1
|
Iyanna N, Donohue JK, Lorence JM, Guyette FX, Gimbel E, Brown JB, Daley BJ, Eastridge BJ, Miller RS, Nirula R, Harbrecht BG, Claridge JA, Phelan HA, Vercruysse GA, O'Keefe T, Joseph B, Shutter LA, Sperry JL. Early Glasgow Coma Scale Score and Prediction of Traumatic Brain Injury: A Secondary Analysis of Three Harmonized Prehospital Randomized Clinical Trials. PREHOSP EMERG CARE 2024:1-9. [PMID: 39042825 DOI: 10.1080/10903127.2024.2381048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/11/2024] [Accepted: 07/03/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVES The prehospital prediction of the radiographic diagnosis of traumatic brain injury (TBI) in hemorrhagic shock patients has the potential to promote early therapeutic interventions. However, the identification of TBI is often challenging and prehospital tools remain limited. While the Glasgow Coma Scale (GCS) score is frequently used to assess the extent of impaired consciousness after injury, the utility of the GCS scores in the early prehospital phase of care to predict TBI in patients with severe injury and concomitant shock is poorly understood. METHODS We performed a post-hoc, secondary analysis utilizing data derived from three randomized prehospital clinical trials: the Prehospital Air Medical Plasma trial (PAMPER), the Study of Tranexamic Acid During Air Medical and Ground Prehospital Transport trial (STAAMP), and the Pragmatic Prehospital Type O Whole Blood Early Resuscitation (PPOWER) trial. Patients were dichotomized into two cohorts based on the presence of TBI and then further stratified into three groups based on prehospital GCS score: GCS 3, GCS 4-12, and GCS 13-15. The association between prehospital GCS score and clinical documentation of TBI was assessed. RESULTS A total of 1,490 enrolled patients were included in this analysis. The percentage of patients with documented TBI in those with a GCS 3 was 59.5, 42.4% in those with a GCS 4-12, and 11.8% in those with a GCS 13-15. The positive predictive value (PPV) of the prehospital GCS score for the diagnosis of TBI is low, with a GCS of 3 having only a 60% PPV. Hypotension and prehospital intubation are independent predictors of a low prehospital GCS. Decreasing prehospital GCS is strongly associated with higher incidence or mortality over time, irrespective of the diagnosis of TBI. CONCLUSIONS The ability to accurately predict the presence of TBI in the prehospital phase of care is essential. The utility of the GCS scores in the early prehospital phase of care to predict TBI in patients with severe injury and concomitant shock is limited. The use of novel scoring systems and improved technology are needed to promote the accurate early diagnosis of TBI.
Collapse
Affiliation(s)
- Nidhi Iyanna
- Department of Surgery, Division of Trauma and General Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jack K Donohue
- Department of Surgery, Division of Trauma and General Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - John M Lorence
- Department of Surgery, Division of Trauma and General Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Francis X Guyette
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elizabeth Gimbel
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Joshua B Brown
- Department of Surgery, Division of Trauma and General Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Brian J Daley
- Department of Surgery, University of Tennessee Health Science Center, Knoxville, Tennessee
| | - Brian J Eastridge
- Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas
| | | | - Raminder Nirula
- Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Brian G Harbrecht
- Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Jeffrey A Claridge
- Department of Surgery, Metro Health Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Herb A Phelan
- Department of Surgery, University of Texas Southwestern, Dallas, Texas
| | | | - Terence O'Keefe
- Department of Surgery, University of Arizona, Tucson, Arizona
| | - Bellal Joseph
- Department of Surgery, University of Arizona, Tucson, Arizona
| | - Lori A Shutter
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jason L Sperry
- Department of Surgery, Division of Trauma and General Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
2
|
Bergs J, Morr AS, Silva RV, Infante‐Duarte C, Sack I. The Networking Brain: How Extracellular Matrix, Cellular Networks, and Vasculature Shape the In Vivo Mechanical Properties of the Brain. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2402338. [PMID: 38874205 PMCID: PMC11336943 DOI: 10.1002/advs.202402338] [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: 03/04/2024] [Revised: 05/22/2024] [Indexed: 06/15/2024]
Abstract
Mechanically, the brain is characterized by both solid and fluid properties. The resulting unique material behavior fosters proliferation, differentiation, and repair of cellular and vascular networks, and optimally protects them from damaging shear forces. Magnetic resonance elastography (MRE) is a noninvasive imaging technique that maps the mechanical properties of the brain in vivo. MRE studies have shown that abnormal processes such as neuronal degeneration, demyelination, inflammation, and vascular leakage lead to tissue softening. In contrast, neuronal proliferation, cellular network formation, and higher vascular pressure result in brain stiffening. In addition, brain viscosity has been reported to change with normal blood perfusion variability and brain maturation as well as disease conditions such as tumor invasion. In this article, the contributions of the neuronal, glial, extracellular, and vascular networks are discussed to the coarse-grained parameters determined by MRE. This reductionist multi-network model of brain mechanics helps to explain many MRE observations in terms of microanatomical changes and suggests that cerebral viscoelasticity is a suitable imaging marker for brain disease.
Collapse
Affiliation(s)
- Judith Bergs
- Department of RadiologyCharité – Universitätsmedizin BerlinCharitéplatz 110117BerlinGermany
| | - Anna S. Morr
- Department of RadiologyCharité – Universitätsmedizin BerlinCharitéplatz 110117BerlinGermany
| | - Rafaela V. Silva
- Experimental and Clinical Research Centera cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité – Universitätsmedizin BerlinLindenberger Weg 8013125BerlinGermany
- Corporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinECRC Experimental and Clinical Research CenterCharité – Universitätsmedizin BerlinCharitéplatz 110117BerlinGermany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC)Robert‐Rössle‐Straße 1013125BerlinGermany
| | - Carmen Infante‐Duarte
- Experimental and Clinical Research Centera cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité – Universitätsmedizin BerlinLindenberger Weg 8013125BerlinGermany
- Corporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinECRC Experimental and Clinical Research CenterCharité – Universitätsmedizin BerlinCharitéplatz 110117BerlinGermany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC)Robert‐Rössle‐Straße 1013125BerlinGermany
| | - Ingolf Sack
- Department of RadiologyCharité – Universitätsmedizin BerlinCharitéplatz 110117BerlinGermany
| |
Collapse
|
3
|
Piersigilli F, Campi F, Savarese I, Iacona G, Auriti C, Dotta A, Braguglia A, Garcovich M, Bersani I. Role of Brain Elastography in the Neonatal Setting: State of the Art of Ultrasonographic Techniques and Future Perspectives. CHILDREN (BASEL, SWITZERLAND) 2024; 11:752. [PMID: 39062201 PMCID: PMC11274596 DOI: 10.3390/children11070752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/20/2024] [Accepted: 06/17/2024] [Indexed: 07/28/2024]
Abstract
Magnetic resonance imaging is currently used in the neonatal setting for assessing features of the neonatal brain. However, its utilization is constrained by logistic, technical, or clinical challenges. Brain elastography is a new research technique which enhances the diagnostic capability of traditional imaging, and can be paired with both ultrasonography and magnetic resonance imaging. In particular, brain elastography adds objective and quantitative information to traditional imaging by detecting differences in tissue elasticity/stiffness, which may represent a surrogate marker of the physiologic and pathologic features of the neonatal brain. To date, very limited experience exists about the use of brain elastography specifically in the neonatal setting. The aim of the present review was to describe the most recent information about the feasibility and diagnostic accuracy of brain ultrasound elastography (USE) in neonates, and to provide information about the possible future applications and perspectives of brain elastography.
Collapse
Affiliation(s)
- Fiammetta Piersigilli
- Section of Neonatology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, 1200 Bruxelles, Belgium
| | - Francesca Campi
- Department of Medical and Surgical Neonatology, Bambino Gesù Children’s Hospital, 00165 Rome, Italy (I.B.)
| | - Immacolata Savarese
- Department of Medical and Surgical Neonatology, Bambino Gesù Children’s Hospital, 00165 Rome, Italy (I.B.)
| | - Giulia Iacona
- Department of Medical and Surgery, Imperial College London, London SW7 2AZ, UK
| | - Cinzia Auriti
- Department of Medical and Surgical Neonatology, Bambino Gesù Children’s Hospital, 00165 Rome, Italy (I.B.)
| | - Andrea Dotta
- Department of Medical and Surgical Neonatology, Bambino Gesù Children’s Hospital, 00165 Rome, Italy (I.B.)
| | - Annabella Braguglia
- Department of Medical and Surgical Neonatology, Bambino Gesù Children’s Hospital, 00165 Rome, Italy (I.B.)
| | - Matteo Garcovich
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00136 Rome, Italy
| | - Iliana Bersani
- Department of Medical and Surgical Neonatology, Bambino Gesù Children’s Hospital, 00165 Rome, Italy (I.B.)
| |
Collapse
|
4
|
Yu J, Guo H, Qiao X, Jiang L, Chen Y, Liu J, Zhang C, Su X, Zhang H, Wan M. Transcranial ultrasound estimation of viscoelasticity and fluidity in brain tumors aided by transcranial shear waves. ULTRASONICS 2024; 138:107262. [PMID: 38330769 DOI: 10.1016/j.ultras.2024.107262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/06/2024] [Accepted: 02/05/2024] [Indexed: 02/10/2024]
Abstract
Cerebral diseases, such as brain tumors, are intricately linked to the mechanical properties of brain tissues. Estimating the mechanical properties of brain tumors using transcranial ultrasound is a promising approach. However, the complexity of cranial features introduces challenges, such as ultrasound attenuation and interference from multidirectional transcranial shear waves induced by impact vibrations. To address these issues, this study proposes a transcranial ultrasound estimation method assisted by transcranial shear vibrations. Transcranial vibrations apply shear forces on the parietal bone, inducing unidirectional transcranial shear waves within brain tissue, as validated through simulations. Shear waves at different frequencies were captured via transcranial ultrasound, which were used to assess the viscoelasticity and fluidity of brain tumors. Transcranial experimental validations were conducted in 3D-printed models with tumor phantoms and ex vivo animal tumors. Vibration safety assessments were also performed. The results demonstrate that transcranial ultrasound can detect micron displacements induced by transcranial shear waves. In phantom and ex vivo animal experiments, speed distribution maps were employed to determine the size and location of one or two tumors enclosed in the skull model. The results revealed that the proposed approach could detect tumors with a minimum diameter of 0.8 cm and an inter-tumor distance of 0.8 cm. Notably, significant differences in viscoelasticity and fluidity between normal brain tissue and brain tumors were found (p<0.001). The maximum assessment errors for the elasticity, viscosity, and fluidity using transcranial ultrasound were 11.90%, 4.82%, and 0.73%, respectively, indicating that fluidity was more robust than viscoelasticity. The maximum accelerations of the skull were only 3.21 ms-2.
