Name: contrast-enhanced subharmonic aided pressure estimation (shape) using ultrasound imaging with a focus on identifying portal hypertension
Uploaded: 2020-12-05T15:00:00
Description: Watch this Scientific Journal Video about Contrast-Enhanced Subharmonic Aided Pressure Estimation SHAPE Using Ultrasound Imaging with a Focus on Identifying Portal Hypertension at JoVE.com

这项工作部分得到了美国陆军医学研究材料司令部W81XWH-08-1-0503和W81XWH-12-1-0066的支持，AHA授予No0655441U和15SDG25740015以及NIH R21 HL081892，R21 HL130899，R21 HL089175，RC1 DK087365，R01 DK098526，R01 DK118964，R01 CA140338，R01 CA234428，Lantheus Medical Imaging和GE Healthcare，挪威奥斯陆。

托马斯杰斐逊大学和宾夕法尼亚大学医院的机构审查委员会批准了该协议。该协议符合《健康保险流通与责任法案》。美国食品和药物管理局（FDA）为该协议发布了研究性新药批准（IND # 124，465至F. Forsberg）。GE Healthcare（挪威奥斯陆）提供了本研究中使用的UCA（Sonazoid; 表 1）。Sonazoid未被FDA批准用于美国的任何临床应用，这就是为什么需要IND的原因。其他获得 FDA 批准1</s...

<ol>
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F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Guidelines+and+good+clinical+practice+recommendations+for+contrast-enhanced+ultrasound+(CEUS)+in+the+liver-update+2020+WFUMB+in+cooperation+with+EFSUMB,+AFSUMB,+AIUM,+and+FLAUS.">Guidelines and good clinical practice recommendations for contrast-enhanced ultrasound (CEUS) in the liver-update 2020 WFUMB in cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS.</a> Ultrasound in Medicine and Biology. , (2020).</li><li>Gupta, I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+pulse+shaping+on+subharmonic+aided+pressure+estimation+in+vitro+and+in+vivo.">Effect of pulse shaping on subharmonic aided pressure estimation in vitro and in vivo.</a> Journal of Ultrasound in Medicine. 36 (1), 3-11 (2017).</li><li>Dave, J. 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长期以来，无创、准确测量人体内压力一直是一个重要但难以捉摸的临床目标。这里介绍的SHAPE测量协议实现了这一目标。SHAPE程序最关键的组成部分是优化算法，因为在最佳声功率输出下未获得的次谐波数据与静水压力的相关性较差。17，22，23 在Logiq 9扫描仪上实现的该软件的初始版本容易在S曲线的导数中显示多个峰值（参?...

许多不同的超声造影剂（UCA）被批准用于心脏病学（特别是左心室混浊）和放射学（特别是成人和儿童肝脏病变特征）的临床应用。1 超声成像的灵敏度和特异性可以通过静脉内 （IV） 注射由脂质或蛋白质外壳封装的充满气体的微气泡（直径 < 10 μm）作为 UCA 来提高，UCA 穿过整个脉管系统并将信号增强高达 30 dB。1 这些UCA不仅增强了反向散射超声信号，而且在足够的声压（>200 kPa）下，它们还充当非线性振荡器。因此，在接收到的回波中将产生重要的能量成分，范围从次谐波和谐波到超谐波频率。1，2 这些非线性信号分量可以从组织和线性气泡回波中提取（例如，使用脉冲反转），并用于创建对比特定的成像模式，例如次谐波成像（SHI），其接收频率为发射频率的一半（即f 0/2）。3 我们小组在人体临床试验中证明，SHI可以检测与各种肿瘤和组织相关的新血管和小动脉中的血流。4，5，6，7，8，9
我们提倡不使用UCA作为血管示踪剂，而是通过监测次谐波对比气泡振幅变化来作为循环系统中无创压力估计的传感器。10这种称为次谐波辅助压力估计（SHAPE）的创新技术依赖于大多数商业UCA在体外测量的次谐波信号幅度与静水压力（高达186 mmHg）之间的反线性相关性（r2>0.90），如表1所示。10，11 但是，应该注意的是，并非所有 UCA 都表现出这种行为。最值得注意的是，已经表明，来自UCA SonoVue（在美国称为Lumason）的次谐波信号最初随着静水压力的增加而上升，然后是平台期和下降阶段。12尽管如此，SHAPE提供了允许无创获得心脏和整个心血管系统的压力梯度以及肿瘤中的间质液压力的可能性。13，14，15，16，17 最近，我们在商用超声扫描仪上实现了SHAPE算法的实时版本，并提供了概念验证，即SHAPE可以提供体内压力估计，患者的左心室和右心室误差小于3 mmHg。16，17 
迄今为止，SHAPE的最多经验是诊断门静脉高压症，入组了220多名受试者，并在一项多中心试验中证实了初步发现。13，14 门静脉高压定义为门静脉与肝静脉或下腔静脉之间的压力梯度增加超过 5 mmHg，而临床上显着的门静脉高压 （CSPH） 需要梯度或等效值，肝静脉压梯度 （HVPG） ≥ 10 mmHg。18 CSPH 与胃食管静脉曲张、腹水、肝失代偿、术后失代偿和肝细胞癌的风险增加有关。18，19 发生腹水的患者三年死亡率为 50%，发生腹水自发感染的患者一年死亡率为 70%。肝硬化患者胃食管静脉曲张形成年发病率为5-10%，出血年发生率为4-15%;每次出血发作都有高达20%的死亡风险。18，19 
本手稿描述了如何使用市售设备和UCA进行SHAPE研究，重点是识别患者肝脏中的门静脉高压症。详细解释了实现估算压力变化的最高灵敏度所需的关键校准程序。

