Blood Flow Values Research Articles

The microvascular bed of the skin of lower limbs in patients with intermittent lameness and coronary heart disease as a possible model of their myocardial microcirculation

Purpose: to assess possibility to extrapolate findings of skin microvascular bed examination in lower extremities with laser Doppler flowmetry in patients with obliterating atherosclerosis as a model of their myocardial microcirculation in coronary heart disease.Material and methods. Males with angiographically confirmed coronary heart disease (n = 70) and obliterating atherosclerosis in lower limbarteries (n = 74) were taken in the study. Microcirculation of the skin in the left forearm in the Zakharyin – Head zone in patients with coronaryheart disease and skin microcirculation in the foot of affected limb in patients with obliterating atherosclerosis of arteries of lower extremities were examined with laser Doppler flowmetry. The basal blood flow, amplitude-frequency spectrum of its oscillations, myogenic, neurogenic vascular tone and occlusion parameters were assessed as well. Comparison groups included 50 practically healthy males for the patients with coronary heart disease and 20 males – for the patients with obliterating atherosclerosis of arteries of lower extremities. Patients were examinedat the initial stage and in 2–3 weeks after endovascular restoration of blood flow in the myocardium and lower limbs.Results and discussion. At the initial research stage, the microcirculation picture in patients with coronary heart disease and obliterating ath-erosclerosis in lower extremities differed from that of healthy individuals by shifts covering all links of the microvascular bed and characterizedby constriction of the precapillary segment, a statistically significant decrease in median values of capillary blood flow by 17.5 and 43.1 %,microvascular blood flow reserve – by 11.2 and 31.0 %, as well as by the increase in arteriolovenular blood bypass – by 10.3 and 70.8 %,respectively. After the restoration of blood flow in lower extremities in patients with obliterating atherosclerosis, muscular pain disappeared,and the ankle-shoulder index got normalized. At the same time, one could observe a statistically significant increase in the capillary blood flow(+13.6 %), the increase of reserve potential in microvascular bed (+20.6 %) with the simultaneous decrease of vascular tone in the precapillarysegment (–15.1 %) and of the blood bypass index (–25.0 %). Better clinical picture after coronary angioplasty in patients with coronary heart disease was accompanied with a similar and unidirectional tendency to positive changes in the microvascular bed.Conclusion. As far as etiopathogenetic mechanisms and clinical manifestations of coronary heart disease and obliterating atherosclerosis in arteries of lower extremities have much in common and microcirculatory shifts in forearm and foot skin in these patients before and after angioplasty are unidirectional, all these allow to suggest that one can see similar changes in the myocardium microcirculatory system in patients with coronary heart disease. Thus, it opens possibilities to have a targeted medicamentous impact at the microvascular level.

Dysfunctional Coupling of Cerebral Blood Flow and Susceptibility Value in the Bilateral Hippocampus is Associated with Cognitive Decline in Nondialysis Patients with CKD.

Patients with end stage CKD often develop cognitive decline, but whether this is related to the underlying disease or to hemodialysis remains unclear. We performed three-dimensional pseudocontinuous arterial spin labeling and quantitative susceptibility mapping prospectively in 40 patients with stage 1-4 CKD, 47 nondialysis patients with stage 5 CKD, and 44 healthy controls. Our magnetic resonance imaging data demonstrate that changes in cerebral blood flow-susceptibility coupling might underlie this cognitive decline, perhaps in the hippocampus and thalamus. These results suggest that magnetic resonance imaging parameters are potential biomarkers of cognitive decline in patients with CKD. Moreover, our findings may lead to discovery of novel therapeutic targets to prevent cognitive decline in patients with CKD. Cerebral blood flow (CBF) and susceptibility values reflect vascular and iron metabolism, providing mechanistic insights into conditions of health and disease. Nondialysis patients with CKD show a cognitive decline, but the pathophysiological mechanisms underlying this remain unclear. Three-dimensional pseudocontinuous arterial spin labeling and quantitative susceptibility mapping were prospectively performed in 40 patients with stage 1-4 CKD (CKD 1-4), 47 nondialysis patients with stage 5 CKD (CKD 5ND), and 44 healthy controls (HCs). Voxel-based global and regional analyses of CBF, susceptibility values, and vascular-susceptibility coupling were performed. Furthermore, the association between clinical performance and cerebral perfusion and iron deposition was analyzed. For CBF, patients with CKD 5ND had higher normalized CBF in the hippocampus and thalamus than HCs. Patients with CKD 5ND had higher normalized CBF in the hippocampus and thalamus than those with CKD 1-4. The susceptibility values in the hippocampus and thalamus were lower in patients with CKD 5ND than in HCs. Patients with CKD 5ND had higher susceptibility value in the caudate nucleus than those with CKD 1-4. More importantly, patients with CKD 5ND had lower CBF-susceptibility coupling than HCs. In addition, CBF and susceptibility values were significantly associated with clinical performance. Our findings demonstrate a new neuropathological mechanism in patients with CKD, which leads to regional changes in CBF-susceptibility coupling. These changes are related to cognitive decline, providing potential imaging markers for assessing clinical disability and cognitive decline in these patients.

