稳恒流下腹主动脉旁瘤超声多普勒血流信号的仿真分析

腹主动脉旁瘤超声多普勒血流信号的仿真研究,可以为采用超声多普勒技术检测腹主动脉旁瘤的形成、生长过程和估计动脉旁瘤瘤体大小提供指导。先通过有限元数值计算方法得到稳恒流下腹主动脉旁瘤区域内的血液流场分布,然后采用余弦叠加的合成方法仿真出相应的超声多普勒血流信号,最后对仿真信号进行频谱分析,计算其平均频率,并研究它与腹主动脉旁瘤瘤体大小的关系。结果表明：当动脉旁瘤较小时,平均频率的幅度变化较小;当动脉旁瘤较大时,平均频率的幅度变化较大。因此,采用平均频率的幅度变化可以在一定程度上估计动脉旁瘤的瘤体大小。     

Shear-layer detection in poststenotic flow by spectrum analysis of Doppler signals

Spectrum analysis of the Doppler signals was performed 0.5 tube diameters downstream from an axisymmetric constriction with an area reduction of 80 percent in steady flow at a jet Reynolds number of 2840. Both pulsed and continuous wave (CW) Doppler spectra showed significant reverse flow components in the separated flow. The pulsed Doppler spectra exhibited sudden changes when the sample volume crossed the shear layer between the center jet and the separated flow. A power spectrum equation was theoretically derived from continuity of flow to define the Doppler shift frequency for the shear layer velocity. The CW Doppler spectrum showed a minimum spectrum density at a frequency which equalled the shear layer Doppler shift frequency derived from the equation. The pulsed spectra exhibited the sudden changes at the same frequency as well.     

高频彩色多普勒超声对乳腺癌腋窝淋巴结性质的鉴别价值

目的:研究高频彩色多普勒超声对乳腺癌腋窝良性淋巴结与腋窝转移性淋巴结的鉴别价值。方法:选择2015年2月~2016年6月在我院进行诊治的乳腺癌患者150例,应用高频二维超声结合彩色多普勒血流显像技术,观察腋窝肿大淋巴结的声像图及血流情况。结果:经二维超声发现,乳腺癌腋窝良性淋巴结的皮质多向心增厚(68.93%)、长短径比L/S多2.0(70.58%)、多不融合(93.14%)、多无钙化斑(97.06%);腋窝转移性淋巴结的皮质多偏心增厚(68.48%)、长短径比L/S多2.0(69.57%)、多融合(68.48%)、多有钙化斑(77.17%);两者相比有明显差异(P0.05);经彩色多普勒血流显像技术发现,乳腺癌腋窝良性淋巴结的血流信号分布多呈门型(63.17%),血流丰富程度多为Ⅱ级(54.35%);腋窝转移性淋巴结的血流信号分布多呈周边型(68.93%),血流丰富程度多为Ⅲ级(72.83%);两者相比有明显差异(P0.05)。结论:乳腺癌腋窝良性淋巴结与腋窝转移性淋巴结在内部回声、形态、血流分布特点等方面有显著的差异,高频彩色多普勒超声对乳腺癌腋窝良性淋巴结与腋窝转移性淋巴结具有较高的鉴别价值。     

An Analysis of Resting-State Functional Transcranial Doppler Recordings from Middle Cerebral Arteries