Collapse
Affiliation(s)
- Jianjun Yu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
| | - Hao Guo
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
| | - Xiaoyang Qiao
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
| | - Liyuan Jiang
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
| | - Yiran Chen
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
| | - Jiacheng Liu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
| | - Chaoyang Zhang
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
| | - Xiao Su
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
| | - Hongmei Zhang
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China.
| | - Mingxi Wan
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China.
| |
Collapse
|
5
|
Li R, Zhang Y, Cheng L, Zheng S, Li H, Zhang H, Du L, He W, Zhang W. Experimental study on monitoring microwave ablation efficacy by real-time shear wave elastography in ex vivo porcine brain. Int J Hyperthermia 2023; 41:2297649. [PMID: 38159561 DOI: 10.1080/02656736.2023.2297649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024] Open
Abstract
Objective: Glioma constitutes the most common primary malignant tumor in the central nervous system. In recent years, microwave ablation (MWA) was expected to be applied in the minimally invasive treatment of brain tumors. This study aims to evaluate the feasibility and accuracy of microwave ablation in ex vivo brain tissue by Shear Wave Elastography (SWE) to explore the application value of real-time SWE in monitoring the process of MWA of brain tissue.Methods: Thirty ex vivo brain tissues were treated with different microwave power and ablation duration. The morphologic and microscopic changes of MWA tissues were observed, and the diameter of the ablation areas was measured. In this experiment, SWE is used to quantitatively evaluate brain tissue's degree of thermal injury immediately after ablation.Results: This study It is found that the ablation range measured by SWE after ablation is in good consistency with the pathological range [ICCSWEL1-L1 = 0.975(95% CI:0.959 - 0.985), ICCSWEL2-L2 = 0.887(95% CI:0.779 - 0.938)]. At the same time, the SWE value after ablation is significantly higher than before (mean ± SD,9.88 ± 2.64 kPa vs.23.6 ± 13.75 kPa; p < 0.001). In this study, the SWE value of tissues in different pathological states was further analyzed by the ROC curve (AUC = 0.86), and the threshold for distinguishing normal tissue from tissue after ablation was 13.7 kPa. The accuracy of evaluating ablation tissue using SWE can reach 84.72%, providing data support for real-time quantitative observation of the ablation range.Conclusion: In conclusion the accurate visualization and real-time evaluation of the organizational change range of the MWA process can be realized by real-time SWE.
Collapse
Affiliation(s)
- Rui Li
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yukang Zhang
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Linggang Cheng
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuai Zheng
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hongbing Li
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hongxia Zhang
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lijuan Du
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wen He
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Zhang
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
6
|
Zaed I, Della Pepa GM, Cannizzaro D, Menna G, Cardia A. Applicability and efficacy of ultrasound elastography in neurosurgery: a systematic review of the literature. J Neurosurg Sci 2023; 67:750-757. [PMID: 36239425 DOI: 10.23736/s0390-5616.22.05866-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
INTRODUCTION Neurosurgery is one of the fields in which intraoperative imaging is paramount. One of these main imaging tools that have been acquiring the interest of the neurosurgical community is Ultrasound elastography (USE), which is an imaging technology sensitive to tissue stiffness. Here we present a systematic review of the use of USE in neurosurgery. EVIDENCE ACQUISITION A systematic review of the literature has been performed, according to the PRISMA guideline, for the last 30 years on 3 different databases (MEDLINE, Scopus, and Cochrane), to gather all the studies on the use of ultrasound elastography for neurosurgical pathologies, including both clinical and laboratory studies. EVIDENCE SYNTHESIS A total of 15 articles met the inclusion criteria. USE has widely and safely been used especially for oncological lesions (meningiomas and gliomas) and focal cortical dysplasia. However, there are also encouraging laboratory studies about its application for the management of traumatic brain injury, and ischemic stroke. CONCLUSIONS This systematic review showed that, despite the lack of strong evidence, USE is a valid intraoperative tool, especially in oncological neurosurgery.
Collapse
Affiliation(s)
- Ismail Zaed
- Department of Neurosurgery, ASST Ovest Milanese, Legnano Hospital, Milan, Italy -
| | - Giuseppe M Della Pepa
- Institute of Neurosurgery, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Delia Cannizzaro
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Neurosurgery, IRCCS Humanitas Clinic, Rozzano, Milan, Italy
| | - Grazia Menna
- Institute of Neurosurgery, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Andrea Cardia
- Department of Neurosurgery, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland
| |
Collapse
|
7
|
Bryniarska-Kubiak N, Kubiak A, Trojan E, Wesołowska J, Lekka M, Basta-Kaim A. Oxygen-Glucose Deprivation in Organotypic Hippocampal Cultures Leads to Cytoskeleton Rearrangement and Immune Activation: Link to the Potential Pathomechanism of Ischaemic Stroke. Cells 2023; 12:1465. [PMID: 37296586 PMCID: PMC10252361 DOI: 10.3390/cells12111465] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/18/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
Ischaemic stroke is characterized by a sudden loss of blood circulation to an area of the brain, resulting in a corresponding loss of neurologic function. As a result of this process, neurons in the ischaemic core are deprived of oxygen and trophic substances and are consequently destroyed. Tissue damage in brain ischaemia results from a complex pathophysiological cascade comprising various distinct pathological events. Ischaemia leads to brain damage by stimulating many processes, such as excitotoxicity, oxidative stress, inflammation, acidotoxicity, and apoptosis. Nevertheless, less attention has been given to biophysical factors, including the organization of the cytoskeleton and the mechanical properties of cells. Therefore, in the present study, we sought to evaluate whether the oxygen-glucose deprivation (OGD) procedure, which is a commonly accepted experimental model of ischaemia, could affect cytoskeleton organization and the paracrine immune response. The abovementioned aspects were examined ex vivo in organotypic hippocampal cultures (OHCs) subjected to the OGD procedure. We measured cell death/viability, nitric oxide (NO) release, and hypoxia-inducible factor 1α (HIF-1α) levels. Next, the impact of the OGD procedure on cytoskeletal organization was evaluated using combined confocal fluorescence microscopy (CFM) and atomic force microscopy (AFM). Concurrently, to find whether there is a correlation between biophysical properties and the immune response, we examined the impact of OGD on the levels of crucial ischaemia cytokines (IL-1β, IL-6, IL-18, TNF-α, IL-10, IL-4) and chemokines (CCL3, CCL5, CXCL10) in OHCs and calculated Pearsons' and Spearman's rank correlation coefficients. The results of the current study demonstrated that the OGD procedure intensified cell death and nitric oxide release and led to the potentiation of HIF-1α release in OHCs. Moreover, we presented significant disturbances in the organization of the cytoskeleton (actin fibers, microtubular network) and cytoskeleton-associated protein 2 (MAP-2), which is a neuronal marker. Simultaneously, our study provided new evidence that the OGD procedure leads to the stiffening of OHCs and a malfunction in immune homeostasis. A negative linear correlation between tissue stiffness and branched IBA1 positive cells after the OGD procedure suggests the pro-inflammatory polarization of microglia. Moreover, the negative correlation of pro- and positive anti-inflammatory factors with actin fibers density indicates an opposing effect of the immune mediators on the rearrangement of cytoskeleton induced by OGD procedure in OHCs. Our study constitutes a basis for further research and provides a rationale for integrating biomechanical and biochemical methods in studying the pathomechanism of stroke-related brain damage. Furthermore, presented data pointed out the interesting direction of proof-of-concept studies, in which follow-up may establish new targets for brain ischemia therapy.
Collapse
Affiliation(s)
- Natalia Bryniarska-Kubiak
- Laboratory of Immunoendocrinology, Department of Experimental Neuroendocrinology, Maj Institute of Pharmacology, Polish Academy of Sciences, 12 Smętna St., 31-343 Kraków, Poland
| | - Andrzej Kubiak
- Department of Biophysical Microstructures, Institute of Nuclear Physics, Polish Academy of Sciences, 152 Radzikowskiego St., 31-342 Kraków, Poland
- Laboratory of Stem Cell Biology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, 7 Gronostajowa St., 30-387 Kraków, Poland
| | - Ewa Trojan
- Laboratory of Immunoendocrinology, Department of Experimental Neuroendocrinology, Maj Institute of Pharmacology, Polish Academy of Sciences, 12 Smętna St., 31-343 Kraków, Poland
| | - Julita Wesołowska
- Laboratory for In Vivo and In Vitro Imaging, Maj Institute of Pharmacology, Polish Academy of Sciences, 12 Smętna St., 31-343 Kraków, Poland
| | - Małgorzata Lekka
- Department of Biophysical Microstructures, Institute of Nuclear Physics, Polish Academy of Sciences, 152 Radzikowskiego St., 31-342 Kraków, Poland
| | - Agnieszka Basta-Kaim
- Laboratory of Immunoendocrinology, Department of Experimental Neuroendocrinology, Maj Institute of Pharmacology, Polish Academy of Sciences, 12 Smętna St., 31-343 Kraków, Poland
| |
Collapse
|
8
|
Abstract
Recently, substrate stiffness has been involved in the physiology and pathology of the nervous system. However, the role and function of substrate stiffness remain unclear. Here, we review known effects of substrate stiffness on nerve cell morphology and function in the central and peripheral nervous systems and their involvement in pathology. We hope this review will clarify the research status of substrate stiffness in nerve cells and neurological disorder.
Collapse
Affiliation(s)
- Weijin Si
- Key Laboratory of Cognitive Science, Hubei Key Laboratory of Medical Information Analysis and Tumor Diagnosis & Treatment, Laboratory of Membrane Ion Channels and Medicine, College of Biomedical Engineering, South-Central Minzu University, Wuhan 430074, China
| | - Jihong Gong
- Key Laboratory of Cognitive Science, Hubei Key Laboratory of Medical Information Analysis and Tumor Diagnosis & Treatment, Laboratory of Membrane Ion Channels and Medicine, College of Biomedical Engineering, South-Central Minzu University, Wuhan 430074, China
| | - Xiaofei Yang
- Key Laboratory of Cognitive Science, Hubei Key Laboratory of Medical Information Analysis and Tumor Diagnosis & Treatment, Laboratory of Membrane Ion Channels and Medicine, College of Biomedical Engineering, South-Central Minzu University, Wuhan 430074, China
| |
Collapse
|
9
|
Hwang M, Zhang Z, Katz J, Freeman C, Kilbaugh T. Brain contrast-enhanced ultrasonography and elastography in infants. Ultrasonography 2022; 41:633-649. [PMID: 35879109 PMCID: PMC9532200 DOI: 10.14366/usg.21224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/20/2022] [Accepted: 03/30/2022] [Indexed: 11/19/2022] Open
Abstract
Advanced ultrasound techniques, including brain contrast-enhanced ultrasonography and elastography, are increasingly being explored to better understand infant brain health. While conventional brain ultrasonography provides a convenient, noninvasive means of assessing major intracranial pathologies, its value in revealing functional and physiologic insights into the brain lags behind advanced imaging techniques such as magnetic resonance imaging. In this regard, contrast-enhanced ultrasonography provides highly precise functional information on macrovascular and microvascular perfusion, while brain elastography offers information on brain stiffness that may be associated with relevant physiological factors of diagnostic, therapeutic, and/or prognostic utility. This review details the technical background, current understanding and utility, and future directions of these two emerging advanced ultrasound techniques for neonatal brain applications.
