porcine blood, both whole blood and RBC suspension were stirred at a rotation speed of 200 rpm. Three different rotation speeds of 100, 200 and 300 rpm were carried out for rat blood experiments. The attenuation coefficients of both rat and porcine blood were found to increase linearly with frequency and hematocrit (the values of coefficients of determination (r(2)) are around 0.82-0.97 for all cases). The average attenuation coefficient of rat whole blood with a hematocrit of 40% increased from 0.26 Nepers mm(-1) at 30 MHz to 0.47 Nepers mm(-1) at 60 MHz. The maximum backscattering coefficients of both rat and porcine RBC suspensions were between 10% and 15% hematocrits at all frequencies. The fourth-power dependence of backscatter on frequency was approximately valid for rat RBC suspensions with hematocrits between 6% and 40%. However, the frequency dependence of the backscatter estimate deviates from a fourth-power law for porcine RBC suspension with hematocrit higher than 20%. The backscattering coefficient plateaued for hematocrits higher than 15% in porcine blood, but for rat blood it was maximal around a hematocrit of 20% at the same rotation speed, and shifted to a hematocrit of 10% at a higher speed. The backscattering properties of rat RBCs in plasma are similar to those of RBCs in saline at a higher rotation speed. The differences in attenuation and backscattering between rat and porcine blood may be attributed to RBCs' being smaller and the RBC aggregation level being lower for rat blood than for porcine blood.

Evaluation of the sensitivity of an in vitro high frequency ultrasound device to monitor the coagulation process: study of the effects of heparin treatment in a murine model

This study evaluates the sensitivity of a new in vitro high frequency ultrasound test of the whole blood coagulation process. A rat model of anticoagulant treatment is reported. Many recent studies of the role of red blood cells in the whole blood coagulation process have revealed an increasing demand for global tests of the coagulation process performed on whole blood instead of plasma samples. In contrast to existing optical tests, high frequency ultrasound presents the advantages of characterizing the mechanical properties of whole blood clotting. Ultrasound longitudinal wave velocity and integrated attenuation coefficient (IAC) were simultaneously assessed in a 10 to 30 MHz frequency range during the whole blood coagulation process in vitro in rats under anticoagulant therapy. Differences between humans and rats were also clearly emphasized in non-clotting blood and in clotting blood using specific criteria deduced from acoustic parameters (ultrasound velocity for non-clotting blood:=1574+/-2m/s for rats and 1583+/-3m/s for humans and IAC=2.25+/-0.14 dB/cm for rats and 1.5+/-0.23 dB/cm for humans). We also measured the coagulation time t(0) from the acoustic velocity (t(0) =11.15+/-7 min for control rat blood and 43.3+/-11.4 min for human blood). Different doses of heparin were administered to rats. The sensitivity of the ultrasound device to the effects of heparin was evaluated. Differences between non-treated rats and chronically and acutely treated rats were recorded and quantified. We particularly noted that the slope S and the amplitude I of the variations in acoustic velocity were linked to clot retraction, which is a good indicator of the platelet function. The amplitude of the variations in S was between (20+/-8) x1 0(-3) m/s(2) for control group rats, and (0.92+/-0.35) x 10(-3) m/s(2) for chronic heparin-treated group rats. The values of I were 15 times higher for control group rats than for chronic heparin-treated group rats.

Cyclic variations of high-frequency ultrasonic backscattering from blood under pulsatile flow

It was shown previously that ultrasonic scattering from whole blood varies during the flow cycle under pulsatile flow both in vitro and in vivo. It has been postulated that the cyclic variations of the backscattering signal are associated with red blood cell (RBC) aggregation in flowing whole blood. To obtain a better understanding of the relationship between blood backscattering and RBC aggregation behavior for pulsatile flowing blood, the present study used high-frequency ultrasound to characterize blood properties. The backscattering signals from both whole blood and an RBC suspension at different peak flow velocities (from 10 to 30 cm/s) and hematocrits (20% and 40%) under pulsatile flow (stroke rate of 20 beats/min) were measured with 3 single-element transducers at frequencies of 10, 35, and 50 MHz in a mock flow loop. To avoid the frequency response problem of a Doppler flowmeter, the integrated backscatter (IB) and flow velocity as functions of time were calculated directly using RF signals from flowing blood. The experimental results showed that cyclic variations of the IB curve were clearly observed at a low flow velocity and a hematocrit of 40% when using 50 MHz ultrasound, and that these variations became weaker as the peak flow velocity increased. However, these cyclic variations were detected only at 10 cm/s when using 10 MHz ultrasound. These results demonstrate that a high flow velocity can stop the formation of rouleaux and that a high hematocrit can promote RBC aggregation to produce cyclic variations of the backscattering signal under pulsatile flow. In addition, slight cyclic variations of the IB curve for an RBC suspension were observed at 35 and 50 MHz. Furthermore, the peak of the IB curve from whole blood led the peak of the velocity waveform when using high-frequency ultrasound, which could be explained by the assumption that a rapid flow can promote RBC aggregation under pulsatile flow. Together, the experimental results showed that the sensitivity and resolution of detecting blood properties are higher for 50 MHz ultrasound than for 10 MHz ultrasound.

