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Ultrasound examination of the kidneys with grey-scale imaging and colour Doppler ultrasound is the most common renal imaging modality. A few years ago, contrast-enhanced ultrasound (CEUS) emerged as a non-invasive perfusion imaging modality to evaluate the renal vessels and microvascularisation. These contrast media contain intravenous microbubbles (sulfur hexafluoride), which have no deleterious effect on renal function. Being free of iodine, they also pose no risk for the thyroid gland. CEUS of the kidneys is mainly used for the evaluation of renal cysts and the analysis of renal lesions suspicious for malignancy. Also this method is used to visualise inflammation as well as renal perfusion after trauma or infarction., (© Georg Thieme Verlag KG Stuttgart · New York.)

We measure the detection and discrimination efficiencies of conventional power-Doppler estimation of perfusion without contrast enhancement. The measurements are made in a phantom with known blood-mimicking fluid flow rates in the presence of clutter and noise. Efficiency is measured by comparing functions of the areas under the receiver operating characteristic curve for Doppler estimators with those of the ideal discriminator, for which we estimate the temporal covariance matrix from echo data. Principal-component analysis is examined as a technique for increasing the accuracy of covariance matrices estimated from echo data. We find that Doppler estimators are <50% efficient at directed perfusion detection between 0.1 and 2.0 mL/min per 2 cm(2) flow area. The efficiency was 20%-40% for the task of discriminating between two perfusion rates in the same range. We conclude that there are reasons to search for more efficient perfusion estimators, one that incorporates covariance matrix information that could significantly enhance the utility of Doppler ultrasound without contrast enhancement.

Objectives: The relation between dopamine infusion and renal hemodynamics and function has not been studied in renal allografts during early recovery. We analyzed the dose response of dopamine infusion on renal blood flow and function in human kidney transplant recipients at reperfusion and during early graft recovery., Materials and Methods: Phasic and mean renal blood flow was measured by the pulsed Doppler technique using implantable Doppler microprobes in contact with the graft artery. Systemic and renal parameters were recorded on dopamine infusion (0, 3, 5, and 10 μg·kg⁻¹·min⁻¹) immediately after transplant (day 0) in 13 patients and at day 6 in 7/13 patients with early graft recovery. Results are expressed as median and interquartile range between the 25th and 75th percentiles., Results: At day 0, 3 μg·kg⁻¹·min⁻¹) dopamine did not increase mean renal blood flow over baseline (580 mL/min [219-663 mL/min] vs 542 mL/min [207-686 mL/min]; P = .84). There was an absence of effect with higher dopamine doses, whereas cardiac output, heart rate, and systolic and mean arterial pressure were significantly increased. Urinary sodium excretion, creatinine clearance, and urine output increased dose dependently, with a positive correlation between the increase in urine output and mean arterial pressure (r = 0.48, P < .001). At day 6, 3 μg·kg⁻¹·min⁻¹ dopamine increased mean renal blood flow over baseline (318 mL/min [234-897 mL/min] vs 191 mL/min [173-706 mL/min]; P = .016), with no further increase at higher doses., Conclusions: Immediately after transplant, kidney grafts with ischemic-reperfusion injury are fully dilated and do not respond to dopamine. The specific renal effects observed are due to systemic hemodynamic status. Vascular responsiveness to a "renal dopamine dose" returns on graft recovery.

Introduction: PI as an independent indicator of resistance to flow is a widely-accepted alternative index to measurement of flow volume in vessels. This study aimed to determine the normal values and chronological trend of PI of abdominal wall free flaps in breast reconstruction and to revalidate its clinical relevance in post-operative monitoring of these flaps., Materials and Methods: 47 patients with breast reconstruction using DIEP, MS-TRAM and bi-pedicled DIEP flaps were assessed for PI of the supplying perforator vessels using a hand-held colour Doppler ultrasound device over 6 post-operative days. Triplicate measurements were obtained by one operator once daily concurrently with haemodynamic parameters., Results: DIEP flaps demonstrate a descending trend of PI and resistance to blood flow post-operatively (p=0.005) similar to non-perforator free flaps. MS-TRAM flaps show higher initial PI values and vascular resistance compared to DIEP flaps (p=0.038). PI values show no correlation with haemodynamic parameters (r=0.2, n=38). Flaps with venous insufficiency demonstrate significantly higher values of PI (p=0.03)., Conclusions: PI is an objective, non-invasive, efficient, easy-to-measure, reproducible and quickly-responsive indicator of perfusion of DIEP flaps., (Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Fetal intrauterine growth restriction (IUGR) results in abnormal cardiac function that is apparent antenatally due to advances in fetoplacental Doppler ultrasound and fetal echocardiography. Increasingly, these imaging modalities are being employed clinically to examine cardiac function and assess wellbeing in utero, thereby guiding timing of birth decisions. Here, we used a rabbit model of IUGR that allows analysis of cardiac function in a clinically relevant way. Using isoflurane induced anesthesia, IUGR is surgically created at gestational age day 25 by performing a laparotomy, exposing the bicornuate uterus and then ligating 40-50% of uteroplacental vessels supplying each gestational sac in a single uterine horn. The other horn in the rabbit bicornuate uterus serves as internal control fetuses. Then, after recovery at gestational age day 30 (full term), the same rabbit undergoes examination of fetal cardiac function. Anesthesia is induced with ketamine and xylazine intramuscularly, then maintained by a continuous intravenous infusion of ketamine and xylazine to minimize iatrogenic effects on fetal cardiac function. A repeat laparotomy is performed to expose each gestational sac and a microultrasound examination (VisualSonics VEVO 2100) of fetal cardiac function is performed. Placental insufficiency is evident by a raised pulsatility index or an absent or reversed end diastolic flow of the umbilical artery Doppler waveform. The ductus venosus and middle cerebral artery Doppler is then examined. Fetal echocardiography is performed by recording B mode, M mode and flow velocity waveforms in lateral and apical views. Offline calculations determine standard M-mode cardiac variables, tricuspid and mitral annular plane systolic excursion, speckle tracking and strain analysis, modified myocardial performance index and vascular flow velocity waveforms of interest. This small animal model of IUGR therefore affords examination of in utero cardiac function that is consistent with current clinical practice and is therefore useful in a translational research setting.

