Ultrasound monitoring of microcirculation: An original study from the laboratory bench to the clinic

Aghabaglou, Fariba; Ainechi, Ana; Abramson, Haley G.; Curry, Eli; Kaovasia, Tarana Parvez; Kamal, Serene; Acord, Molly; Mahapatra, Smruti; Pustavoitau, Aliaksei; Smith, Beth A.; Azadi, Javad; Son, Jennifer K.; Suk, Ian; Theodore, Nicholas; Tyler, Betty; Manbachi, Amir

doi:10.1111/micc.12770

Cited by 14 publications

(9 citation statements)

References 52 publications

(135 reference statements)

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“…Ultrasound is used in medicine for diagnostic (typically > 2 MHz) and therapeutic (typically < 3 MHz) purposes [1]. Due to its ability to characterize tissue and blood flow remotely (e.g., non-invasively) without ionizing radiation, ultrasound is a desirable option for detecting tissue and vascular abnormalities and modeling biological systems [2]. In spinal cord injury (SCI) cases, it is crucial for clinicians to monitor and control blood flow to the site of injury to promote proper healing.…”

Section: Introductionmentioning

confidence: 99%

Computational modeling towards focused ultrasound therapy for spinal cord injury: visualization of beam propagation through patient-specific anatomy

Kumar

Tsehay

González

et al. 2023

Medical Imaging 2023: Image-Guided Procedures, Robotic Interventions, and Modeling

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Ultrasound holds promise for use in spinal cord injury cases for both diagnostic and therapeutic purposes. Focused ultrasound applications demand an added threshold of study to ensure the safety and efficacy of the therapy. For optimal treatment outcomes, it is crucial to understand whether relevant structures are being targeting with sufficient energy without damaging neighboring tissue and vasculature. However, it is difficult to predict the expected displacement and pressure profile of the ultrasound wavefront due to challenges with visualizing an acoustic beam in real-time and complex patient-specific anatomy. This challenge is particularly prominent in anatomies with varying medium acoustic properties that cause reflection and distortion of the signal, which is inherent to the composition of the spinal cord and is exacerbated by the formations of injury-induced hematomas. Incorrect placement of focused ultrasound transducers can be detrimental to patient health, specifically if therapeutic ultrasound is used at higher intensities, as the beam propagation can target healthy tissue and important structures that could lead to tissue damage and death. We study how computational tools can be leveraged to aid placement of the transducer using an ultrasound simulation software, Wave 3000 Plus, that allows for the visualization of ultrasound propagation through anatomical structures. By simulating the propagation of ultrasound beams through patient-specific Digital Imaging and Communications in Medicine (DICOM) images, we study computational approaches to determine the optimal placement of devices. In this study, we use in vivo porcine spinal cord images following spinal cord injury (as an example medical use case) to determine if the injury site is being targeted appropriately and to visualize the distribution of pressure throughout the simulation. We demonstrate that Wave 3000 Plus is a viable approach for visualizing ultrasound propagation through patient-specific anatomies.

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Section: Introductionmentioning

confidence: 99%

Computational modeling towards focused ultrasound therapy for spinal cord injury: visualization of beam propagation through patient-specific anatomy

Kumar

Tsehay

González

et al. 2023

Medical Imaging 2023: Image-Guided Procedures, Robotic Interventions, and Modeling

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“…Traditionally, non-contrast methods are only able to detect ow in blood vessels exceeding a certain size and ow velocity (i.e., arteries and arterioles), and motion artifact can render it di cult to detect small vessels with low ow velocities. [18], [23] Consequently, non-contrast methods are unable to measure capillary perfusion, which represents how much blood is effectively delivered to the tissue. [10] Additionally, non-contrast ultrasound is limited to measuring ow through vessels within the imaging plane.…”

Section: Introductionmentioning

confidence: 99%

“…Non-contrast ultrasound does not require any infusion. Moreover, new non-contrast techniques, such as Superb Microvascular Imaging (SMI) [23] and functional ultrasound,[28] in combination with high-frequency ultrasound transducers, have overcome the barrier of measuring ow in small vessels with much lower ow velocity than was previously possible. Additionally, the anatomy of the spinal cord is particularly suitable for non-contrast imaging.…”

