1
|
Zhang L, Dong YF, Chen Y, Li XG, Wang YH, Wang Y, Ge ZT, Wang X, Cai S, Yang X, Zhu QL, Li JC. Impact of Microbubble Degradation and Flow Velocity on Subharmonic-aided Pressure Estimation (SHAPE): An Experimental Investigation. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:1020-1027. [PMID: 38594125 DOI: 10.1016/j.ultrasmedbio.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/12/2024] [Accepted: 03/21/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE This study aimed to investigate the impact of microbubble degradation and flow velocity on Sub-Harmonic Aided Pressure Estimation (SHAPE), and to explore the correlation between subharmonic amplitude and pressure as a single factor. METHODS We develop an open-loop vascular phantom platform system and utilize a commercial ultrasound machine and microbubbles for subharmonic imaging. Subharmonic amplitude was measured continuously at constant pressure and flow velocity to assess the impact of microbubble degradation. Flow velocity was varied within a range of 4-14 cm/s at constant pressure to investigate its relationship to subharmonic amplitude. Furthermore, pressure was varied within a range of 10-110 mm Hg at constant flow velocity to assess its isolated effect on subharmonic amplitude. RESULTS Under constant pressure and flow velocity, subharmonic amplitude exhibited a continuous decrease at an average rate of 0.221 dB/min, signifying ongoing microbubble degradation during the experimental procedures. Subharmonic amplitude demonstrated a positive correlation with flow velocity, with a variation ratio of 0.423 dB/(cm/s). Under controlled conditions of microbubble degradation and flow velocity, a strong negative linear correlation was observed between pressure and subharmonic amplitude across different Mechanical Index (MI) settings (all R2 > 0.90). The sensitivity of SHAPE was determined to be 0.025 dB/mmHg at an MI of 0.04. CONCLUSION The assessment of SHAPE sensitivity is affected by microbubble degradation and flow velocity. Excluding the aforementioned influencing factors, a strong linear negative correlation between pressure and subharmonic amplitude was still evident, albeit with a sensitivity coefficient lower than previously reported values.
Collapse
Affiliation(s)
- Li Zhang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yi-Fan Dong
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yao Chen
- Department of Ultrasound, GE Healthcare Medical System (China), Shanghai, China
| | - Xiao-Gang Li
- Biobank Facility, National Infrastructures for Translational Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Ya-Hong Wang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Ying Wang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zhi-Tong Ge
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xin Wang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Sheng Cai
- Department of Health Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiao Yang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Qing-Li Zhu
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jian-Chu Li
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
| |
Collapse
|
2
|
Qiao X, Zhang R, Yu J, Yan Y, Bouakaz A, Su X, Liu J, Zong Y, Wan M. Noninvasive assessment of pressure distribution and fractional flow in middle cerebral artery using microbubbles and plane wave in vitro. ULTRASONICS 2024; 138:107244. [PMID: 38237398 DOI: 10.1016/j.ultras.2024.107244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/20/2023] [Accepted: 01/09/2024] [Indexed: 04/02/2024]
Abstract
Fractional flow has been proposed for quantifying the degree of functional stenosis in cerebral arteries. Herein, subharmonic aided pressure estimation (SHAPE) combined with plane wave (PW) transmission was employed to noninvasively estimate the pressure distribution and fractional flow in the middle cerebral artery (MCA) in vitro. Consequently, the effects of incident sound pressure (peak negative pressures of 86-653 kPa), pulse repetition frequency (PRF), number of pulses, and blood flow rate on the subharmonic pressure relationship were investigated. The radio frequency data were stored and beamformed offline, and the subharmonic amplitude over a 0.4 MHz bandwidth was extracted using a 12-cycle PW at 4 MHz. The optimal incident sound pressure was 217 kPa without skull (sensitivity = 0.09 dB/mmHg; r2 = 0.997) and 410 kPa with skull (median sensitivity = 0.06 dB/mmHg; median r2 = 0.981). The optimal PRF was 500 Hz, as this value affords the highest sensitivity (0.09 dB/mmHg; r2 = 0.976) and temporal resolution. In addition, the blood flow rate exhibited a lesser effect on the subharmonic pressure relationship in our experimental setup. Using the optimized parameters, the blood pressure distribution and fractional flow (FFs) were measured. As such, the FFs value was in high agreement with the value measured using the pressure sensor (FFm). The mean ± standard deviations of the FF difference (FFm - FFs) were 0.03 ± 0.06 without skull and 0.01 ± 0.05 with skull.
Collapse
Affiliation(s)
- Xiaoyang Qiao
- Xi'an Jiaotong University, College of Life Science and Technology, Xi'an, China
| | - Ruiyan Zhang
- Xi'an Jiaotong University, College of Life Science and Technology, Xi'an, China
| | - Jianjun Yu
- Xi'an Jiaotong University, College of Life Science and Technology, Xi'an, China
| | - Yadi Yan
- Xi'an Jiaotong University, College of Life Science and Technology, Xi'an, China
| | - Ayache Bouakaz
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - Xiao Su
- Xi'an Jiaotong University, College of Life Science and Technology, Xi'an, China
| | - Jiacheng Liu
- Xi'an Jiaotong University, College of Life Science and Technology, Xi'an, China
| | - Yujin Zong
- Xi'an Jiaotong University, College of Life Science and Technology, Xi'an, China.
| | - Mingxi Wan
- Xi'an Jiaotong University, College of Life Science and Technology, Xi'an, China.