Objective: Management and follow-up of chronic aortic dissections continue to be a clinical challenge due to progressive dilatation and subsequent rupture. To predict complications, guidelines suggest follow-up of aortic diameter. However, dilatation is triggered by hemodynamic parameters (pressures/wall shear stresses) and geometry of false (FL) and true lumen (TL), information not captured by diameter alone. Therefore, we aimed at better understanding the influence of dissection anatomy on TL and FL hemodynamics., Methods: In vitro studies were performed using pulsatile flow in realistic dissected latex/silicone geometries with varying tear number, size, and location. We assessed three different conformations: (1) proximal tear only; (2) distal tear only; (3) both proximal and distal tears. All possible combinations (n = 8) of small (10% of aortic diameter) and large (25% of aortic diameter) tears were considered. Pressure, velocity, and flow patterns were analyzed within the lumina (at proximal and distal sections) and at the tears. We also computed the FL mean pressure index (FPI(mean)%) as a percentage of the TL mean pressure, to compare pressures among models., Results: The presence of large tears equalized FL/TL pressures compared with models with only small tears (proximal FPI(mean)% 99.85 ± 0.45 vs 92.73 ± 3.63; distal FPI(mean)% 99.51 ± 0.80 vs 96.35 ± 1.96; P < .001). Thus, large tears resulted in slower velocities through the tears (systolic velocity <180 cm/s) and complex flows within the FL, whereas small tears resulted in lower FL pressures, higher tear velocities (systolic velocity >290 cm/s), and a well-defined flow. Additionally, both proximal and distal tears act as entry and exit. During systole, flow enters the FL through all tears simultaneously, while during diastole, flow leaves through all communications. Flow through the FL, from proximal to distal tears or vice versa, is minimal., Conclusions: Our results suggest that FL hemodynamics heavily depends on cumulative tear size, and thus, it is an important parameter to take into account when clinically assessing chronic aortic dissections., (Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)

The ultrasound imaging has the potential to become a dominant technique for noninvasive therapies and least invasive surgeries. Few cases may require using multiple probes of different units with different modes of ultrasound on the same patient. It generates imaging artifacts, which makes it complicated to gather information from the acquired image. This study was to identify and analyse the artifacts which are produced by simultaneous use of two probes with different/same operating frequencies. Six imaging studies were performed. First of all, the imaging artifacts of the 3.5 MHz and 6 MHz center frequencies with similar (longitudinal) positions of the probes. Secondly, with similar operating frequencies the 6 MHz probe changed from longitudinal to transverse placement to analyse the resulting artifacts. The third study was done with transverse placement of 3.5 MHz probe. The rest of the three cases were just the repetition with common pulse frequencies. Such artifacts in 3D ultrasound images are more obscure than the other artifacts associated and reported.

To evaluate cardiac output (CO), both invasive and semi-invasive monitors are used in critical care medicine. The pulmonary artery catheter is an invasive tool to assess CO with the major criticism that the level of its invasiveness is not supported by an improvement in patients' outcomes. The interest in a lesser invasive techniques is high. Therefore, alternative techniques have been developed recently, and are used frequently in critical care medicine. Cardiac output can be monitored continuously by different devices that analyze the stroke volume and CO. The purpose of this review is to understand these new technologies and their applications and limitations.

Background: With the advent of numerous minimally invasive medical procedures, accurate catheter guidance has become imperative. We introduce and test an approach for catheter guidance by ultrasound imaging and pulsed-wave (PW) Doppler., Methods: A steerable catheter is fitted with a small piezoelectric crystal at its tip that actively transmits signals driven by a function generator. We call this an active-tip (AT) catheter. In a water tank, we immersed a "target" crystal and a rectangular matrix of four "reference" crystals. Two-dimensional (2D) ultrasound imaging was used for initial guidance and visualization of the catheter shaft, and then PW Doppler mode was used to identify the AT catheter tip and guide it to the simulated target that was also visible in the 2D ultrasound image. Ten guiding trials were performed from random initial positions of the AT catheter, each starting at approximately 8 cm from the target., Results: After the ten navigational trials, the average final distance of the catheter tip from the target was 2.4 ± 1.2 mm, and the range of distances from the trials was from a minimum of 1.0 mm to a maximum of 4.5 mm., Conclusions: Although early in the development process, these quantitative in vitro results show promise for catheter guidance with ultrasound imaging and tip identification by PW Doppler., (©2011, The Authors. Journal compilation ©2011 Wiley Periodicals, Inc.)