Collapse
Affiliation(s)
- Misun Hwang
- Department of Radiology, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Zeng Zhang
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Joseph Katz
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Colbey Freeman
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Todd Kilbaugh
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
10
|
Hu L, Yang S, Jin B, Wang C. Advanced Neuroimaging Role in Traumatic Brain Injury: A Narrative Review. Front Neurosci 2022; 16:872609. [PMID: 35495065 PMCID: PMC9043279 DOI: 10.3389/fnins.2022.872609] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/14/2022] [Indexed: 12/11/2022] Open
Abstract
Traumatic brain injury (TBI) is a common source of morbidity and mortality among civilians and military personnel. Initial routine neuroimaging plays an essential role in rapidly assessing intracranial injury that may require intervention. However, in the context of TBI, limitations of routine neuroimaging include poor visualization of more subtle changes of brain parenchymal after injury, poor prognostic ability and inability to analyze cerebral perfusion, metabolite and mechanical properties. With the development of modern neuroimaging techniques, advanced neuroimaging techniques have greatly boosted the studies in the diagnosis, prognostication, and eventually impacting treatment of TBI. Advances in neuroimaging techniques have shown potential, including (1) Ultrasound (US) based techniques (contrast-enhanced US, intravascular US, and US elastography), (2) Magnetic resonance imaging (MRI) based techniques (diffusion tensor imaging, magnetic resonance spectroscopy, perfusion weighted imaging, magnetic resonance elastography and functional MRI), and (3) molecular imaging based techniques (positron emission tomography and single photon emission computed tomography). Therefore, in this review, we aim to summarize the role of these advanced neuroimaging techniques in the evaluation and management of TBI. This review is the first to combine the role of the US, MRI and molecular imaging based techniques in TBI. Advanced neuroimaging techniques have great potential; still, there is much to improve. With more clinical validation and larger studies, these techniques will be likely applied for routine clinical use from the initial research.
Collapse
Affiliation(s)
- Ling Hu
- Department of Ultrasound, Hangzhou Women’s Hospital, Hangzhou, China
| | - Siyu Yang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bo Jin
- Department of Neurology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, China
| | - Chao Wang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Chao Wang,
| |
Collapse
|
11
|
Freeman CW, Hwang M. Advanced Ultrasound Techniques for Neuroimaging in Pediatric Critical Care: A Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:170. [PMID: 35204891 PMCID: PMC8870205 DOI: 10.3390/children9020170] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 12/31/2022]
Abstract
Because of its portability, safety profile, and accessibility, ultrasound has been integral in pediatric neuroimaging. While conventional B-mode and Doppler ultrasound provide anatomic and limited flow information, new and developing advanced ultrasound techniques are facilitating real-time visualization of brain perfusion, microvascular flow, and changes in tissue stiffness in the brain. These techniques, which include contrast-enhanced ultrasound, microvascular imaging, and elastography, are providing new insights into and new methods of evaluating pathologies affecting children requiring critical care, including hypoxic-ischemic encephalopathy, stroke, and hydrocephalus. This review introduces advanced neurosonography techniques and their clinical applications in pediatric neurocritical care.
Collapse
Affiliation(s)
- Colbey W. Freeman
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA 19104, USA;
| | - Misun Hwang
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA 19104, USA;
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| |
Collapse
|
12
|
Mechanosensing and the Hippo Pathway in Microglia: A Potential Link to Alzheimer's Disease Pathogenesis? Cells 2021; 10:cells10113144. [PMID: 34831369 PMCID: PMC8622675 DOI: 10.3390/cells10113144] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 01/01/2023] Open
Abstract
The activation of microglia, the inflammatory cells of the central nervous system (CNS), has been linked to the pathogenesis of Alzheimer’s disease and other neurodegenerative diseases. How microglia sense the changing brain environment, in order to respond appropriately, is still being elucidated. Microglia are able to sense and respond to the mechanical properties of their microenvironment, and the physical and molecular pathways underlying this mechanosensing/mechanotransduction in microglia have recently been investigated. The Hippo pathway functions through mechanosensing and subsequent protein kinase cascades, and is critical for neuronal development and many other cellular processes. In this review, we examine evidence for the potential involvement of Hippo pathway components specifically in microglia in the pathogenesis of Alzheimer’s disease. We suggest that the Hippo pathway is worth investigating as a mechanosensing pathway in microglia, and could be one potential therapeutic target pathway for preventing microglial-induced neurodegeneration in AD.
Collapse
|
13
|
Silva RV, Morr AS, Mueller S, Koch SP, Boehm-Sturm P, Rodriguez-Sillke Y, Kunkel D, Tzschätzsch H, Kühl AA, Schnorr J, Taupitz M, Sack I, Infante-Duarte C. Contribution of Tissue Inflammation and Blood-Brain Barrier Disruption to Brain Softening in a Mouse Model of Multiple Sclerosis. Front Neurosci 2021; 15:701308. [PMID: 34497486 PMCID: PMC8419310 DOI: 10.3389/fnins.2021.701308] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/19/2021] [Indexed: 12/17/2022] Open
Abstract
Neuroinflammatory processes occurring during multiple sclerosis cause disseminated softening of brain tissue, as quantified by in vivo magnetic resonance elastography (MRE). However, inflammation-mediated tissue alterations underlying the mechanical integrity of the brain remain unclear. We previously showed that blood-brain barrier (BBB) disruption visualized by MRI using gadolinium-based contrast agent (GBCA) does not correlate with tissue softening in active experimental autoimmune encephalomyelitis (EAE). However, it is unknown how confined BBB changes and other inflammatory processes may determine local elasticity changes. Therefore, we aim to elucidate which inflammatory hallmarks are determinant for local viscoelastic changes observed in EAE brains. Hence, novel multifrequency MRE was applied in combination with GBCA-based MRI or very small superparamagnetic iron oxide particles (VSOPs) in female SJL mice with induced adoptive transfer EAE (n = 21). VSOPs were doped with europium (Eu-VSOPs) to facilitate the post-mortem analysis. Accumulation of Eu-VSOPs, which was previously demonstrated to be sensitive to immune cell infiltration and ECM remodeling, was also found to be independent of GBCA enhancement. Following registration to a reference brain atlas, viscoelastic properties of the whole brain and areas visualized by either Gd or VSOP were quantified. MRE revealed marked disseminated softening across the whole brain in mice with established EAE (baseline: 3.1 ± 0.1 m/s vs. EAE: 2.9 ± 0.2 m/s, p < 0.0001). A similar degree of softening was observed in sites of GBCA enhancement i.e., mainly within cerebral cortex and brain stem (baseline: 3.3 ± 0.4 m/s vs. EAE: 3.0 ± 0.5 m/s, p = 0.018). However, locations in which only Eu-VSOP accumulated, mainly in fiber tracts (baseline: 3.0 ± 0.4 m/s vs. EAE: 2.6 ± 0.5 m/s, p = 0.023), softening was more pronounced when compared to non-hypointense areas (percent change of stiffness for Eu-VSOP accumulation: -16.81 ± 16.49% vs. for non-hypointense regions: -5.85 ± 3.81%, p = 0.048). Our findings suggest that multifrequency MRE is sensitive to differentiate between local inflammatory processes with a strong immune cell infiltrate that lead to VSOP accumulation, from disseminated inflammation and BBB leakage visualized by GBCA. These pathological events visualized by Eu-VSOP MRI and MRE may include gliosis, macrophage infiltration, alterations of endothelial matrix components, and/or extracellular matrix remodeling. MRE may therefore represent a promising imaging tool for non-invasive clinical assessment of different pathological aspects of neuroinflammation.
Collapse
Affiliation(s)
- Rafaela Vieira Silva
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Immunology, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Einstein Center for Neurosciences Berlin, Berlin, Germany
| | - Anna S Morr
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Berlin, Germany
| | - Susanne Mueller
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Experimental Neurology and Center for Stroke Research, Berlin, Germany.,Charité - Universitätsmedizin Berlin, NeuroCure Cluster of Excellence and Charité Core Facility 7T Experimental MRIs, Berlin, Germany
| | - Stefan Paul Koch
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Experimental Neurology and Center for Stroke Research, Berlin, Germany.,Charité - Universitätsmedizin Berlin, NeuroCure Cluster of Excellence and Charité Core Facility 7T Experimental MRIs, Berlin, Germany
| | - Philipp Boehm-Sturm
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Experimental Neurology and Center for Stroke Research, Berlin, Germany.,Charité - Universitätsmedizin Berlin, NeuroCure Cluster of Excellence and Charité Core Facility 7T Experimental MRIs, Berlin, Germany
| | - Yasmina Rodriguez-Sillke
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Flow & Mass Cytometry Core Facility, Berlin, Germany
| | - Désirée Kunkel
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Flow & Mass Cytometry Core Facility, Berlin, Germany
| | - Heiko Tzschätzsch
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Berlin, Germany
| | - Anja A Kühl
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jörg Schnorr
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Berlin, Germany
| | - Matthias Taupitz
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Berlin, Germany
| | - Ingolf Sack
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Berlin, Germany
| | - Carmen Infante-Duarte
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Immunology, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Einstein Center for Neurosciences Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC Experimental and Clinical Research Center, Berlin, Germany
| |
Collapse
|
14
|
Bryniarska-Kubiak N, Kubiak A, Lekka M, Basta-Kaim A. The emerging role of mechanical and topographical factors in the development and treatment of nervous system disorders: dark and light sides of the force. Pharmacol Rep 2021; 73:1626-1641. [PMID: 34390472 PMCID: PMC8599311 DOI: 10.1007/s43440-021-00315-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 12/14/2022]
Abstract
Nervous system diseases are the subject of intensive research due to their association with high mortality rates and their potential to cause irreversible disability. Most studies focus on targeting the biological factors related to disease pathogenesis, e.g. use of recombinant activator of plasminogen in the treatment of stroke. Nevertheless, multiple diseases such as Parkinson’s disease and Alzheimer’s disease still lack successful treatment. Recently, evidence has indicated that physical factors such as the mechanical properties of cells and tissue and topography play a crucial role in homeostasis as well as disease progression. This review aims to depict these factors’ roles in the progression of nervous system diseases and consequently discusses the possibility of new therapeutic approaches. The literature is reviewed to provide a deeper understanding of the roles played by physical factors in nervous system disease development to aid in the design of promising new treatment approaches.
