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

Dette arbejde støttes delvist af U.S. Army Medical Research Material Command under W81XWH-08-1-0503 og W81XWH-12-1-0066, af AHA-tilskud nr. 0655441U og 15SDG25740015 samt af NIH R21 HL081892, R21 HL130899, R21 HL089175, RC1 DK087365, R01 DK098526, R01 DK118964, R01 CA140338, R01 CA234428, af Lantheus Medical Imaging og af GE Healthcare, Oslo, Norge.

De institutionelle bedømmelsesudvalg for både Thomas Jefferson University og Hospital of the University of Pennsylvania godkendte denne protokol. Protokollen er i overensstemmelse med Health Insurance Portability and Accountability Act. United States Food and Drug Administration (FDA) udstedte en Investigational New Drug godkendelse (IND # 124.465 til F. Forsberg) for denne protokol. GE Healthcare (Oslo, Norge) leverede UCA, der blev brugt i denne forskning (Sonazoid; Tabel 1). Sonazoid er ikke godkend...

<ol>
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R., 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=Chronic+liver+disease:+noninvasive+subharmonic+aided+pressure+estimation+of+hepatic+venous+pressure+gradient.">Chronic liver disease: noninvasive subharmonic aided pressure estimation of hepatic venous pressure gradient.</a> Radiology. 268 (2), 581-588 (2013).</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=Diagnosing+portal+hypertension+with+noninvasive+subharmonic+pressure+estimates+from+an+ultrasound+contrast+agent.">Diagnosing portal hypertension with noninvasive subharmonic pressure estimates from an ultrasound contrast agent.</a> Radiology. , (2020).</li><li>Nam, K., 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=Monitoring+neoadjuvant+chemotherapy+for+breast+cancer+by+using+three-dimensional+subharmonic+aided+pressure+estimation+and+imaging+with+US+contrast+agents:+preliminary+experience.">Monitoring neoadjuvant chemotherapy for breast cancer by using three-dimensional subharmonic aided pressure estimation and imaging with US contrast agents: preliminary experience.</a> Radiology. 285 (1), 53-62 (2017).</li><li>Dave, J. K., 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=Non-invasive+intra-cardiac+pressure+measurements+using+subharmonic-aided+pressure+estimation:+proof+of+concept+in+humans.">Non-invasive intra-cardiac pressure measurements using subharmonic-aided pressure estimation: proof of concept in humans.</a> Ultrasound in Medicine and Biology. 43 (11), 2718-2724 (2017).</li><li>Esposito, C., Dickie, K., Forsberg, F., Dave, J. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Developing+an+interface+and+investigating+optimal+parameters+for+real-time+intra-cardiac+subharmonic+aided+pressure+estimation.">Developing an interface and investigating optimal parameters for real-time intra-cardiac subharmonic aided pressure estimation.</a> IEEE Transactions on Ultrasonics, Ferroelectrics and Frequency Control. , (2020).</li><li>Bosch, J., Groszmann, R. J., Shah, V. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evolution+in+the+understanding+of+the+pathophysiological+basis+of+portal+hypertension:+How+changes+in+paradigm+are+leading+to+successful+new+treatments.">Evolution in the understanding of the pathophysiological basis of portal hypertension: How changes in paradigm are leading to successful new treatments.</a> Journal of Hepatology. 62, 121-130 (2015).</li><li>Procopet, B., Berzigotti, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnosis+of+cirrhosis+and+portal+hypertension:+imaging,+non-invasive+markers+of+fibrosis+and+liver+biopsy.">Diagnosis of cirrhosis and portal hypertension: imaging, non-invasive markers of fibrosis and liver biopsy.</a> Gastroenterology Report. 5 (2), 79-89 (2017).</li><li>Dietrich, C. 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. K., 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=On+the+implementation+of+an+automated+acoustic+output+optimization+algorithm+for+subharmonic+aided+pressure+estimation.">On the implementation of an automated acoustic output optimization algorithm for subharmonic aided pressure estimation.</a> Ultrasonics. 53 (4), 880-888 (2013).</li><li>Gupta, I., Eisenbrey, J. R., Machado, P., Stanczak, M., Wallace, K., Forsberg, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=On+factors+impacting+subharmonic-+aided+pressure+estimation+(SHAPE).">On factors impacting subharmonic- aided pressure estimation (SHAPE).</a> Ultrasonic Imaging. 41 (1), 35-48 (2019).</li><li>Eisenbrey, J. R., Daecher, A., Kramer, M. 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Ikke-invasiv, nøjagtig måling af tryk i menneskekroppen har længe været et vigtigt, men undvigende klinisk mål. Protokollen for SHAPE-målinger, der præsenteres her, opnår dette mål. Den mest kritiske komponent i SHAPE-proceduren er optimeringsalgoritmen, da subharmoniske data, der ikke er erhvervet ved den optimale akustiske effekt, korrelerer dårligt med hydrostatiske tryk. 17,22,23 Den oprindelige version af denne software, der blev implementeret på en Logiq 9-scanner, var tilbøjeli...