| |
Collapse
|
3
|
Wang P, Tan C, Ji X, Bai J, Yu ACH, Qin P. Sensitivity improvement of subharmonic-based pressure measurement using phospholipid-coated monodisperse microbubbles. ULTRASONICS SONOCHEMISTRY 2024; 104:106830. [PMID: 38432151 PMCID: PMC10920959 DOI: 10.1016/j.ultsonch.2024.106830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/09/2024] [Accepted: 02/22/2024] [Indexed: 03/05/2024]
Abstract
The use of the subharmonic signal from microbubbles exposed to ultrasound is a promising safe and cost-effective approach for the non-invasive measurement of blood pressure. Achieving a high sensitivity of the subharmonic amplitude to the ambient overpressure is crucial for clinical applications. However, currently used microbubbles have a wide size distribution and diverse shell properties. This causes uncertainty in the response of the subharmonic amplitude to changes in ambient pressure, which limits the sensitivity. The aim of this study was to use monodisperse microbubbles to improve the sensitivity of subharmonic-based pressure measurements. With the same shell materials and gas core, we used a flow-focusing microfluidic chip and a mechanical agitation method to fabricate monodisperse (∼2.45-µm mean radius and 4.7 % polydisperse index) and polydisperse microbubbles (∼1.51-µm mean radius and 48.4 % polydisperse index), respectively. We varied the ultrasound parameters (i.e., the frequency, peak negative pressure (PNP) and pulse length), and found that there was an optimal excitation frequency (2.8 MHz) for achieving maximal subharmonic emission for monodisperse microbubbles, but not for polydisperse microbubbles. Three distinct regimes (occurrence, growth, and saturation) were identified in the response of the subharmonic amplitude to increasing PNP for both monodisperse and polydisperse microbubbles. For the polydisperse microbubbles, the subharmonic amplitude decreased either monotonically or non-monotonically with ambient overpressure, depending on the PNP. By contrast, for the monodisperse microbubbles, there was only a monotonic decrease at all PNPs. The maximum sensitivity (1.18 dB/kPa, R2 = 0.97) of the subharmonic amplitude to ambient overpressure for the monodisperse microbubbles was ∼6.5 times higher than that for the polydisperse microbubbles (0.18 dB/kPa, R2 = 0.88). These results show that monodisperse microbubbles can achieve a more consistent response of the subharmonic signal to changes in ambient overpressure and greatly improve the measurement sensitivity.
Collapse
Affiliation(s)
- Pengcheng Wang
- School of Sensing Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Chunjie Tan
- School of Sensing Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Xiang Ji
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Jingfeng Bai
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China.
| | - Alfred C H Yu
- Schlegel Research Institute for Aging, University of Waterloo, Waterloo, ON, N2L3G1, Canada
| | - Peng Qin
- School of Sensing Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China.
| |
Collapse
|
4
|
Esposito C, Machado P, McDonald ME, Savage MP, Fischman D, Mehrotra P, Cohen IS, Ruggiero N, Walinsky P, Vishnevsky A, Dickie K, Davis M, Forsberg F, Dave JK. Evaluation of Intracardiac Pressures Using Subharmonic-aided Pressure Estimation with Sonazoid Microbubbles. Radiol Cardiothorac Imaging 2024; 6:e230153. [PMID: 38358329 PMCID: PMC10912883 DOI: 10.1148/ryct.230153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 12/13/2023] [Accepted: 01/10/2024] [Indexed: 02/16/2024]
Abstract
Purpose To investigate if the right ventricular (RV) systolic and left ventricular (LV) diastolic pressures can be obtained noninvasively using the subharmonic-aided pressure estimation (SHAPE) technique with Sonazoid microbubbles. Materials and Methods Individuals scheduled for a left and/or right heart catheterization were prospectively enrolled in this institutional review board-approved clinical trial from 2017 to 2020. A standard-of-care catheterization procedure was performed by advancing fluid-filled pressure catheters into the LV and aorta (n = 25) or RV (n = 22), and solid-state high-fidelity pressure catheters into the LV and aorta in a subset of participants (n = 18). Study participants received an infusion of Sonazoid microbubbles (GE HealthCare), and SHAPE data were acquired using a validated interface developed on a SonixTablet (BK Medical) US scanner, synchronously with the pressure catheter data. A conversion factor, derived using cuff-based pressure measurements with a SphygmoCor XCEL PWA (ATCOR) and subharmonic signal from the aorta, was used to convert the subharmonic signal into pressure values. Errors between the pressure measurements obtained using the SHAPE technique and pressure catheter were compared. Results The mean errors in pressure measurements obtained with the SHAPE technique relative to those of the fluid-filled pressure catheter were 1.6 mm Hg ± 1.5 [SD] (P = .85), 8.4 mm Hg ± 6.2 (P = .04), and 7.4 mm Hg ± 5.7 (P = .09) for RV systolic, LV minimum diastolic, and LV end-diastolic pressures, respectively. Relative to the measurements with the solid-state high-fidelity pressure catheter, the mean errors in LV minimum diastolic and LV end-diastolic pressures were 7.2 mm Hg ± 4.5 and 6.8 mm Hg ± 3.3 (P ≥ .44), respectively. Conclusion These results indicate that SHAPE with Sonazoid may have the potential to provide clinically relevant RV systolic and LV diastolic pressures. Keywords: Ultrasound-Contrast, Cardiac, Aorta, Left Ventricle, Right Ventricle ClinicalTrials.gov registration no.: NCT03245255 © RSNA, 2024.
Collapse
Affiliation(s)
- Cara Esposito
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Priscilla Machado
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Maureen E. McDonald
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Michael P. Savage
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - David Fischman
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Praveen Mehrotra
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Ira S. Cohen
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Nicholas Ruggiero
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Paul Walinsky
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Alec Vishnevsky
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Kristopher Dickie
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Marguerite Davis
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Flemming Forsberg
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Jaydev K. Dave
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| |
Collapse
|
5
|
卢 慧, 王 云, 黄 来, 徐 岗, 周 娟, 虞 文, 李 飞. [Experimental study on high-frequency subharmonic scattering characteristics of ultrasound contrast agent microbubbles under low ambient pressure]. SHENG WU YI XUE GONG CHENG XUE ZA ZHI = JOURNAL OF BIOMEDICAL ENGINEERING = SHENGWU YIXUE GONGCHENGXUE ZAZHI 2023; 40:1209-1216. [PMID: 38151945 PMCID: PMC10753315 DOI: 10.7507/1001-5515.202304012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/29/2023] [Indexed: 12/29/2023]
Abstract
Correlation between nonlinear subharmonic scattering of ultrasound contrast agent microbubbles and ambient pressure is expected to be used for local brain tissue pressure monitoring. Although high-frequency ultrasound has achieved high-resolution imaging of intracranial microvessels, the research on high-frequency subharmonic scattering characteristics of microbubbles is insufficient at present, which restricts the research progress of estimating local brain tissue pressure based on high-frequency subharmonic scattering of microbubbles. Therefore, under the excitation of 10 MHz high-frequency ultrasound, the effects of different acoustic pressures and ambient pressures on the high-frequency subharmonic scattering characteristics of three different ultrasound contrast agents including SonoVue, Sonazoid and Huashengxian were investigated in this in vitro study. Results showed that the subharmonic scattering amplitudes of the three microbubbles increased with the increase of ambient pressure at the peak negative acoustic pressures of 696, 766 and 817 kPa, and there was a favorable linear correlation between subharmonic amplitude and ambient pressure. Under the above three acoustic pressures, the highest correlation coefficient of SonoVue was 0.948 ( P = 0.03), the highest sensitivity of pressure measurement was 0.248 dB/mm Hg and the minimum root mean square error (RMSE) was 2.64 mm Hg. Sonazoid's highest correlation coefficient was 0.982 ( P < 0.01), the highest sensitivity of pressure measurement was 0.052 dB/mm Hg and the minimum RMSE was 1.51 mm Hg. The highest correlation coefficient of Huashengxian was 0.969 ( P = 0.02), the highest sensitivity of pressure measurement was 0.098 dB/mm Hg and the minimum RMSE was 2.00 mm Hg. The above in vitro experimental results indicate that by selecting ultrasound contrast agent microbubbles and optimizing acoustic pressure, the correlation between high-frequency subharmonic scattering of microbubbles and ambient pressure can be improved, the sensitivity of pressure measurement can be upgraded, and the measurement error can be reduced to meet the clinical demand for local brain tissue pressure measurement, which provided an important experimental basis for subsequent research in vivo.