Collapse
Affiliation(s)
- Natalia Bryniarska-Kubiak
- Laboratory of Immunoendocrinology, Department of Experimental Neuroendocrinology, Maj Institute of Pharmacology, Polish Academy of Sciences, Smętna 12, 31-343, Kraków, Poland.
| | - Andrzej Kubiak
- Department of Biophysical Microstructures, Institute of Nuclear Physics, Polish Academy of Sciences, 31342, Kraków, Poland
| | - Małgorzata Lekka
- Department of Biophysical Microstructures, Institute of Nuclear Physics, Polish Academy of Sciences, 31342, Kraków, Poland
| | - Agnieszka Basta-Kaim
- Laboratory of Immunoendocrinology, Department of Experimental Neuroendocrinology, Maj Institute of Pharmacology, Polish Academy of Sciences, Smętna 12, 31-343, Kraków, Poland.
| |
Collapse
|
15
|
Guo Q, Kawahata I, Degawa T, Ikeda-Matsuo Y, Sun M, Han F, Fukunaga K. Fatty Acid-Binding Proteins Aggravate Cerebral Ischemia-Reperfusion Injury in Mice. Biomedicines 2021; 9:529. [PMID: 34068550 PMCID: PMC8150391 DOI: 10.3390/biomedicines9050529] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/29/2021] [Accepted: 05/04/2021] [Indexed: 12/14/2022] Open
Abstract
Fatty acid-binding proteins (FABPs) regulate the intracellular dynamics of fatty acids, mediate lipid metabolism and participate in signaling processes. However, the therapeutic efficacy of targeting FABPs as novel therapeutic targets for cerebral ischemia is not well established. Previously, we synthesized a novel FABP inhibitor, i.e., FABP ligand 6 [4-(2-(5-(2-chlorophenyl)-1-(4-isopropylphenyl)-1H-pyrazol-3-yl)-4-fluorophenoxy)butanoic acid] (referred to here as MF6). In this study, we analyzed the ability of MF6 to ameliorate transient middle cerebral artery occlusion (tMCAO) and reperfusion-induced injury in mice. A single MF6 administration (3.0 mg/kg, per os) at 0.5 h post-reperfusion effectively reduced brain infarct volumes and neurological deficits. The protein-expression levels of FABP3, FABP5 and FABP7 in the brain gradually increased after tMCAO. Importantly, MF6 significantly suppressed infarct volumes and the elevation of FABP-expression levels at 12 h post-reperfusion. MF6 also inhibited the promotor activity of FABP5 in human neuroblastoma cells (SH-SY5Y). These data suggest that FABPs elevated infarct volumes after ischemic stroke and that inhibiting FABPs ameliorated the ischemic injury. Moreover, MF6 suppressed the inflammation-associated prostaglandin E2 levels through microsomal prostaglandin E synthase-1 expression in the ischemic hemispheres. Taken together, the results imply that the FABP inhibitor MF6 can potentially serve as a neuroprotective therapeutic for ischemic stroke.
Collapse
Affiliation(s)
- Qingyun Guo
- Department of Pharmacology, Graduate School of Pharmaceutical Sciences, Tohoku University, 6-3 Aramaki-Aoba, Aoba-Ku, Sendai 980-8578, Japan; (Q.G.); (I.K.); (T.D.); (M.S.)
| | - Ichiro Kawahata
- Department of Pharmacology, Graduate School of Pharmaceutical Sciences, Tohoku University, 6-3 Aramaki-Aoba, Aoba-Ku, Sendai 980-8578, Japan; (Q.G.); (I.K.); (T.D.); (M.S.)
| | - Tomohide Degawa
- Department of Pharmacology, Graduate School of Pharmaceutical Sciences, Tohoku University, 6-3 Aramaki-Aoba, Aoba-Ku, Sendai 980-8578, Japan; (Q.G.); (I.K.); (T.D.); (M.S.)
| | - Yuri Ikeda-Matsuo
- Laboratory of Pharmacology, Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Hokuriku University, Kanagawa-Machi, Kanazawa 920-1181, Japan;
| | - Meiling Sun
- Department of Pharmacology, Graduate School of Pharmaceutical Sciences, Tohoku University, 6-3 Aramaki-Aoba, Aoba-Ku, Sendai 980-8578, Japan; (Q.G.); (I.K.); (T.D.); (M.S.)
| | - Feng Han
- School of Pharmacy, Nanjing Medical School, Nanjing 211166, China;
| | - Kohji Fukunaga
- Department of Pharmacology, Graduate School of Pharmaceutical Sciences, Tohoku University, 6-3 Aramaki-Aoba, Aoba-Ku, Sendai 980-8578, Japan; (Q.G.); (I.K.); (T.D.); (M.S.)
| |
Collapse
|
16
|
Garcés Iñigo E, Llorens Salvador R, Escrig R, Hervás D, Vento M, Martí-Bonmatí L. Quantitative Evaluation of Neonatal Brain Elasticity Using Shear Wave Elastography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:795-804. [PMID: 32876366 DOI: 10.1002/jum.15464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/09/2020] [Accepted: 07/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To demonstrate the feasibility of 2-dimensional brain ultrasound shear wave elastography (SWE) and to define the average elasticity values of the gray and white matter in term neonates. METHODS This work was a prospective observational single-center study including 55 healthy term neonates consecutively recruited in the maternity ward between the second and third postnatal days. All were successfully evaluated with a cerebral SWE examination performed with a multifrequency 4-9-MHz transducer. Bilateral sagittal planes of the thalamus and corona radiata were used to measure stiffness using a quantitative SWE method. Several elastograms with 5 to 15 nonoverlapping areas were obtained from the 2 different anatomic locations. The 5 most central measurements were averaged as representative values. RESULTS The 55 neonates ranged from 37 to 40 weeks' gestation. The estimated mean velocity values of the thalamus (1.17 m/s; 95% confidence interval, 1.13, 1.22 m/s) and corona radiata (1.60 m/s; 95% confidence interval, 1.57, 1.64 m/s) were statistically different (P < .001). There was no significant influence of laterality, gestational age, cephalic perimeter, sex, length, or type of delivery on the stiffness measurements. CONCLUSIONS Brain ultrasound SWE is feasible and allows measurements of neonatal brain elasticity. The elasticity of the thalamus and corona radiata at the frontal white matter in healthy term neonates is different. The knowledge of normal SWE ranges in term neonates allows comparative studies under pathologic conditions.
Collapse
Affiliation(s)
| | | | - Raquel Escrig
- Department of Pediatrics, Neonatal Research Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - David Hervás
- Data Science, Biostatistics, and Bioinformatics Platform, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Máximo Vento
- Department of Pediatrics, Neonatal Research Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Luis Martí-Bonmatí
- Department of Radiology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Research Group on Biomedical Imaging, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| |
Collapse
|
17
|
Chan HW, Uff C, Chakraborty A, Dorward N, Bamber JC. Clinical Application of Shear Wave Elastography for Assisting Brain Tumor Resection. Front Oncol 2021; 11:619286. [PMID: 33732645 PMCID: PMC7956956 DOI: 10.3389/fonc.2021.619286] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/08/2021] [Indexed: 12/20/2022] Open
Abstract
Background The clinical outcomes for brain tumor resection have been shown to be significantly improved with increased extent of resection. To achieve this, neurosurgeons employ different intra-operative tools to improve the extent of resection of brain tumors, including ultrasound, CT, and MRI. Young’s modulus (YM) of brain tumors have been shown to be different from normal brain but the accuracy of SWE in assisting brain tumor resection has not been reported. Aims To determine the accuracy of SWE in detecting brain tumor residual using post-operative MRI scan as “gold standard”. Methods Thirty-four patients (aged 1–62 years, M:F = 15:20) with brain tumors were recruited into the study. The intraoperative SWE scans were performed using Aixplorer® (SuperSonic Imagine, France) using a sector transducer (SE12-3) and a linear transducer (SL15-4) with a bandwidth of 3 to 12 MHz and 4 to 15 MHz, respectively, using the SWE mode. The scans were performed prior, during and after brain tumor resection. The presence of residual tumor was determined by the surgeon, ultrasound (US) B-mode and SWE. This was compared with the presence of residual tumor on post-operative MRI scan. Results The YM of the brain tumors correlated significantly with surgeons’ findings (ρ = 0.845, p < 0.001). The sensitivities of residual tumor detection by the surgeon, US B-mode and SWE were 36%, 73%, and 94%, respectively, while their specificities were 100%, 63%, and 77%, respectively. There was no significant difference between detection of residual tumor by SWE, US B-mode, and MRI. SWE and MRI were significantly better than the surgeon’s detection of residual tumor (p = 0.001 and p < 0.001, respectively). Conclusions SWE had a higher sensitivity in detecting residual tumor than the surgeons (94% vs. 36%). However, the surgeons had a higher specificity than SWE (100% vs. 77%). Therefore, using SWE in combination with surgeon’s opinion may optimize the detection of residual tumor, and hence improve the extent of brain tumor resection.
Collapse
Affiliation(s)
- Huan Wee Chan
- Joint Department of Physics, Institute of Cancer Research and the Royal Marsden Hospital, Sutton, United Kingdom.,Neurosurgery Department, Southampton General Hospital, Southampton, United Kingdom
| | - Christopher Uff
- Neurosurgery Department, Royal London Hospital, London, United Kingdom
| | - Aabir Chakraborty
- Neurosurgery Department, Southampton General Hospital, Southampton, United Kingdom
| | - Neil Dorward
- Neurosurgery Department, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Jeffrey Colin Bamber
- Joint Department of Physics, Institute of Cancer Research and the Royal Marsden Hospital, Sutton, United Kingdom
| |
Collapse
|
18
|
Woodward KE, de Jesus P, Esser MJ. Neuroinflammation and Precision Medicine in Pediatric Neurocritical Care: Multi-Modal Monitoring of Immunometabolic Dysfunction. Int J Mol Sci 2020; 21:E9155. [PMID: 33271778 PMCID: PMC7730047 DOI: 10.3390/ijms21239155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/26/2020] [Accepted: 11/28/2020] [Indexed: 11/17/2022] Open
Abstract
The understanding of molecular biology in neurocritical care (NCC) is expanding rapidly and recognizing the important contribution of neuroinflammation, specifically changes in immunometabolism, towards pathological disease processes encountered across all illnesses in the NCC. Additionally, the importance of individualized inflammatory responses has been emphasized, acknowledging that not all individuals have the same mechanisms contributing towards their presentation. By understanding cellular processes that drive disease, we can make better personalized therapy decisions to improve patient outcomes. While the understanding of these cellular processes is evolving, the ability to measure such cellular responses at bedside to make acute care decisions is lacking. In this overview, we review cellular mechanisms involved in pathological neuroinflammation with a focus on immunometabolic dysfunction and review non-invasive bedside tools that have the potential to measure indirect and direct markers of shifts in cellular metabolism related to neuroinflammation. These tools include near-infrared spectroscopy, transcranial doppler, elastography, electroencephalography, magnetic resonance imaging and spectroscopy, and cytokine analysis. Additionally, we review the importance of genetic testing in providing information about unique metabolic profiles to guide individualized interpretation of bedside data. Together in tandem, these modalities have the potential to provide real time information and guide more informed treatment decisions.
Collapse
Affiliation(s)
| | | | - Michael J. Esser
- Alberta Children’s Hospital, University of Calgary, Calgary, AB T3B 6A8, Canada; (K.E.W.); (P.d.J.)
| |
Collapse
|
19
|
Liao J, Yang H, Yu J, Liang X, Chen Z. Progress in the Application of Ultrasound Elastography for Brain Diseases. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:2093-2104. [PMID: 32385862 DOI: 10.1002/jum.15317] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/28/2020] [Accepted: 04/08/2020] [Indexed: 06/11/2023]
Abstract
Ultrasound (US) can be used to evaluate the brain structure and nervous system damage. Patients with neurologic symptoms need rapid, noninvasive imaging with high spatial resolution and tissue contrast. Magnetic resonance imaging is currently the most sensitive and specific imaging method for evaluating neuropathologic conditions. This approach does present some challenges, such as the need to transport patients who may be seriously ill to the magnetic resonance imaging suite and the need for patients to remain for a considerable time. Cranial US provides a very valuable imaging method for clinicians, which can make a rapid diagnosis and evaluation without ionizing radiation. The main disadvantage of cranial US is its low sensitivity and specificity for subtle/early lesions. In recent years, with the rapid development of anatomic and functional US technology, the practicability of US diagnosis and intervention has been greatly improved. Ultrasound elastography may have the potential to improve the sensitivity and specificity of various cranial nerve conditions. Ultrasound elastography has received considerable critical attention, and an increasing number of studies have recognized its critical role in evaluating brain diseases. At present, US elastography has been applied to the evaluation of traumatic brain injury, ischemic stroke, intraoperative brain tumors, and hypoxic ischemic encephalopathy. The latest animal experiments and human clinical trial developments in the applications of US elastography for brain diseases are summarized in this review.