Remote Bio Vision: Perfusion Imaging Based Non-Contact Autonomic Biosignal Measurement Algorithm

Due to the outbreak of new viruses in recent years, the need for contactless medical systems has significantly increased for monitoring, treating, managing, and preventing diseases. Systems are constantly being developed to replace conventional biosignal measuring methods with contactless medical systems. Several systems that substitute attachable sensors in conventional systems have been developed to measure diverse biosignals using images captured with visible cameras. Most non-contact biometric systems have certain limitations, for example, they can only measure a single biosignal, such as the heart rate, oxygen saturation, or blood pressure. They are also easily affected by external factors such as lighting conditions and noises. Furthermore, a blood pressure measuring system based on the pulse transit time requires physical contact and accuracy depends on the measurement location. This study examined a system that provides highly accurate biosignals to overcome these limitations of conventional biosignal measurement systems. This study proposes a biosignal measurement system that uses an infra-red camera to reduce visible light noise. The proposed system uses light sources outside the visible range and measures the amplified reflected light using a near infra-red camera to calculate the heart rate and oxygen saturation. The blood flow value is calculated by the measured heart rate and oxygen saturation. Based on measured data, blood pressure is estimated without contact with the body. We compared the proposed system with an existing non-contact blood pressure measurement system. The proposed system showed an average error rate of 2.07% in blood pressure measurement, which increased by 3.86% compared to the conventional system. Also, this study enabled the early detection of pressure ulcers, which is difficult to measure quantitatively.

Estimating Hemodynamic Significant Deformations of Brachiocephalic Arteries Using CT Perfusion

Background and Aim: The cause of most strokes is associated with the pathology of the carotid arteries. Many modern researchers suggest preventive surgery in the presence of arterial deformity to prevent strokes. The hemodynamic significance of carotid deformities is determined by morphological and functional disorders at the level of tortuosity, the reaction of cerebral blood flow is not often considered. Here, we assume that cerebral autoregulation in tortuosity can be different. Methods and Materials/Patients: A total of 64 patients (31-75 years old) with 110 carotid deformities were analyzed. Duplex color mapping, computed tomography angiography of carotid arteries, and computed tomography perfusion were performed by estimating the absolute and average values of cerebral blood flow (mL/100 g/min), cerebral blood volume (mL/100 g), Mean transit time (MTT) (s) in similar areas of the cortex. In 6 patients, the acetazolamide challenge test was used to evaluate the autoregulatory disturbances. Results: According to computed tomography angiography and duplex color mapping, 18(28.1%) patients had unilateral tortuosity, and 46(71.9%) patients had bilateral tortuo s ity. Hemodynamically significant deformities were detected in 33 cases (30% of tortuosity). In 54 cases (49% of tortuosity), the deformities were accompanied by carotid stenosis. Perfusion disorders were detected in 23 of 64 patients (35.9%). In the majority of cases (75% of all perfusion disorders), hypoperfusion was diagnosed on the side corresponding to the maximum degree of stenosis, regardless of the location of the tortuosity. Neurologically significant hypoperfusion, compensated by collateral blood flow revealed only in 7.8% of cases of hemodynamic significant internal carotid artery deformity without concomitant atherosclerosis. Conclusion: The decision on surgical correction of carotid artery tortuosity should be made while considering both local changes in hemodynamics and proven violations of autoregulation of cerebral blood flow, especially in patients with concomitant carotid stenosis.