Polyvinyl alcohol cryogel (PVA-C) is presented as a vessel-mimicking material for use in anatomically realistic Doppler flow phantoms. Three different batches of 10% wt PVA-C containing (i) PVA-C alone, (ii) PVA-C with antibacterial agent and (iii) PVA-C with silicon carbide particles were produced, each with 1-6 freeze-thaw cycles. The resulting PVA-C samples were characterized acoustically (over a range 2.65 to 10.5 MHz) and mechanically to determine the optimum mixture and preparation for mimicking the properties of healthy and diseased arteries found in vivo. This optimum mix was reached with the PVA-C with antibacterial agent sample, prepared after two freeze/thaw cycles, which achieved a speed of sound of 1538 ± 5 m s(-1) and a Young's elastic modulus of 79 ± 11 kPa. This material was used to make a range of anatomically realistic flow phantoms with varying degrees of stenoses, and subsequent flow experiments revealed that higher degrees of stenoses and higher velocities could be achieved without phantom rupturing compared with a phantom containing conventional wall-less vessels., (Copyright © 2011 World Federation for Ultrasound in Medicine & Biology. All rights reserved.)

Numerous cardiac output (CO) monitors have been produced that provide continuous rather than intermittent readings. Bland and Altman has become the standard method for validating their performance against older standards. However, the Bland and Altman method only assesses precision and does not assess how well a device detects serial changes in CO (trending ability). Currently, there is no consensus on how trending ability, or trend analysis, should be performed. Therefore, we performed a literature review to identify articles published between 1997 and 2009 that compared methods of continuous CO measurement. Identified articles were grouped according to measurement technique and statistical methodology. Articles that analyzed trending ability were reviewed with the aim of finding an acceptable statistical method. Two hundred two articles were identified. The most popular methods were pulse contour (69 articles), Doppler (54), bioimpedance (38), and transpulmonary or continuous thermodilution (27). Forty-one articles addressed trending, and of these only 23 provided an in-depth analysis. Several common statistical themes were identified: time plots, regression analysis, Bland and Altman using change in CO (ΔCO), and the 4-quadrant plot, which used direction of change of ΔCO to determine the concordance. This plot was further refined by exclusion of data when values were small. Receiver operating characteristic curves were used to define the exclusion zone. In animal studies, a reliable reference standard such as an aortic flowprobe was frequently used, and regression or time plots could be used to show trending. Clinical studies were more problematic because data collection points were fewer (8-10 per subject). The consensus was to use the 4-quadrant plot with exclusion zones and apply concordance analysis. A concordance rate of >92% when using a 15% zone indicated good trending. A new method of presenting trend data (ΔCO) on a polar plot is proposed. Agreement was shown by the angle with the horizontal axis and ΔCO by the distance from the center. Trending can be assessed by the vertical limits of the data, similar to the Bland and Altman method.

A model is presented for pulse-echo imaging of three-dimensional, linear, weakly-scattering continuum media by ultrasound array transducers. The model accounts for the diffracted fields of focused array subapertures in both transmit and receive modes, multiple transmit and receive focal zones, frequency-dependent attenuation, and aberration caused by mismatched medium and beamformer sound speeds. For a given medium reflectivity function, computation of a B-scan requires evaluation of a depth-dependent transmit/receive beam product, followed by two one-dimensional convolutions and a one-dimensional summation. Numerical results obtained using analytic expressions for transmit and receive beams agree favorably with measured B-scan images and speckle statistics.

Objectives: Gaseous microemboli (GME) are a cause of neurocognitive deficit postcardiac surgery with cardiopulmonary bypass. However, the measurement of microbubbles during cardiopulmonary bypass is not easy, because blood is an opaque fluid and contains microparticles. Recently, two new microbubble counters, the Gampt BC200 and the emboli detection and classification (EDAC) quantifier, were developed for use during cardiac surgery. The accuracy of both devices was validated against industrial standards., Methods: A clear blood analogue (30%/70% glycerol-water) was pumped, by means of a rollerpump out of a partially filled arterial line screen filter with a nominal pore size of 20 microm. Downstream the pump, all test sensors and an optical cuvette, were inserted in a vertically mounted 3/8 inch tubing. Measurements were taken at flows of 405, 1080, 3000 and 6000 ml/min. Backlight shadowgraphy and optical counting were used as industrial reference techniques for measuring size and counts., Results: On average the EDAC quantifier underestimates average bubble diameter by 35+/-1%, 13+/-8%, 71+/-7% and 33+/-4% at 405, 1080, 3000 and 6000 ml/min, respectively. The Gampt BC200 has good sizing agreement at 1080 ml/min (+5+/-17%) and 3000 ml/min (+33+/-6%) but overestimates average diameter by 220+/-40% and 295+/-49% at 405 and 6000 ml/min, respectively. Both devices only partially count the number of microbubbles at higher flows. At 3 l/min the EDAC counts 38%, the Gampt 18% of total counts and at 6 l/min both the EDAC and Gampt only count 3% of total counts., Conclusions: Both the EDAC and Gampt can be used in a clinical setting for monitoring basal GME production. However, both devices have some major limitations when used for studying 'worst case' scenarios. One should take great caution when correlating measured data with neurocognitive outcome. Finally, results obtained by one device in a first study cannot be compared nor exchanged with results from the other device in a second study.

Background: The purpose of this study is to measure blood flow velocity of rabbit retinal vessels using a 45-MHz ultrasonic Doppler system with a needle transducer., Methods: A high-frequency pulsed Doppler system that utilizes a 45-MHz PMN-PT needle transducer was developed to measure retinal blood flow velocity in situ. The pulsed Doppler allowed the differentiation of retinal from choroidal blood flow velocity. The needle transducer was inserted into the vitreous cavity through a 20-gauge incision port to access the retinal vessels. The first phase of the experiment evaluated the reproducibility of the measurements. The second phase measured velocities at four positions from the optic disc edge to the distal part of each vessel in nine eyes for the temporal and six eyes for the nasal portions. The angle between the transducer and the retinal vessel at each site was measured in enucleated rabbit eyes to estimate and compensate for measurement errors., Results: In the first phase, the average measurement error was 5.97 +/- 1.34%. There was no significant difference comparing all eyes. In the second phase, the velocities gradually slowed from the disc edge to the distal part, and temporal velocities were faster than nasal velocities at all measurement sites., Conclusion: This study demonstrated the feasibility of reliably measuring retinal blood flow velocity using a 45-MHz ultrasonic Doppler system with a needle transducer.