Three-dimensional reconstruction of the "bright ring" echogenicity from porcine blood upstream in a stenosed tube

To investigate the echogenicity variation due to blood flow disturbance near a stenosis under pulsatile flow, a series of in vitro experiments were performed in a rigid tube with an eccentric stenosis of 70% area reduction in a mock flow loop. An ultrasonic B-mode with a Doppler spectrogram was used to correlate echogenicity with flow speed and stroke rate. This paper reports echogenicity variation upstream of a stenosis under pulsatile flow. The experimental results showed that blood flow disturbed by the stenosis affects echogenicity and red blood cell rouleaux upstream. A hypoechoic "black hole" was shown at the center of the stream at systole. During diastole, the "bright ring" in cross-sectional images was observed as eddy-like or parabolic profiles in longitudinal images. These images could be reconstructed into a 3-dimensional animation, providing a better understanding of dynamic changes of the rouleaux distribution upstream of a stenosis under pulsatile flow.

Interest of the attenuation coefficient in multiparametric high frequency ultrasound investigation of whole blood coagulation process

Previous studies [R. Libgot, F. Ossant, Y. Gruel, P. Lermusiaux, and F. Patat, Proc.-IEEE Utrason. Symp. 4, 2259-2262 (2005); R. Libgot-Calle, F. Ossant, Y. Gruel, P. Lermusiaux, and F. Patat, Ultrasound Med. Biol. 34, 252-264 (2008); F. Ossant, R. Libgot, P. Coupe, P. Lermusiaux, and F. Patat, Proc.-IEEE Ultrason. Symp. 2, 846-849 (2004)] showed the potential of an in vitro high frequency ultrasound (beyond 20 MHz) device to describe the blood clotting process. The parameters were simultaneously estimated in double transmission (DT) with the calculation of the velocity of longitudinal waves and in backscattering (BS) modes with the estimation of the integrated BS coefficient and the effective scatterer size. The aim of the present study was to show how the integrated attenuation coefficient (IAC) assessed in DT mode could provide additional information on this process, especially regarding the fibrin polymerization which is an important part of the coagulation process. A characteristic time t(a) of the variations in IAC that could be linked to fibrin formation was identified.

Monte Carlo study on ultrasound backscattering by three-dimensional distributions of red blood cells

A Monte Carlo study on ultrasound backscattering by red blood cells (RBCs) is presented for three-dimensional (3D) distributions of particles. The cells were treated as classical spherical particles and accordingly, the Boltzmann distribution was considered to describe probability distribution of energy states of a system composed of such particles. The well-known Metropolis algorithm can generate configurations according to that probability distribution and therefore, was employed in this study to simulate some realizations of both nonaggregating and aggregating RBCs. The study of nonaggregating particles was motivated to compare simulations with existing experimental results and consequently, to validate the model. In the case of aggregating RBCs, the interaction potential between cells was modeled with the Morse potential and the frequency-dependent backscattering coefficient (BSC) was investigated at different hematocrits (H, particle volume fractions). The impact of aggregation potential on the spectral slope (SS) was also evaluated. It is shown that BSC increased as the magnitude of aggregating potential was raised and the effect was more pronounced at higher hematocrits. Moreover, spectral slopes at nonaggregating and low aggregating conditions were found to be around 4, which is consistent with the Rayleigh scattering theory. However, it had diminished significantly, particularly at higher hematocrits as the magnitude of the attractive potential energy was raised. For instance, at H=40% SS dropped from 4.04 for nonaggregating particles to 3.62 at the highest aggregating potential considered in this study. Our results suggest that this 3D model is capable of reflecting the effects of RBC aggregation on BSC and SS.