Investigation of Retinal Vascular Parameters and Choroidal Vascular Index in Patients Developing Hyphema After Unilateral Blunt Trauma

To evaluate retinal and choroidal vascular changes in cases with hyphema after blunt ocular trauma that did not cause globe rupture or any retinal pathology. This cross-sectional study included 29 patients who developed hyphema after unilateral blunt ocular trauma (BOT). The other healthy eyes of the same patients were evaluated as the control group. Optical coherence tomography-angiography (OCT-A) was used for imaging. In addition, choroidal parameters were compared by calculating the choroidal vascular index (CVI) and using choroidal thickness measurements by two independent researchers. Superior and deep flow values were significantly decreased in the traumatic hyphema group compared to the control group (p<0.05). Parafoveal deep vascular density (parafoveal dVD) values were decreased in traumatized eyes compared to control eyes (p=0.000). Vascular density values were similar other than that. In addition, there was a significant decrease in optic disc blood flow (ODF) and optic nerve head density (ONHD) values compared to the control group (p<0.05). In addition, no significant difference was observed between the groups in terms of mean CVI values (p>0.05). Non-invasive diagnostic tools such as OCTA and EDI-OCT can be used to detect and monitor early changes in retinal and choroidal microvascular flow in cases of traumatic hyphema.

Are there reliable multiparametric MRI criteria for differential diagnosis between intracranial meningiomas and solitary intracranial dural metastases?

Intracranial meningiomas are the most common tumors of the central nervous system (CNS). Meningiomas account for up to 36% of all brain tumors. The incidence of metastatic brain lesions has not been determined. Up to 30% of adult patients with cancer of one localization or another suffer from a secondary tumor lesion of the brain. The vast majority of meningiomas have meningeal localization; >90% are solitary. The incidence of intracranial dural metastases (IDM) is 8-9% of cases, while in 10% of cases, the brain is the only localization, and in 50% of cases the metastases are solitary. Typically, the task of distinguishing between meningioma and dural metastasis does not involve difficulties. Periodically, there is a situation when the differential diagnosis between these tumors is ambiguous, since meningiomas and solitary IDM may have similar characteristics, in particular, a cavity-less solid structure, limited diffusion of water molecules, the presence of extensive peritumoral edema, and an identical contrast pattern. The present study included 100 patients with newly diagnosed tumors of the CNS, who subsequently underwent examination and neurosurgical treatment at the Federal Center for Neurosurgery with histological verification between May 2019 and October 2022. Depending on the histological conclusion, two study groups of patients were distinguished: The first group consisted of patients diagnosed with intracranial meningiomas (n=50) and the second group of patients were diagnosed with IDM (n=50). The study was performed using a magnetic resonance imaging (MRI) General Electric Discovery W750 3T before and after contrast enhancement. The diagnostic value of this study was estimated using Receiver Operating Characteristic curve and area under the curve analysis. Based on the results of the study, it was found that the use of multiparametric MRI (mpMRI) in the differential diagnosis of intracranial meningiomas and IDM was limited by the similarity of the values of the measured diffusion coefficient. The assumption, previously put forward in the literature, regarding the presence of a statistically significant difference in the apparent diffusion coefficient values, which make it possible to differentiate tumors, was not confirmed. When analyzing perfusion data, IDM showed higher cerebral blood flow (CBF) values compared with intracranial meningiomas (P≤0.001). A threshold value of the CBF index was revealed, which was 217.9 ml/100 g/min, above which it is possible to predict IDM with a sensitivity and specificity of 80.0 and 86.0%, respectively. Diffusion-weighted images are not reliable criteria for differentiating intracranial meningiomas from IDM and should not influence the diagnosis suggested by imaging. The technique for assessing the perfusion of a meningeal lesion makes it possible to predict metastases with a sensitivity and specificity close to 80-90% and deserves attention when making a diagnosis. In the future, in order to reduce the number of false negative and false positive results, mpMRI would require additional criteria to be included in the protocol. Since IDM differs from intracranial meningiomas in the severity of neoangiogenesis and, accordingly, in greater vascular permeability, the technique for assessing vascular permeability (wash-in parameter with dynamic contrast enhancement) may serve as a refining criterion for distinguishing between dural lesions.