Functional transcrannial Doppler (fTCD) is used for monitoring the hemodynamics characteristics of major cerebral arteries. Its resting-state characteristics are known only when considering the maximal velocity corresponding to the highest Doppler shift (so called the envelope signals). Significantly more information about the resting-state fTCD can be gained when considering the raw cerebral blood flow velocity (CBFV) recordings. In this paper, we considered simultaneously acquired envelope and raw CBFV signals. Specifically, we collected bilateral CBFV recordings from left and right middle cerebral arteries using 20 healthy subjects (10 females). The data collection lasted for 15 minutes. The subjects were asked to remain awake, stay silent, and try to remain thought-free during the data collection. Time, frequency and time-frequency features were extracted from both the raw and the envelope CBFV signals. The effects of age, sex and body-mass index were examined on the extracted features. The results showed that the raw CBFV signals had a higher frequency content, and its temporal structures were almost uncorrelated. The information-theoretic features showed that the raw recordings from left and right middle cerebral arteries had higher content of mutual information than the envelope signals. Age and body-mass index did not have statistically significant effects on the extracted features. Sex-based differences were observed in all three domains and for both, the envelope signals and the raw CBFV signals. These findings indicate that the raw CBFV signals provide valuable information about the cerebral blood flow which can be utilized in further validation of fTCD as a clinical tool.     

Determination of volume of vortices in poststenotic pulsatile flow by ultrasonic Doppler power ratio and spectrum analysis

Based on the principle of ultrasonic Doppler flowmetry, a power ratio was derived from independent forward and reverse flow Doppler shift signals to measure a ratio of the volume of vortices to the total vessel volume in poststenotic separated flow. The ratio was also proportional to the ratio of the cross-sectional areas of vortices to the vessel lumen. In vitro pulsatile flow experiments were performed to test the methodology and to study flow separation and vortex shedding downstream from model stenoses. The averaged flow cross-sectional area ratio linearly correlated (r = 0.91) with the actual area reduction of the stenosis.     

Some characteristics of laminar flow velocity spectra detected by a 20 MHz pulsed ultrasound Doppler

For the purpose of improving accuracy of noninvasive flow measurements in small (1–2 mm diameter) blood vessels, an existing 20 MHz pulsed ultrasound Doppler velocimeter (PUDVM) has been augmented to allow fast Fourier transformation (FFT) of its Doppler shift signal. The modified instrument was used to collect velocity spectra for a benchtop test section delivering precise Poiseuille flows at velocities in the range of physiological interest. The velocity spectra demonstrated a substantial degree of broadening, much of which was attributable to the geometry of the finite sample volume size. Several spectral indices were studied as a function of flow field variables. Results showed that the intensity-weighted mean Doppler shift frequency, when converted to its corresponding velocity v_M, agreed very closely with the theoretically predicted local fluid velocity. Measurement linearity and repeatability were evaluated for a number of system variables, indicating that FFT performance was essentially unaffected by several parameters capable of causing major degradation of (phasic) Doppler shift signals produced by conventional zero-crossing-counter circuitry. As presently configured, the augmented PUDVM instrument is fully capable of detailed flow field mapping in small subcutaneous vessels such as human digital arteries.     

Noninvasive ultrasonic measurement of arterial wall motion in mice

Despite the extensive use of genetically altered mice to study cardiovascular physiology and pathology, it remains difficult to quantify arterial function noninvasively in vivo. We have developed a noninvasive Doppler method for quantifying vessel wall motion in anesthetized mice. A 20-MHz probe was held by an alligator clip and positioned over the carotid arteries of 16 mice, including six 3- to 5-mo-old wild-type (WT), four 30-mo-old senescent (old), two apolipoprotein E null (ApoE), and four alpha-smooth muscle actin null (alpha-SMA) mice. Doppler signals were obtained simultaneously from both vessel walls and from blood flow. The calculated displacement signals from the near and far walls were subtracted to generate a diameter signal from which the excursion and an augmentation index were calculated. The excursion ranged between 13 microm (in ApoE) and 95 microm (in alpha-SMA). The augmentation index was lowest in the WT mice (0.06) and highest in the old mice (0.29). We conclude that Doppler signal processing may be used to measure vessel wall motion in mice with high spatial and temporal resolution and that diameter signals can replace pressure signals for calculating the augmentation index. This noninvasive method is able to identify and confirm characteristic changes in arterial properties previously associated with age, atherosclerosis, and the absence of vascular tone.     

