Name: Forfatter Spotlight: Vurdering af pålideligheden af Doppler-ultralyd ved måling af benblodgennemstrømning
Uploaded: 2023-12-15T13:50:00
Description: Watch this Scientific Journal Video about Assessing the Reliability of Doppler Ultrasound in Measuring Leg Blood Flow at JoVE.com

Center for Fysisk Aktivitetsforskning (CFAS) er støttet af TrygFonden (bevilling ID 101390 og ID 20045. JPH blev støttet af bevillinger fra Helsefonden og Rigshospitalet. Under dette arbejde blev RMGB støttet af en post.doc. bevilling fra Rigshospitalet.

Undersøgelsen blev evalueret af Region Hovedstadens Etiske Komité (sagsnr. H-21054272), som fastslog, at der var tale om et kvalitetsstudie. I overensstemmelse med dansk lovgivning blev studiet således godkendt lokalt af det interne Forsknings- og Kvalitetsforbedringsråd på Klinisk Fysiologisk og Nuklearmedicinsk Afdeling, Rigshospitalet (journalnr. KF-509-22). Undersøgelsen blev udført i overensstemmelse med retningslinjerne i Helsingfors-erklæringen. Alle forsøgspersoner gav mundtligt og skriftligt informeret ...

Vurdering af benblodgennemstrømning i træningsbelastninger

Denne undersøgelse vurderede pålideligheden af Doppler ultralydsmetode til evaluering af benblodgennemstrømning (LBF) under submaksimal knæekstensorøvelse med et ben hos raske deltagere. Resultaterne indikerede høj pålidelighed inden for dagen og acceptabel pålidelighed mellem dagen, mens interraterpålidelighed blev fundet uacceptabel i hvile og ved 0 W.
Selvom sondefjernelse mellem målinger syntes at have ringe indflydelse, kunne forskellen i pålidelighed mellem målinger inden for...

Doppler ultralyd, der blev introduceret i 1980'erne, er blevet flittigt brugt til at bestemme kontraherende muskelblodgennemstrømning, især i knæekstensormodellen med et ben, hvilket muliggør måling af blodgennemstrømningen i den fælles lårbensarterie (CFA) under aktivering af lille muskelmasse 1,2,3,4,5,6 . Doppler ultralydbaseret blodgennemstrømningsteknologi har givet værdifuld indsigt i vaskulær regulering i forskellige populationer, herunder raske voksne7,8, personer med diabetes9, hypertension 10, KOL 11,12 og hjertesvigt 13,14.
En fordel ved Doppler ultralyd er dens ikke-invasivitet sammenlignet med andre blodgennemstrømningsbestemmelsesmetoder som termofortynding, og det kan kombineres med arteriel og venøs kateterisering, hvis det er nødvendigt 3,4,6,15. Det muliggør også måling af blodgennemstrømningshastighed fra slag til slag, hvilket gør det muligt at detektere hurtige ændringer16. Doppler-ultralydbaserede blodmålinger har imidlertid begrænsninger, herunder vanskeligheder med at opnå stabile optagelser under overdreven bevægelse af lemmer ved næsten maksimale træningsintensiteter og kravet om ultralydtilgængelighed til det målrettede blodkar, eksklusive evalueringer under ergometercykling15. Derfor er knæekstensormodellen med et ben velegnet til LBF-evaluering ved hjælp af Doppler-ultralyd under dynamisk træning ved submaksimale intensiteter17, hvilket minimerer indflydelsen af træningsrelaterede hjerte- og lungebegrænsninger og letter sammenligninger mellem raske forsøgspersoner og patienter med hjerte-lungesygdomme11.
På trods af at den er meget udbredt, er pålideligheden mellem dagen af knæekstensormodellen med et ben ved hjælp af Doppler-ultralyd ikke blevet undersøgt i større skala i de seneste årtier, med tidligere undersøgelser, der involverer små populationer (n = 2)3,18,19,20.
Denne undersøgelse havde til formål at undersøge (1) pålideligheden inden for test-retest, (2) pålideligheden mellem dagen test-retest og (3) inter-rater-pålideligheden af Doppler-ultralyd til LBF-evaluering under knæekstensorøvelse med et ben ved 0 W, 6 W, 12 W og 18 W. Målingerne blev udført i et klinisk realistisk scenarie, hvor sonden blev fjernet mellem målingerne. Det er vigtigt at bemærke, at flere iboende og eksterne miljøfaktorer, der vides at påvirke LBF, ikke blev kontrolleret under målingerne, hvilket kunne introducere variabilitet og påvirke pålideligheden. I betragtning af fremskridt inden for Doppler-ultralydsteknologi og blodgennemstrømningsanalysesoftware antog vi, at selv i en ukontrolleret indstilling kunne acceptabel pålidelighed inden for og mellem dagen af LBF-målinger opnås ved alle intensiteter, når de udføres af den samme sonograf.