Collapse
Affiliation(s)
- 慧敏 卢
- 南京大学 医学院附属鼓楼医院 重症医学科(南京 210008)Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, P. R. China
- 中国科学院 深圳先进技术研究院 劳特伯生物医学成像研究中心(广东深圳 518055)Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055, P. R. China
| | - 云 王
- 南京大学 医学院附属鼓楼医院 重症医学科(南京 210008)Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, P. R. China
- 中国科学院 深圳先进技术研究院 劳特伯生物医学成像研究中心(广东深圳 518055)Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055, P. R. China
| | - 来鑫 黄
- 南京大学 医学院附属鼓楼医院 重症医学科(南京 210008)Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, P. R. China
| | - 岗 徐
- 南京大学 医学院附属鼓楼医院 重症医学科(南京 210008)Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, P. R. China
| | - 娟 周
- 南京大学 医学院附属鼓楼医院 重症医学科(南京 210008)Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, P. R. China
| | - 文魁 虞
- 南京大学 医学院附属鼓楼医院 重症医学科(南京 210008)Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, P. R. China
| | - 飞 李
- 南京大学 医学院附属鼓楼医院 重症医学科(南京 210008)Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, P. R. China
| |
Collapse
|
6
|
Noninvasive assessment of intracranial pressure using subharmonic-aided pressure estimation: An experimental study in canines. J Trauma Acute Care Surg 2022; 93:882-888. [PMID: 35687796 DOI: 10.1097/ta.0000000000003720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Intracranial hypertension is a common clinicopathological syndrome in neurosurgery, and a timely understanding of the intracranial pressure (ICP) may help guide clinical treatment. We aimed to investigate the correlation between subharmonic contrast-enhanced ultrasound (SHCEUS) parameters and ICP in experimental canines. METHODS A dynamic model of ICP change from 11 mm Hg to 50 mm Hg was established in experimental canines by placing a latex balloon into the epidural space and injecting saline into the balloon. In addition, a pressure sensor was placed in the brain parenchyma to record the changes in ICP. When the ICP stabilized after each increase, subharmonic-aided pressure estimation (SHAPE) technology was performed to obtain the SHCEUS parameters, including the basal venous and adjacent intracranial arterial subharmonic amplitude and SHAPE gradient (subharmonic amplitude in the intracranial artery minus that in the basal vein). The correlation between these parameters and ICP was analyzed. RESULTS The subharmonic amplitude of the basal vein was negatively correlated with the ICP (r = -0.798), and the SHAPE gradient was positively correlated with the ICP (r = 0.628). According to the guidelines for ICP monitoring in patients with traumatic brain injury, we defined 20 mm Hg, 25 mm Hg, and 30 mm Hg as the cutoff ICP levels. The area under the receiver operating characteristic curve of the basal venous subharmonic amplitude for diagnosing intracranial hypertension ≥20 mm Hg, ≥25 mm Hg, and ≥30 mm Hg was 0.867 (95% confidence interval [CI], 0.750-0.943), 0.884 (95% CI, 0.770-0.954), and 0.875 (95% CI, 0.759-0.948), respectively. The area under the receiver operating characteristic curve of the SHAPE gradient for diagnosing intracranial hypertension ≥20 mm Hg, ≥25 mm Hg, and ≥30 mm Hg was 0.839 (95% CI, 0.716-0.924), 0.842 (95% CI, 0.720-0.926), and 0.794 (95% CI, 0.665-0.890), respectively. CONCLUSION SHCEUS parameters are correlated with ICP. The SHAPE technique can assist in evaluating ICP changes in canines, which provides a new idea and method for evaluating ICP.
Collapse
|
7
|
Machado P, Gupta I, Fenkel JM, Gummadi S, Stanczak M, Wessner CE, Shaw CM, Schultz S, Soulen MC, Wallace K, Eisenbrey JR, Forsberg F. Ultrasound Pressure Estimation for Diagnosing Portal Hypertension in Patients Undergoing Dialysis for Chronic Kidney Disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2181-2189. [PMID: 34850412 PMCID: PMC9156659 DOI: 10.1002/jum.15897] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/08/2021] [Accepted: 10/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Hepatic venous pressure gradient (HVPG) is considered the standard in quantifying portal hypertension, but can be unreliable in dialysis patients. A noninvasive ultrasound technique, subharmonic-aided pressure estimation (SHAPE), may be a valuable surrogate of these pressure estimates. This study compared SHAPE and HVPG with pathology findings for fibrosis in dialysis patients. METHODS This was a subgroup study from an IRB-approved trial that included 20 patients on dialysis undergoing SHAPE examinations of portal and hepatic veins using a modified Logiq 9 scanner (GE, Waukesha, WI), during infusion of Sonazoid (GE Healthcare, Oslo, Norway). SHAPE was compared to HVPG and pathology findings using the Ludwig-Batts scoring system for fibrosis. Logistic regression, ROC analysis, and t-tests were used to compare HVPG and SHAPE with pathological findings of fibrosis. RESULTS Of 20 cases, 5 had HVPG values corresponding to subclinical and clinical portal hypertension (≥6 and ≥10 mmHg, respectively) while 15 had normal HVPG values (≤5 mmHg). SHAPE and HVPG correlated moderately (r = 0.45; P = .047). SHAPE showed a trend toward correlating with fibrosis (r = 0.42; P = .068), while HVPG did not (r = 0.18; P = .45). SHAPE could differentiate between mild (stage 0-1) and moderate to severe (stage 2-4) fibrosis (-10.4 ± 4.9 dB versus -5.4 ± 3.2 dB; P = .035), HVPG could not (3.0 ± 0.6 mmHg versus 4.8 ± 0.7 mmHg; P = .30). ROC curves showed a diagnostic accuracy for SHAPE of 80%, while HVPG reached 76%. CONCLUSION Liver fibrosis staging in dialysis patients evaluated for portal hypertension appears to be more accurately predicted by SHAPE than by HVPG; albeit in a small sample size.
