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Li S, Chen C, Lof J, Stolze EA, Sklenar J, Chen X, Pacella JJ, Villanueva FS, Matsunaga TO, Everbach EC, Radio SJ, Westphal S, Xie F, Leng X, Porter TR. Effect of Ambient Conditions on Acoustic Activation of the Perfluoropropane Droplets Within the Infarct Zone. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:1232-1239. [PMID: 38760280 PMCID: PMC11189723 DOI: 10.1016/j.ultrasmedbio.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Acoustically activated perfluoropropane droplets (PD) formulated from lipid encapsulated microbubble preparations produce a delayed myocardial contrast enhancement that preferentially highlights the infarct zones (IZ). Since activation of PDs may be temperature sensitive, it is unclear what effect body temperature (BT) has on acoustic activation (AA). OBJECTIVE We sought to determine whether the microvascular retention and degree of myocardial contrast intensity (MCI) would be affected by BT at the time of intravenous injection. METHODS We administered intravenous (IV) PD in nine rats following 60 min of ischemia followed by reperfusion. Injections in these rats were given at temperatures above and below 36.5°C, with high MI activation in both groups at 3 or 6 min following IV injection (IVI). In six additional rats (three in each group), IV PDs were given only at one temperature (<36.5°C or ≥36.5°C), permitting a total of 12 comparisons of different BT. Differences in background subtracted MCI at 3-6 min post-injection were compared in the infarct zone (IZ) and remote zone (RZ). Post-mortem lung hematoxylin and eosin (H&E) staining was performed to assess the effect potential thermal activation on lung tissue. RESULTS Selective MCI within the IZ was observed in 8 of 12 rats who received IVI of PDs at <36.5°C, but none of the 12 rats who had IVI at the higher temperature (p < 0.0001). Absolute MCI following droplet activation was significantly higher in both the IZ and RZ when given at the lower BT. H&E indicated significant red blood extravasation in 5/7 rats who had had IV injections at higher BT, and 0/7 rats who had IV PDs at <36.5°C. CONCLUSIONS Selective IZ enhancement with AA of intravenous PDs is possible, but temperature sensitive. Thermal activation appears to occur when PDs are given at higher temperatures, preventing AA, and increasing unwanted bioeffects.
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Affiliation(s)
- Shouqiang Li
- Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China; Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Cheng Chen
- University of Pittsburgh Medical Center; Pittsburgh, PA, USA
| | - John Lof
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Elizabeth A Stolze
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Xucai Chen
- University of Pittsburgh Medical Center; Pittsburgh, PA, USA
| | - John J Pacella
- University of Pittsburgh Medical Center; Pittsburgh, PA, USA
| | | | - Terry O Matsunaga
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, USA
| | - E Carr Everbach
- Department of Engineering, Swarthmore College, Swarthmore, PA, USA
| | - Stanley J Radio
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sherry Westphal
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Feng Xie
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Xiaoping Leng
- Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China.
| | - Thomas R Porter
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
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Li S, Chen C, Lof J, Stolze EA, Sklenar J, Chen X, Pacella JJ, Villanueva FS, Matsunaga TO, Everbach EC, Radio SJ, Westphal SN, Shiva S, Xie F, Leng X, Porter TR. Acoustic Activation Imaging With Intravenous Perfluoropropane Nanodroplets Results in Selective Bioactivation of the Risk Area. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:1063-1080. [PMID: 38440926 PMCID: PMC11093707 DOI: 10.1002/jum.16435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/09/2024] [Accepted: 02/10/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Acoustically activatable perfluoropropane droplets (PD) can be formulated from commercially available microbubble preparations. Diagnostic transthoracic ultrasound frequencies have resulted in acoustic activation (AA) predominately within myocardial infarct zones (IZ). OBJECTIVE We hypothesized that the AA area following acute coronary ischemia/reperfusion (I/R) would selectively enhance the developing scar zone, and target bioeffects specifically to this region. METHODS We administered intravenous PD in 36 rats and 20 pigs at various stages of myocardial scar formation (30 minutes, 1 day, and 7 days post I/R) to determine what effect infarct age had on the AA within the IZ. This was correlated with histology, myeloperoxidase activity, and tissue nitrite activity. RESULTS The degree of AA within the IZ in rats was not associated with collagen content, neutrophil infiltration, or infarct age. AA within 24 hours of I/R was associated with increased nitric oxide utilization selectively within the IZ (P < .05 compared with remote zone). The spatial extent of AA in pigs correlated with infarct size only when performed before sacrifice at 7 days (r = .74, P < .01). CONCLUSIONS Acoustic activation of intravenous PD enhances the developing scar zone following I/R, and results in selective tissue nitric oxide utilization.