Development and characterization of a blood mimicking fluid for high intensity focused ultrasound

A blood mimicking fluid (BMF) has been developed for the acoustic and thermal characterizations of high intensity focused ultrasound (HIFU) ablation devices. The BMF is based on a degassed and de-ionized water solution dispersed with low density polyethylene microspheres, nylon particles, gellan gum, and glycerol. A broad range of physical parameters, including attenuation coefficient, speed of sound, viscosity, thermal conductivity, and diffusivity, were characterized as a function of temperature (20-70 degrees C). The nonlinear parameter B/A and backscatter coefficient were also measured at room temperature. Importantly, the attenuation coefficient is linearly proportional to the frequency (2-8 MHz) with a slope of about 0.2 dB cm(-1) MHz(-1) in the 20-70 degrees C range as in the case of human blood. Furthermore, sound speed and bloodlike backscattering indicate the usefulness of the BMF for ultrasound flow imaging and ultrasound-guided HIFU applications. Most of the other temperature-dependent physical parameters are also close to the reported values in human blood. These properties make it a unique HIFU research tool for developing standardized exposimetry techniques, validating numerical models, and determining the safety and efficacy of HIFU ablation devices.

High levels of high sensitivity C-reactive protein predict the progression of chronic rheumatic mitral stenosis

BACKGROUND

High sensitive C-Reactive Protein (hs-CRP) predicts morbidity and mortality in various clinical conditions. The effect of hsCRP on progression of chronic rheumatic mitral stenosis (CRMS) has not been demonstrated.

METHODS AND RESULTS

A total of 132 patients with CRMS (95 female, 37 male) and 145 control (100 female, 45 male) were included in the study. Baseline clinical, echocardiographic, hematologic and hs-CRP measurements were collected prospectively. Mean mitral valve area (MVA) was 1.4 +/- 0.3 cm(2), mean wilkins valve score value was 8.9 +/- 1.7, left atrial diameter was 5.0 +/- 0.7 cm, left atrial area was 37.2 +/- 12.6 cm(2), and systolic pulmonary arterial pressure (SPAP) was 44 +/- 11 mmHg in patients with CRMS. The mean levels of hs-CRP value, fibrinogen, and mean platelet volume (MPV) were significantly higher in CRMS group compared to control group. The levels of hsCRP were found to be positively correlated with mean Wilkins valve score value, SPAP, presence of atrial fibrillation (AF), left atrial diameter, left atrial area, presence of LASEC(+), fibrinogen, and MPV and inversely correlated with MVA in patients with CRMS. Linear regression analysis revealed that the hsCRP level independently affects mean Wilkins valve score value, left atrial area (LAA), LASEC(+) and AF in the patients with CRMS.

CONCLUSIONS

These results suggest that increased hsCRP levels are associated with CRMS severity. These association may be important when treating patients with CRMS.

Simulation and validation of arterial ultrasound imaging and blood flow

We reviewed the simulation and validation of arterial ultrasound imaging and blood flow assessment. The physical process of ultrasound imaging and measurement is complex, especially in disease. Simulation of physiological flow in a phantom with tissue equivalence of soft tissue, vessel wall and blood is now achievable. Outstanding issues are concerned with production of anatomical models, simulation of arterial disease, refinement of blood mimics to account for non-Newtonian behavior and validation of velocity measurements against an independent technique such as particle image velocimetry. String and belt phantoms offer simplicity of design, especially for evaluation of velocity estimators, and have a role as portable test objects. Electronic injection and vibrating test objects produce nonphysiologic Doppler signals, and their role is limited. Computational models of the ultrasound imaging and measurement process offer considerable flexibility in their ability to alter multiple parameters of both the propagation medium and ultrasound instrument. For these models, outstanding issues are concerned with the inclusion of different tissue types, multilayer arteries, inhomogeneous tissues and diseased tissues.

High frequency ultrasound device to investigate the acoustic properties of whole blood during coagulation

This study was designed to investigate the changes in acoustic properties of whole blood during the coagulation process. High frequency (from 20 to 40 MHz) ultrasound parameters were measured both in double transmission (DT) and backscattering (BS) mode to assess sound velocity and backscatter coefficient, respectively. The integrated backscatter coefficient (IBC) and the effective scatterer size (ESS) were deducted from the backscatter coefficient. Measurements were performed on whole blood samples collected from 12 healthy volunteers. During the blood clotting process (2 h observation), acoustic parameters were measured with 15 s time resolution for the transmission parameter and 5 s (for the 5 first min) and 30 s (for the end of the observation time) for the backscattering parameters. The results obtained clearly showed that simultaneous measurements of parameters in DT and BS modes are able to identify several stages during the in vitro blood clotting process. In particular, red blood cell (RBC) aggregation can be described from the backscattering parameters and liquid-gel transition phase of blood from the sound velocity. Intra- and inter-individual dispersion of these parameters were also measured and discussed.