Doppler flow and string phantoms have been used to assess the performance of ultrasound Doppler systems in terms of parameters such as sensitivity, velocity accuracy and sample volume registration. However, because of the nature of their construction, they cannot challenge the accuracy and repeatability of modern digital ultrasound systems or give objective measures of system performance. Electronic Doppler phantoms are able to make use of electronically generated test signals, which may be controlled precisely in terms of frequency, amplitude and timing. The Leicester Electronic Doppler Phantom uses modern digital signal processing methods and field programmable gate array technology to overcome some of the limitations of previously described electronic phantoms. In its present form, it is able to give quantitative graphical assessments of frequency response and range gate characteristics, as well as measures of dynamic range and velocity measurement accuracy. The use of direct acoustic coupling eliminates uncertainties caused by Doppler beam effects, such as intrinsic spectral broadening, but prevents their evaluation., (Copyright 2010 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)

Doppler ultrasound is an important noninvasive diagnostic tool for cardiovascular diseases. Modern ultrasound imaging systems utilize spectral Doppler techniques for quantitative evaluation of blood flow velocities, and these measurements play a crucial rule in the diagnosis and grading of arterial stenosis. One drawback of Doppler-based blood flow quantification is that the operator has to manually specify the angle between the Doppler ultrasound beam and the vessel orientation, which is called the Doppler angle, in order to calculate flow velocities. In this paper, we will describe a computer vision approach to automate the Doppler angle estimation. Our approach starts with the segmentation of blood vessels in ultrasound color Doppler images. The segmentation step is followed by an estimation technique for the Doppler angle based on a skeleton representation of the segmented vessel. We conducted preliminary clinical experiments to evaluate the agreement between the expert operator's angle specification and the new automated method. Statistical regression analysis showed strong agreement between the manual and automated methods. We hypothesize that the automation of the Doppler angle will enhance the workflow of the ultrasound Doppler exam and achieve more standardized clinical outcome.

The small size, high heart rate and small tissue displacement of a mouse require small sensors that are capable of high spatial and temporal tissue displacement resolutions and multichannel data acquisition systems with high sampling rates for simultaneous measurement of high fidelity signals. We developed and evaluated an ultrasound-based mouse vascular research system (MVRS) that can be used to characterize vascular physiology in normal, transgenic, surgically altered and disease models of mice. The system consists of multiple 10/20MHz ultrasound transducers, analog electronics for Doppler displacement and velocity measurement, signal acquisition and processing electronics and personal computer based software for real-time and off-line analysis. In vitro testing of the system showed that it is capable of measuring tissue displacement as low as 0.1mum and tissue velocity (mum/s) starting from 0. The system can measure blood velocities up to 9m/s (with 10MHz Doppler at a PRF of 125kHz) and has a temporal resolution of 0.1 milliseconds. Ex vivo tracking of an excised mouse carotid artery wall using our Doppler technique and a video pixel tracking technique showed high correlation (R(2)=0.99). The system can be used to measure diameter changes, augmentation index, impedance spectra, pulse wave velocity, characteristic impedance, forward and backward waves, reflection coefficients, coronary flow reserve and cardiac motion in murine models. The system will facilitate the study of mouse vascular mechanics and arterial abnormalities resulting in significant impact on the evaluation and screening of vascular disease in mice.

During Doppler ultrasound assessment of blood flow, a wall filter is used to reduce or eliminate high-amplitude, low-velocity signals from the vessel wall and the surrounding tissue. This study investigated the impact of a range of wall filters (22 Hz, 75 Hz, 128 Hz, and 252 Hz) on the accuracy of forearm blood flow monitoring during the sympathoexcitatory application of lower body negative pressure, when peripheral blood flow may decrease substantially. The 252 Hz filter eliminated diastolic flow in 4 of 10 participants. In the remaining participants, the 252 Hz filter minimized the sensitivity of the pulsatility index. The interpretation of physiological responses could ultimately be compromised by using filters beyond 128 Hz.

Background: Permanent prostate brachytherapy (PPB) is a common treatment for early stage prostate cancer. While the modern approach using trans-rectal ultrasound guidance has demonstrated excellent outcome, the efficacy of PPB depends on achieving complete radiation dose coverage of the prostate by obtaining a proper radiation source (seed) distribution. Currently, brachytherapy seed placement is guided by trans-rectal ultrasound imaging and fluoroscopy. A significant percentage of seeds are not detected by trans-rectal ultrasound because certain seed orientations are invisible making accurate intra-operative feedback of radiation dosimetry very difficult, if not impossible. Therefore, intra-operative correction of suboptimal seed distributions cannot easily be done with current methods. Vibro-acoustography (VA) is an imaging modality that is capable of imaging solids at any orientation, and the resulting images are speckle free., Objective and Methods: The purpose of this study is to compare the capabilities of VA and pulse-echo ultrasound in imaging PPB seeds at various angles and show the sensitivity of detection to seed orientation. In the VA experiment, two intersecting ultrasound beams driven at f(1)=3.00 MHz and f(2)=3.020 MHz respectively were focused on the seeds attached to a latex membrane while the amplitude of the acoustic emission produced at the difference frequency 20 kHz was detected by a low frequency hydrophone., Results: Finite element simulations and results of experiments conducted under well-controlled conditions in a water tank on a series of seeds indicate that the seeds can be detected at any orientation with VA, whereas pulse-echo ultrasound is very sensitive to the seed orientation., Conclusion: It is concluded that vibro-acoustography is superior to pulse-echo ultrasound for detection of PPB seeds.