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Affiliation(s)
- Shouqiang Li
- Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Cheng Chen
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - John Lof
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Elizabeth A Stolze
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | - Xucai Chen
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - John J Pacella
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Flordeliza S Villanueva
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Terry O Matsunaga
- Department of Biomedical Engineering, University of Arizona, Tucson, Arizona, USA
| | - E Carr Everbach
- Department of Engineering, Swarthmore College, Swarthmore, Pennsylvania, USA
| | - Stanley J Radio
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sherry N Westphal
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sruti Shiva
- Department of Pharmacology and Chemical Biology, Molecular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Feng Xie
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Xiaoping Leng
- Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Thomas R Porter
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Zeng P, Chen C, Lof J, Stolze E, Li S, Chen X, Pacella J, Villanueva FS, Matsunaga T, Everbach EC, Fei H, Xie F, Porter T. Acoustic Detection of Retained Perfluoropropane Droplets Within the Developing Myocardial Infarct Zone. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:2322-2334. [PMID: 36050231 PMCID: PMC9547398 DOI: 10.1016/j.ultrasmedbio.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
Perfluoropropane droplets (PDs) cross endothelial barriers and can be acoustically activated for selective myocardial extravascular enhancement following intravenous injection (IVI). Our objective was to determine how to optimally activate extravascular PDs for transthoracic ultrasound-enhanced delineation of a developing scar zone (DSZ). Ultrafast-frame-rate microscopy was conducted to determine the effect of pulse sequence on the threshold of bubble formation from PDs. In vitro studies were subsequently performed at different flow rates to determine acoustic activation and inertial cavitation thresholds for a PD infusion using multipulse fundamental non-linear or single-pulse harmonic imaging. IVIs of PDs were given in 9 rats and 10 pigs following prolonged left anterior descending ischemia to detect and quantify PD kinetics within the DSZ. A multipulse sequence had a lower myocardial index threshold for acoustic activation by ultrafast-frame-rate microscopy. Acoustic activation was observed at a myocardial index ≥0.4 below the inertial cavitation threshold for both pulse sequences. In rats, confocal microscopy and serial acoustic activation imaging detected higher droplet presence (relative to remote regions) within the DSZ at 3 min post-IVI. Transthoracic high-mechanical-index impulses with fundamental non-linear imaging in pigs at this time post-IVI resulted in selective contrast enhancement within the DSZ.
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Affiliation(s)
- Ping Zeng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Cheng Chen
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - John Lof
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Elizabeth Stolze
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Shouqiang Li
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA; Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xucai Chen
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - John Pacella
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Flordeliza S Villanueva
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Terry Matsunaga
- Department of Biomedical Engineering, University of Arizona, Tucson, Arizona, USA; Department of Medical Imaging, University of Arizona, Tucson, Arizona, USA
| | | | - Hongwen Fei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Feng Xie
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Thomas Porter
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA.