Assessment of blood coagulation under various flow conditions with ultrasound backscattering

Several in vitro studies have employed ultrasonic techniques to detect varying properties of coagulating blood under static or stirred conditions. Most of those studies mainly addressed on the development and feasibility of modalities and however were not fully considering the effect of blood flow. To better elucidate this issue, ultrasonic backscattering were measured from the coagulating porcine blood circulated in a mock flow loop with various steady laminar flows at mean shear rates from 10 to 100 s(-1). A 3 ml of 0.5 M CaCl2 solution for inducing blood coagulation was added to that of 30 ml blood circulated in the conduit. For each measurement carried out with a 10-MHz transducer, backscattered signals digitized at 100-MHz sampling frequency were acquired for a total of 20 min at temporal resolution of 50 A-lines per s. The integrated backscatter (IB) was calculated for assessing backscattering properties of coagulating blood. The results show that blood coagulation tended to be increased corresponding to the addition of CaCl2 solution: the IB was increased approximately 6.1 +/- 0.6 (mean +/- standard deviation), 5.4 +/- 0.9, and 4.5 +/- 1.2 dB at 310 +/- 62, 420 +/- 88, and 610 +/- 102 s associated with mean shear rates of 10, 40, and 100 s(-1), respectively. The rate of increasing IB for evaluating the growth of clot was estimated to be 0.075 +/- 0.017, 0.052 +/- 0.027, and 0.038 +/- 0.012 delta dB delta s(-1) corresponding to the increase of mean shear rates. These results consistently demonstrate that higher shear rate tends to prolong the duration for the flowing blood to be coagulated and to decrease the rate of IB. Moreover, the laminar flow was changed to turbulent flow during that the blood was clotting discerned by spatial variations of ultrasound backscattering in the conduit. All these results validate that ultrasound backscattering is feasible to be utilized for detecting and assessing blood coagulation under dynamic conditions.

Statistical variations of ultrasound signals backscattered from flowing blood

The statistical distributions of ultrasonic signals backscattered from blood have recently been used to characterize hemodynamic properties, such as red blood cell (RBC) aggregation and blood coagulation. However, a thorough understanding of the relationship between blood properties and the statistical behavior of signals backscattered from flowing blood is still lacking. This prompted us to use the statistical parameter to characterize signals backscattered from both whole blood and RBC suspensions at different flow velocities (from 10 to 60 cm/s) and hematocrits (from 20% to 50%) under a steady laminar flow condition. The Nakagami parameter, scaling parameter, backscatter amplitude profile and flow velocity profile across a flow tube were acquired using a 10 MHz focused ultrasonic transducer. The backscattered signal peaked approximately at the centerline of the flow tube due to the effects of RBC aggregation, with the peak value increasing as the flow velocity of whole blood decreased. The Nakagami parameter increased from 0.45 to 0.78 as the flow velocity increased from 10 to 60 cm/s. The probability density function (PDF) of signals backscattered from flowing whole blood conformed with a pre-Rayleigh distribution. The Nakagami parameter was close to 1 for signals backscattered from RBC suspensions at all the flow velocities and hematocrits tested, for which the PDF was Rayleigh distributed. These differences in the statistical distributions of backscattered signals between whole blood and RBC suspensions suggest that variations in the size of dynamic scatterers in the flow affect the shape of the backscattered signal envelope, which should be considered in future statistical models used to characterize blood properties.

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

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

Experimental ultrasound characterization of red blood cell aggregation using the structure factor size estimator

The frequency dependence of the ultrasonic backscattering coefficient (BSC) was studied to assess the level of red blood cell (RBC) aggregation. Three monoelement focused wideband transducers were used to insonify porcine blood sheared in a Couette flow from 9 to 30 MHz. A high shear rate was first applied to promote disaggregation. Different residual shear rates were then used to promote formation of RBC aggregates. The structure factor size estimator (SFSE), a second-order data reduction model based on the structure factor, was applied to the frequency-dependent BSC. Two parameters were extracted from the model to describe the level of aggregation at 6% and 40% hematocrits: W, the packing factor, and D the aggregate diameter, expressed in number of RBCs. Both parameters closely matched theoretical values for nonaggregated RBCs. W and D increased during aggregation with stabilized values modulated by the applied residual shear rate. Furthermore, parameter D during the kinetics of aggregation at 6% hematocrit under static conditions correlated with an optical RBC aggregate size estimation from microscopic images (r(2)=0.76). To conclude, the SFSE presents an interesting framework for tissue characterization of partially correlated dense tissues such as aggregated RBCs.