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			<td>EKO GEL</td>
			<td>EKKOMED A7S</td>
			<td>DK-7500 Holstebro</td>
			<td></td>
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			<td>RStudio, version 1.4.1717</td>
			<td>R Project for Statistical Computing</td>
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			<td></td>
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			<td>Saltin Chair</td>
			<td></td>
			<td></td>
			<td>This was built from an ergometer bike and a carseat owned by Professor Bengt Saltin. The steelconstruction was built from a specialist who custommade it.</td>
		</tr>
		<tr>
			<td>Ultrasound apparatus equipped with a linear probe (9 MHz, Logic E9)</td>
			<td>GE Healthcare</td>
			<td>Unknown</td>
			<td>GE Healthcare, Milwaukee, WI, USA</td>
		</tr>
		<tr>
			<td>&#160; &#160;</td>
			<td>&#160; &#160;</td>
			<td>&#160; &#160;</td>
			<td>Ultrasound gel</td>
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doppler ultrasound-based leg blood flow assessment during single-leg knee-extensor exercise in an uncontrolled setting

Doppler ultralyd har revolutioneret vurderingen af organblodgennemstrømning og er meget udbredt i forskning og kliniske indstillinger. Mens Doppler ultralydsbaseret vurdering af kontraherende blodgennemstrømning i benmusklen er almindelig i humane undersøgelser, kræver pålideligheden af denne metode yderligere undersøgelse. Derfor havde denne undersøgelse til formål at undersøge intra-dag test-retest, mellem-dag test-retest og inter-rater pålidelighed af Doppler ultralyd til vurdering af benblodgennemstrømning under hvile og graduerede enkeltbens knæforlængelser (0 W, 6 W, 12 W og 18 W), hvor ultralydssonden fjernes mellem målinger. Undersøgelsen omfattede tredive raske forsøgspersoner (alder: 33 ± 9,3, mand / kvinde: 14/16), der besøgte laboratoriet på to forskellige forsøgsdage adskilt af 10 dage. Undersøgelsen kontrollerede ikke for større confounders såsom ernæringstilstand, tidspunkt på dagen eller hormonstatus. På tværs af forskellige træningsintensiteter viste resultaterne høj pålidelighed inden for dagen med en variationskoefficient (CV) fra 4,0% til 4,3%, acceptabel pålidelighed mellem dagen med et CV fra 10,1% til 20,2% og interrater pålidelighed med et CV fra 17,9% til 26,8%. Derfor, i et virkeligt klinisk scenario, hvor kontrol af forskellige miljøfaktorer er udfordrende, kan Doppler ultralyd bruges til at bestemme benblodgennemstrømningen under submaksimal enkeltbens knæekstensorøvelse med høj pålidelighed inden for dagen og acceptabel pålidelighed mellem dagen, når den udføres af den samme sonograf.