Pulsed Doppler ultrasound system for the measurement of velocity distributions and flow disturbances in arterial prostheses

For the investigation of flow through prosthetic arteries a pulsed Doppler ultrasound system has been characterized. Preliminary in vitro experiments using this system are described; they verify its suitability for making velocity profile and flow disturbance measurements. The output from a frequency tracker is compared with spectral analysis of Doppler signals for both laminar and turbulent flow regimes and the root mean square fluctuations on the tracker output signal are used to identify transition from laminar to turbulent flow. In addition, the turbulent itensity of poststenotic flow is quantified at several axial locations and for different rates of flow. Finally, we present velocity profile measurements which were obtained using a deconvolution technique to account for the finite size of the sample volume.     

Calf blood flow and posture: Doppler ultrasound calibrated by plethysmography.

A procedure was developed that enables measurement of rapid variations in calf blood flow during voluntary rhythmic contraction of the calf muscles in supine, sitting, and standing positions. During the exercise, maximum blood velocity is measured by Doppler ultrasound equipment in the popliteal artery. The Doppler signals are calibrated by plethysmography to enable calculation of blood flow during exercise in ml.100 ml-1.min-1. Knowledge of the cross-sectional area of the vessel and the angle of insonation is not required in this procedure. Evaluation of the calibration method with 10 healthy volunteers showed that for each subject a new calibration was necessary after a change in posture; the relationship between the blood flow and the maximum Doppler frequency averaged over one heart cycle was linear for each calibration.     

A reevaluation and discussion on the threshold limit for hemolysis in a turbulent shear flow

One major factor of red blood cell damage induced by artificial heart valves is the magnitude of turbulent shear stresses in the flow field. An often-cited threshold for hemolysis is 400 N/m(2) (Sallam and Hwang, Biorheology 21 (1984) 783). This value, however, was measured with a one-component laser Doppler anemometer and was not calculated from the major principal Reynolds shear stress, therefore underestimating the threshold. This study performed flow field measurements under similar conditions, using a two-component laser Doppler anemometer and determining major principal Reynolds shear stress, to reevaluate the hemolytic threshold as 800 N/m(2) with an exposure time of 1 ms. The Kolmogorov length scales, approximately 9 microm, are capable of inflicting direct damage to the red blood cells. These results will serve as a more accurate reference in future heart valve design and testing.     

Characterisation of vortex shedding in vascular anastomosis models using pulsed Doppler ultrasound.

Vortex shedding at vascular anastomoses were investigated in vitro using a 20 MHz pulsed-wave Doppler velocimeter. Centreline velocity measurements were made at various axial distances in simplified polyurethane models of proximal and distal end-to-side anastomoses of angles 15, 30, 45, 60 and 80 degrees using pulsatile flow waveforms similar to those in femoropopliteal bypass grafts. The in-phase and quadrature Doppler signals were recorded and the maximum frequency waveform, averaged over 64 cycles, was obtained using short-time Fourier transform. A fourth-order Butterworth low-pass filter was employed to separate the vortex velocity signal from the convective velocity. The vortex signal envelope was calculated using a Hilbert transform method and the vortex amplitude was taken as the maximum of this envelope. The results show that higher vortex amplitude were found in the proximal anastomoses and under resting flow conditions. Although the vortex amplitudes generally increased with angles of anastomosis, they were found to be higher in the 60 degrees than in the 80 degrees proximal anastomosis. The vortex structures were investigated using spectrograms and these show prominent features at 40-50 Hz indicative of the short-duration oscillatory signals during the decelerative phase of systole expected from the passage of vortices. The study indicates that flow disturbances due to vortex shedding may be a common feature in femoropopliteal bypass grafts.     