Section: Introductionmentioning

confidence: 99%

Non-Contrast Ultrasound Image Analysis for Spatial and Temporal Distribution of Blood Flow After Spinal Cord Injury

Routkevitch,

Soulé,

Kats

et al. 2023

Preprint

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Ultrasound technology can provide high-resolution imaging of blood flow following spinal cord injury (SCI). Blood flow imaging may improve critical care management of SCI, yet is limited clinically by the invasive nature of contrast agent injection required for high-resolution, continuous monitoring. In this study, we aim to establish non-contrast ultrasound as a clinically translatable imaging technique for spinal cord blood flow via comparison to contrast-based methods and by measuring the spatial distribution of blood flow after SCI. A rodent model of contusion SCI at the T12 spinal level was carried out using three different impact forces. We compared images of spinal cord blood flow taken using both non-contrast and contrast-enhanced ultrasound. Subsequently, we processed the images as a function of distance from injury, yielding the distribution of blood flow through space after SCI, and found the following. (1) Both non-contrast and contrast-enhanced imaging methods resulted in similar blood flow distributions (Spearman’s ρ = 0.55, p < 0.0001). (2) We found an area of decreased flow at the injury epicenter, or umbra (p < 0.0001). Unexpectedly, we found increased flow at the periphery, or penumbra (rostral, p < 0.05; caudal, p < 0.01), following SCI. However, distal flow remained unchanged, in what is presumably unaffected tissue. (3) Finally, tracking blood flow in the injury zones over time revealed interesting dynamic changes. After an initial decrease, blood flow in the penumbra increased during the first 10 minutes after injury, while blood flow in the umbra and distal tissue remained constant over time. These results demonstrate the viability of non-contrast ultrasound as a clinical monitoring tool. Furthermore, our surprising observations of increased flow in the injury periphery pose interesting new questions about how the spinal cord vasculature reacts to SCI, with potentially increased significance of the penumbra.

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“…New ultrasonic methods dedicated to slow flow visualization have been recently developed to access the microvascular network, such as MV-Flow ( Gettle and Revzin, 2020 ; Giuffrida et al, 2021 ). Based on a high frame rate associated with dedicated filters, MV-Flow allows a high sensitivity of flow measurements in small arterioles and venules, giving access to a vascular mapping of tissue ( Aghabaglou et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

Microvascular assessment of fascio-cutaneous flaps by ultrasound: A large animal study

et al. 2022

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Objectives: Blood perfusion quality of a flap is the main prognostic factor for success. Microvascular evaluation remains mostly inaccessible. We aimed to evaluate the microflow imaging mode, MV-Flow, in assessing flap microvascularization in a pig model of the fascio-cutaneous flap.Methods: On five pigs, bilateral saphenous fascio-cutaneous flaps were procured on the superficial femoral vessels. A conventional ultrasound evaluation in pulsed Doppler and color Doppler was conducted on the ten flaps allowing for the calculation of the saphenous artery flow rate. The MV-Flow mode was then applied: for qualitative analysis, with identification of saphenous artery collaterals; then quantitative, with repeated measurements of the Vascularity Index (VI), percentage of pixels where flow is detected relative to the total ultrasound view area. The measurements were then repeated after increasing arterial flow by clamping the distal femoral artery.Results: The MV-Flow mode allowed a better follow-up of the saphenous artery’s collaterals and detected microflows not seen with the color Doppler. The VI was correlated to the saphenous artery flow rate (Spearman rho of 0.64; p = 0.002) and allowed to monitor the flap perfusion variations.Conclusion: Ultrasound imaging of microvascularization by MV-Flow mode and its quantification by VI provides valuable information in evaluating the microvascularization of flaps.

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Ultrasound monitoring of microcirculation: An original study from the laboratory bench to the clinic

Cited by 14 publications

References 52 publications

Computational modeling towards focused ultrasound therapy for spinal cord injury: visualization of beam propagation through patient-specific anatomy

Computational modeling towards focused ultrasound therapy for spinal cord injury: visualization of beam propagation through patient-specific anatomy

Non-Contrast Ultrasound Image Analysis for Spatial and Temporal Distribution of Blood Flow After Spinal Cord Injury

Microvascular assessment of fascio-cutaneous flaps by ultrasound: A large animal study

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