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Contrast Ultrasound, Sonothrombolysis and Sonoperfusion in Cardiovascular Disease: Shifting to Theragnostic Clinical Trials. JACC Cardiovasc Imaging 2022; 15:345-360. [PMID: 34656483 PMCID: PMC8837667 DOI: 10.1016/j.jcmg.2021.07.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 07/23/2021] [Indexed: 02/03/2023]
Abstract
Contrast ultrasound has a variety of applications in cardiovascular medicine, both in diagnosing cardiovascular disease as well as providing prognostic information. Visualization of intravascular contrast microbubbles is based on acoustic cavitation, the characteristic oscillation that results in changes in the reflected ultrasound waves. At high power, this acoustic response generates sufficient shear that is capable of enhancing endothelium-dependent perfusion in atherothrombotic cardiovascular disease (sonoperfusion). The oscillation and collapse of microbubbles in response to ultrasound also induces microstreaming and jetting that can fragment thrombus (sonothrombolysis). Several preclinical studies have focused on identifying optimal diagnostic ultrasound settings and treatment regimens. Clinical trials have been performed in acute myocardial infarction, stroke, and peripheral arterial disease often with improved outcome. In the coming years, results of ongoing clinical trials along with innovation and improvements in sonothrombolysis and sonoperfusion will determine whether this theragnostic technique will become a valuable addition to reperfusion therapy.
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Cimorelli M, Flynn MA, Angel B, Reimold E, Banka SS, Andrien B, Fafarman A, Huneke R, Kohut A, Wrenn S. Selective Enhancement of Swine Myocardium with a Novel Ultrasound Enhancing Agent During Transthoracic Echocardiography. J Cardiovasc Transl Res 2022; 15:722-729. [PMID: 35099715 DOI: 10.1007/s12265-022-10207-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/20/2022] [Indexed: 11/30/2022]
Abstract
Ultrasound enhancing agents are approved to delineate the endocardial border and opacify the left ventricle cavity (LVC). We present a nested phase change agent (NPCA) designed to enable selective myocardial enhancement without enhancing the LVC by employing a dual-activation mechanism dependent on sufficient ultrasound intensity and the microenvironment of the myocardium. Swine received bolus injections of NPCA while echocardiograms were collected and processed to determine background-subtracted acoustic intensities (AI) in the LVC and septal myocardium. At mechanical index (MI) ≥ 0.8, the NPCA enhanced the myocardium selectively (p < 0.001) while the LVC remained at baseline AI. A 5-mL bolus of NPCA enhanced swine myocardium and enhancement persisted for > 5 min at 1.4 MI, while hemodynamics and EKG remained normal. Our findings demonstrate that the NPCA enhances swine myocardium selectively without enhancing the LVC. The NPCA could have utility for functional and structural echocardiographic studies with clinical ultrasound using standard settings.
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Affiliation(s)
- Michael Cimorelli
- Chemical and Biological Engineering, Drexel University, Philadelphia, PA, USA.
| | - Michael A Flynn
- Chemical and Biological Engineering, Drexel University, Philadelphia, PA, USA
| | - Brett Angel
- Cardiology, Drexel University College of Medicine, Philadelphia, PA, USA.,Cardiology, Tower Health, Phoenixville, PA, USA
| | - Emily Reimold
- University Laboratory Animal Resources, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Sahil S Banka
- Cardiology, Einstein Medical Center, Philadelphia, PA, USA
| | - Benjamin Andrien
- Chemical and Biological Engineering, Drexel University, Philadelphia, PA, USA
| | - Aaron Fafarman
- Chemical and Biological Engineering, Drexel University, Philadelphia, PA, USA
| | - Richard Huneke
- University Laboratory Animal Resources, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Andrew Kohut
- Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Steven Wrenn
- Chemical and Biological Engineering, Drexel University, Philadelphia, PA, USA. .,Chemical Engineering, Virginia Tech, Blacksburg, VA, USA.