Poststenotic flow disturbance in the dog aorta as measured with pulsed Doppler ultrasound

Blood flow velocity was measured in the dog aorta distal to mechanically induced constrictions of various degrees of severity employing an 8-MHz pulsed Doppler ultrasound velocimeter and a phase-lock loop frequency tracking method for extracting velocity from the Doppler quadrature signals. The data were analyzed to construct ensemble average velocity waveforms and random velocity disturbances. In any individual animal the effect of increasing the degree of stenosis beyond approximately 25 percent area reduction was to produce increasing levels of random velocity disturbance. However, variability among animals was such that the sensitivity of random behavior to the degree of stenosis was degraded to the point that it appears difficult to employ Doppler ultrasound measurements of random disturbances to discriminate among stenoses with area reductions less than approximately 75 percent. On the other hand, coherent vortex structures in velocity waveforms consistently occurred distal to mild constrictions (25-50 percent area reduction). Comparison of the phase-lock loop Doppler ultrasound data with simultaneous measurements using invasive hot-film anemometry, which possesses excellent frequency response, demonstrates that the ultrasound method can reliably detect those flow phenomena in such cases. Thus, the identification of coherent, rather than random, flow disturbances may offer improved diagnostic capability for noninvasively detecting arteriosclerotic plaques at relatively early stages of development.     

A new approach for the evaluation of the severity of coarctation of the aorta using Doppler velocity index and effective orifice area: in vitro validation and clinical implications

Early detection and accurate estimation of COA severity are the most important predictors of successful long-term outcome. However, current clinical parameters used for the evaluation of the severity of COA have several limitations and are flow dependent. The objectives of this study are to evaluate the limitations of current existing parameters for the evaluation of the severity of coarctation of the aorta (COA) and suggest two new parameters: COA Doppler velocity index and COA effective orifice area. Three different severities of COAs were tested in a mock flow circulation model under various flow conditions and in the presence of normal and stenotic aortic valves. Catheter trans-COA pressure gradients and Doppler echocardiographic trans-COA pressure gradients were evaluated. COA Doppler velocity index was defined as the ratio of pre-COA to post-COA peak velocities measured by Doppler echocardiography. COA Doppler effective orifice area was determined using continuity equation. The results show that peak-to-peak trans-COA pressure gradient significantly increased with flow rate (from 83% to 85%). Peak Doppler pressure gradient also significantly increased with flow rate (80-85%). A stenotic or bicuspid aortic valve increased peak Doppler pressure gradient by 20-50% for a COA severity of 75%. Both COA Doppler velocity index and COA effective orifice area did not demonstrate significant flow dependence or dependence upon aortic valve condition. As a conclusion, COA Doppler velocity index and COA effective orifice area are flow independent and do not depend on aortic valve conditions. They can, then, more accurately predict the severity of COA.     

Flow disturbance measurements through a constricted tube at moderate Reynolds numbers

Instantaneous velocities in the field distal to contoured axisymmetric stenoses were measured with a laser Doppler anemometer. Upstream flow conditions were steady and spanned a range of Reynolds numbers from 500 to 2000. Autocorrelation functions and spectra of the velocity were employed to describe the nature of fluid dynamic disturbances. Depending upon the degree of stenosis and the Reynolds number, the flow field contained disturbances of a discrete oscillation frequency, of a turbulent nature, or both. If turbulence was detected in a given experiment, it was always preceded upstream by velocity oscillations at discrete frequency arising from vortex shedding. For mild degrees of stenosis (50% area reduction or less) the intensity of flow disturbances was relatively low until the Reynolds number exceeded 1000, thus highlighting difficulties to be expected in employing flow disturbance detection as a diagnostic tool in the recognition of early atherosclerosis in major arteries. In view of the relatively high noise levels inherent in noninvasive Doppler ultrasound systems employed clinically, it seems unlikely that detection of stenoses of less than 50% area reduction is feasible unless the Reynolds numbers exceed 1000 or unless pulsatility introduces new unsteady flow features beyond those studied here.     