Doppler ultrasound, introduced in the 1980s, has been extensively used to determine contracting muscle blood flow, particularly in the single-leg knee-extensor model, allowing measurement of blood flow in the common femoral artery (CFA) during small muscle mass activation1,2,3,4,5,6. Doppler ultrasound-based blood flow technology has provided valuable insights into vascular regulation in various populations, including healthy adults7,8, individuals with diabetes9, hypertension10, COPD11,12, and heart failure13,14.
One advantage of Doppler ultrasound is its non-invasiveness compared to other blood flow determination methods like thermodilution, and it can be combined with arterial and venous catheterization if necessary3,4,6,15. It also enables beat-to-beat blood flow velocity measurement, allowing for the detection of rapid changes16. However, Doppler ultrasound-based blood measurements have limitations, including difficulties in obtaining stable recordings during excessive limb movement at near-maximal exercise intensities and the requirement for ultrasound accessibility to the targeted blood vessel, excluding evaluations during ergometer bicycling15. Hence, the single-leg knee-extensor model is well-suited for LBF evaluation using Doppler ultrasound during dynamic exercise at submaximal intensities17, minimizing the influence of exercise-related heart and lung limitations and facilitating comparisons between healthy subjects and patients with cardio-pulmonary diseases11.
Despite being widely used, the between-day reliability of the single-leg knee-extensor model using Doppler ultrasound has not been investigated on a larger scale in recent decades, with prior studies involving small populations (n = 2)3,18,19,20.
This study aimed to investigate (1) the within-day test-retest reliability, (2) the between-day test-retest reliability, and (3) the inter-rater reliability of Doppler ultrasound for LBF evaluation during single-leg knee-extensor exercise at 0 W, 6 W, 12 W, and 18 W. The measurements were conducted in a clinically realistic scenario where the probe was removed between measurements. It is important to note that several intrinsic and extrinsic environmental factors known to influence LBF were not controlled during the measurements, which could introduce variability and affect reliability. Considering advancements in Doppler ultrasound technology and blood flow analysis software, we hypothesized that, even in an uncontrolled setting, acceptable within- and between-day reliability of LBF measurements could be achieved at all intensities when performed by the same sonographer.

Forfatter Spotlight: Vurdering af pålideligheden af Doppler-ultralyd ved måling af benblodgennemstrømning 

Doppler ultralydsbaseret blodgennemstrømningsvurdering af ben under knæekstensorøvelse med et ben i en ukontrolleret indstilling

This method is widely recognized and applied in numerous clinical and research settings. The primary objective of this study was to assist the reproducibility of the method, thereby providing valuable insights into the measurement error. By doing so, we can say what is genuine physiological change and what is due to measurement error.Ultimately, this will enhance our understanding of this method. The primary obstacle lies in exploring physiological changes during various activities in everyday life, as conducting such investigation is feasible only under specific experimental setups. t has been over two decades since the last reliability study was conducted during single leg knee extensor exercise.Over this period, technology has significantly evolved, making it imperative to revisit this research area to gain valuable insight into the measurement era associated with the current method. Doppler ultrasound is non-invasive compared to other blood flow determination methods like Thermodilution, and it can be combined with arterial and venous catheterization if necessary. It also enables beat to beat blood flow velocity measurements so we could detect rapid changes.In the future, our main goal is to investigate the regulation of blood flow to contracting skeletal muscle in patients with chronic obstructive pulmonary disease.

Deltagere Fra maj 2022 til oktober 2022 blev i alt tredive raske mænd og kvinder rekrutteret til at deltage i undersøgelsen. Alle deltagere havde ingen historie med kardiovaskulære, metaboliske eller neurologiske sygdomme. De blev ikke instrueret i at foretage ændringer i deres sædvanlige vaner, herunder koffein, alkohol, nikotin, kraftig motion eller andre faktorer, der potentielt kunne påvirke vaskulær funktion.
Eksperimentelle procedurer Deltag...

Watch this Scientific Journal Video about Assessing the Reliability of Doppler Ultrasound in Measuring Leg Blood Flow at JoVE.com

Denne test-retest-undersøgelse evaluerede blodgennemstrømningen i benene målt ved Doppler-ultralydsteknikken under knæekstensorøvelse med et ben. Metodens pålidelighed inden for dagen, mellem dagen og interrater blev undersøgt. Tilgangen demonstrerede høj pålidelighed inden for dagen og acceptabel mellem dagen. Interraterens pålidelighed var imidlertid uacceptabelt lav under hvile og ved lave arbejdsbelastninger.