Relation between Sympathetic Overactivity and Left Atrial Spontaneous Echo Contrast in Patients with Mitral Stenosis and Sinus Rhythm

BACKGROUND

Spontaneous echo contrast (SEC) is common in patients with mitral stenosis (MS) and presence of SEC in left atrium (LA) is associated with a higher risk of thromboembolism. Recently, an increase in activation of platelets was demonstrated in patients with SEC raising the hypothesis that platelets are involved in the pathogenesis of SEC. In this study, we evaluated effects of autonomic nervous system activity on SEC formation in patients with rheumatic MS and sinus rhythm by heart rate variability analysis.

METHODS AND RESULTS

Twenty-six patients with LASEC were compared with 28 patients without LASEC. Mean heart rate, low frequency (LF) and low frequency/high frequency (LF/HF) ratio were significantly higher, standard deviation of all NN (SDNN), root mean square of successive differences (RMSSD), number of NN intervals that differed by more than 50 ms from adjacent interval divided by the total number of all NN intervals (PNN50) and high frequency (HF) values were lower in the patients with LASEC. A standard deviation of all NN intervals <90ms separated the patients with LASEC from control subjects with a sensitivity of 77% and specificity of 90%; a low frequency >79.5 with a sensitivity of 92% and specificity of 90; a low frequency/high frequency ratio >3.7 with a sensitivity of 96% and specificity of 90%. A left atrial diameter >4.3 cm increased the LASEC formation by 3.0 folds, HR >78 beats/min by 6.4 folds, standard deviation of all NN intervals <90 ms by 9.2 folds, a low frequency/high frequency ratio >3.7 by 6.4 folds, sP-selectin>142 by 5.8 folds. Variables affecting sP-selectin levels were LA diameter, mitral valve area, transmitral mean gradient, left ventricular ejection fraction, the presence of mitral regurgitation, HR, standard deviation of all NN intervals, low frequency, high frequency and low frequency/high frequency ratio.

CONCLUSION

Sympathetic overactivity and reduced heart rate variability are important determinants for LASEC formation and increased s-P selectin levels. Therefore, platelet activation via increased sympathetic activity may play an important role in pathogenesis of LASEC.

Rheology and ultrasound scattering from aggregated red cell suspensions in shear flow

The shear flow dynamics of reversible red cell aggregates in dense suspensions were investigated by ultrasound scattering, to study the shear disruption processes of Rayleigh clusters and examine the effective mean field approximation used in microrheological models. In a first section, a rheo-acoustical model, in the Rayleigh scattering regime, is proposed to describe the shear stress dependence of the low frequency scattered power in relation to structural parameters. The fractal scattering regime characterizing the anisotropic scattering from flocs of size larger than the ultrasound wavelength is further discussed. In the second section, we report flow-dependent changes in the low-frequency scattering coefficient in a plane-plane flow geometry to analyze the shear disruption processes of hardened or deformable red cell aggregates in neutral dextran polymer solution. Rheo-acoustical experiments are examined on the basis of the rheo-acoustical model and the effective medium approximation. The ability of ultrasound scattering technique to determine the critical disaggregation shear stress and to give quantitative information on particle surface adhesive energy is analyzed. Lastly, the shear-thinning behavior of weakly aggregated hardened or deformable red cells is described.

Developmental changes in integrated ultrasound backscatter from embryonic blood in vivo in mice at high US frequency

Mouse blood imaged using high-frequency ultrasound (US) is more echogenic in embryos than in adults. Studying changes in blood echogenicity in embryos may be of fundamental interest in studies on the genetic regulation of normal and abnormal blood development in mutant mice. Embryonic red blood cells (RBCs) are large and nucleated in midgestation but decrease in size and become enucleated as they mature. We therefore hypothesised that these structural alterations are responsible for variations in echogenicity of embryonic blood with gestational age and development. The objective of the current study was to quantify these structural changes in echogenicity (echo brightness) and apparent integrated backscatter (AIB) from embryonic blood at high US frequencies in vivo in mice. Results from anaesthetised pregnant mice studied using transcutaneous US showed that echogenicity of embryonic blood in the heart, aorta and umbilical cord and AIB within the heart chambers peaked at embryonic day (ED) 13.5 and then decreased progressively toward term. Between EDs 13.5 and 17.5 (near term), RBC mean cell volume decreased from 133 to 109 fL, haematocrit increased from 12 to 34%, and the percentage of nucleated RBCs decreased from 59 to 2%. Relative to younger ages, RBC nuclei at ED 13.5 were small and dense (pyknotic) which may have contributed to the peak in echogenicity and AIB at this age. To calculate the AIB, radiofrequency (RF) signals with centre frequencies of 28 MHz and 35 MHz were integrated over the 16- to 35-MHz and 21- to 42-MHz frequency range, respectively. At 28 MHz, mean apparent integrated backscatter of blood in the embryonic heart increased significantly from 0.0023 +/- 0.0004 Sr.cm(-1) (mean +/- SEM) at ED 12.5 to peak at 0.0037 +/- 0.0005 Sr.cm(-1) at ED 13.5. The mean AIB then decreased progressively with advancing gestation to 0.0002 +/- 0.0001 Sr.cm(-1) at ED 17.5. At 35 MHz, the mean AIB changed similarly with gestational age, except that values were lower than at 28 MHz at all ages. Higher attenuation of US at 35 MHz than at 28 MHz in tissue likely accounted for the lower AIB of blood insonified at 35 MHz. We speculate that developmental changes in red cell morphology are responsible for the observed changes in echogenicity and AIB of embryonic blood with gestational age in mice.