Application study of DTI combined with ASL in the crossed cerebellar diaschisis after subacute cerebral hemorrhage.

To study the value of 3.0T magnetic resonance imaging with diffusion tensor imaging (DTI) and 3D-arterial spin labeling (ASL) perfusion imaging in the diagnosis of the crossed cerebellar diaschisis (CCD) after the unilateral supratentorial subacute cerebral hemorrhage. Fifty-eight patients with the unilateral supratentorial subacute cerebral hemorrhage who underwent diffusion tensor imaging (DTI), 3D-arterial spin labeling (ASL), and conventional magnetic resonance imaging (MRI) scanning were enrolled. Cerebral blood flow (CBF) values of the perihematomal edema (PHE) and bilateral cerebellar hemisphere were measured on ASL mapping, and the fractional anisotropy (FA) and mean diffusivity (MD) values of the bilateral cortical, pontine, and middle cerebellar peduncle (MCP) were measured on DTI mapping. In the CCD(+) group, FA values of the cerebral cortex and pontine ipsilateral to the lesion were statistically reduced compared to the contralateral side (P < 0.05), and the FA and MD values of the middle cerebellar peduncle (MCP) contralateral to the lesion were statistically reduced compared to the ipsilateral side (P < 0.05). Positive correlation was detected between the CBF values of the perihematomal edema (PHE) and the CBF values of cerebellar hemispheres (r = 0.642, P < 0.05), whereas the CBF values of PHE had a significantly high positive correlation with the FA in the contralateral MCP (r = 0.854, P < 0.05). CBF values in the contralateral cerebellar hemisphere correlated with FA (r = 0.466, P < 0.05) and MD values (r = 0.718, P < 0.05) in the contralateral MCP. Hemodynamic alterations of PHE and cortical-ponts-cerebellum (CPC) fibrous pathway damage are associated with the development of CCD; DTI technique can assess the degree of CPC fiber pathway injury at an early stage.

Prediction of Occurrence of Cerebral Infarction After Successful Mechanical Thrombectomy for Ischemic Stroke in the Anterior Circulation by Arterial Spin Labeling

PurposeThe overall goal of our study is to create modified Alberta Stroke Program Early Computed Tomography Score (ASPECTS) determined by the findings on arterial spin labeling imaging (ASL) to predict the prognosis of patients with acute ischemic stroke after successful mechanical thrombectomy (MT). Prior to that, we examined predictive factors including the value of cerebral blood flow (CBF) measured by ASL for occurrence of cerebral infarction at the region of interest (ROI) used in the ASPECTS after successful MT.MethodsOf the 92 consecutive patients with acute ischemic stroke treated with MT at our institution between April 2013 and April 2021, a total of 26 patients who arrived within 8 h after stroke onset and underwent MT resulting in a thrombolysis in cerebral infarction score of 2B or 3 were analyzed. Magnetic resonance imaging, including diffusion-weighted imaging (DWI) and ASL, was performed on arrival and the day after MT. The asymmetry index (AI) of CBF by ASL (ASL-CBF) before MT was calculated for 11 regions of interest using the DWI-Alberta Stroke Program Early CT Score.ResultsOccurrence of infarction after successful MT for ischemic stroke in the anterior circulation can be expected when the formula 0.3211 × history of atrial fibrillation +0.0096 × the AI of ASL-CBF before MT (%) +0.0012 × the time from onset to reperfusion (min) yields a value below 1.0 or when the AI of ASL-CBF before MT is below 61.5%.ConclusionThe AI of ASL-CBF before MT or a combination of a history of atrial fibrillation, the AI of ASL-CBF before MT, and the time from onset to reperfusion can be used to predict the occurrence of infarction in patients arriving within 8 h after stroke onset in which reperfusion with MT was successful.