Doppler ultrasound has revolutionized the assessment of organ blood flow and is widely used in research and clinical settings. While Doppler ...

Denne metode er bredt anerkendt og anvendes i adskillige kliniske og forskningsmæssige indstillinger. Det primære formål med denne undersøgelse var at hjælpe metodens reproducerbarhed og derved give værdifuld indsigt i målefejlen. Ved at gøre det kan vi sige, hvad der er ægte fysiologisk forandring, og hvad der skyldes målefejl.I sidste ende vil dette øge vores forståelse af denne metode. Den primære hindring ligger i at udforske fysiologiske ændringer under forskellige aktiviteter i hverdagen, da det kun er muligt at gennemføre en sådan undersøgelse under specifikke eksperimentelle opsætninger. t har været over to årtier siden den sidste pålidelighedsundersøgelse blev udført under knæekstensorøvelse med et ben.I løbet af denne periode har teknologien udviklet sig markant, hvilket gør det bydende nødvendigt at genbesøge dette forskningsområde for at få værdifuld indsigt i den måleæra, der er forbundet med den nuværende metode. Doppler ultralyd er ikke-invasiv sammenlignet med andre metoder til bestemmelse af blodgennemstrømning som termofortynding, og det kan kombineres med arteriel og venøs kateterisering, hvis det er nødvendigt. Det gør det også muligt for slag at slå blodgennemstrømningshastighedsmålinger, så vi kunne registrere hurtige ændringer.I fremtiden er vores hovedmål at undersøge reguleringen af blodgennemstrømningen til sammentrækning af skeletmuskulatur hos patienter med kronisk obstruktiv lungesygdom.

doppler-ultrasound-based-leg-blood-flow-assessment-during-single-leg

Research

JoVE Journal

Medicine

Doppler Ultrasound-Based Leg Blood Flow Assessment During Single-Leg Knee-Extensor Exercise in an Uncontrolled Setting

Doppler ultrasound has revolutionized the assessment of organ blood flow and is widely used in research and clinical settings. While Doppler ultrasound-based assessment of contracting leg muscle blood flow is common in human studies, the reliability of this method requires further investigation. Therefore, this study aimed to investigate the within-day test-retest, between-day test-retest, and inter-rater reliability of Doppler ultrasound for assessing leg blood flow during rest and graded single-leg knee-extensions (0 W, 6 W, 12 W, and 18 W), with the ultrasound probe being removed between measurements. The study included thirty healthy subjects (age: 33 &#177; 9.3, male/female: 14/16) who visited the laboratory on two different experimental days separated by 10 days. The study did not control for major confounders such as nutritional state, time of day, or hormonal status. Across different exercise intensities, the results demonstrated high within-day reliability with a coefficient of variation (CV) ranging from 4.0% to 4.3%, acceptable between-day reliability with a CV ranging from 10.1% to 20.2%, and inter-rater reliability with a CV ranging from 17.9% to 26.8%. Therefore, in a real-life clinical scenario where controlling various environmental factors is challenging, Doppler ultrasound can be used to determine leg blood flow during submaximal single-leg knee-extensor exercise with high within-day reliability and acceptable between-day reliability when performed by the same sonographer.

This test-retest study evaluated leg blood flow measured by the Doppler ultrasound technique during single-leg knee-extensor exercise. The within-day, between-day, and inter-rater reliability of the method was investigated. The approach demonstrated high within-day and acceptable between-day reliability. However, the inter-rater reliability was unacceptably low during rest and at low workloads.