Ultrasound imaging

Modern ultrasonic transducers mainly employ lead zirconate titanate (PZT) but vinylidene fluoride trifluoroethylene copolymer (P (VDF-TrPE)) is becoming more competitive. The static scanner is now largely replaced by mechanical or electronically controlled array real time systems; the speed of scanning is limited by the speed of sound and the resolution depends on the wavelength and so, ultimately, on the attenuation in tissue. Tissue inhomogeneities degrade the resolution. Intraoperative and intracavitary scanners have advantages in some anatomical situations and ultrasonic imaging can guide extracorporeal shock wave lithotripsy. Inexpensive battery powered scanners will soon become available. Duplex scanners are used to localize the acquisition of Doppler signals; blood flow volume rate can be estimated from measurements of blood velocity and vessel cross-sectional area, or by the attenuation-compensated technique which avoids the main sources of error. Colour flow mapping combines real time imaging with Doppler information, but has limited scanning speed. Computed tomography and acoustical microscopy are feasible. Speckle arises from the coherent nature of ultrasound and can be suppressed by summing uncorrelated images or by filtering. Image manipulation and display techniques are being developed to cope with three dimensional scan data and the approach is compatible with picture archiving and communication systems (PACS). Tissue characterization based on the measurement of properties has been disappointing but blood flow analysis and contrast agents are promising. Quality assurance programmes are crucial; ultrasonic diagnosis appears to be free from hazard and prudent use is determined by cost-benefit considerations.     

Measurement of human fetal blood flow.

Real-time B-mode ultrasonography was combined with a pulsed Doppler ultrasound technique for transcutaneous measurement of human fetal blood flow in the aorta and intra-abdominal part of the umbilical vein. The target vessel was located and its diameter measured in the two-dimensional real-time image. The pulsed Doppler transducer was attached to the real-time transducer at a fixed angle. By processing the Doppler shift signals the instrument estimated the mean and maximum blood velocities and the integral under the velocity curves. This permitted calculation of the blood flow. The method was applied to 26 fetuses in normal late pregnancies. Mean blood flow in the descending part of the fetal aorta based on maximum velocity was 191 ml/kg/min. Mean flow in the intra-abdominal part of the umbilical vein was 110 ml/kg/min. This method of measurement is non-invasive and opens new perspectives in studying fetal haemodynamics.     

Regional variations of laser Doppler blood flow in ischemic skin flaps

An island skin flap was designed on the left inferior epigastric neurovascular bundle of anesthetized male rats. Blood flow was measured in situ with a laser Doppler flowmeter at 20 discrete points on a grid system (5 points in each quadrant of the flap) before and after surgery, or before vascular occlusion, during reperfusion, and 48 to 72 hours later. Two series of experiments were performed. In the first series, the raised flap was placed in a bath containing heated Ringer's solution and the left pedicle was cross-clamped. After 30 minutes, adenosine at a concentration that produced supramaximal vasodilatation, or its vehicle, was added to the bath. After 1 hour total occlusion time, the vascular clamp was released and adenosine treatment was continued for the first 30 minutes of reperfusion. In the second series, the protocol was similar except that adenosine, or its vehicle, was infused into the ischemic flap by means of the distal stump of the right inferior epigastric artery. After 48 to 72 hours, fluorescein was injected IV. The data showed a significant regional variation in baseline laser Doppler blood flow that was further altered by surgically raising the flap. Whereas proximal axial laser Doppler blood flow was essentially unchanged from the preoperative baseline, distal axial laser Doppler blood flow decreased 10 to 50 percent, and proximal and distal dependent laser Doppler blood flow decreased 50 to 80 percent. Thus no single value accurately reflected total flap perfusion. Necrosis occurred only in the dependent flap regions, which confirmed previous work. In the dependent regions, especially along the incision line, postoperative laser Doppler blood flow was lowest.(ABSTRACT TRUNCATED AT 250 WORDS)     

Detection of coronary microembolization by Doppler ultrasound in patients with stable angina pectoris during percutaneous coronary interventions under an adjunctive antithrombotic therapy with abciximab: design and rationale of the High Intensity Transient Signals ReoPro (HITS-RP) study

Background

Embolization of atherosclerotic debris from the rupture of a vulnerable atherosclerotic plaque occurs iatrogenically during percutaneous coronary interventions (PCI) and can induce myocardial necrosis. These microembolizations are detected as high intensity transient signals (HITS) using intracoronary Doppler technology.