Collapse
Affiliation(s)
- Jianyi Liao
- Department of Ultrasound Medicine, Laboratory of Ultrasound Molecular Imaging, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Huihui Yang
- Department of Ultrasound Medicine, Laboratory of Ultrasound Molecular Imaging, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jinsui Yu
- Department of Ultrasound Medicine, Laboratory of Ultrasound Molecular Imaging, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaowen Liang
- Department of Ultrasound Medicine, Laboratory of Ultrasound Molecular Imaging, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhiyi Chen
- Department of Ultrasound Medicine, Laboratory of Ultrasound Molecular Imaging, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| |
Collapse
|
20
|
Ultrasound Elastography: Review of Techniques, Clinical Application, Technical Limitations, and Safety Considerations in Neonatology. ACTA MEDICA MARTINIANA 2020. [DOI: 10.2478/acm-2020-0009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Abstract
Ultrasound elastography is a relatively new non-invasive diagnostic imaging technology that maps elastic properties and the stiffness of soft tissue. In general, these methods can be classified into strain imaging methods that use internal or external compression stimuli and a shear wave imaging that use ultrasound-generated travelling shear wave stimuli. In this review we describe the basics of ultrasound elastography, discuss differences between various ultrasound elastography techniques, and review advantages, limitations, and the safety of these techniques in clinical practice, especially in neonatology. Furthermore, we review the potential of application of elastography in revealing brain injury and characterizing age dependent differences in preterm and term infants.
Collapse
|
21
|
Asal N, İnal M, Şahan MH, Say B. Assessment of the optic nerve using strain and shear-wave elastography in patients with pseudotumour cerebri. Clin Radiol 2020; 75:629-635. [PMID: 32381345 DOI: 10.1016/j.crad.2020.03.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 03/31/2020] [Indexed: 12/18/2022]
Abstract
AIM To evaluate the optic nerve using strain elastography (SE) and shear-wave elastography (SWE) in idiopathic intracranial hypertension (IIH) patients in comparison to participants in the control group. MATERIALS AND METHODS Eighty eyes were evaluated in 40 cases consisting of 20 IIH patients and 20 participants in the control group. This study was conducted using SE and SWE in addition optic nerve sonography measurements of participants in the IIH patient group and the control group. SE patterns were categorised using three main types and two subtypes. Quantitative measurements of optic nerve stiffness with SWE were expressed in kilopascals. RESULTS In the IIH patient group, type 2 and type 1 elasticity patterns were primarily observed, followed by type 3 patterns. In the control group, type 3 elasticity patterns were most often observed, while type 2 elasticity patterns were seen less frequently. Statistically significance differences in the types of elasticity strain patterns were observed between the groups (p<0.01). Quantitative analysis was also performed, and the SWE moduli were obtained for the control group (10.1±0.28 kPa) and the IIH patient group (26.97±1 kPa). A statistically significant difference in the SWE modulus was found between the groups (p<0.01). CONCLUSION Biomechanical changes may have occurred in the optic nerve secondary to increased intracranial pressure in IIH patients. Strain and shear elastography may have potential as assistive diagnostic techniques for the detection and follow-up of these changes.
Collapse
Affiliation(s)
- N Asal
- Department of Radiology, Kirikkale University School of Medicine, Kirikkale, Turkey.
| | - M İnal
- Department of Radiology, Kirikkale University School of Medicine, Kirikkale, Turkey
| | - M H Şahan
- Department of Radiology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - B Say
- Department of Neurology, Kirikkale University School of Medicine, Kirikkale, Turkey
| |
Collapse
|
22
|
Makhija EP, Espinosa-Hoyos D, Jagielska A, Van Vliet KJ. Mechanical regulation of oligodendrocyte biology. Neurosci Lett 2019; 717:134673. [PMID: 31838017 DOI: 10.1016/j.neulet.2019.134673] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 11/25/2019] [Accepted: 12/01/2019] [Indexed: 12/27/2022]
Abstract
Oligodendrocytes (OL) are a subset of glial cells in the central nervous system (CNS) comprising the brain and spinal cord. The CNS environment is defined by complex biochemical and biophysical cues during development and response to injury or disease. In the last decade, significant progress has been made in understanding some of the key biophysical factors in the CNS that modulate OL biology, including their key role in myelination of neurons. Taken together, those studies offer translational implications for remyelination therapies, pharmacological research, identification of novel drug targets, and improvements in methods to generate human oligodendrocyte progenitor cells (OPCs) and OLs from donor stem cells in vitro. This review summarizes current knowledge of how various physical and mechanical cues affect OL biology and its implications for disease, therapeutic approaches, and generation of human OPCs and OLs.
Collapse
Affiliation(s)
- Ekta P Makhija
- BioSystems & Micromechanics (BioSyM) Interdisciplinary Research Group, Singapore-MIT Alliance for Research & Technology (SMART) CREATE, Singapore 138602; Critical Analytics for Manufacturing Personalized-Medicine (CAMP) Interdisciplinary Research Group, Singapore-MIT Alliance for Research & Technology (SMART) CREATE, 138602, Singapore
| | - Daniela Espinosa-Hoyos
- BioSystems & Micromechanics (BioSyM) Interdisciplinary Research Group, Singapore-MIT Alliance for Research & Technology (SMART) CREATE, Singapore 138602; Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139 USA
| | - Anna Jagielska
- BioSystems & Micromechanics (BioSyM) Interdisciplinary Research Group, Singapore-MIT Alliance for Research & Technology (SMART) CREATE, Singapore 138602; Department of Materials Science & Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139 USA.
| | - Krystyn J Van Vliet
- BioSystems & Micromechanics (BioSyM) Interdisciplinary Research Group, Singapore-MIT Alliance for Research & Technology (SMART) CREATE, Singapore 138602; Critical Analytics for Manufacturing Personalized-Medicine (CAMP) Interdisciplinary Research Group, Singapore-MIT Alliance for Research & Technology (SMART) CREATE, 138602, Singapore; Department of Materials Science & Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139 USA; Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139 USA.
| |
Collapse
|
23
|
Establishment of an Experimental Intracerebral Haemorrhage Model for Mass Effect Research using a Thermo-sensitive Hydrogel. Sci Rep 2019; 9:13838. [PMID: 31554852 PMCID: PMC6761290 DOI: 10.1038/s41598-019-50188-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 09/05/2019] [Indexed: 12/12/2022] Open
Abstract
The mechanical response of brain tissue closely relates to cerebral blood flow and brain diseases. During intracerebral haemorrhage (ICH), a mass effect occurs during the initial bleeding and results in significant tissue deformation. However, fewer studies have focused on the brain damage mechanisms and treatment approaches associated with mass effects compared to the secondary brain injuries after ICH, which may be a result of the absence of acceptable animal models mimicking a mass effect. Thus, a thermo-sensitive poly (N-isopropylacrylamide) (PNIPAM) hydrogel was synthesized and injected into the rat brain to establish an ICH model for mass effect research. The PNIPAM hydrogel or autologous blood was injected to establish an ICH animal model, and the space-occupying volumes, brain tissue elasticity, brain oedema, neuronal cell death, iron deposition and behavioural recovery were evaluated. The lower critical solution temperature of PNIPAM hydrogel was 32 °C, and the PNIPAM hydrogel had a rough surface with similar topography and pore structure to a blood clot. Furthermore, the ICH model animals who received an injection of PNIPAM and blood produced similar lesion volumes, elasticity changes and mechanically activated ion channel piezo-2 upregulation in brain tissue. Meanwhile, slight iron deposition, neuronal cell death and brain oedema were observed in the PNIPAM hydrogel model compared to the blood model. In addition, the PNIPAM hydrogel showed good biocompatibility and stability in vivo via subcutaneous implantation. Our findings show that PNIPAM hydrogel cerebral infusion can form a mass effect similar to haematoma and minimize the interference of blood, and the establishment of a mass effect ICH model is beneficial for understanding the mechanism of primary brain injury and the role of mass effects in secondary brain damage after ICH.
Collapse
|
24
|
Lay FY, Chen PY, Cheng HF, Kuo YM, Huang CC. Ex Vivo Evaluation of Mouse Brain Elasticity Using High-Frequency Ultrasound Elastography. IEEE Trans Biomed Eng 2019; 66:3426-3435. [PMID: 30892196 DOI: 10.1109/tbme.2019.2905551] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Most neurodegenerative diseases are highly linked with aging. The mechanical properties of the brain should be determined for predicting and diagnosing age-related brain diseases. A preclinical animal study is crucial for neurological disease research. However, estimation of the elasticity properties of different regions of mouse brains remains difficult because of the size of the brain. In this paper, high-frequency ultrasound elastography (HFUSE) based on shear wave imaging was proposed for mapping the stiffness of the mouse brain at different ages ex vivo. METHODS For HFUSE, a 40-MHz ultrasound array transducer with an ultrafast ultrasound imaging system was used in this paper. The accuracy and resolution during HFUSE were determined through a mechanical testing system and by conducting phantom experiments. RESULTS In the experiments, the error in the elastic modulus measurement was approximately 10% on average, and the axial resolution was 248 μm. Animal testing was conducted using mice that were 4 (young aged) and 11 (middle aged) months old. The elasticity distributions of the cortex and hippocampus in the mouse brains were obtained through HFUSE. CONCLUSION The average shear moduli of the cortex and hippocampus were 3.84 and 2.33 kPa for the 4-month-old mice and 3.77 and 1.94 kPa for the 11-month-old mice, respectively. No statistical difference was observed in the cortex stiffness of mice of different ages. However, the hippocampus significantly softened with aging.
Collapse
|
25
|
Al-Habib A, Albakr A, Al Towim A, Alkubeyyer M, Abu Jamea A, Albadr F, Eldawlatly AA, Kashour T, Alkhalidi H, Alzahrani T. In vivo assessment of spinal cord elasticity using shear wave ultrasound in dogs. J Neurosurg Spine 2018; 29:461-469. [DOI: 10.3171/2018.2.spine171195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVEEvaluation of living tissue elasticity has wide applications in disease characterization and prognosis prediction. Few previous ex vivo attempts have been made to characterize spinal cord elasticity (SCE). Recently, tissue elasticity assessment has been clinically feasible using ultrasound shear wave elastography (SWE). The current study aims to characterize SCE in healthy dogs, in vivo, utilizing SWE, and to address SCE changes during compression.METHODSTen Greyhound dogs (mean age 14 months; mean weight 14.3 kg) were anesthetized and tracheally intubated, with hemodynamic and neurological monitoring. A 3-level, midcervical laminectomy was performed. SCE was assessed at baseline. Next, 8- and 13-mm balloon compressions were sequentially applied ventral to the spinal cord.RESULTSThe mean SCE was 18.5 ± 7 kPa. Elasticity of the central canal, pia mater, and dura mater were 21.7 ± 9.6 kPa, 26.1 ± 14.8 kPa, and 63.2 ± 11.5 kPa, respectively. As expected, the spinal cord demonstrated less elasticity than the dura mater (p < 0.0001) and pia mater (trend toward significance p = 0.08). Notably, the 13-mm balloon compression resulted in a stiffer spinal cord than at baseline (233 ± 73 kPa versus 18.5 ± 7 kPa, p < 0.0001) and 8-mm balloon compression (233 ± 73 kPa versus 185 ± 68 kPa, p < 0.048).CONCLUSIONSIn vivo SCE evaluation using SWE is feasible and comparable to earlier reports, as demonstrated by physical sectioning of the spinal cord. The compressed spinal cord is stiffer than a free spinal cord, with a linear increase in SCE with increasing mechanical compression. Knowledge of the biomechanical properties of the spinal cord including SCE has potential implications for disease management and prognosis.