Echogenicity variations from porcine blood I: the "bright collapsing ring" under pulsatile flow

The temporal and radial variations of the echogenicity from porcine blood were investigated using a linear M12L transducer with a GE LOGIQ 700 Expert system. The "bright collapsing ring" (BRCR) phenomenon, a bright echogenic ring converging from the periphery to the center of the tube wall and eventually collapsing during a pulsatile cycle in cross-sectional B-mode images, was observed from porcine blood in a mock flow loop within a 0.95-cm diameter tube under certain flow conditions. The BRCR phenomenon from porcine blood was stronger as the peak speed was increased from 10 to 25 cm/s, and the mean echogenicity and the "black hole" (BLH) phenomenon, a central echo-poor zone surrounded by a bright hyperechoic zone, became weaker. As stroke rate was increased from 20 to 60 beats/min (bpm), both the BRCR and the BLH phenomena became weaker. These two phenomena were observed at three transmitting frequencies (9, 11 and 13 MHz). As hematocrit was increased from 12 to 45%, the BRCR phenomenon became more apparent. The nonlinear behavior of backscatter as a function of hematocrit reaching a maximum at hematocrit of 10 approximately 20% was observed near the tube wall, but it changed at the center of the tube, indicating the importance of hemodynamics on the ultrasonic backscatter from flowing blood. The combined effects of shear rate and acceleration on red blood cell aggregation are suggested as a possible mechanism for these phenomena.

Comparison of new ultrasound index with laser reference and viscosity indexes for erythrocyte aggregation quantification

We have previously established new ultrasonic indexes for erythrocyte aggregation using a Couette device, and validated them toward the Rayleigh's theory and reproducibility. Two hydrodynamic protocols were applied on various suspensions and their aggregation degrees were characterized by: 1. for the decreasing shear rates protocol: the power P(US) at the nominal frequency of the transducer used; 2. for the kinetic protocol: aggregation times (latency and half-rise times), variation between initial disaggregated state (Vo) and final aggregated state (V(inf)) and AI(US), which is the integral of the kinetic curve over time. The objective of the present study was to demonstrate the ability of these indexes to characterize the aggregation dynamics of suspensions with various levels of aggregation induced by concentrations of dextran 70 kD (Dx) of 10, 20 and 40 g/L added to washed red cells resuspended in saline solution. The results showed a maximum of backscattered power (P(US)) for Dx = 40 g/L with the decreasing shear rates protocol. We measured a final aggregation level (V(inf)), a minimal aggregation time (T(m)) and a maximal value of AI(US) for Dx = 40 g/L with the aggregation kinetics protocol. On the other hand, viscosity is increased with dextran concentration. These evolutions of the ultrasound (US) indexes and viscosity with dextran concentrations are consistent with literature reports. In addition, a particularly interesting phenomenon of US backscattering enhancement was observed for kinetics with no null final shear rate, which has never before been reported in such a precise manner. By another way, each of the dextran suspensions was tested on the laser erythroaggregometer that is presently considered as the "gold standard" method for erythrocyte characterization. The laser indexes (aggregation time T(a), aggregation indexes AI(10s) and AI(60s)), deduced from a kinetic protocol, have similar significance to the US ones. Statistical comparisons have been done between laser and ultrasonic indexes and significant correlations (0.001 < p < 0.01) were obtained. The set of results allowed us to conclude that ultrasonic indexes are suitable markers for the erythrocyte aggregation.