Single-Leg Knee-Extensor Chair Setup and Ultrasound Apparatus Configuration for Leg Blood Flow Assessment

To begin, position the participant in the single leg knee extensor chair with their back resting against the chair. Place a chair or bench to stabilize the inactive leg. To ensure the electrodes are equidistant from the heart, fix one ECG electrode on the right side of the chest wall in the third intercostal space.Place the second one on the left side in the third intercostal space. Then place the third one on the left side in the 11th intercostal space. After electrode placement, position the participant at an angle greater than 90 degrees between the abdomen and thigh.Adjust the arm connecting the single knee extensor chair to the flywheel. This enables the participant to extend the knee fully. Tie the leg tightly to the pedal of the chair to avoid the usage of muscles in the lower part of the limb.Next, press the turn on button on the ultrasound apparatus. Press patient to create a new file for the examination. Move the cursor to new patient and press enter.Then fill out the patient ID.Move the cursor to create and press enter. Connect the lead to the electrodes. Press probe and choose the linear probe.Apply ultrasound gel to the probe.

Enkeltbenet knæ-extensor stol opsætning og ultralyd apparat konfiguration til ben blodgennemstrømning vurdering

Doppler Ultrasound Scan and Blood Flow Quantitation in Leg-Extension Exercises

To begin, place the probe on the inguinal region of the participant then find the optimal arterial section for leg blood flow or LBF measurements. Make a cross-sectional image of the common femoral artery. Turn the Gain button clockwise to increase gain and counterclockwise to decrease gain.Turn the Depth button clockwise to increase the depth and counterclockwise to decrease it. After adjustment, ensure that the artery is in the middle of the screen and the blood is black. In 2D mode, press Freeze once then scroll using the track ball to find an end-systolic image.Press Measure once and move the cursor to the superficial intimal layer of the artery then press Enter. Next, move the cursor to the deep intimal layer of the artery and press Enter to obtain the diameter at end-systole. Press Freeze then turn the probe 90 degrees clockwise while keeping the artery centered on the screen and probe parallel to the artery to create a longitudinal view.Press the PW button, followed by the Measure button. Move the cursor to auto and press Enter then click Flow Volume and press Enter. Move the cursor to Live and press Enter to obtain the trace and finish by pressing Measure once.To obtain the velocity at an insonation angle of less than 60 degrees. Turn the Steer Angle button clockwise to decrease it and counterclockwise to increase it. Turn the Angle Correction button to validate the trace captured with the cursor horizontal to the artery.Press Sample Volume to adjust the volume according to the width of the artery while avoiding contact with the artery wall. To decrease the sample size, press the left arrow and increase by pressing the right arrow. Next, turn the Sound button clockwise then obtain the blood flow velocity trace with simultaneous 2D visualization of the artery and audiovisual blood velocity feedback.Obtain the first trace during seated rest for 30 seconds, and press Image Store twice to save the trace. Then, instruct the participant to maintain a pace of 60 RPM during the test. Using the same conditions, record the trace data at a pace of 60 RPM and zero watts.Add resistance to the single leg knee extensor chair. Then, ask the participant to complete a minimum of 150 seconds of exercise before obtaining 30 seconds of trace. Press Image Store twice to save the trace.Once all the images are obtained, press Review, press track ball and move the cursor to the desired image then double click on Enter. Once the desired trace appears, press Measure. Then, from the dropdown menu, select Flow Volume and press Enter.Next, select 2D Ultrasound Image and press Enter. Then drag the cursor until it reaches the diameter measured during rest and press Enter again. Turn the Cursor Select button clockwise twice.Then, by scrolling the track ball and pressing Enter, choose a 30-second trace between two vertical lines. There were no statistically significant differences in the absolute LBF values between the Within Day or Between Day measurements. LBF increased progressively across the incremental workloads.The value ranges from 0.36 liter per minute at rest to 2.44 liter per minute during exercise at 18 watts. Bland Altman Plots of LBF measurements for Within Day reliability showed no outliers. In contrast, a few outliers were observed in the Between Day measurements, and several outliers were observed during the Interrater measurements.In test/retest reliability, the smallest real difference values were lower for Within Day measurements compared to the Between Day and Interrater measurements. Similarly, the coefficient of variation values were higher in the Between Day and Interrater measurements compared to the Within Day measurements. The intraclass correlation coefficient values showed that the reliability at all workloads during Within Day and Between Day were higher than 0.90.Conversely, the Interrater measurements yielded ICC values as low as 0.41.