<table>
	<tbody>
		<tr>
			<td>2 mL syringe</td>
			<td>Becton Dickinson</td>
			<td>309637</td>
			<td>Used for reconstituting Sonazoid</td>
		</tr>
		<tr>
			<td>10 mL saline-filled syringe</td>
			<td>Becton Dickinson</td>
			<td>306545</td>
			<td>Used for flushing line to verify IV access</td>
		</tr>
		<tr>
			<td>500 mL saline bag</td>
			<td>Baxter Healthcare Corp</td>
			<td>2131323</td>
			<td>Used for co-infusion with Sonazoid</td>
		</tr>
		<tr>
			<td>C1-6-D curvi-linear proble</td>
			<td>GE Healthcare</td>
			<td>H40472LT</td>
			<td>Used for liver imaging</td>
		</tr>
		<tr>
			<td>Chemoprotect Spike</td>
			<td>Codan USA</td>
			<td>C355</td>
			<td>Chemospike used for reconstituting Sonazoid</td>
		</tr>
		<tr>
			<td>Discofix C Blue</td>
			<td>B. Braun Medical Inc</td>
			<td>16494C</td>
			<td>3-way stopcock</td>
		</tr>
		<tr>
			<td>Intrafix Safeset 180 cm</td>
			<td>B. Braun Medical Inc</td>
			<td>4063000</td>
			<td>Infusion tubing</td>
		</tr>
		<tr>
			<td>Logiq E10 ultrasound scanner</td>
			<td>GE Healthcare</td>
			<td>H4928US</td>
			<td>Used for conventional ultrasound imaging as well as for SHI and SHAPE</td>
		</tr>
		<tr>
			<td>Luer lock 10 mL syringe</td>
			<td>Becton Dickinson</td>
			<td>300912</td>
			<td>For infusion of Sonazoid</td>
		</tr>
		<tr>
			<td>Medfusion 3500 syringe pump</td>
			<td>Smiths Medical</td>
			<td>3500-500</td>
			<td>Used for infusing Sonazoid at 0.18 mL/kg/hour</td>
		</tr>
		<tr>
			<td>Perfusor-leitung tubing 150 mm</td>
			<td>B. Braun Medical Inc</td>
			<td>8722960</td>
			<td>Extension line enabling syringe connection to patient&#39;s IV access</td>
		</tr>
		<tr>
			<td>SHI/SHAPE software</td>
			<td>GE Healthcare</td>
			<td>H4920CI</td>
			<td>Contrast-specific imaging software</td>
		</tr>
		<tr>
			<td>Sigma Spectrum infusion system</td>
			<td>Baxter Healthcare Corp</td>
			<td>35700BAX</td>
			<td>Pump used for co-infusing saline at 120 mL/hour</td>
		</tr>
		<tr>
			<td>Sonazoid</td>
			<td>GE Healthcare</td>
			<td></td>
			<td>Gas-filled microbubble based ultrasound contrast agent</td>
		</tr>
		<tr>
			<td>sterile water, 2 mL</td>
			<td>B. Braun Medical Inc</td>
			<td></td>
			<td>Used for reconstituting Sonazoid</td>
		</tr>
		<tr>
			<td>ultrasound gel</td>
			<td>Cardinal Health</td>
			<td>USG-250BT</td>
			<td>Used for contact between probe and patient</td>
		</tr>
		<tr>
			<td>Venflon IV cannula 22GA</td>
			<td>Becton Dickinson</td>
			<td>393202</td>
			<td>Cannula needle for obtaining IV access</td>
		</tr>
	</tbody>
</table>

contrast-enhanced subharmonic aided pressure estimation (shape) using ultrasound imaging with a focus on identifying portal hypertension