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Krafft MP, Riess JG. Therapeutic oxygen delivery by perfluorocarbon-based colloids. Adv Colloid Interface Sci 2021; 294:102407. [PMID: 34120037 DOI: 10.1016/j.cis.2021.102407] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 03/18/2021] [Accepted: 03/25/2021] [Indexed: 02/06/2023]
Abstract
After the protocol-related indecisive clinical trial of Oxygent, a perfluorooctylbromide/phospholipid nanoemulsion, in cardiac surgery, that often unduly assigned the observed untoward effects to the product, the development of perfluorocarbon (PFC)-based O2 nanoemulsions ("blood substitutes") has come to a low. Yet, significant further demonstrations of PFC O2-delivery efficacy have continuously been reported, such as relief of hypoxia after myocardial infarction or stroke; protection of vital organs during surgery; potentiation of O2-dependent cancer therapies, including radio-, photodynamic-, chemo- and immunotherapies; regeneration of damaged nerve, bone or cartilage; preservation of organ grafts destined for transplantation; and control of gas supply in tissue engineering and biotechnological productions. PFC colloids capable of augmenting O2 delivery include primarily injectable PFC nanoemulsions, microbubbles and phase-shift nanoemulsions. Careful selection of PFC and other colloid components is critical. The basics of O2 delivery by PFC nanoemulsions will be briefly reminded. Improved knowledge of O2 delivery mechanisms has been acquired. Advanced, size-adjustable O2-delivering nanoemulsions have been designed that have extended room-temperature shelf-stability. Alternate O2 delivery options are being investigated that rely on injectable PFC-stabilized microbubbles or phase-shift PFC nanoemulsions. The latter combine prolonged circulation in the vasculature, capacity for penetrating tumor tissues, and acute responsiveness to ultrasound and other external stimuli. Progress in microbubble and phase-shift emulsion engineering, control of phase-shift activation (vaporization), understanding and control of bubble/ultrasound/tissue interactions is discussed. Control of the phase-shift event and of microbubble size require utmost attention. Further PFC-based colloidal systems, including polymeric micelles, PFC-loaded organic or inorganic nanoparticles and scaffolds, have been devised that also carry substantial amounts of O2. Local, on-demand O2 delivery can be triggered by external stimuli, including focused ultrasound irradiation or tumor microenvironment. PFC colloid functionalization and targeting can help adjust their properties for specific indications, augment their efficacy, improve safety profiles, and expand the range of their indications. Many new medical and biotechnological applications involving fluorinated colloids are being assessed, including in the clinic. Further uses of PFC-based colloidal nanotherapeutics will be briefly mentioned that concern contrast diagnostic imaging, including molecular imaging and immune cell tracking; controlled delivery of therapeutic energy, as for noninvasive surgical ablation and sonothrombolysis; and delivery of drugs and genes, including across the blood-brain barrier. Even when the fluorinated colloids investigated are designed for other purposes than O2 supply, they will inevitably also carry and deliver a certain amount of O2, and may thus be considered for O2 delivery or co-delivery applications. Conversely, O2-carrying PFC nanoemulsions possess by nature a unique aptitude for 19F MR imaging, and hence, cell tracking, while PFC-stabilized microbubbles are ideal resonators for ultrasound contrast imaging and can undergo precise manipulation and on-demand destruction by ultrasound waves, thereby opening multiple theranostic opportunities.
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Affiliation(s)
- Marie Pierre Krafft
- University of Strasbourg, Institut Charles Sadron (CNRS), 23 rue du Loess, 67034 Strasbourg, France.
| | - Jean G Riess
- Harangoutte Institute, 68160 Ste Croix-aux-Mines, France
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Delayed Echo Enhancement Imaging to Quantify Myocardial Infarct Size. J Am Soc Echocardiogr 2021; 34:898-909. [PMID: 33711458 DOI: 10.1016/j.echo.2021.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/07/2021] [Accepted: 02/28/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Perfluoropropane droplets formulated from commercial microbubbles exhibit different acoustic characteristics than their parent microbubbles, most likely from enhanced endothelial permeability. This enhanced permeability may permit delayed echo-enhancement imaging (DEEI) similar to delayed enhancement magnetic resonance imaging (DE-MRI). We hypothesized this would allow detection and quantification of myocardial scar. METHODS In 15 pigs undergoing 90 minutes of left anterior descending ischemia by either balloon (n = 13) or thrombotic occlusion (n = 2), DE-MRI was performed at 2-24 days postocclusion. Delayed echo-enhancement imaging was performed at 2-4 minutes following an intravenous injection of 1 mL of 50% Definity (Lantheus Medical) compressed into 180 nm droplets; DEEI was attempted in all pigs with single-pulse harmonic imaging at 1.7 transmit/3.4 MHz receive. Myocardial defects observed with DEEI were quantified (percentage of infarct area) and compared with DE-MRI as well as postmortem staining. In six pigs, multipulse low-mechanical index (MI) fundamental nonlinear imaging (FNLI) with intermittent high-MI impulses was performed to determine whether droplet activation within the infarct zone was achievable with a longer pulse duration. RESULTS The range of infarct size area by DE-MRI ranged from 0% to 46% of total left ventricular area. Single-pulse harmonic imaging detected a contrast defect that correlated closely with infarct area by DE-MRI (r = 0.81, P = .0001). The FNLI high-MI impulses resulted in droplet activation in both the infarct and normal zones. Harmonic subtraction of the FNLI images resulted in infarct zone enhancement that also correlated closely with infarct size (r = 0.83; P = .04). Droplets were observed on postmortem transmission electron microscopy within myocytes of the infarct and remote normal zone. CONCLUSION Intravenously Definity nanodroplets can be utilized to detect and quantify infarct zone at the bedside using DEEI techniques.