A recent study has shown the feasibility of subharmonic (SH) flow imaging at a transmit frequency of 20 MHz. This paper builds on these results by examining the performance of SH flow imaging as a function of transmit pressure. Further, we also investigate the feasibility of SH pulsed-wave Doppler (PWD) imaging. In vitro flow experiments were performed with a 1-mm-diameter wall-less vessel cryogel phantom using the ultrasound contrast agent Definity and an imaging frequency of 20 MHz. The phantom results show that there is an identifiable pressure range where accurate flow velocity and power estimates can be made with SH imaging at 10 MHz (SH10), above which velocity estimates are biased by radiation force effects and unstable bubble behavior, and below which velocity and power estimates are degraded by poor SNR. In vivo validation of SH PWD was performed in an arteriole of a rabbit ear, and blood velocity estimates compared well with fundamental (F20) mode PWD. The ability to suppress tissue signals using SH signals may enable the use of higher frame rates and improve sensitivity to microvascular flow or slow velocities near large vessel walls by reducing or eliminating the need for clutter filters.

Atherosclerotic lesions preferentially originate in arterial regions that experience low wall shear stress (WSS) and reversing flow patterns. Therefore, routinely monitoring arterial WSS may help to identify the potential sites of early atherosclerosis. A new noninvasive ultrasonic method implemented with coded excitation techniques was utilized to improve WSS estimation accuracy and precision by providing high spatial and temporal resolution. WSS measurement errors were quantified in a model system by scanning a linearly varying WSS field (0.3 to 1.9 Pa) within a flow chamber. A 13-bit optimal code (Opt) was found to be most effective in reducing bias and standard deviation in WSS estimates down to approximately 10% and approximately 8%. The measurement errors slowly increased with input WSS for all imaging pulses. The expression of endothelial cellular adhesion molecules vascular cell adhesion molecule-1 (VCAM-1) and endothelial-leukocyte adhesion molecule-1 (E-selectin) was investigated over a similar shear range (0 to 1.6 Pa) to study the impact of relating shear-mediated cellular adhesion molecule (CAM) expression to inaccuracies in WSS measurements. We quantified this influence as the prediction error, which accounts for the ultrasonic measurement errors and the sensitivity of CAM expression within certain shear ranges. The highest prediction errors were observed at WSS <0.8 Pa, where CAM expression is most responsive to WSS. The results emphasize the importance of minimizing estimation errors, especially within low shear regions. Preliminary two-dimensional in vivo shear imaging is also presented to provide information about the spatial heterogeneity in arterial WSS distribution.

In this paper, we report the development of the first high-frequency (HF) pulsed-wave Doppler system using a 30-MHz linear array transducer to assess the cardiovascular functions in small animals. This array-based pulsed-wave Doppler system included a 16-channel HF analog beamformer, a HF pulsed-wave Doppler module, timing circuits, HF bipolar pulsers and analog front ends. The beamformed echoes acquired by the 16-channel analog beamformer were fed directly to the HF pulsed-wave Doppler module. Then the in-phase and quadrature-phase (IQ) audio Doppler signals were digitized by either a sound card or a Gage digitizer and stored in a personal computer. The Doppler spectrogram was displayed on a personal computer in real time. The two-way beamwidths were determined to be 160 microm to 320 microm when the array was electronically focused at different focal points at depths from 5 to 10 mm. A micro-flow phantom, consisting of a polyimide tube with an inner diameter of 127 microm and the wire phantom were used to evaluate and calibrate the system. The results show that the system is capable of detecting motion velocity of the wire phantom as low as 0.1 mm/s, and detecting blood-mimicking flow velocity in the 127-microm tube lower than 7 mm/s. The system was subsequently used to measure the blood flow in vivo in two mouse abdominal superficial vessels, with diameters of approximately 200 microm, and a mouse aorta close to the heart. These results demonstrated that this system may become an indispensable part of the current HF array-based imaging systems for small animal studies.

Objective: To investigate, in a series of metastatic and primary invasive ovarian lesions examined by color Doppler, the prevalence of a main peripheral vessel penetrating into the central part of the ovarian mass with a tree-shaped morphology, defined as the 'lead vessel'., Methods: This was a retrospective study of 31 patients with histopathologically confirmed metastatic involvement of the ovary and 106 patients with confirmed primary invasive ovarian carcinoma, who had undergone standardized ultrasound examination, with established definitions of ultrasound characteristics. We retrieved sonographic images and videoclips, focusing on the detection of the lead vessel., Results: The presence of the lead vessel was detected in 11/31 (35.4%) metastatic ovarian tumors, and in only two (0.01%) cases of primary ovarian carcinoma (P = 0.0001). At color Doppler analysis, metastatic ovarian lesions were characterized by significantly lower pulsatility index (P = 0.0001) and resistance index (P = 0.0001) values, and significantly higher peak systolic velocity (P = 0.0002) and time-averaged maximum velocity (P = 0.04) values, when compared with primary ovarian carcinomas. The lead vessel was detected in 11/21 (52%) solid metastatic lesions and in no cases of multilocular or multilocular-solid lesions (P = 0.008)., Conclusion: The lead vessel is a novel sonographic feature of vascular morphology in solid ovarian metastases. The more frequent observation of this feature in metastatic ovarian tumors compared with primary invasive ovarian carcinomas warrants further investigation in order to explore its potential role in the diagnosis of metastatic ovarian masses., (Copyright (c) 2008 ISUOG. Published by John Wiley & Sons, Ltd.)