Cyclic and radial variation of the Doppler power from porcine whole blood

The Doppler power from porcine blood was observed in a mock flow loop to have cyclic and radial variation during a pulsatile cycle. It was found to decrease with shear rate under steady flow, except near the center of the tube at which other mechanisms such as the effects of radial distribution on the rouleaux might be involved. Under pulsatile flow, the timing of the peak of the Doppler power measured at the center of the tube became closer to the peak systole from 20 to 60 beats/minute (BPM), and the power and velocity peaks coincided at 60 BPM. The overall radial variation of the Doppler power during a whole pulsatile cycle was prominent due to the increase of shear rate from the center to 4.5 mm radial position within a tube of 6.35 mm radius. The cyclic variation of the Doppler power varied with the radial position, being relatively large at the center, reaching a minimum at an intermediate radial position, and increasing again near the wall. The peak of the Doppler power occurred at early systole near the tube wall and lagged the flow closer to the center. The "black hole" phenomenon was observed only over portions of the flow cycle. All these complex variations of the Doppler power across the tube over a cycle are thought to be the result of red cell aggregation, which can be affected by shear rate and acceleration.

Modeling the frequency dependence (5-120 MHz) of ultrasound backscattering by red cell aggregates in shear flow at a normal hematocrit

The frequency dependence of the ultrasound signal backscattered by blood in shear flow was studied using a simulation model. The ultrasound backscattered signal was computed with a linear model that considers the characteristics of the ultrasound system and tissue acoustic properties. The tissue scattering properties were related to the position and shape of the red blood cells (RBCs). A 2D microrheological model simulated the RBC dynamics in a Couette shear flow system. This iterative model, described earlier [Biophys. J. 82, 1696-1710 (2002)], integrates the hydrodynamic effect of the flow, as well as adhesive and repulsive forces between RBCs. RBC aggregation was simulated at 40% hematocrit and shear rates of 0.05-2 s(-1). The RBC aggregate sizes ranged, on average, from 3.3 RBCs at 2 s(-1) to 33.5 cells at 0.05 s(-1). The ultrasound backscattered power was studied at frequencies between 5-120 MHz and insonification angles between 0-180 degrees. At frequencies below approximately 30 MHz, the ultrasound backscattered power increased as the shear rate was decreased and the size of the aggregates was raised. A totally different scattering behavior was noted above 30 MHz. Typical spectral slopes of the backscattered power (log-log scale) between 5-25 MHz equaled 3.8, whereas slopes down to 0.6 were measured at 0.05 s(-1), between 40-60 MHz. The ultrasound backscattered power was shown to be angle dependent at low frequencies (5-25 MHz). The anisotropy persisted at high frequencies (>25 MHz) for small aggregates (at 2 s(-1)). In conclusion, this study sheds some light on the blood backscattering behavior with an emphasis on the non-Rayleigh regime. Additional experimental studies may be necessary to validate the simulation results, and to fully understand the relation between the ultrasound backscattered power, level of RBC aggregation, shear rate, frequency, and insonification angle.

A simulation study of sample volume sensitivity for oblique pulsed finite beam insonation of Doppler ultrasound flow phantom cylindrical vessels

Our previous analysis of the lumen pressure in Doppler ultrasound flow phantoms subject to continuous wave, infinite beam excitation is extended here to consider the pressure and Doppler sample volume complex sensitivity within a range of solid absorbent tubes typical of those used in Doppler ultrasound flow phantoms insonated with a focussed pulsed ultrasound beam. The beam may be incident on the cylindrical shell from any angle and with any offset from the shell axis. The examples considered are of a 5 MHz beam with a 6 dB lateral fullwidth of 1 mm at the focus and a transducer surface acceleration pulse with standard deviation of 1 micros propagating through 10 mm outer diameter, 8 mm inner diameter, Cflex, low-density polyethylene (LDPE), high-density polyethylene (HDPE), and polymethylmethacrylate (PMMA) shells surrounded by water at various beam-vessel angles. Our results confirm earlier analyses suggesting that PMMA, being less well matched to the surrounding media, causes much greater distortion of the sample volume sensitivity than Cflex.

High-frequency backscatter and attenuation measurements of porcine erythrocyte suspensions between 30-90 MHz

There are now diagnostic ultrasonic imaging devices that operate at very high frequencies (VHF) of 20 MHz and beyond for clinical applications in ophthalmology, dermatology and vascular surgery. To be able to better interpret these images and to further the development of these devices, knowledge of ultrasonic attenuation and scattering of biologic tissues, such as blood, in the high-frequency range is crucial. VHF attenuation and backscatter experiments were made on porcine red blood cell (RBC) suspensions, for which much data on attenuation and backscatter can be found in the literature in the lower frequency range. Attenuation and backscatter at hematocrits of 6%, 10%, 15%, 20%, 25% and 30% from 30 to 90 MHz were measured using a modified substitution method that allows the utilization of focused transducers. The results show that the attenuation coefficient from all suspensions increased linearly with frequency and the backscatter coefficient for low hematocrit suspensions was found to have a maximum between 10% and 15%. At higher hematocrits, a decrease in the frequency-dependence was observed, possibly indicating that Rayleigh scattering is no longer valid because the wavelength in the VHF range is comparable to the size of a porcine RBC.