En række forskellige ultralydkontrastmidler (UCA'er) er godkendt til klinisk brug i kardiologi (især venstre ventrikulær opacifikation) og radiologi (især karakterisering af voksne og pædiatriske leverlæsioner) over hele verden. 1 Følsomheden og specificiteten af ultralydsbilleddannelse kan forbedres ved intravenøs (IV) injektion af gasfyldte mikrobobler (diameter < 10 μm) indkapslet af en lipid- eller proteinskal som UCA'er, der krydser hele vaskulaturen og forbedrer signaler med op til 30 dB. 1 Disse UCA'er forbedrer ikke kun de tilbagespredte ultralydssignaler, men ved tilstrækkelige akustiske tryk (> 200 kPa) fungerer de også som ikke-lineære oscillatorer. Derfor vil betydelige energikomponenter blive produceret i de modtagne ekkoer, der spænder fra subharmoniske og harmoniske til ultraharmoniske frekvenser. 1,2 Disse ikke-lineære signalkomponenter kan ekstraheres fra vævs- og lineære bobleekkoer (f.eks. ved hjælp af pulsinversion) og bruges til at skabe kontrastspecifikke billeddannelsesmodaliteter såsom subharmonisk billeddannelse (SHI), som modtager halvdelen af transmissionsfrekvensen (dvs. ved f 0/2). 3 Vores gruppe har i humane kliniske forsøg vist, at SHI kan detektere blodgennemstrømningen i neokar og arterioler forbundet med en række tumorer og væv. 4,5,6,7,8,9 
Vi har anbefalet brugen af UCA'er ikke som vaskulære sporstoffer, men som sensorer til ikke-invasiv trykestimering i kredsløbssystemet ved at overvåge subharmoniske kontrastbobleamplitudevariationer. 10 Denne innovative teknik, kaldet subharmonisk støttet trykestimering (SHAPE), er baseret på den inverse lineære korrelation mellem amplituden af de subharmoniske signaler og det hydrostatiske tryk (op til 186 mmHg) målt for de fleste kommercielle UCA'er in vitro (r2 > 0,90) som opsummeret i tabel 1. 10,11 Det skal dog bemærkes, at ikke alle UCA'er udviser denne adfærd. Mest bemærkelsesværdigt har det vist sig, at subharmoniske signaler fra UCA SonoVue (kendt som Lumason i USA) oprindeligt stiger med hydrostatiske trykstigninger, efterfulgt af et plateau og en faldende fase. 12 Ikke desto mindre giver SHAPE mulighed for at tillade trykgradienter i hjertet og i hele det kardiovaskulære system samt interstitiel væsketryk i tumorer, der kan opnås noninvasivt. 13,14,15,16,17 For nylig implementerede vi en realtidsversion af SHAPE-algoritmen på en kommerciel ultralydsscanner og leverede proof-of-concept, at SHAPE kan levere in vivo-trykestimater med fejl på mindre end 3 mmHg i venstre og højre ventrikel hos patienter. 16,17
Den største erfaring med SHAPE til dato har været til diagnosticering af portalhypertension med mere end 220 forsøgspersoner indskrevet og indledende fund bekræftet i et multicenterforsøg. 13,14 Portalhypertension defineres som en stigning i trykgradienten mellem portalvenen og levervenerne eller den ringere vena cava på over 5 mmHg, mens klinisk signifikant portalhypertension (CSPH) kræver en gradient eller tilsvarende, en hepatisk venøs trykgradient (HVPG) ≥ 10 mmHg. 18 CSPH er forbundet med en øget risiko for gastroøsofageale varicer, ascites, leverdekompensation, postoperativ dekompensation og hepatocellulært karcinom. 18,19 Patienter, der udvikler ascites, har en 50% treårig dødelighed, og dem, der udvikler spontan infektion af ascitesvæsken, bærer en 70% etårig dødelighed. Patienter med skrumpelever har en 5-10% årlig forekomst af gastroøsofageal variceal dannelse og en 4-15% årlig forekomst af blødning; Hver blødningsepisode medfører op til 20% risiko for død. 18,19
Dette manuskript beskriver, hvordan man gennemfører en SHAPE-undersøgelse ved hjælp af kommercielt tilgængeligt udstyr og UCA'er med vægt på at identificere portalhypertension i leveren hos patienter. Den kritiske kalibreringsprocedure, der kræves for at opnå den højeste følsomhed over for estimering af trykændringer, forklares detaljeret.