Collapse
Affiliation(s)
- Priscilla Machado
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ipshita Gupta
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jonathan M Fenkel
- Division of Gastroenterology and Hepatology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Maria Stanczak
- Department of Medical Imaging and Radiation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Corinne E Wessner
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Colette M Shaw
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Susan Schultz
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael C Soulen
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - John R Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
8
|
van Hoeve W, de Vargas Serrano M, Te Winkel L, Forsberg F, Dave JK, Sarkar K, Wessner CE, Eisenbrey JR. Improved Sensitivity of Ultrasound-Based Subharmonic Aided Pressure Estimation Using Monodisperse Microbubbles. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1781-1789. [PMID: 34724241 DOI: 10.1002/jum.15861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Subharmonic aided pressure estimation (SHAPE) has been shown effective for noninvasively measuring hydrostatic fluid pressures in a variety of clinical applications. The objective of this study was to explore potential improvements in SHAPE sensitivity using monodisperse microbubbles. METHODS Populations of monodisperse microbubbles were created using a commercially available microfluidics device (Solstice Pharmaceuticals). Size distributions were assessed using a Coulter Counter and stability of the distribution following fabrication was evaluated over 24 hours. Attenuation of the microbubble populations from 1 to 10 MHz was then quantified using single element transducers to identify each formulation's resonance frequency. Frequency spectra over increasing driving amplitudes were investigated to determine the nonlinear phases of subharmonic signal generation. SHAPE sensitivity was evaluated in a hydrostatic pressure-controlled water bath using a Logiq E10 scanner (GE Healthcare). RESULTS Monodisperse lipid microbubble suspensions ranging from 2.4 to 5.3 μm in diameter were successfully created and they showed no discernable change in size distribution over 24 hours following activation. Calculated resonance frequencies ranged from 2.1 to 6.3 MHz and showed excellent correlation with microbubble diameter (R2 > 0.99). When investigating microbubble frequency response, subharmonic signal occurrence was shown to begin at 150 kPa peak negative pressure, grow up to 225 kPa, and saturate at approximately 250 kPa. Using the Logiq E10, monodisperse bubbles demonstrated a SHAPE sensitivity of -0.17 dB/mmHg, which was nearly twice the sensitivity of the commercial polydisperse microbubble currently being used in clinical trials. CONCLUSIONS Monodisperse microbubbles have the potential to greatly improve the sensitivity of SHAPE for the noninvasive measurement of hydrostatic pressures.
Collapse
Affiliation(s)
| | | | | | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jaydev K Dave
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kausik Sarkar
- Department of Mechanical and Aerospace Engineering, The George Washington University, Washington, DC, USA
| | - Corinne E Wessner
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - John R Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
9
|
Langeveld SAG, Meijlink B, Beekers I, Olthof M, van der Steen AFW, de Jong N, Kooiman K. Theranostic Microbubbles with Homogeneous Ligand Distribution for Higher Binding Efficacy. Pharmaceutics 2022; 14:pharmaceutics14020311. [PMID: 35214044 PMCID: PMC8878664 DOI: 10.3390/pharmaceutics14020311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/14/2022] [Accepted: 01/16/2022] [Indexed: 02/05/2023] Open
Abstract
Phospholipid-coated targeted microbubbles are used for ultrasound molecular imaging and locally enhanced drug delivery, with the binding efficacy being an important trait. The use of organic solvent in microbubble production makes the difference between a heterogeneous or homogeneous ligand distribution. This study demonstrates the effect of ligand distribution on the binding efficacy of phospholipid-coated ανβ3-targeted microbubbles in vitro using a monolayer of human umbilical-vein endothelial cells and in vivo using chicken embryos. Microbubbles with a homogeneous ligand distribution had a higher binding efficacy than those with a heterogeneous ligand distribution both in vitro and in vivo. In vitro, 1.55× more microbubbles with a homogeneous ligand distribution bound under static conditions, while this was 1.49× more under flow with 1.25 dyn/cm2, 1.56× more under flow with 2.22 dyn/cm2, and 1.25× more in vivo. The in vitro dissociation rate of bound microbubbles with homogeneous ligand distribution was lower at low shear stresses (1–5 dyn/cm2). The internalized depth of bound microbubbles was influenced by microbubble size, not by ligand distribution. In conclusion, for optimal binding the use of organic solvent in targeted microbubble production is preferable over directly dispersing phospholipids in aqueous medium.
Collapse
Affiliation(s)
- Simone A. G. Langeveld
- Thorax Center, Biomedical Engineering, Erasmus University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (B.M.); (I.B.); (M.O.); (A.F.W.v.d.S.); (N.d.J.); (K.K.)
- Correspondence:
| | - Bram Meijlink
- Thorax Center, Biomedical Engineering, Erasmus University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (B.M.); (I.B.); (M.O.); (A.F.W.v.d.S.); (N.d.J.); (K.K.)
| | - Inés Beekers
- Thorax Center, Biomedical Engineering, Erasmus University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (B.M.); (I.B.); (M.O.); (A.F.W.v.d.S.); (N.d.J.); (K.K.)
- Department of Health, ORTEC B.V., 2719 EA Zoetermeer, The Netherlands
| | - Mark Olthof
- Thorax Center, Biomedical Engineering, Erasmus University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (B.M.); (I.B.); (M.O.); (A.F.W.v.d.S.); (N.d.J.); (K.K.)
| | - Antonius F. W. van der Steen
- Thorax Center, Biomedical Engineering, Erasmus University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (B.M.); (I.B.); (M.O.); (A.F.W.v.d.S.); (N.d.J.); (K.K.)
| | - Nico de Jong
- Thorax Center, Biomedical Engineering, Erasmus University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (B.M.); (I.B.); (M.O.); (A.F.W.v.d.S.); (N.d.J.); (K.K.)