Acoustic output measurements of diagnostic ultrasound scanners are currently performed in water and derated to approximate in situ values. The derating scheme ignores nonlinear propagation of sound waves and has been shown in previous numerical and experimental studies to tend to underestimate relevant pressure and intensity values in tissue mimicking media. This work describes an alternative method, which uses a tissue-mimicking liquid with attenuation coefficient slope of 0.3 dB/cm/MHz, speed of sound of 1,540 m/s and nonlinearity parameter B/A of 7.5. The acoustic properties of this liquid are stable for at least 2 y after production. Initial results using a single M-mode configuration are presented. These results confirm that derating can significantly underestimate the pulse intensity integral and peak rarefactional pressure.

The appearance of ultrasound images depends critically on the physical interactions of sound with the tissues in the body. The basic principles of ultrasound imaging and the physical reasons for many common artifacts are described.

Ultrasound contrast agents oscillate approximately linearly up to a certain pressure range where nonlinearity sets in. Nonlinear microbubble oscillations are exploited in ultrasound pulse-echo imaging as this improves the contrast-to-tissue ratio. Here we report the observation of a highly nonlinear response of phospholipid-coated contrast agents at pressures as low as 50 kPa, termed "compression-only" behavior, where the microbubbles only compress, yet hardly expand. Time-resolved bubble dynamics recorded through ultra high-speed imaging revealed that nearly 40% of the coated bubbles show "compression-only" behavior.

High-frequency needle ultrasound transducers with an aperture size of 0.4 mm were fabricated using lead magnesium niobate-lead titanate (PMN-33% PT) as the active piezoelectric material. The active element was bonded to a conductive silver particle matching layer and a conductive epoxy backing through direct contact curing. An outer matching layer of parylene was formed by vapor deposition. The active element was housed within a polyimide tube and a 20-gauge needle housing. The magnitude and phase of the electrical impedance of the transducer were 47 omega and -38 degrees, respectively. The measured center frequency and -6 dB fractional bandwidth of the PMN-PT needle transducer were 44 MHz and 45%, respectively. The two-way insertion loss was approximately 15 dB. In vivo high-frequency, pulsed-wave Doppler patterns of blood flow in the posterior portion and in vitro ultrasonic backscatter microscope (UBM) images of the rabbit eye were obtained with the 44-MHz needle transducer.

The role that an ultrasonic piezoelectric transducer plays in an ultrasonic measurement system can be described in terms of the transducer's input electrical impedance and its sensitivity. Here, a new model-based approach is proposed to determine both the transducer impedance and sensitivity in a pulse-echo setup. This new method is much simpler to apply than previous "self-reciprocity" calibration methods for determining sensitivity and generalizes those methods. It is demonstrated that sensitivities obtained with this new method agree well with the sensitivities obtained by a three-transducer method commonly used in calibration studies. It is demonstrated that at the megahertz frequencies at which ultrasonic transducers operate it is important to compensate for cabling effects in these measurements. The influence of the pulser/receiver settings on the results obtained also will be discussed.

The blood coagulation mechanism consists of a series of concatenated chemical reactions, governed by the coagulation factors present in the blood plasma, after the activation of the clot mechanism. The last reaction corresponds to the fibrinogen conversion into fibrin, followed by the fibrin polymerisation and production of a stable fibrin network. During the clotting process, there is a sol-gel transformation of the medium. The subject of the present paper is the measurement of the ultrasonic attenuation coefficient for human blood plasma during the coagulation process, in the frequency range of 8 to 22 MHz. The clot was obtained after the procedure to measure the prothrombin time (approximately 12 s): mixing 150 microL of reconstituted lyophilised normal plasma with 300 microL of reconstituted lyophilised thromboplastin immersed in a water bath with the temperature controlled at 36.5 degrees C. The attenuation coefficient for pure plasma remained constant within the measurement period of 10 s and at frequencies of 8, 9, 10, 15, 20, 21 and 22 MHz. On the other hand, there is a detectable time-decay of the attenuation coefficient for samples of plasma going through the coagulation process and at frequencies of 8, 9, 10 and 15 MHz. The time-decay becomes less and less detectable as the frequency increases and it becomes completely undetectable at 20, 21 and 22 MHz.

Pulsed-wave Doppler (PWD) sonography allows the quantitative measurement of blood flow in vessels if the vessel's diameter and the angle (Doppler angle theta) between the ultrasound beam and the vessel's flow direction are known. In current clinical routine, these parameters are manually determined by the examiner. However the manual determination is time-consuming and a source of error in blood flow measurements because of inaccuracy and variability. To overcome these problems, we present methods for an automated Doppler gate placement and Doppler angle estimation based on image processing algorithms. The Doppler gate is determined by analyzing the intensity profile along the ultrasound beam. To calculate the Doppler angle, we present a multiscale approach which estimates the vessel's flow direction by principal component analysis. A first evaluation shows promising results. Our automated approach yields parameters which match the parameters determined by clinical experts very well.