Collapse
Affiliation(s)
- Amro Al-Habib
- 1Division of Neurosurgery, Department of Surgery, and
| | | | | | | | | | | | | | | | - Hisham Alkhalidi
- 5Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | |
Collapse
|
26
|
deCampo D, Hwang M. Characterizing the Neonatal Brain With Ultrasound Elastography. Pediatr Neurol 2018; 86:19-26. [PMID: 30180999 DOI: 10.1016/j.pediatrneurol.2018.06.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 06/10/2018] [Indexed: 12/14/2022]
Abstract
Prematurity is associated with significant neurological injury and impaired neurodevelopment. In neonatology, ultrasonography is frequently used to assess for neurological injury. Ultrasonography allows rapid bedside imaging without radiation. Its limitations include the need for operator experience, lack of quantification, and lower prognostic power when compared with magnetic resonance imaging. Elastography is one of several technical advances used to enhance the diagnostic capability of traditional ultrasound. By detecting differences in tissue stiffness between normal and abnormal tissue, elastography has the potential to add objective and quantitative data to ultrasound imaging. Quantitative values could then be used to help detect injury, correlate outcome to predict prognosis, and guide surgical intervention. Since developmental processes such as myelination and neuropil formation may also influence brain stiffness, elastography may also serve as a unique tool to further delineate developmental differences between preterm and term infants. In this review, we provide a general overview of elastography, its application in neonatal neuroimaging, and possible future directions.
Collapse
Affiliation(s)
- Danielle deCampo
- Department of Pediatrics, Johns Hopkins Hospital, Baltimore, Maryland
| | - Misun Hwang
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| |
Collapse
|
27
|
Shin SS, Huisman TAGM, Hwang M. Ultrasound Imaging for Traumatic Brain Injury. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1857-1867. [PMID: 29388231 DOI: 10.1002/jum.14547] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/17/2017] [Accepted: 10/30/2017] [Indexed: 06/07/2023]
Abstract
Traumatic brain injury (TBI) is challenging to assess even with recent advancements in computed tomography and magnetic resonance imaging. Ultrasound (US) imaging has previously been less utilized in TBI compared to conventional imaging because of limited resolution in the intracranial space. However, there have been substantial improvements in contrast-enhanced US and development of novel techniques such as intravascular US. Also, continued research provides further insight into cerebrovascular parameters from transcranial Doppler imaging. These advancements in US imaging provides the community of TBI imaging researchers and clinicians new opportunities in clinically monitoring and understanding the pathologic mechanisms of TBI.
Collapse
Affiliation(s)
- Samuel S Shin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Thierry A G M Huisman
- Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Misun Hwang
- Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
28
|
Albayrak E, Kasap T. Evaluation of Neonatal Brain Parenchyma Using 2-Dimensional Shear Wave Elastography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:959-967. [PMID: 28850723 DOI: 10.1002/jum.14366] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 07/15/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the stiffness of the neonatal brain using 2-dimensional shear wave elastography in term and preterm neonates and to investigate possible stiffness differences between groups. METHODS A total of 83 neonates, including 44 term and 39 preterm, were included in the study. Shear wave elastographic measurements of the thalamus and occipital periventricular white matter were conducted via the anterior fontanel. The Pearson correlation coefficient was used to determine the association between the birth week and stiffness values of the thalamus and periventricular white matter. A receiver operating characteristic analysis was applied to determine the power of the stiffness of the thalamus and periventricular white matter in predicting a significant preterm classification. P < .05 was considered significant. RESULTS The brain parenchymal stiffness values measured from both the thalamus and periventricular white matter were found to be significantly lower in the preterm group compared with the term group. The periventricular white matter stiffness values were found to be lower than thalamus stiffness values in both groups. According to the receiver operating characteristic curve, the optimal cutoff values for determining prematurity were defined to be less than 8.28 kPa for the mean thalamus stiffness and less than 6.59 kPa for the periventricular white matter. CONCLUSIONS This study shows that differences between brain stiffness values in preterm and term neonates can be shown by using 2-dimensional shear wave elastography, and the results may be reference points for evaluating neonatal brain stiffness in research on patients with various illnesses.
Collapse
Affiliation(s)
- Eda Albayrak
- Department of Radiology, Gaziosmanpasa University, Medical Faculty, Tokat, Turkey
| | - Tuba Kasap
- Department of Pediatrics, Gaziosmanpasa University, Medical Faculty, Tokat, Turkey
| |
Collapse
|
29
|
Ertl M, Raasch N, Hammel G, Harter K, Lang C. Transtemporal Investigation of Brain Parenchyma Elasticity Using 2-D Shear Wave Elastography: Definition of Age-Matched Normal Values. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:78-84. [PMID: 28982629 DOI: 10.1016/j.ultrasmedbio.2017.08.1885] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/23/2017] [Accepted: 08/28/2017] [Indexed: 06/07/2023]
Abstract
The goal of our research was to assess the possibility of reliable investigation of brain tissue stiffness using ultrasonographic brain parenchyma elastography with an intact temporal bone. We enrolled 108 patients after exclusion of intracranial pathology or healthy volunteers. All patients were subdivided by age into groups: 20-40, 40-60 and >60 y. For statistical analysis, the χ2 test and t-test were used. The mean values, regardless of age and other parameters, were 3.34 kPa (SD = 0.59) on the left side and 3.33 kPa (SD = 0.58) on the right side. We found no correlation between the values, body mass index (r = 0.07, p = 0.48) and sex (t = -0.11, p = 0.91), but we observed a highly significant correlation between the values and age (r = 0.43, p <0.0001). We found ultrasonographic brain parenchyma elastography to be a valid, reproducible and investigator-independent method that reliably determines brain parenchyma stiffness. Normal values should serve as a reference for studies on various intracranial lesions.
Collapse
Affiliation(s)
- Michael Ertl
- Clinic for Neurology and Neurophysiology, Klinikum Augsburg, Augsburg, Germany.
| | - Nele Raasch
- Clinic for Neurology and Neurophysiology, Klinikum Augsburg, Augsburg, Germany
| | - Gertrud Hammel
- Chair and Institute of Environmental Medicine, UNIKA-T, Technical University of Munich and Helmholtz Zentrum München, Germany - German Research Center for Environmental Health, Augsburg, Germany; CK-CARE, Christine Kühne - Center for Allergy and Research and Education, Davos, Switzerland
| | - Katharina Harter
- Chair and Institute of Environmental Medicine, UNIKA-T, Technical University of Munich and Helmholtz Zentrum München, Germany - German Research Center for Environmental Health, Augsburg, Germany; CK-CARE, Christine Kühne - Center for Allergy and Research and Education, Davos, Switzerland
| | - Christopher Lang
- Clinic for Neurology and Neurophysiology, Klinikum Augsburg, Augsburg, Germany
| |
Collapse
|
30
|
Bailey C, Huisman TA, de Jong RM, Hwang M. Contrast-Enhanced Ultrasound and Elastography Imaging of the Neonatal Brain: A Review. J Neuroimaging 2017; 27:437-441. [DOI: 10.1111/jon.12443] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/20/2017] [Accepted: 03/21/2017] [Indexed: 12/16/2022] Open
Affiliation(s)
- Christopher Bailey
- Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science; Johns Hopkins Hospital; Baltimore MD
| | - Thierry A.G.M. Huisman
- Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science; Johns Hopkins Hospital; Baltimore MD
| | - Robert M. de Jong
- Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science; Johns Hopkins Hospital; Baltimore MD
| | - Misun Hwang
- Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science; Johns Hopkins Hospital; Baltimore MD
| |
Collapse
|
31
|
A Force-Visualized Silicone Retractor Attachable to Surgical Suction Pipes. SENSORS 2017; 17:s17040773. [PMID: 28379193 PMCID: PMC5422046 DOI: 10.3390/s17040773] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 03/25/2017] [Accepted: 04/02/2017] [Indexed: 11/28/2022]
Abstract
This paper presents a force-visually-observable silicone retractor, which is an extension of a previously developed system that had the same functions of retracting, suction, and force sensing. These features provide not only high usability by reducing the number of tool changes, but also a safe choice of retracting by visualized force information. Suction is achieved by attaching the retractor to a suction pipe. The retractor has a deformable sensing component including a hole filled with a liquid. The hole is connected to an outer tube, and the liquid level displaced in proportion to the extent of deformation resulting from the retracting load. The liquid level is capable to be observed around the surgeon’s fingertips, which enhances the usability. The new hybrid structure of soft sensing and hard retracting allows the miniaturization of the retractor as well as a resolution of less than 0.05 N and a range of 0.1–0.7 N. The overall structure is made of silicone, which has the advantages of disposability, low cost, and easy sterilization/disinfection. This system was validated by conducting experiments.
Collapse
|
32
|
Yin Z, Hughes JD, Trzasko JD, Glaser KJ, Manduca A, Van Gompel J, Link MJ, Romano A, Ehman RL, Huston J. Slip interface imaging based on MR-elastography preoperatively predicts meningioma-brain adhesion. J Magn Reson Imaging 2017; 46:1007-1016. [PMID: 28194925 PMCID: PMC5600107 DOI: 10.1002/jmri.25623] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 12/16/2016] [Accepted: 12/18/2016] [Indexed: 01/26/2023] Open
Abstract
Purpose To investigate the ability of slip interface imaging (SII), a recently developed magnetic resonance elastography (MRE)‐based technique, to predict the degree of meningioma–brain adhesion, using findings at surgery as the reference standard. Materials and Methods With Institutional Review Board approval and written informed consent, 25 patients with meningiomas >2.5 cm in maximal diameter underwent preoperative SII assessment. Intracranial shear motions were introduced using a soft, pillow‐like head driver and the resulting displacement field was acquired with an MRE pulse sequence on 3T MR scanners. The displacement data were analyzed to determine tumor–brain adhesion by assessing intensities on shear line images and raw as well as normalized octahedral shear strain (OSS) values along the interface. The SII findings of shear line images, OSS, and normalized OSS were independently and blindly correlated with surgical findings of tumor adhesion by using the Cohen's κ coefficient and chi‐squared test. Results Neurosurgeons categorized the surgical plane as extrapial (no adhesion) in 15 patients, mixed in four, and subpial (adhesion) in six. Both shear line images and OSS agreed with the surgical findings in 18 (72%) cases (fair agreement, κ = 0.37, 95% confidence interval [CI]: 0.05–0.69), while normalized OSS was concordant with the surgical findings in 23 (92%) cases (good agreement, κ = 0.86, 95% CI: 0.67–1). The correlation between SII predictions (shear line images, OSS, and normalized OSS) and the surgical findings were statistically significant (chi‐squared test, P = 0.02, P = 0.02, and P < 0.0001, respectively). Conclusion SII preoperatively evaluates the degree of meningioma–brain adhesion noninvasively, allowing for improved prediction of surgical risk and tumor resectability. Level of Evidence: 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2017;46:1007–1016.