<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

Ikke-invasiv, nøjagtig måling af tryk i menneskekroppen har længe været et vigtigt, men undvigende klinisk mål. Kontrastmidler til ultralydsbilleddannelse er gasfyldte, indkapslede mikrobobler (diameter < 10 μm), der krydser hele vaskulaturen og forbedrer signalerne med op til 30 dB. Disse mikrobobler producerer også ikke-lineære svingninger ved frekvenser, der spænder fra den subharmoniske (halvdelen af transmissionsfrekvensen) til højere harmoniske. Den subharmoniske amplitude har et omvendt lineært forhold til det omgivende hydrostatiske tryk. Her præsenteres et ultralydssystem, der er i stand til at udføre subharmonisk støttet trykestimering (SHAPE) i realtid. Under ultralydkontrastmiddelinfusion aktiveres en algoritme til optimering af akustiske udgange. Efter denne kalibrering har subharmoniske mikroboblesignaler (dvs. SHAPE) den højeste følsomhed over for trykændringer og kan bruges til ikke-invasivt at kvantificere tryk. Nytten af SHAPE-proceduren til identifikation af portalhypertension i leveren er vægten her, men teknikken har anvendelighed på tværs af mange kliniske scenarier.

Som med alle ultralydsbilleddannelsesundersøgelser er den første overvejelse for leverform at opnå de bedst mulige baseline gråtonebilleder af målområdet og for at sikre (ved hjælp af Doppler-billeddannelse), at der ikke er nogen intrahepatiske portalvenøse shunts eller andre vaskulære abnormiteter til stede. I tilfælde af leverbilleddannelse til diagnosticering af portalhypertension er nøglen at visualisere både portalvenen og en levervene i samme dybde for at minimere virkningen af dæmpning (<strong class=...

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

En protokol til noninvasivt estimering af omgivende tryk ved hjælp af subharmonisk ultralydsbilleddannelse af infunderede kontrastmikrobobler (efter passende kalibrering) beskrives med eksempler fra humane patienter med kronisk leversygdom.

Kontrastforstærket subharmonisk støttet trykestimering (SHAPE) ved hjælp af ultralydsbilleddannelse med fokus på identifikation af portalhypertension

Noninvasive, accurate measurement of pressures within the human body has long been an important but elusive clinical goal. Contrast agents for ultrasound ...

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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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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

Gennemføre flere Imaging tilstande med et fluorescens mikroskop

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

Materiale dannelse af rekombinante Spider Silks gennem vandig Solvation ved hjælp af varme og tryk

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

Patient-specifikke Polyvinyl Alkohol Phantom Fabrikation med ultralyd og X-Ray Kontrast til brain tumor kirurgi planlægning

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