- Imaging Physics, Delft University of Technology, 2628 CJ Delft, The Netherlands
| | - Klazina Kooiman
- Thorax Center, Biomedical Engineering, Erasmus University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (B.M.); (I.B.); (M.O.); (A.F.W.v.d.S.); (N.d.J.); (K.K.)
| |
Collapse
|
10
|
Hepatic Vein Contrast-Enhanced Ultrasound Subharmonic Imaging Signal as a Screening Test for Portal Hypertension. Dig Dis Sci 2021; 66:4354-4360. [PMID: 33392869 PMCID: PMC9026769 DOI: 10.1007/s10620-020-06790-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 12/14/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Portal hypertension is the underlying cause of most complications associated with cirrhosis, with the hepatic venous pressure gradient (HVPG) used for diagnosis and disease progression. Subharmonic imaging (SHI) is a contrast-specific imaging technique receiving at half the transmit frequency resulting in better tissue suppression. AIMS To determine whether the presence of optimized SHI signals inside the hepatic vein can be used as a screening test for portal hypertension. METHODS This prospective trial had 131 patients undergoing SHI examination of portal and hepatic veins using a modified Logiq 9 scanner (GE, Waukesha, WI). Images acquired after infusion of the ultrasound contrast agent Sonazoid (GE Healthcare, Oslo, Norway) were assessed for the presence of optimized SHI signals in the hepatic vein and compared to the HVPG values obtained as standard of care. RESULTS Of 131 cases, 64 had increased HVPG values corresponding to subclinical (n = 31) and clinical (n = 33) portal hypertension (> 5 and > 10 mmHg, respectively), and 67 had normal HVPG values (< 5 mmHg). Two readers performed independent, binary qualitative assessments of the acquired digital clips. Reader one (experienced radiologist) achieved for the subclinical subgroup sensitivity of 98%, specificity of 88%, and ROC area of 0.93 and for the clinical subgroup sensitivity of 100% and specificity of 61%, with an ROC area of 0.74. Reader two (less experienced radiologist) achieved for the subclinical subgroup sensitivity of 77%, specificity of 76%, and ROC area of 0.76 and for the clinical subgroup sensitivity of 88% and specificity of 63%, with an ROC area of 0.70. Readers agreement was of 83% with kappa value of 0.66. CONCLUSION The presence of optimized SHI signals inside the hepatic vein can be a qualitative screening test for portal hypertension, which could reduce the need for invasive diagnostic procedures.
Collapse
|
11
|
Gupta I, Fenkel JM, Eisenbrey JR, Machado P, Stanczak M, Wessner CE, Shaw CM, Miller C, Soulen MC, Wallace K, Forsberg F. A Noninvasive Ultrasound Based Technique to Identify Treatment Responders in Patients with Portal Hypertension. Acad Radiol 2021; 28 Suppl 1:S128-S137. [PMID: 33341374 DOI: 10.1016/j.acra.2020.11.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/18/2020] [Accepted: 11/28/2020] [Indexed: 02/07/2023]
Abstract
RATIONALE AND OBJECTIVE Subharmonic aided pressure estimation (SHAPE) is based on the inverse relationship between the subharmonic amplitude of ultrasound contrast microbubbles and ambient pressure. The aim of this study was to verify if SHAPE can accurately monitor disease progression in patients identified with portal hypertension. MATERIALS & METHODS A modified Logiq 9 scanner with a 4C curvi-linear probe (GE, Waukesha, WI) was used to acquire SHAPE data (transmitting and receiving at 2.5 and 1.25 MHz, respectively) using Sonazoid (GE Healthcare, Oslo, Norway; FDA IND 124,465). Twenty-one (median age 59 years; 12 Males) of the 178 patients enrolled in this institutional review board approved study (14F.113) were identified as having clinically significant portal hypertension based on their hepatic venous pressure gradient results ≥ 10 mmHg. Repeat SHAPE examinations were done every 6.2 months. Liver function tests and clinical indicators were used to establish treatment response. RESULTS Of the 21 portal hypertensive subjects, 11 had successful follow up scans with an average follow up time of 6.2 months. There was a significantly larger SHAPE signal reduction in the group who were classified as treatment responders (n = 10; -4.01±3.61 dB) compared to the single nonresponder (2.33 dB; p < 0.001). Results for responders matched the corresponding clinical outcomes of improved model for end stage liver disease (MELD) scores, improvement in underlying cause of portal hypertension, improved liver function tests and reduced ascites. CONCLUSION SHAPE can potentially monitor disease progression in portal hypertensive patients and hence, may help clinicians in patient management. A larger study would further validate this claim.
Collapse
|
12
|
Esposito C, Dickie K, Forsberg F, Dave JK. Developing an Interface and Investigating Optimal Parameters for Real-Time Intracardiac Subharmonic-Aided Pressure Estimation. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:579-585. [PMID: 32784134 PMCID: PMC7983258 DOI: 10.1109/tuffc.2020.3016264] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Thisstudy focuses on evaluating the real-time functionality of a customized interface and investigating the optimal parameters for intracardiac subharmonic-aided pressure estimation (SHAPE) utilizing Definity (Lantheus Medical Imaging Inc., North Billerica, MA, USA) and Sonazoid (GE Healthcare, Oslo, Norway) microbubbles. Pressure measurements within the chambers of the heart yield critical information for managing cardiovascular diseases. An alternative to current, invasive, clinical cardiac catheterization procedures is utilizing ultrasound contrast agents and SHAPE to noninvasively estimate intracardiac pressures. Therefore, this work developed a customized interface (on a SonixTablet, BK Ultrasound, Peabody, MA, USA) for real-time intracardiac SHAPE. In vitro, a Doppler flow phantom was utilized to mimic the dynamic pressure changes within the heart. Definity (15.0- [Formula: see text] microspheres corresponding to 0.1-0.15 mL) and Sonazoid (GE Healthcare; 0.4- [Formula: see text] microspheres corresponding to 0.05-0.15 mL) microbubbles were used. Data were acquired for varying transmit frequencies (2.5-4.0 MHz), and pulse shaping options (square wave and chirp down) to determine optimal transmit parameters. Simultaneously obtained radio frequency data and ambient pressure data were compared. For Definity, the chirp down pulse at 3.0 MHz yielded the highest correlation ( r = - 0.77 ± 0.2 ) between SHAPE and pressure catheter data. For Sonazoid, the square wave pulse at 2.5 MHz yielded the highest correlation ( r = - 0.72 ± 0.2 ). In conclusion, the real-time functionality of the customized interface has been verified, and the optimal parameters for utilizing Definity and Sonazoid for intracardiac SHAPE have been determined.