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8
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Kutty S. The 21st Annual Feigenbaum Lecture: Beyond Artificial: Echocardiography from Elegant Images to Analytic Intelligence. J Am Soc Echocardiogr 2020; 33:1163-1171. [DOI: 10.1016/j.echo.2020.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 02/02/2023]
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9
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Cimorelli M, Flynn MA, Angel B, Reimold E, Fafarman A, Huneke R, Kohut A, Wrenn S. A Voltage-Sensitive Ultrasound Enhancing Agent for Myocardial Perfusion Imaging in a Rat Model. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2388-2399. [PMID: 32593498 DOI: 10.1016/j.ultrasmedbio.2020.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 05/13/2020] [Accepted: 05/19/2020] [Indexed: 06/11/2023]
Abstract
Echocardiographers with specialized expertise sometimes perform myocardial perfusion imaging using U.S. Food and Drug Administration-approved microbubbles in an off-label capacity, correlating microbubble replenishment in the near field with blood flow through the myocardium. This study reports the in vivo clinical feasibility of a voltage-sensitive ultrasound enhancing agent (UEA) for myocardial perfusion imaging. Four UEAs were injected into Sprague-Dawley rats while ultrasound images were collected to quantify brightness in the left ventricular (LV) cavity, septal wall, and posterior wall in systole and diastole. Formulation IV, a phase change agent nested within a negatively charged phospholipid bilayer, increased the tissue-to-cavity ratio in both systole and diastole in the septal wall, 6 dB, and in the posterior wall, 5 dB, while leaving the LV cavity at baseline. This outcome improves the signal of the myocardium relative to the LV cavity and shows promise as a myocardial perfusion UEA.
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Affiliation(s)
- Michael Cimorelli
- Chemical and Biological Engineering, Drexel University, Philadelphia, Pennsylvania, USA
| | - Michael A Flynn
- Chemical and Biological Engineering, Drexel University, Philadelphia, Pennsylvania, USA
| | - Brett Angel
- Cardiology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Emily Reimold
- University Laboratory Animal Resources, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Aaron Fafarman
- Chemical and Biological Engineering, Drexel University, Philadelphia, Pennsylvania, USA
| | - Richard Huneke
- University Laboratory Animal Resources, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Andrew Kohut
- Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Steven Wrenn
- Chemical and Biological Engineering, Drexel University, Philadelphia, Pennsylvania, USA.
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Jing B, Brown ME, Davis ME, Lindsey BD. Imaging the Activation of Low-Boiling-Point Phase-Change Contrast Agents in the Presence of Tissue Motion Using Ultrafast Inter-frame Activation Ultrasound Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1474-1489. [PMID: 32143861 PMCID: PMC7199438 DOI: 10.1016/j.ultrasmedbio.2020.01.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 01/23/2020] [Accepted: 01/26/2020] [Indexed: 05/13/2023]
Abstract
Nanoscale phase-change contrast agents (PCCAs) have been found to have great potential in non-invasive extravascular imaging and therapeutic delivery. However, the contrast-to-tissue ratio (CTR) of PCCA images is usually limited because of either physiological motion or incomplete cancelation of tissue signal. Therefore, to improve the CTR of PCCA images in the presence of physiological motion, a new imaging technique, ultrafast inter-frame activation ultrasound (UIAU) imaging, is proposed and validated. Results of studies with controlled motion in tissue-mimicking phantoms indicate UIAU could provide significantly higher CTRs (maximum: 17.3 ± 0.9 dB) relative to conventional pulse inversion imaging (maximum CTR: 3.4 ± 1.4 dB). UIAU has CTRs up to 16.1 ± 1.0 dB relative to 3.9 ± 2.3 dB for differential imaging in the presence of physiological motion at 20 mm/s. In vivo imaging of PCCAs in the rat liver also reveals the ability of UIAU to enhance PCCA image contrast in the presence of physiological motion.