A new ultrasound principle for characterizing erythrocyte aggregation: in vitro reproducibility and validation

RATIONALE AND OBJECTIVES

There is no method currently available to quantify erythrocyte aggregation in vivo. In this work, using a Couette system, we defined new ultrasound indexes potentially applicable for non-invasive investigations.

METHODS

Two ultrasound protocols were developed: (1) a protocol in which decreasing shear rates ranging from 200 to 1 s-1 were applied to solutions; and (2) a protocol in which a 200 s-1 shear rate was initially applied followed by stoppage of flow (a kinetics protocol). New ultrasound indexes were defined as: the power PUS at the nominal frequency of each transducer, Rayleigh's slope (tangent of the curve PUS = f(log(F)) through the 3.5 to 15 MHz frequency bandwidth) and kinetic indexes characterizing the aggregation/aggregability of the suspension.

RESULTS

Using washed erythrocytes resuspended in saline, it was shown that the ultrasound intensity is dependent at 3.54 +/- 5.9% (NS) to the power of the frequency (theoretical value = 4). Using 10 total blood samples extracted from a single pig, good reproducibility for all indexes (5%) was demonstrated.

CONCLUSIONS

A suitable and reproducible methodology was developed and validated for studying erythrocyte aggregation in calibrated in vitro conditions.

A point process approach to assess the frequency dependence of ultrasound backscattering by aggregating red blood cells

To study the shear-thinning rheological behavior of blood, an acoustical measurement of the erythrocyte aggregation level can be obtained by analyzing the frequency dependence of ultrasonic backscattering from blood. However, the relation that exists among the variables describing the aggregation level and the backscattering coefficient needs to be better clarified. To achieve this purpose, a three-dimensional random model, the Neyman-Scott point process, is proposed to simulate red cell clustering in aggregative conditions at a low hematocrit (H<5%). The frequency dependence of the backscattering coefficient of blood, in non-Rayleigh conditions, is analytically derived from the model, as a function of the size distribution of the aggregates and of their mass fractal dimension. Quantitative predictions of the backscatter increase due to red cell aggregation are given. The parametric model of backscatter enables two descriptive indices of red cell aggregation to be extracted from experimental data, the packing factor W and the size factor delta. Previously published backscatter measurements from porcine whole blood at 4.5% hematocrit, in the frequency range of 3.5 MHz-12.5 MHz, are used to study the shear-rate dependence of these two indices.

Doppler power variation from porcine blood under steady and pulsatile flow

Although a number of recent studies have demonstrated that the echogenicity of blood varies as a function of time under pulsatile flow, the fundamental mechanisms responsible for it are still uncertain. To better understand this phenomenon, the Doppler power from porcine blood and polystyrene microsphere suspensions was measured at the center of the tube as functions of two crucial parameters, flow velocity and stroke rate (for pulsatile flow), under steady and pulsatile flow in a mock flow loop. In the present study, the experimental results were obtained with a 10-MHz pulsed Doppler system with a frequency response estimated more accurately by electronic injection, and validated by comparing to the radiofrequency (RF) signal acquired from the same Doppler instrument. The results show that the Doppler power from microspheres and porcine red blood cell (RBC) suspensions did not vary appreciably (< 2 dB), with either the speed or stroke rate (for pulsatile flow only) under steady and pulsatile flow. It was found that the Doppler power from porcine whole blood under steady flow decreased with the speed by approximately 13 dB from 3 to 33 cm/s and was only 3 dB higher than that from RBC suspension at 33 cm/s, suggesting minimal RBC aggregation in whole blood at this speed. The apparent cyclic variation from whole blood was observed at 20 and 40 beats/min (BPM). The cyclic variation became more obvious as the speed and stroke rate decreased. The mean Doppler power over a cycle increased as the peak speed decreased. The Doppler power reached a maximum near peak systole and a minimum at late diastole at the center of the tube. This pattern cannot be explained by RBC aggregation due to the shear rate alone, and may be attributed to acceleration and deceleration along with aggregation. The cyclic variation was not observed at 60 BPM, probably because of a lack of time for aggregation to occur.