Collapse
|
13
|
Forsberg F, Gupta I, Machado P, Shaw CM, Fenkel JM, Wallace K, Eisenbrey JR. Contrast-Enhanced Subharmonic Aided Pressure Estimation (SHAPE) using Ultrasound Imaging with a Focus on Identifying Portal Hypertension. J Vis Exp 2020. [PMID: 33346203 DOI: 10.3791/62050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Noninvasive, accurate measurement of pressures within the human body has long been an important but elusive clinical goal. Contrast agents for ultrasound imaging are gas-filled, encapsulated microbubbles (diameter < 10 μm) that traverse the entire vasculature and enhance signals by up to 30 dB. These microbubbles also produce nonlinear oscillations at frequencies ranging from the subharmonic (half of the transmit frequency) to higher harmonics. The subharmonic amplitude has an inverse linear relationship with the ambient hydrostatic pressure. Here an ultrasound system capable of performing real-time, subharmonic aided pressure estimation (SHAPE) is presented. During ultrasound contrast agent infusion, an algorithm for optimizing acoustic outputs is activated. Following this calibration, subharmonic microbubble signals (i.e., SHAPE) have the highest sensitivity to pressure changes and can be used to noninvasively quantify pressure. The utility of the SHAPE procedure for identifying portal hypertension in the liver is the emphasis here, but the technique has applicability across many clinical scenarios.
Collapse
Affiliation(s)
| | - Ipshita Gupta
- Department of Radiology, Thomas Jefferson University; School of Biomedical Engineering, Sciences and Health Systems, Drexel University
| | | | | | - Jonathan M Fenkel
- Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University
| | | | | |
Collapse
|
14
|
Gupta I, Eisenbrey JR, Machado P, Stanczak M, Wessner CE, Shaw CM, Gummadi S, Fenkel JM, Tan A, Miller C, Parent J, Schultz S, Soulen MC, Sehgal CM, Wallace K, Forsberg F. Diagnosing Portal Hypertension with Noninvasive Subharmonic Pressure Estimates from a US Contrast Agent. Radiology 2020; 298:104-111. [PMID: 33201789 DOI: 10.1148/radiol.2020202677] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background The current standard for assessing the severity of portal hypertension is the invasive acquisition of hepatic venous pressure gradient (HVPG). A noninvasive US-based technique called subharmonic-aided pressure estimation (SHAPE) could reduce risk and enable routine acquisition of these pressure estimates. Purpose To compare quantitative SHAPE to HVPG measurements to diagnose portal hypertension in participants undergoing a transjugular liver biopsy. Materials and Methods This was a prospective cross-sectional trial conducted at two hospitals between April 2015 and March 2019 (ClinicalTrials.gov identifier, NCT02489045). This trial enrolled participants who were scheduled for transjugular liver biopsy. After standard-of-care transjugular liver biopsy and HVPG pressure measurements, participants received an infusion of a US contrast agent and saline. During infusion, SHAPE data were collected from a portal vein and a hepatic vein, and the difference was compared with HVPG measurements. Correlations between data sets were determined by using the Pearson correlation coefficient, and statistical significance between groups was determined by using the Student t test. Receiver operating characteristic analysis was performed to determine the sensitivity and specificity of SHAPE. Results A total of 125 participants (mean age ± standard deviation, 59 years ± 12; 80 men) with complete data were included. Participants at increased risk for variceal hemorrhage (HVPG ≥12 mm Hg) had a higher mean SHAPE gradient compared with participants with lower HVPGs (0.79 dB ± 2.53 vs -4.95 dB ± 3.44; P < .001), which is equivalent to a sensitivity of 90% (13 of 14; 95% CI: 88, 94) and a specificity of 80% (79 of 99; 95% CI: 76, 84). The SHAPE gradient between the portal and hepatic veins was in good overall agreement with the HVPG measurements (r = 0.68). Conclusion Subharmonic-aided pressure estimation is an accurate noninvasive technique for detecting clinically significant portal hypertension. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Kiessling in this issue.
Collapse
Affiliation(s)
- Ipshita Gupta
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - John R Eisenbrey
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Priscilla Machado
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Maria Stanczak
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Corinne E Wessner
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Colette M Shaw
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Sriharsha Gummadi
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Jonathan M Fenkel
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Alison Tan
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Cynthia Miller
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Julia Parent
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Susan Schultz
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Michael C Soulen
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Chandra M Sehgal
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Kirk Wallace
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Flemming Forsberg
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| |
Collapse
|
15
|
Garbuzenko DV, Arefyev NO. Primary prevention of bleeding from esophageal varices in patients with liver cirrhosis: An update and review of the literature. J Evid Based Med 2020; 13:313-324. [PMID: 33037792 DOI: 10.1111/jebm.12407] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/19/2020] [Indexed: 12/12/2022]
Abstract
All patients with liver cirrhosis and portal hypertension should be stratified by risk groups to individualize different therapeutic strategies to increase the effectiveness of treatment. In this regard, the development of primary prophylaxis of variceal bleeding and its management according to the severity of portal hypertension may be promising. This paper is to describe the modern principles of primary prophylaxis of esophageal variceal bleeding in patients with liver cirrhosis. The PubMed and EMbase databases, Web of Science, Google Scholar, and the Cochrane Database of Systematic Reviews were used to search for relevant publications from 1999 to 2019. The results suggested that depending on the severity of portal hypertension, patients with cirrhosis should be divided into those who need preprimary prophylaxis, which aims to prevent the formation of esophageal varices, and those who require measures that aim to prevent esophageal variceal bleeding. In subclinical portal hypertension, therapy should be etiological and pathogenetic. Cirrhosis with clinically significant portal hypertension should receive nonselective β-blockers if they have small esophageal varices and risk factors for variceal bleeding. Nonselective β-blockers are the first-line drugs for the primary prevention of bleeding from medium to large-sized esophageal varices. Endoscopic band ligation is indicated for the patients who are intolerant to nonselective β-blockers or in the case of contraindications to pharmacological therapy. In summary, the stratification of cirrhotic patients by the severity of portal hypertension and an individual approach to the choice of treatment may increase the effectiveness of therapy as well as improve survival rate of these patients.