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Affiliation(s)
- Bowen Jing
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | - Milton E Brown
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | - Michael E Davis
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA; Children's Heart Research & Outcomes Center, Children's Healthcare of Atlanta & Emory University, Atlanta, Georgia, USA; Division of Cardiology, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Brooks D Lindsey
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA; School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA.
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Abstract
PURPOSE OF REVIEW This review will provide recent pre-clinical and initial clinical trials exploring the efficacy of sonothrombolysis as an adjunct to current emergent therapies in acute coronary syndromes. RECENT FINDINGS The initial clinical trials examining the efficacy of short pulse duration diagnostic ultrasound (DUS) high mechanical index impulses in patients with ST segment elevation myocardial infarction (STEMI) have demonstrated that there is improved patency of the infarct vessel, and improved microvascular flow following percutaneous coronary intervention. Subsequent randomized prospective trials have confirmed that in patients with acute STEMI receiving an intravenous microbubble infusion, diagnostic high mechanical index impulses applied in the apical windows pre- and post-percutaneous coronary intervention have reduced myocardial infarction size, as assessed by magnetic resonance imaging at 72 h following presentation, and have been associated with better left ventricular systolic function at 6 month follow-up. Sonothrombolysis has potential for improving early epicardial coronary artery patency and reduce left ventricular remodeling when added to current interventional strategies in STEMI.
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Affiliation(s)
- Thomas R Porter
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Nebraska Medical Center, 982265 Nebraska Medical Center, Omaha, NE, 68198, USA.
| | - Wilson Mathias
- Departamento de Cardiopneumologia da Faculdade de Medicina, University of Sao Paulo School of Medicine, Sao Paulo, State of Sao Paulo, 03178-200, Brazil
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12
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Loskutova K, Grishenkov D, Ghorbani M. Review on Acoustic Droplet Vaporization in Ultrasound Diagnostics and Therapeutics. BIOMED RESEARCH INTERNATIONAL 2019; 2019:9480193. [PMID: 31392217 PMCID: PMC6662494 DOI: 10.1155/2019/9480193] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/10/2019] [Accepted: 06/20/2019] [Indexed: 02/06/2023]
Abstract
Acoustic droplet vaporization (ADV) is the physical process in which liquid undergoes phase transition to gas after exposure to a pressure amplitude above a certain threshold. In recent years, new techniques in ultrasound diagnostics and therapeutics have been developed which utilize microformulations with various physical and chemical properties. The purpose of this review is to give the reader a general idea on how ADV can be implemented for the existing biomedical applications of droplet vaporization. In this regard, the recent developments in ultrasound therapy which shed light on the ADV are considered. Modern designs of capsules and nanodroplets (NDs) are shown, and the material choices and their implications for function are discussed. The influence of the physical properties of the induced acoustic field, the surrounding medium, and thermophysical effects on the vaporization are presented. Lastly, current challenges and potential future applications towards the implementation of the therapeutic droplets are discussed.
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Affiliation(s)
- Ksenia Loskutova
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, SE-141 57 Huddinge, Sweden
| | - Dmitry Grishenkov
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, SE-141 57 Huddinge, Sweden
| | - Morteza Ghorbani
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, SE-141 57 Huddinge, Sweden
- Mechatronics Engineering Program, Faculty of Engineering and Natural Science, Sabanci University, Istanbul 34956, Turkey
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