Collapse
Affiliation(s)
- Ziying Yin
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Joshua D Hughes
- Department of Neurosurgery, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Joshua D Trzasko
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Kevin J Glaser
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Armando Manduca
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Jamie Van Gompel
- Department of Neurosurgery, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Michael J Link
- Department of Neurosurgery, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Anthony Romano
- Naval Research Laboratory, Code 7160, Washington, DC, USA
| | - Richard L Ehman
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - John Huston
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| |
Collapse
|
33
|
Kazemirad S, Bernard S, Hybois S, Tang A, Cloutier G. Ultrasound Shear Wave Viscoelastography: Model-Independent Quantification of the Complex Shear Modulus. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2016; 63:1399-1408. [PMID: 27362951 DOI: 10.1109/tuffc.2016.2583785] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Ultrasound shear wave elastography methods are commonly used for estimation of mechanical properties of soft biological tissues in diagnostic medicine. A limitation of most currently used elastography methods is that they yield only the shear storage modulus ( G' ) but not the loss modulus ( G'' ). Therefore, no information on viscosity or loss tangent (tan δ) is provided. In this paper, an ultrasound shear wave viscoelastography method is developed for model-independent quantification of frequency-dependent viscoelastic complex shear modulus of macroscopically homogeneous tissues. Three in vitro tissue-mimicking phantoms and two ex vivo porcine liver samples were evaluated. Shear waves were remotely induced within the samples using several acoustic radiation force pushes to generate a semicylindrical wave field similar to those generated by most clinically used elastography systems. The complex shear modulus was estimated over a broad frequency range (up to 1000 Hz) through the analytical solution of the developed inverse wave propagation problem using the measured shear wave speed and amplitude decay versus propagation distance. The shear storage and loss moduli obtained for the in vitro phantoms were compared with those from a planar shear wave method and the average differences over the whole frequency range studied were smaller than 7% and 15%, respectively. The reliability of the proposed method highlights its potential for viscoelastic tissue characterization, which may improve noninvasive diagnosis.
Collapse
|
34
|
Li C, Zhang C, Li J, Cao X, Song D. An Experimental Study of the Potential Biological Effects Associated with 2-D Shear Wave Elastography on the Neonatal Brain. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1551-1559. [PMID: 27112914 DOI: 10.1016/j.ultrasmedbio.2016.02.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 02/24/2016] [Accepted: 02/29/2016] [Indexed: 06/05/2023]
Abstract
2-D Shear wave elastography (SWE) imaging is widely used in clinical practice, and some researchers have applied this technique in the evaluation of neonatal brains. However, the immediate and long-term impacts of dynamic radiation force exposure on the neonatal central nervous system remain unknown. In this study, we exposed neonatal mice to 2-D SWE scanning for 10 min, 20 min and 30 min under diagnostic mode (mechanical index [MI]: 1.3; thermal index [TI]: 0.5), respectively. For the control group, the neonatal mice were sham irradiated for 30 min with the machine powered off. Their brains were collected and analyzed using histologic staining and western blot analysis at 24 h and 3 mo after the 2-D SWE scanning. The Morris water maze (MWM) test was used to assess learning and memory function of the mice at 3 mo of age. The results indicated that using 2-D SWE in evaluating brains of neonatal mice does not cause detectable histologic changes, nor does it have long-term effects on their learning and memory abilities. However, the PI3 K/AKT/mTOR pathway was disturbed when the 2-D SWE scanning lasted for more than 30 min, and the expression of p-PKCa was suppressed by 10 min or more in 2-D SWE scanning. Although these injuries may be self-repaired as the mice grow, more attention should be paid to the scanning duration when applying 2-D-SWE elastography in the assessment of neonatal brains.
Collapse
Affiliation(s)
- Changtian Li
- Department of Ultrasound, The Southern Building, Chinese PLA General Hospital, Beijing, China
| | - Changsheng Zhang
- Anesthesia and Operation Center, Chinese PLA General Hospital, Beijing, China
| | - Junlai Li
- Department of Ultrasound, The Southern Building, Chinese PLA General Hospital, Beijing, China.
| | - Xiaolin Cao
- Department of Ultrasound, The Southern Building, Chinese PLA General Hospital, Beijing, China
| | - Danfei Song
- Department of Ultrasound, The Southern Building, Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
35
|
Gu Q, Tomaskovic‐Crook E, Lozano R, Chen Y, Kapsa RM, Zhou Q, Wallace GG, Crook JM. Functional 3D Neural Mini-Tissues from Printed Gel-Based Bioink and Human Neural Stem Cells. Adv Healthc Mater 2016; 5:1429-38. [PMID: 27028356 DOI: 10.1002/adhm.201600095] [Citation(s) in RCA: 233] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/08/2016] [Indexed: 12/19/2022]
Abstract
Direct-write printing of stem cells within biomaterials presents an opportunity to engineer tissue for in vitro modeling and regenerative medicine. Here, a first example of constructing neural tissue by printing human neural stem cells that are differentiated in situ to functional neurons and supporting neuroglia is reported. The supporting biomaterial incorporates a novel clinically relevant polysaccharide-based bioink comprising alginate, carboxymethyl-chitosan, and agarose. The printed bioink rapidly gels by stable cross-linking to form a porous 3D scaffold encapsulating stem cells for in situ expansion and differentiation. Differentiated neurons form synaptic contacts, establish networks, are spontaneously active, show a bicuculline-induced increased calcium response, and are predominantly gamma-aminobutyric acid expressing. The 3D tissues will facilitate investigation of human neural development, function, and disease, and may be adaptable for engineering other 3D tissues from different stem cell types.
Collapse
Affiliation(s)
- Qi Gu
- ARC Centre of Excellence for Electromaterials Science Intelligent Polymer Research Institute AIIM Facility Innovation Campus University of Wollongong Squires Way Fairy Meadow New South Wales 2519 Australia
- State Key Laboratory of Stem Cell and Reproductive Biology Institute of Zoology Chinese Academy of Sciences Beijing 100101 P. R. China
| | - Eva Tomaskovic‐Crook
- ARC Centre of Excellence for Electromaterials Science Intelligent Polymer Research Institute AIIM Facility Innovation Campus University of Wollongong Squires Way Fairy Meadow New South Wales 2519 Australia
- Illawarra Health and Medical Research Institute University of Wollongong Wollongong New South Wales 2522 Australia
| | - Rodrigo Lozano
- ARC Centre of Excellence for Electromaterials Science Intelligent Polymer Research Institute AIIM Facility Innovation Campus University of Wollongong Squires Way Fairy Meadow New South Wales 2519 Australia
| | - Yu Chen
- ARC Centre of Excellence for Electromaterials Science Intelligent Polymer Research Institute AIIM Facility Innovation Campus University of Wollongong Squires Way Fairy Meadow New South Wales 2519 Australia
| | - Robert M. Kapsa
- ARC Centre of Excellence for Electromaterials Science Intelligent Polymer Research Institute AIIM Facility Innovation Campus University of Wollongong Squires Way Fairy Meadow New South Wales 2519 Australia
- Department of Medicine St Vincent's Hospital The University of Melbourne Fitzroy Victoria 3065 Australia
| | - Qi Zhou
- State Key Laboratory of Stem Cell and Reproductive Biology Institute of Zoology Chinese Academy of Sciences Beijing 100101 P. R. China
| | - Gordon G. Wallace
- ARC Centre of Excellence for Electromaterials Science Intelligent Polymer Research Institute AIIM Facility Innovation Campus University of Wollongong Squires Way Fairy Meadow New South Wales 2519 Australia
| | - Jeremy M. Crook
- ARC Centre of Excellence for Electromaterials Science Intelligent Polymer Research Institute AIIM Facility Innovation Campus University of Wollongong Squires Way Fairy Meadow New South Wales 2519 Australia
- Illawarra Health and Medical Research Institute University of Wollongong Wollongong New South Wales 2522 Australia
- Department of Surgery St Vincent's Hospital The University of Melbourne Fitzroy Victoria 3065 Australia
| |
Collapse
|
36
|
Wilson CL, Hayward SL, Kidambi S. Astrogliosis in a dish: substrate stiffness induces astrogliosis in primary rat astrocytes. RSC Adv 2016; 6:34447-34457. [PMID: 32742641 PMCID: PMC7394306 DOI: 10.1039/c5ra25916a] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Astrogliosis due to brain injury or disease can lead to varying molecular and morphological changes in astrocytes. Magnetic resonance elastography and ultrasound have demonstrated that brain stiffness varies with age and disease state. However, there is a lack in understanding the role of varied stiffness on the progression of astrogliosis highlighting a critical need to engineer in vitro models that mimic disease stages. Such models need to incorporate the dynamic changes in the brain microenvironment including the stiffness changes. In this study we developed a polydimethyl siloxane (PDMS) based platform that modeled the physiologically relevant stiffness of brain in both a healthy (200 Pa) and diseased (8000 Pa) state to investigate the effect of stiffness on astrocyte function. We observed that astrocytes grown on soft substrates displayed a consistently more quiescent phenotype while those on stiff substrates displayed an astrogliosis-like morphology. In addition to morphological changes, astrocytes cultured on stiff substrates demonstrated significant increase in other astrogliosis hallmarks - cellular proliferation and glial fibrillary acidic protein (GFAP) protein expression. Furthermore, culturing astrocytes on a stiff surface resulted in increased reactive oxygen species (ROS) production, increased super oxide dismutase activity and decreased glutamate uptake. Our platform lends itself for study of potential therapeutic strategies for brain injury focusing on the intricate brain microenvironment-astrocytes signaling pathways.
Collapse
Affiliation(s)
- Christina L Wilson
- Department of Chemical and Biomolecular Engineering, University of Nebraska-Lincoln, 820 N 16 Street, 207 Othmer Hall, NE, 68588, USA
| | - Stephen L Hayward
- Department of Chemical and Biomolecular Engineering, University of Nebraska-Lincoln, 820 N 16 Street, 207 Othmer Hall, NE, 68588, USA
| | - Srivatsan Kidambi
- Department of Chemical and Biomolecular Engineering, University of Nebraska-Lincoln, 820 N 16 Street, 207 Othmer Hall, NE, 68588, USA
- Nebraska Center for Materials and Nanoscience, University of Nebraska-Lincoln, 855 N 16 St, Lincoln, NE, 68588, USA
- Nebraska Center for the Prevention of Obesity Diseases, University of Nebraska-Lincoln, 316C Leverton Hall, 1700 35 Street, NE, 68583, USA
- Mary and Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, 42nd and Emile Street, Omaha, NE, 68198, USA
- Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| |
Collapse
|
37
|
White NJ, Mehic E, Wang X, Chien D, Lim E, St John AE, Stern SA, Mourad PD, Rieger M, Fries D, Martinowitz U. Rediscovering the wound hematoma as a site of hemostasis during major arterial hemorrhage. J Thromb Haemost 2015; 13:2202-9. [PMID: 26414624 PMCID: PMC4777306 DOI: 10.1111/jth.13158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 09/17/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Treatments for major internal bleeding after injury include permissive hypotension to decrease the rate of blood loss, intravenous infusion of plasma or clotting factors to improve clot formation, and rapid surgical hemostasis or arterial embolization to control bleeding vessels. Yet, little is known regarding major internal arterial hemostasis, or how these commonly used treatments might influence hemostasis. OBJECTIVES (i) To use a swine model of femoral artery bleeding to understand the perivascular hemostatic response to contained arterial hemorrhage. (ii) To directly confirm the association between hemodynamics and bleeding velocity. (iii) To observe the feasibility of delivering an activated clotting factor directly to internal sites of bleeding using a simplified angiographic approach. METHODS Ultrasound was used to measure bleeding velocity and in vivo clot formation by elastography in a swine model of contained femoral artery bleeding with fluid resuscitation. A swine model of internal pelvic and axillary artery hemorrhage was also used to demonstrate the feasibility of local delivery of an activated clotting factor. RESULTS In this model, clots formed slowly within the peri-wound hematoma, but eventually contained the bleeding. Central hemodynamics correlated positively with bleeding velocity. Infusion of recombinant human activated factor VII into the injured artery near the site of major internal hemorrhage in the pelvis and axillae was feasible. CONCLUSIONS We rediscovered that clot formation within the peri-wound hematoma is an integral component of hemostasis and a feasible target for the treatment of major internal bleeding using activated clotting factors delivered using a simplified angiographic approach.