Collapse
Affiliation(s)
| | - Nikolay Olegovich Arefyev
- Department of Pathological Anatomy and Forensic Medicine, South Ural State Medical University, Chelyabinsk, Russia
| |
Collapse
|
16
|
Nio AQX, Faraci A, Christensen-Jeffries K, Raymond JL, Monaghan MJ, Fuster D, Forsberg F, Eckersley RJ, Lamata P. Optimal Control of SonoVue Microbubbles to Estimate Hydrostatic Pressure. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2020; 67:557-567. [PMID: 31634833 PMCID: PMC7053253 DOI: 10.1109/tuffc.2019.2948759] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 10/16/2019] [Indexed: 05/13/2023]
Abstract
The measurement of cardiac and aortic pressures enables diagnostic insight into cardiac contractility and stiffness. However, these pressures are currently assessed invasively using pressure catheters. It may be possible to estimate these pressures less invasively by applying microbubble ultrasound contrast agents as pressure sensors. The aim of this study was to investigate the subharmonic response of the microbubble ultrasound contrast agent SonoVue (Bracco Spa, Milan, Italy) at physiological pressures using a static pressure phantom. A commercially available cell culture cassette with Luer connections was used as a static pressure chamber. SonoVue was added to the phantom, and radio frequency data were recorded on the ULtrasound Advanced Open Platform (ULA-OP). The mean subharmonic amplitude over a 40% bandwidth was extracted at 0-200-mmHg hydrostatic pressures, across 1.7-7.0-MHz transmit frequencies and 3.5%-100% maximum scanner acoustic output. The Rayleigh-Plesset equation for single-bubble oscillations and additional hysteresis experiments were used to provide insight into the mechanisms underlying the subharmonic pressure response of SonoVue. The subharmonic amplitude of SonoVue increased with hydrostatic pressure up to 50 mmHg across all transmit frequencies and decreased thereafter. A decreasing microbubble surface tension may drive the initial increase in the subharmonic amplitude of SonoVue with hydrostatic pressure, while shell buckling and microbubble destruction may contribute to the subsequent decrease above 125-mmHg pressure. In conclusion, a practical operating regime that may be applied to estimate cardiac and aortic blood pressures from the subharmonic signal of SonoVue has been identified.
Collapse
Affiliation(s)
- Amanda Q. X. Nio
- Department of Biomedical EngineeringSchool of Biomedical Engineering and Imaging SciencesKing’s College LondonLondonSE1 7EHU.K.
| | - Alessandro Faraci
- Department of Biomedical EngineeringSchool of Biomedical Engineering and Imaging SciencesKing’s College LondonLondonSE1 7EHU.K.
| | - Kirsten Christensen-Jeffries
- Department of Biomedical EngineeringSchool of Biomedical Engineering and Imaging SciencesKing’s College LondonLondonSE1 7EHU.K.
| | - Jason L. Raymond
- Department of Engineering ScienceUniversity of OxfordOxfordOX1 3PJU.K.
| | - Mark J. Monaghan
- Department of CardiologyKing’s College HospitalLondonSE5 9RSU.K.
| | - Daniel Fuster
- Institut Jean Le Rond D’Alembert, Sorbonne UniversitéCenter National de la Recherche Scientifique, UMR 7190F-75005ParisFrance
| | - Flemming Forsberg
- Department of RadiologyThomas Jefferson UniversityPhiladelphiaPA19107USA
| | - Robert J. Eckersley
- Department of Biomedical EngineeringSchool of Biomedical Engineering and Imaging SciencesKing’s College LondonLondonSE1 7EHU.K.
| | - Pablo Lamata
- Department of Biomedical EngineeringSchool of Biomedical Engineering and Imaging SciencesKing’s College LondonLondonSE1 7EHU.K.
| |
Collapse
|
17
|
Gupta I, Freid B, Masarapu V, Machado P, Trabulsi E, Wallace K, Halpern E, Forsberg F. Transrectal Subharmonic Ultrasound Imaging for Prostate Cancer Detection. Urology 2019; 138:106-112. [PMID: 31899231 DOI: 10.1016/j.urology.2019.12.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/21/2019] [Accepted: 12/23/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess the prostate cancer (CaP) detection rates of contrast-enhanced, transrectal subharmonic ultrasound imaging (SHI). MATERIALS AND METHODS This IRB-approved study enrolled 55 subjects. The initial 5 subjects were studied for SHI optimization, while the remaining 50 were evaluated with contrast-enhanced sonography using continuous SHI, color, and power Doppler as well as conventional grayscale, continuous color, and power Doppler and SHI combined with maximum flash replenishment. A maximum of 6 directed biopsy cores were obtained from sites of greatest asymmetrical enhancement, followed by spatially distributed cores in a double sextant distribution. Subharmonic time-intensity parameters, including time to peak intensity, peak intensity, and estimated perfusion were also evaluated for each directed biopsy core. Receiver operating characteristic curve analysis and conditional logistic regression were employed to assess the benefit of each modality and the quantitative SHI parameters. RESULTS Cancer was detected in 22 of 50 subjects. Among subjects with clinically significant CaP (n = 11), targeted cores were more likely to be positive (odds ratio 1.39, P = .02). The majority of patients detected by SHI demonstrated significant CaP (5/8); SHI remained an independent marker of malignancy in a multivariate logistic regression model (P = .027). Receiver operating characteristic curve analysis of imaging findings compared to biopsy results yielded diagnostic accuracies ranging from 0.59 to 0.80 for all imaging modalities with the highest being for quantitative subharmonic perfusion estimates. CONCLUSION This first-in-humans study provides a preliminary estimate of the diagnostic accuracy of SHI for detection of clinically significant CaP (up to 80%).
Collapse
Affiliation(s)
- I Gupta
- Thomas Jefferson University, Philadelphia, PA
| | - B Freid
- Thomas Jefferson University, Philadelphia, PA
| | - V Masarapu
- Thomas Jefferson University, Philadelphia, PA
| | - P Machado
- Thomas Jefferson University, Philadelphia, PA
| | - E Trabulsi
- Thomas Jefferson University, Philadelphia, PA
| | | | - E Halpern
- Thomas Jefferson University, Philadelphia, PA
| | - F Forsberg
- Thomas Jefferson University, Philadelphia, PA.
| |
Collapse
|
18
|
Xu G, Li F, Mao Y. Portal pressure monitoring-state-of-the-art and future perspective. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:583. [PMID: 31807564 DOI: 10.21037/atm.2019.09.22] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Portal hypertension is a serious symptom of chronic liver diseases, which can lead to many critical complications, such as the formation of varices related to upper digestive bleeding, ascites, infection, hepatic encephalopathy, renal failure, and even death. As a result, portal pressure monitoring has important prognostic and clinical implications. The hepatic venous pressure gradient measurement, a gold-standard method applied to monitor portal pressure, is invasive and only available in experienced centers. Over the past decade, noninvasive methods aimed at monitoring the portal pressure have been increasingly investigated, including serum markers, radiological features, ultrasound elastography, doppler and contrast-enhanced ultrasonography. In this study, we focused on both invasive and noninvasive methods for portal pressure monitoring and explored their roles in clinical setting. The advantages and limitations of various techniques for future research are also discussed.