长期以来，无创、准确测量人体内压力一直是一个重要但难以捉摸的临床目标。用于超声成像的造影剂是充满气体的封装微气泡（直径< 10 μm），可穿过整个脉管系统并将信号增强多达 30 dB。这些微气泡还产生非线性振荡，频率范围从次谐波（发射频率的一半）到更高次谐波。次谐波幅度与环境静水压力呈反比线性关系。这里介绍了一种能够执行实时次谐波辅助压力估计（SHAPE）的超声系统。在超声造影剂输注期间，激活了优化声学输出的算法。在此校准之后，次谐波微气泡信号（即SHAPE）对压力变化具有最高的灵敏度，可用于无创量化压力。SHAPE程序在识别肝脏门静脉高压症方面的效用是这里的重点，但该技术在许多临床场景中具有适用性。

与所有超声影像学检查一样，肝脏 SHAPE 的首要考虑因素是获得目标区域的最佳基线灰度图像，并确保（使用多普勒成像）不存在肝内门静脉分流或其他血管异常。在用于诊断门静脉高压的肝脏成像的情况下，关键是在同一深度上可视化门静脉和肝静脉，以尽量减少衰减的影响（图1）。
尽管UCA浓度不被认为是SHAPE程序10，23...

Watch this Scientific Journal Video about Contrast-Enhanced Subharmonic Aided Pressure Estimation SHAPE Using Ultrasound Imaging with a Focus on Identifying Portal Hypertension at JoVE.com

Contrast-Enhanced Subharmonic Aided Pressure Estimation SHAPE Using Ultrasound Imaging with a Focus on Identifying Portal Hypertension

通过人类慢性肝病患者的例子描述了利用注入对比微泡的次谐波超声成像（经过适当校准）无创估计环境压力的方案。

使用超声成像的对比增强次谐波辅助压力估计 （SHAPE），重点是识别门静脉高压症

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Contrast-Enhanced Subharmonic Aided Pressure Estimation (SHAPE) Using Ultrasound Imaging with a Focus on Identifying Portal Hypertension

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Real-time Monitoring of High Intensity Focused Ultrasound (HIFU) Ablation of In Vitro Canine Livers Using Harmonic Motion Imaging for Focused Ultrasound (HMIFU)

Real-time Monitoring of High Intensity Focused Ultrasound HIFU Ablation of In Vitro Canine Livers Using Harmonic Motion Imaging for Focused Ultrasound HMIFU

高强度的实时监控聚焦超声（HIFU）消融<em&gt;体外</em&gt;使用谐运动成像的聚焦超声犬肝脏（HMIFU）

Harmonic Motion Imaging for Focused Ultrasound (HMIFU) is a technique that can perform and monitor high-intensity focused ultrasound (HIFU) ablation. An ...

Double Emulsion Generation Using a Polydimethylsiloxane (PDMS) Co-axial Flow Focus Device

Double Emulsion Generation Using a Polydimethylsiloxane PDMS Co-axial Flow Focus Device

复乳代使用聚二甲基硅氧烷（PDMS）同轴流量聚焦设备

Double emulsions are useful in a number of biological and industrial applications in which it is important to have an aqueous carrier fluid. This paper ...

An Experimental Protocol for Assessing the Performance of New Ultrasound Probes Based on CMUT Technology in Application to Brain Imaging

基于 CMUT 技术的新型超声探头在脑成像中的应用研究

The possibility to perform an early and repeatable assessment of imaging performance is fundamental in the design and development process of new ...

Conducting Multiple Imaging Modes with One Fluorescence Microscope

使用一个荧光显微镜进行多种成像模式

Fluorescence microscopy is a powerful tool to detect biological molecules in situ and monitor their dynamics and interactions in real-time. In addition to ...

Material Formation of Recombinant Spider Silks through Aqueous Solvation using Heat and Pressure

热、压水固化重组蜘蛛丝的材料形成

Many spiders produce seven types of silks. Six of the silks are fiber in form when produced by the spiders. These fibers are not water soluble. In order ...

Patient-Specific Polyvinyl Alcohol Phantom Fabrication with Ultrasound and X-Ray Contrast for Brain Tumor Surgery Planning

患者特异性聚乙烯酒精幻影制造与超声波和X射线对比脑肿瘤手术规划

Phantoms are essential tools for clinical training, surgical planning and the development of novel medical devices. However, it is challenging to create ...

使用超声成像的对比增强次谐波辅助压力估计 （SHAPE），重点是识别门静脉高压症

使用超声成像的对比增强次谐波辅助压力估计（SHAPE），重点是识别门静脉高压症