Presentation of the hypothesis

In the presented study we will test if abciximab (ReoPro?) infusion reduces high intensity transient signals in patients with stable angina pectoris undergoing PCI in comparison to standard therapy alone.

Testing the hypothesis

The High Intensity Transient Signals ReoPro? (HITS-RP) study will enroll 60 patients. It is a prospective, single center, randomized, double-blinded, controlled trial. The study is designed to compare the efficacy of intravenous abciximab administration for reduction of microembolization during elective PCI. Patients will be randomized in a 1:1 fashion to abciximab or placebo infusion. The primary end point of the HITS-RP-Study is the number of HITS during PCI measured by intracoronary Doppler wire. Secondary endpoints are bleeding complications, elevation of cardiac biomarkers or ECG changes after percutaneous coronary interventions, changes in coronary flow velocity reserve, hs-CRP elevation, any major adverse cardio-vascular event during one month follow-up.

Implications of the hypothesis

The HITS-RP-Study addresses important questions regarding the efficacy of intravenous abciximab administration in reducing microembolization and periprocedural complications in stable angina pectoris patients undergoing PCI.

Trial registration

The trial is registered under http://www.drks-neu.uniklinik-freiburg.de/drks_web/:DRKS00000603.     

Dynamic evaluation of blood flow microcirculation by combined use of the laser Doppler flowmetry and high‐speed videocapillaroscopy methods

The dynamic light scattering methods are widely used in biomedical diagnostics involving evaluation of blood flow. However, there exist some difficulties in quantitative interpretation of backscattered light signals from the viewpoint of diagnostic information. This study considers the application of the high‐speed videocapillaroscopy (VCS) method that provides the direct measurement of the red blood cells (RBCs) velocity into a capillary. The VCS signal presents true oscillation nature of backscattered light caused by moving RBCs. Thus, the VCS signal can be assigned as a reference one with respect to more complicated signals like in laser Doppler flowmetry (LDF). An essential correlation between blood flow velocity oscillations in a separate human capillary and the integral perfusion estimate obtained by the LDF method has been found. The observation of blood flow by the VCS method during upper arm occlusion has shown emergence of the reverse blood flow effect in capillaries that corresponds to the biological zero signal in the LDF. The reverse blood flow effect has to be taken into account in interpretation of LDF signals.      

Measurement of mucosal blood flow in the canine intestine with laser doppler velocimetry

Laser Doppler velocimetry is a technique for continuous estimation of changing blood flow in the surface of a tissue and does not require invasion of the circulation. This technique is based upon the Doppler principle that a shift in the frequency of an electromagnetic wave emitted or reflected from a moving object is proportional to the velocity of the object. The capacity of Laser Doppler velocimetry to estimate changes in intestinal mucosal blood flow was tested in a canine free flow preparation. In anesthetized dogs in which a segment of ileum was isolated, simultaneous measurements of instantaneous changes in total blood flow (measured with the electromagnetic blood flow meter) and instantaneous changes in presumed mucosal blood flow (using laser Doppler velocimetry) were obtained. Determinations were made during conditions of rest, prostacyclin induced vasodilation and norepinephrine induced vasoconstriction. Changes in laser Doppler velocimeter readings were qualitatively similar to and temporally related to changes in total blood flow to the gut segment during administration of the vasoactive drugs. The magnitude and direction of changes with the two measurements were significantly correlated. Stabilizing the laser probe on the mucosal surface to ensure reproducible readings proved technically difficult. Pharmacologically induced changes in laser Doppler velocimeter estimated changes in flow were more readily correlated with changes in electromagnetic flow meter readings than were control values obtained with the two methods.