Power-doppler ultrasonography is an accurate tool for early pregnancy detection in donkeys

Early detection of pregnancy could enhance the reproductive efficiency of donkeys, as the species has a wide range for the first detection of the embryonic vesicle (EV) via B-mode ultrasonography. This study aimed to assess the uterine blood flow of jennies as an early indirect pregnancy diagnostic test. We hypothesized that uterine blood flow is increased, thus, serving as an early pregnancy diagnostic tool. Jennies (n=52) were bred with fresh semen from a fertile jack, and nine jennies were not bred and served as controls; ovulation (Day-0) was confirmed at 12h intervals for all jennies. Power-doppler and B-mode ultrasonography were performed on Days 7 to 10 to assess the uterine horn blood flow and identification of EV, respectively; the latter was repeated on Day 15. Uterine horn blood flow was evaluated using spot meter techniques, measuring mean pixel intensity. Progesterone concentrations were determined with RIA on Days 7 to 10. Data were assessed for normality with Shapiro- Wilk's test and mixed models. Receiving operating curve was used to determine the cut off value for uterine blood flow. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for blood flow on Days 7 to 10 were calculated to identify pregnant jennies and confirmed on Day 15. Significance was set as P≤0.05 and tendency as 0.05<P<0.1. Of 52 bred jennies, 29 (53%) were confirmed pregnant on Day 15. B-modeultrasonography identified 17.2% (5/29) of the EVs on Day 9 and 48.3% (14/29) on Day 10; no EVs were identified on Days 7 to 8. Pregnant jennies (n=29) had greater uterine blood flow in comparison with non-pregnant jennies (144.8±1.5 vs. 139.2±1.3 pixels/unit, n=32) (P=0.007), with an SD of the difference of 6.3 pixels/unit (p=0.008). There was no effect of time (P=0.48) or group x time interaction between (P=0.70) for uterine blood flow. Progesterone concentrations did not change within Days 7 to 10 (P=0.81), and there was no group x time interaction (P=0.49). Progesterone tended to be greater in pregnant than non-pregnant jennies (P=0.07). There was no effect of time (P=0.79), group (P=0.77), or group x time interaction (P=0.92) for uterine horns. Sensitivity from Days-7-to-10 were 86%, 82%, 60%, and 62%, respectively. In contrast, specificity for Days 7 to 10 was 80%, 88%, 78%, and 75%, respectively. The PPV and NPV for Days 7 to 10 were 81% and 85%; 75% and 20%; 35% and 33%; and 30% and 27%; respectively. In conclusion, this study demonstrated the efficacy of power-doppler-ultrasonography as a sensitive and specific tool for early indirect detection of pregnancy in donkeys, whereas standard B-mode first detected a small percentage of pregnancies on Days 9 to 10. Power-doppler could facilitate the breeding management of donkeys, such as timing the induction of luteolysis in non-pregnant jennies at Days 7 to 10 post-ovulation.

Prediction of intracranial hemorrhage after internal carotid artery stenting in patients with symptomatic severe carotid stenosis by computed tomography perfusion.

To explore the risk of intracranial hemorrhage (ICH) after internal carotid artery stenting (CAS) in patients with symptomatic severe carotid stenosis by computed tomography perfusion (CTP). The clinical and imaging data of 87 patients with symptomatic severe carotid stenosis who underwent CTP before CAS were retrospectively analyzed. The absolute values of the cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and time to peak (TTP) were calculated. The relative values (i.e., the rCBF, rCBV, rMTT, and rTTP), defined as the comparison between ipsilateral and contralateral hemispheres, were also derived. The degree of carotid artery stenosis was divided into 3 grades, and the Willis' circle was classified into 4 types. The relationship between the occurrence of the ICH and CTP parameters, the Willis' circle type, and the clinical baseline data were evaluated. A receiver operating characteristic (ROC) curve analysis was performed to determine the most effective CTP parameter for the prediction of ICH. In total, 8 patients (9.2%) developed ICH after CAS. The results showed that the CBF (P=0.025), MTT (P=0.029), rCBF (P=0.006), rMTT (P=0.004), rTTP (P=0.006), and the degree of carotid artery stenosis (P=0.021) differed significantly between the ICH group and non-ICH group. The ROC curve analysis showed that the CTP parameter with the maximal area under the curve (AUC) for ICH was rMTT (AUC =0.808), which indicated that patients with an rMTT >1.88 were more likely to develop ICH (sensitivity: 62.5%, specificity: 96.2%). The occurrence of ICH after CAS was not related to the type of Willis' circle (P=0.713). CTP can be used to predict ICH after CAS in patients with symptomatic severe carotid stenosis, and patients with a preoperative rMTT >1.88 should be closely monitored for evidence of ICH after CAS.