Objective: To assess whether carotid blood flow measurements predict abnormalities in cerebral hemispheric perfusion., Design: The Quantix/NDTM system was used to measure carotid artery blood flow in nine patients with subarachnoid haemorrhage who underwent CT perfusion scanning., Results: No significant correlation was found between internal carotid artery blood flow and ipsilateral cerebral hemispheric perfusion (013, p>0.05) but there was a statistically significant correlation between total internal carotid and global cerebral perfusion (0.63, p<0.05)., Conclusions: This is the first report comparing the Quantix/NDTM system with CT perfusion. Our data do not show a statistically significant correlation between extracranial blood flow and cerebral hemispheric perfusion. This is in contrast to two previous studies where Quantix/NDTM measurements were compared with measurements of cerebral perfusion using the Xenon clearance technique.

Our previous studies have shown that short intense pulses delivered at certain pulse repetition frequencies (PRF) can achieve localized, clean erosion in soft tissue. In this paper, the intensity thresholds for ultrasound induced erosion and the effects of pulse intensity on erosion characterized by axial erosion rate, perforation area and volume erosion rate were investigated on in vitro porcine atrial wall tissue. Ultrasound pulses with a 3-cycle pulse duration and a 20-kHz PRF were delivered by a 788-kHz single element focused transducer. I(SPPA) values of 1000 to 9000 W/cm2 were tested. Results show the following: (1) the estimated intensity threshold for generating erosion was at I(SPPA) of 3220 W/cm2; (2) the axial erosion rate increased with higher intensity at I(SPPA) < or = 5000 W/cm2, while decreased with higher intensity at I(SPPA) > or = 5000 W/cm2; and (3) the perforation area and the volume erosion rate increased with higher intensity.

We have developed a sonomicrometer and continuous wavelength (CW) Doppler flowmeter for a multichannel telemetry system. These developments will enable us to measure ventricular dimension and coronary artery blood velocity, which are valuable parameters to characterize sudden cardiac death (SCD) in ambulatory animal models of ventricular arrhythmias. The design goals for the sensors were accuracy, low power consumption, small size and compatibility with each other. The circuits were designed successfully and tested simultaneously in vivo. The CW Doppler flowmeter draws 9 mA and the sonomicrometer draws 28 mA on a 5-V supply. The ability to measure heart dimension and blood velocity will add significantly to our understanding of the sequence of events leading up to spontaneous sudden cardiac death.

Background: Cardiac output is an essential parameter for the hemodynamic assessment of patients with cardiovascular disease. The authors tested in an animal model the feasibility of measuring cardiac output by transcutaneous fluorescence monitoring of an intravenous bolus injection of indocyanine green., Methods: Fluorescence dilution cardiac output was measured in 10 anesthetized rabbits and compared with cardiac output measured with a pulmonary thermodilution catheter and to aortic velocity measured by Doppler ultrasound. Indocyanine green fluorescence was excited with a near-infrared laser and measured with an optical probe positioned on the central ear artery. Measurements were obtained during baseline conditions as well as during short-term decreases and increases of the cardiac output., Results: The fluorescence of circulating indocyanine green detected transcutaneously varied proportionally to that of arterial blood samples, which allowed for calibration in terms of blood concentration of indocyanine green. Average values of fluorescence dilution cardiac output and thermodilution cardiac output measured in baseline conditions were 412 (+/- 13) and 366 (+/- 11) ml/min, respectively. Fluorescence dilution cardiac output showed a close, one-to-one linear relation with thermodilution cardiac output in each animal and in the pooled data from all animals (slope = 0.95 x 0.03; R = 0.94). Fluorescence dilution cardiac output overestimated thermodilution cardiac output by an average of 46 (+/- 6) ml/min during baseline conditions. Fluorescence dilution cardiac output was tightly correlated with aortic velocity., Conclusions: The proposed technique yielded accurate estimates of the cardiac output in experimental animals. This study should provide an initial framework for clinical testing of this new minimally invasive method for measuring cardiac output.

This work introduces a method for the in vivo measurement and analysis of turbulence within the leakage of a mechanical heart valve. Several analysis techniques were applied to ultrasound measurements acquired within the atrium of a pig, and error associated with these techniques was analyzed. The technique chosen applies cyclic averaging to mean and maximum velocity measurements within small, normalized phase windows to calculate Reynolds normal stresses in the direction of the ultrasound beam. Maximum shear stresses are estimated from these normal stresses using an analytical technique. The stresses observed were smaller than those reported from previous in vitro simulations.

Blood and tissue velocity are measured and analysed in cardiac, vascular and other applications of diagnostic ultrasound (US). An error in system calibration is a potential risk for misinterpretation of the measurements. To determine the accuracy in velocity calibration, we tested three common commercial US systems using a Doppler string phantom. We tested pulsed and continuous-wave Doppler modes for velocities relevant to both cardiac blood flow and tissue-velocity estimation. The US systems were tested with settings and transducers commonly used in cardiac applications. One system consistently overestimated velocity by about 5%, whereas the other two systems were quite accurate in velocity estimation. These findings emphasize the importance of continuous quality control of US equipment.

Pulse-inversion-based fundamental imaging was experimentally investigated for the enhancement of contrast detection. The pulse-inversion technique involves two firings with inverted waveforms. When the returning echoes from the two firings are summed, the residue signal is limited to even-order harmonics for tissue. However, when the returning echoes are from microbubbles, the fundamental signal is not completely cancelled because the reaction of the bubbles under compression is different from that under rarefaction. Thus, with the application of pulse-inversion technique, the fundamental signal can be used to enhance the contrast-to-tissue ratio. In this paper, B-mode, pulse-inversion-based fundamental images were constructed with various transmit waveforms. Motion artifacts also were studied. The results indicate that the contrast-to-tissue ratio was significantly enhanced compared to that obtained using either conventional, fundamental imaging or second-harmonic imaging. Longer transmit pulses resulted in a better signal-to-noise ratio, but did not noticeably affect the nonlinear response of the bubbles. In addition, the optimal ratio of the magnitude of the positive pulse to that of the negative pulse was unity, in terms of avoiding the uncancelled, third-order response in the fundamental frequency range. It also was found that the pulse-inversion fundamental technique is highly sensitive to tissue motion because the fundamental tissue signal is not cancelled when motion is present.

