Name: 著者スポットライト:脚の血流の測定におけるドップラー超音波の信頼性の評価
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

Centre for Physical Activity Research (CFAS) は、TrygFonden (助成金 ID 101390 および ID 20045) の支援を受けています。JPHは、ヘルセフォンデンとリグスホスピタレットからの助成金によって支援されました。この作業中、RMGBはpost.docによってサポートされました。Rigshospitaletからの助成金。

この研究は、デンマーク首都圏の地域倫理委員会(ファイル番号H-21054272)によって評価され、質の高い研究であると判断されました。したがって、デンマークの法律に従って、この研究は、リグスホスピタレットの臨床生理学および核医学部門の内部研究および品質改善委員会によって現地で承認されました(ファイル番号。KF-509-22)。この研究は、ヘルシンキ宣言のガイドラインに従って実施?...

トレーニングワークロードにおける脚の血流の評価

この研究では、健康な参加者における最大下片脚膝伸筋運動中の脚血流(LBF)を評価するためのドップラー超音波法の信頼性を評価しました。その結果、日中の信頼性は高く、日中の信頼性は許容できるが、評価者間の信頼性は安静時および0Wでは許容できないことがわかった。
測定と測定の間のプローブの取り外しはほとんど影響がないように見えましたが、日中測定と?...

1980年代に導入されたドップラー超音波は、特に片足膝伸筋モデルにおいて、収縮する筋肉の血流を測定するために広く使用されており、小筋肉量の活性化中の総大腿動脈(CFA)の血流を測定できます1,2,3,4,5,6 .ドップラー超音波ベースの血流技術は、健康な成人7,8、糖尿病患者9、高血圧患者10、COPD11,12、心不全13,14など、さまざまな集団の血管調節に関する貴重な洞察を提供しています。
ドップラー超音波の利点の1つは、熱希釈などの他の血流測定方法と比較して非侵襲性であり、必要に応じて動脈および静脈カテーテル法と組み合わせることができます3,4,6,15。また、拍動間の血流速度測定も可能になり、急激な変化の検出が可能になります16。しかし、ドップラー超音波による血液測定には限界があり、最大に近い運動強度での過度の四肢運動中に安定した記録を得ることが困難であることや、エルゴメーターによる自転車運転中の評価を除いて、標的血管への超音波アクセス性が要求されるなどがある15。したがって、片脚膝伸筋モデルは、最大下強度での動的運動中にドップラー超音波を使用したLBF評価に適しており17、運動関連の心臓および肺の制限の影響を最小限に抑え、健康な被験者と心肺疾患の患者との比較を容易にします11。
広く使用されているにもかかわらず、ドップラー超音波を使用した片脚膝伸筋モデルの日中信頼性は、ここ数十年で大規模に調査されておらず、以前の研究では小さな集団(n = 2)3,18,19,20が対象となっています。
本研究は、(1)0W、6W、12W、18Wでの片脚膝伸筋運動中のLBF評価のためのドップラー超音波の評価者間信頼性、(2)日中のテスト-再テストの信頼性、および(3)評価者間の信頼性を調査することを目的とした。測定は、測定と測定の間にプローブを取り外すという臨床的に現実的なシナリオで実施されました。LBFに影響を与えることが知られているいくつかの内因性および外因性の環境要因は、測定中に制御されていなかったため、ばらつきが生じ、信頼性に影響を与える可能性があることに注意することが重要です。ドップラー超音波技術と血流分析ソフトウェアの進歩を考慮すると、制御されていない設定でも、同じ超音波検査技師が実行した場合、LBF測定の許容可能な日内および日中の信頼性がすべての強度で達成できるという仮説を立てました。

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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>Saltin Chair</td>
			<td></td>
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			<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

ドップラー超音波は、臓器の血流の評価に革命をもたらし、研究や臨床現場で広く使用されています。収縮した脚の筋肉の血流のドップラー超音波ベースの評価は人間の研究では一般的ですが、この方法の信頼性にはさらなる調査が必要です。したがって、この研究は、安静時の脚の血流を評価するためのドップラー超音波の日内テスト-再テスト、日中のテスト-再テスト、および評価者間の信頼性を調査することを目的としていました グレード付き片脚膝伸展(0 W、6 W、12 W、および18 W)は、測定と測定の間に超音波プローブを取り外します。この研究には、30人の健康な被験者(年齢:33±9.3、男性/女性:14/16)が含まれ、10日間隔の2つの異なる実験日に実験室を訪れました。この研究では、栄養状態、時間帯、ホルモン状態などの主要な交絡因子は制御されていなかった。さまざまな運動強度において、変動係数(CV)が4.0%から4.3%の範囲で高い日中信頼性、CVが10.1%から20.2%の範囲で許容できる日中信頼性、CVが17.9%から26.8%の範囲で評価者間信頼性が実証されました。したがって、さまざまな環境要因の制御が困難な実際の臨床シナリオでは、ドップラー超音波を使用して、同じ超音波検査技師が実施した場合、高い日内信頼性と許容可能な日中信頼性を備えた、最大下片脚膝伸筋運動中の脚の血流を決定することができます。

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.

著者スポットライト:脚の血流の測定におけるドップラー超音波の信頼性の評価 

制御されていない環境での片脚膝伸筋運動中のドップラー超音波ベースの脚の血流評価

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.

参加者 2022 年 5 月から 2022 年 10 月にかけて、合計 30 人の健康な男女が研究に参加するために募集されました。すべての参加者は、心血管疾患、代謝疾患、または神経疾患の病歴がありませんでした。カフェイン、アルコール、ニコチン、激しい運動、または血管機能に影響を与える可能性のあるその他の要因など、通常の習慣を変更するように指示されていません。
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Watch this Scientific Journal Video about Assessing the Reliability of Doppler Ultrasound in Measuring Leg Blood Flow at JoVE.com

このテスト再テスト研究では、片脚膝伸筋運動中にドップラー超音波技術によって測定された脚の血流を評価しました。分析法の日中、日中、および評価者間の信頼性を調査しました。このアプローチは、日中および許容可能な日中の信頼性が高いことを実証しました。しかし、評価者間の信頼性は、安静時や低作業負荷時に許容できないほど低かった。

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

この方法は、多くの臨床および研究環境で広く認識され、適用されています。この研究の主な目的は、分析法の再現性を支援し、それによって測定誤差に関する貴重な洞察を提供することでした。そうすることで、何が本当の生理学的変化で、何が測定誤差によるものなのかを知ることができます。最終的には、この方法の理解が深まります。主な障害は、日常生活のさまざまな活動中の生理学的変化を探索することにあり、そのような調査は特定の実験設定の下でのみ実行可能であるためです。Tは、最後の信頼性研究が片足の膝伸筋運動中に実施されてから20年以上経ちました。この間、技術は大きく進化しており、現在の方法に関連する測定時代に関する貴重な洞察を得るために、この研究分野を再検討することが不可欠です。ドップラー超音波は、熱希釈などの他の血流測定方法と比較して非侵襲的であり、必要に応じて動脈および静脈カテーテル法と組み合わせることができます。また、拍動から拍動までの血流速度を測定できるため、急激な変化を検出することができます。将来的には、慢性閉塞性肺疾患患者の骨格筋収縮への血流制御を調査することを主な目標としています。

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.

医学

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.

脚の血流評価のための片脚膝伸筋椅子のセットアップと超音波装置の構成

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.