Collapse
Affiliation(s)
- Gang Xu
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC and Chinese Academy of Medical Sciences, Beijing 100730, China.,Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Fei Li
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China.,Shenzhen Key Laboratory of Ultrasound Imaging and Therapy, Shenzhen 518055, China
| | - Yilei Mao
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC and Chinese Academy of Medical Sciences, Beijing 100730, China
| |
Collapse
|
19
|
Gupta I, Eisenbrey JR, Machado P, Stanczak M, Wallace K, Forsberg F. On Factors Affecting Subharmonic-aided Pressure Estimation (SHAPE). ULTRASONIC IMAGING 2019; 41:35-48. [PMID: 30417745 PMCID: PMC6689132 DOI: 10.1177/0161734618812083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Subharmonic-aided pressure estimation (SHAPE) estimates hydrostatic pressure using the inverse relationship with subharmonic amplitude variations of ultrasound contrast agents (UCAs). We studied the impact of varying incident acoustic outputs (IAO), UCA concentration, and hematocrit on SHAPE. A Logiq 9 scanner with a 4C curvilinear probe (GE, Milwaukee, Wisconsin) was used with Sonazoid (GE Healthcare, Oslo, Norway) transmitting at 2.5 MHz and receiving at 1.25 MHz. An improved IAO selection algorithm provided improved correlations ( r from -0.85 to -0.95 vs. -0.39 to -0.98). There was no significant change in SHAPE gradient as the pressure increased from 10 to 40 mmHg and hematocrit concentration was tripled from 1.8 to 4.5 mL/L (Δ0.00-0.01 dB, p = 0.18), and as UCA concentration was increased from 0.2 to 1.2 mL/L (Δ0.02-0.05 dB, p = 0.75). The results for the correlation between the SHAPE gradient and hematocrit values for patients ( N = 100) in an ongoing clinical trial were also calculated showing a poor correlation value of 0.14. Overall, the SHAPE gradient is independent of hematocrit and UCA concentration. An improved algorithm for IAO selection will make SHAPE more accurate.
Collapse
Affiliation(s)
- Ipshita Gupta
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
- School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, PA 19104, USA
| | - John R. Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Priscilla Machado
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Maria Stanczak
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | | | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| |
Collapse
|
20
|
Improvement of Detection Sensitivity of Microbubbles as Sensors to Detect Ambient Pressure. SENSORS 2018; 18:s18124083. [PMID: 30469461 PMCID: PMC6308843 DOI: 10.3390/s18124083] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 11/14/2018] [Accepted: 11/19/2018] [Indexed: 01/16/2023]
Abstract
Microbubbles are considered a promising tool for noninvasive estimation of local blood pressure. It is reported that the subharmonic scattering amplitude of microbubbles decreases by 9 to 12 dB when immersed in the media under an ambient pressure variation from 0 to 180 mmHg. However, the pressure sensitivity still needs to be improved to satisfy clinical diagnostic requirements. Here, we investigated the effects of acoustic parameters on the pressure sensitivity of microbubbles through measuring the acoustic attenuation and scattering properties of commercially available SonoVue microbubbles. Our results showed that the first harmonic, subharmonic, and ultraharmonic amplitudes of microbubbles were reduced by 6.6 dB, 10.9 dB, and 9.3 dB at 0.225 mechanical index (MI), 4.6 dB, 19.8 dB, and 12.3 dB at 0.25 MI, and 18.5 dB, 17.6 dB, and 12.6 dB at 0.3 MI, respectively, when the ambient pressure increased from 0 to 180 mmHg. Our finding revealed that a moderate MI (0.25–0.4) exciting microbubbles could significantly improve their sensitivities to detect ambient pressure.
Collapse
|
21
|
Shekhar H, Smith NJ, Raymond JL, Holland CK. Effect of Temperature on the Size Distribution, Shell Properties, and Stability of Definity ®. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:434-446. [PMID: 29174045 PMCID: PMC5759968 DOI: 10.1016/j.ultrasmedbio.2017.09.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 09/28/2017] [Accepted: 09/29/2017] [Indexed: 05/08/2023]
Abstract
Physical characterization of an ultrasound contrast agent (UCA) aids in its safe and effective use in diagnostic and therapeutic applications. The goal of this study was to investigate the impact of temperature on the size distribution, shell properties, and stability of Definity®, a U.S. Food and Drug Administration-approved UCA used for left ventricular opacification. A Coulter counter was modified to enable particle size measurements at physiologic temperatures. The broadband acoustic attenuation spectrum and size distribution of Definity® were measured at room temperature (25 °C) and physiologic temperature (37 °C) and were used to estimate the viscoelastic shell properties of the agent at both temperatures. Attenuation and size distribution was measured over time to assess the effect of temperature on the temporal stability of Definity®. The attenuation coefficient of Definity® at 37 °C was as much as 5 dB higher than the attenuation coefficient measured at 25 °C. However, the size distributions of Definity® at 25 °C and 37 °C were similar. The estimated shell stiffness and viscosity decreased from 1.76 ± 0.18 N/m and 0.21 × 10-6 ± 0.07 × 10-6 kg/s at 25 °C to 1.01 ± 0.07 N/m and 0.04 × 10-6 ± 0.04 × 10-6 kg/s at 37 °C, respectively. Size-dependent differences in dissolution rates were observed within the UCA population at both 25 °C and 37 °C. Additionally, cooling the diluted UCA suspension from 37 °C to 25 °C accelerated the dissolution rate. These results indicate that although temperature affects the shell properties of Definity® and can influence the stability of Definity®, the size distribution of this agent is not affected by a temperature increase from 25 °C to 37 °C.
Collapse
Affiliation(s)
- Himanshu Shekhar
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
| | - Nathaniel J Smith
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jason L Raymond
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - Christy K Holland
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio, USA; Department of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, USA
| |
Collapse
|