In the post genome-sequencing era, physiological phenotyping of genetically engineered mice is critical to further our understanding of the functional consequences of specific genetic defects. We have developed a 40-50 MHz ultrasound biomicroscopy-(UBM) guided, pulsed Doppler system for the sensitive detection of in vivo blood velocity waveforms in the mouse embryonic cardiovascular system. Our approach uses separate transducers for simultaneous imaging and Doppler blood flow measurements. To this end, unfocused, air-backed lithium niobate (LiNbO3) transducers provide sensitive Doppler detection and the flexibility of adjusting the axial position of the pulsed Doppler sample volume over many millimeters depth range of the collimated ultrasound beam. In this paper we describe the fabrication and characterization of the electromechanical and ultrasonic beam properties of 44-MHz LiNbO3 Doppler transducers. We further demonstrate the utility of these Doppler transducers for interrogating blood vessels such as the dorsal aorta over a range of mouse embryonic stages and axial range-gate depths.

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

Conventional Pulsed Wave Doppler (PWD) systems acquire an ensemble of N echoes per beam line at a constant pulse repetition frequency fprf, so that the pulse repetition interval equals Tpri = 1/fpn. The total time span determines the velocity resolution, and Tpri the unambiguous velocity range. The ensemble size N is by approximation inversely proportional to the frame rate, assuming that the system performs interleaving. For a given frame rate, a tradeoff can only be made between velocity resolution and velocity range. We propose an approach that allows increasing velocity resolution or range while keeping the frame rate constant. The approach is based on nonuniform sampling, i.e. sampling with varying sampling intervals. Thus, for a given ensemble size N a larger total time span, which would increase velocity resolution, or a shorter minimal Tpn, which would increase the velocity range, may be chosen. The conventional Doppler signal processing techniques are not compatible with nonuniform sampling. We, therefore, developed a velocity estimation algorithm for arbitrary sampling that is based on cross correlation. Furthermore, an adaptive wall filter was implemented that differentiates between tissue motion and blood flow. The new approach was successfully tested with in vitro and in vivo data.

The ultrasonic pulse-echo backscattered amplitude integral (BAI)-mode imaging technique has been developed to inspect the seal integrity of hermetically sealed, flexible food packages. With a focused 17.3-MHz transducer acquiring radio frequency (RF) echo data in a static rectilinear stop-and-go pattern, this technique was able to reliably detect channel defects as small as 38 microm in diameter and occasionally detect 6-microm-diameter channels. This contribution presents our experimental spatial sampling study of the BAI-mode imaging technique with a continuous zigzag scanning protocol that simulates a real-time production line inspection method in continuous motion. Two transducers (f/2 17.3 MHz and f/3 20.3 MHz) were used to acquire RF echo data in a zigzag raster pattern from plastic film samples bearing rectilinear point reflector arrays of varying grid spacings. The average BAI-value difference (deltaBAI) between defective and intact regions and the contrast-to-noise ratio (CNR) were used to assess image quality as a function of three spatial sampling variables: transducer spatial scanning step size, array sample grid spacing, and transducer -6-dB pulse-echo focal beam spot size. For a given grid size, the deltaBAI and CNR degraded as scanning step size in each spatial dimension increased. There is an engineering trade-off between the BAI-mode image quality and the transducer spatial sampling. The optimal spatial sampling step size has been identified to be between one and two times the -6-dB pulse-echo focal beam lateral diameter.

Existing tail-cuff pressure devices for mice use tail flow sensors that measure only systolic and mean pressure. We developed a method to obtain systolic and diastolic pressure in mice using a pulsed Doppler flow velocity sensor and a tail-cuff and validated the method against pressure signals obtained simultaneously from a fluid-filled catheter. The tail-cuff was pressurized to suprasystolic levels to completely occlude the tail artery and then released gradually. The pressure at which the tail flow reappeared was recorded as systolic and the pressure at which the tail flow became continuous was recorded as diastolic. Regression analysis of tail-cuff pressures over catheter pressures obtained from healthy mice (n = 16) showed a high degree of association (r(sys) = 0.95, r(dia) = 0.94, both at p < 0.001). Bland-Altman analysis showed good agreement between the two methods, with a mean difference of -13 ( +/- 12 SD) mmHg and 3 ( +/- 10 SD) mmHg in the systolic (58 to 250 mmHg) and diastolic (48 to 178 mmHg) pressure measurements, respectively. Bland-Altman plots of tail-cuff blood pressures of a second group of mice (n = 20) showed good agreement between repeated measurements obtained on the same day, but had higher variability between measurements made on different days.

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

This paper presents a novel approach for speckle reduction and coherence enhancement of ultrasound images based on nonlinear coherent diffusion (NCD) model. The proposed NCD model combines three different models. According to speckle extent and image anisotropy, the NCD model changes progressively from isotropic diffusion through anisotropic coherent diffusion to, finally, mean curvature motion. This structure maximally low-pass filters those parts of the image that correspond to fully developed speckle, while substantially preserving information associated with resolved-object structures. The proposed implementation algorithm utilizes an efficient discretization scheme that allows for real-time implementation on commercial systems. The theory and implementation of the new technique are presented and verified using phantom and clinical ultrasound images. In addition, the results from previous techniques are compared with the new method to demonstrate its performance.