Collapse
Affiliation(s)
- N J White
- Division of Emergency Medicine, University of Washington, Seattle, WA, USA
| | - E Mehic
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - X Wang
- Division of Emergency Medicine, University of Washington, Seattle, WA, USA
| | - D Chien
- Division of Emergency Medicine, University of Washington, Seattle, WA, USA
| | - E Lim
- Division of Emergency Medicine, University of Washington, Seattle, WA, USA
| | - A E St John
- Division of Emergency Medicine, University of Washington, Seattle, WA, USA
| | - S A Stern
- Division of Emergency Medicine, University of Washington, Seattle, WA, USA
| | - P D Mourad
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
- Division of Engineering and Mathematics, University of Washington, Bothell, WA, USA
| | - M Rieger
- Department of Diagnostic & Interventional Radiology, Medical Clinic Innsbruck, Innsbruck, Austria
| | - D Fries
- Clinical Department for General and Surgical Intensive Care Medicine of the Clinic for Anaesthesia and General Intensive Care Medicine, Medical Clinic Innsbruck, Innsbruck, Austria
| | - U Martinowitz
- Department for Hematology, TelHashomer University Hospital, Telaviv, Israel
| |
Collapse
|
38
|
Suarez MW, Dever DD, Gu X, Ray Illian P, McClintic AM, Mehic E, Mourad PD. Transcranial vibro-acoustography can detect traumatic brain injury, in-vivo: Preliminary studies. ULTRASONICS 2015; 61:151-156. [PMID: 25964238 DOI: 10.1016/j.ultras.2015.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 04/21/2015] [Accepted: 04/25/2015] [Indexed: 06/04/2023]
Abstract
Vibro-acoustography (VA) uses two or more beams of confocal ultrasound to generate local vibrations within their target tissue through induction of a time-dependent radiation force whose frequency equals that of the difference of the applied frequencies. While VA has proven effective for assaying the mechanical properties of clinically relevant tissue such as breast lesions and tissue calcifications, its application to brain remains unexplored. Here we investigate the ability of VA to detect acute and focal traumatic brain injury (TBI) in-vivo through the use of transcranially delivered high-frequency (2 MHz) diagnostic focused ultrasound to rat brain capable of generating measurable low-frequency (200-270 kHz) acoustic emissions from outside of the brain. We applied VA to acute sham-control and TBI model rats (sham N=6; TBI N=6) and observed that acoustic emissions, captured away from the site of TBI, had lower amplitudes for TBI as compared to sham-TBI animals. The sensitivity of VA to acute brain damage at frequencies currently transmittable across human skulls, as demonstrated in this preliminary study, supports the possibility that the VA methodology may one day serve as a technique for detecting TBI.
Collapse
Affiliation(s)
- Martin W Suarez
- Department of Bioengineering, Univ. of WA, 1959 NE Pacific St., Box 356470, Seattle, WA 98195, United States; Department of Neurological Surgery, Univ. of WA, 1959 NE Pacific St., Box 356470, Seattle, WA 98195, United States
| | - David D Dever
- Department of Bioengineering, Univ. of WA, 1959 NE Pacific St., Box 356470, Seattle, WA 98195, United States
| | - Xiaohan Gu
- Department of Bioengineering, Univ. of WA, 1959 NE Pacific St., Box 356470, Seattle, WA 98195, United States
| | - P Ray Illian
- Applied Physics Laboratory, Univ. of WA, 1959 NE Pacific St., Box 356470, Seattle, WA 98195, United States
| | - Abbi M McClintic
- Department of Neurological Surgery, Univ. of WA, 1959 NE Pacific St., Box 356470, Seattle, WA 98195, United States
| | - Edin Mehic
- Department of Bioengineering, Univ. of WA, 1959 NE Pacific St., Box 356470, Seattle, WA 98195, United States; Department of Neurological Surgery, Univ. of WA, 1959 NE Pacific St., Box 356470, Seattle, WA 98195, United States
| | - Pierre D Mourad
- Department of Bioengineering, Univ. of WA, 1959 NE Pacific St., Box 356470, Seattle, WA 98195, United States; Department of Neurological Surgery, Univ. of WA, 1959 NE Pacific St., Box 356470, Seattle, WA 98195, United States; Applied Physics Laboratory, Univ. of WA, 1959 NE Pacific St., Box 356470, Seattle, WA 98195, United States; Division of Engineering and Mathematics, Univ. of WA Bothell, 1959 NE Pacific St., Box 356470, Seattle, WA 98195, United States.
| |
Collapse
|
39
|
Previtera ML, Firestein BL. Glutamate affects dendritic morphology of neurons grown on compliant substrates. Biotechnol Prog 2015; 31:1128-32. [PMID: 25827105 DOI: 10.1002/btpr.2085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 03/25/2015] [Indexed: 12/26/2022]
Abstract
Brain stiffness changes in response to injury or disease. As a secondary consequence, glutamate is released from neurons and astroglia. Two types of glutamate receptors, N-methyl-d-aspartate (NMDA) and α-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors, sense mechanotransduction, leading to downstream signaling in neurons. Recently, our group reported that these two receptors affect dendrite morphology in hippocampal neurons grown on compliant substrates. Blocking receptor activity has distinct effects on dendrites, depending on whether neurons are grown on soft or stiff gels. In the current study, we examine whether exposure to glutamate itself alters stiffness-mediated changes to dendrites in hippocampal neurons. We find that glutamate augments changes seen when neurons are grown on soft gels of 300 or 600 Pa, but in contrast, glutamate attenuates changes seen when neurons are grown on stiff gels of 3,000 Pa. These results suggest that there is interplay between mechanosensing and glutamate receptor activation in determining dendrite morphology in neurons.
Collapse
Affiliation(s)
- Michelle L Previtera
- Graduate Program in Molecular Biosciences, the State University of New Jersey, Piscataway, NJ, 08854-8082.,Dept. of Cell Biology and Neuroscience, the State University of New Jersey, Piscataway, NJ, 08854-8082
| | - Bonnie L Firestein
- Dept. of Cell Biology and Neuroscience, the State University of New Jersey, Piscataway, NJ, 08854-8082.,Dept. of Biomedical Engineering, Rutgers, the State University of New Jersey, Piscataway, NJ, 08854-8082
| |
Collapse
|
40
|
Xu ZS, Yao A, Chu SS, Paun MK, McClintic AM, Murphy SP, Mourad PD. Detection of mild traumatic brain injury in rodent models using shear wave elastography: preliminary studies. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1763-1771. [PMID: 25253822 DOI: 10.7863/ultra.33.10.1763] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Traumatic brain injury (TBI) can cause adverse physiologic changes in fluid content within the brain, which may lead to changes in tissue elasticity (eg, stiffness). This study evaluated the ability of ultrasonic shear wave elastography to observe these changes in the brain after TBI in vivo. METHODS Mice and rats received a mild TBI or sham surgery and were imaged acutely or 24 hours after injury using shear wave elastography, and the hemispheric stiffness values were compared. RESULTS Stiffness values were consistent across brain hemispheres of sham TBI rodents. By 24 hours after TBI, relative brain tissue stiffness values for mice and rats each decreased ipsilaterally and increased contralaterally, both relative to each other and compared to sham TBI rodents (P < .05). The absolute tissue elasticity value increased for rats (P < .05) but not for mice. CONCLUSIONS Differences between intrahemispheric stiffness values of rodent brains by 24 hours after mild TBI may reflect the observed edema and hemorrhage ipsilateral to TBI and the known reduction of cerebral blood flow in both brain hemispheres. If these hypotheses hold true, ultrasonic shear wave elastography may offer a method for detecting adverse changes in fluid content within the brain after mild TBI.
Collapse
Affiliation(s)
- Zinnia S Xu
- Department of Bioengineering (Z.S.X., A.Y., S.S.C., P.D.M.), Applied Physics Laboratory (M.K.P., P.D.M.), and Department of Neurological Surgery (A.M.M., S.P.M., P.D.M.), University of Washington, Seattle, Washington USA
| | - Anning Yao
- Department of Bioengineering (Z.S.X., A.Y., S.S.C., P.D.M.), Applied Physics Laboratory (M.K.P., P.D.M.), and Department of Neurological Surgery (A.M.M., S.P.M., P.D.M.), University of Washington, Seattle, Washington USA
| | - Stephanie S Chu
- Department of Bioengineering (Z.S.X., A.Y., S.S.C., P.D.M.), Applied Physics Laboratory (M.K.P., P.D.M.), and Department of Neurological Surgery (A.M.M., S.P.M., P.D.M.), University of Washington, Seattle, Washington USA
| | - Marla K Paun
- Department of Bioengineering (Z.S.X., A.Y., S.S.C., P.D.M.), Applied Physics Laboratory (M.K.P., P.D.M.), and Department of Neurological Surgery (A.M.M., S.P.M., P.D.M.), University of Washington, Seattle, Washington USA
| | - Abbi M McClintic
- Department of Bioengineering (Z.S.X., A.Y., S.S.C., P.D.M.), Applied Physics Laboratory (M.K.P., P.D.M.), and Department of Neurological Surgery (A.M.M., S.P.M., P.D.M.), University of Washington, Seattle, Washington USA
| | - Sean P Murphy
- Department of Bioengineering (Z.S.X., A.Y., S.S.C., P.D.M.), Applied Physics Laboratory (M.K.P., P.D.M.), and Department of Neurological Surgery (A.M.M., S.P.M., P.D.M.), University of Washington, Seattle, Washington USA
| | - Pierre D Mourad
- Department of Bioengineering (Z.S.X., A.Y., S.S.C., P.D.M.), Applied Physics Laboratory (M.K.P., P.D.M.), and Department of Neurological Surgery (A.M.M., S.P.M., P.D.M.), University of Washington, Seattle, Washington USA.
| |
Collapse
|
41
|
Mueller JK, Tyler WJ. A quantitative overview of biophysical forces impinging on neural function. Phys Biol 2014; 11:051001. [DOI: 10.1088/1478-3975/11/5/051001] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
42
|
|