Comparative Analysis of Indicators of Microcirculation Stability in the Temporal Regions of the Head in Young Men and Women.

Indicators (markers) of microcirculation stability of the temporal regions of the head in young male and female subjects were studied. In 20 healthy volunteers aged 18-19 years (10 men and 10 women), synchronous measurements of the microcirculation of symmetrical temporal regions of the head were performed by laser Doppler flowmetry. Numerical values of stability markers (T1, T2, ζ) and parameters a1, a2, b1, b2 of the differential equation system describing oscillatory processes in the microcirculation system of the studied regions were obtained using the computational and experimental methodology developed by us earlier. It is shown that the right-left hemodynamic balance of microcirculation in men is maintained at the expense of the balance between the change in blood flow on the right and the initial value of blood flow on the left (coefficient b1) and in women, by the balance between the change in blood flow on the left and the initial value of blood flow on the right (coefficient a2). In women, the contribution of the right channel of the microcirculation to the right-left hemodynamic is significantly higher than in men. In general, the quantitative indicators (markers) of the stability of the microcirculation of the temporal regions of the head in women were higher than in men, which attests to higher stress resistance of the female organism in comparison with the male.

The incremental value of CCTA-derived myocardial radiomics signature for ischemia diagnosis with reference to CT myocardial perfusion imaging.

To explore the incremental value of myocardial radiomics signature derived from static coronary computed tomography angiography (CCTA) for identifying myocardial ischemia based on stress dynamic CT myocardial perfusion imaging (CT-MPI). Patients who underwent CT-MPI and CCTA were retrospectively enrolled from two independent institutions, one used as training and the other as testing. Based on CT-MPI, coronary artery supplying area with relative myocardial blood flow (rMBF) value <0.8 was considered ischemia. Conventional imaging features of target plaques which caused the most severe narrowing of the vessel included area stenosis, lesion length (LL), total plaque burden, calcification burden, non-calcification burden, high-risk plaque (HRP) score, and CT fractional flow reserve (CT-FFR). Myocardial radiomics features were extracted at three vascular supply areas from CCTA images. The optimized radiomics signature was added to the conventional CCTA features to build the combined model (radiomics + conventional). There were 168 vessels from 56 patients enrolled in the training set, and the testing set consisted of 135 vessels from 45 patients. From either cohort, HRP score, LL, stenosis ≥50% and CT-FFR ≤0.80 were associated with ischemia. The optimal myocardial radiomics signature consisted of nine features. The detection of ischemia using the combined model was significantly improved compared with conventional model in both training and testing set (AUC 0.789 vs 0.608, p < 0.001; 0.726 vs 0.637, p = 0.045). Myocardial radiomics signature extracted from static CCTA combining with conventional features could provide incremental value to diagnose specific ischemia. Myocardial radiomics signature extracted from CCTA may capture myocardial characteristics and provide incremental value to detect specific ischemia when combined with conventional features.

(123) Novel Low Intensity Shockwave Therapy Sham Delivery Method (Zero Energy) Assessed Objectively by Grayscale and Doppler Ultrasound Results

Abstract Introduction Most ED LiSWT studies use the IIEF as a primary outcome. While clinically relevant, the IIEF does not directly assess erectile tissue structure. To establish a more objective parameter, we investigated the estimation of hypoechoic area in grayscale ultrasound images of erectile tissue as an objective primary outcome for clinical trials assessing the efficacy of LiSWT. During erection, grayscale imaging of the penis demonstrates corpora cavernosa (CC) that is homogenous in healthy men and heterogeneous to varying degrees in men with ED. A critical aspect of using grayscale ultrasound is to determine that sham treatment reliably results in no significant improvement in erectile tissue structure. Other studies have used sham probes with cotton wadding or non-penetrable gel pads to dampen delivery of shockwave energy flux density, however a small amount of energy may still be delivered. We report a novel sham-controlled methodology in LiSWT RCT for ED. Objective To evaluate erectile tissue heterogeneity as an endpoint in LiSWT sham-controlled trials using grayscale analysis of percent hypoechoic regions in CC after sham delivery of zero energy flux density. Methods A single-blind, sham-controlled, randomized prospective study was performed in men with ED naïve to any kind of acoustic wave therapy. Those meeting inclusion/exclusion completed baseline assessments and were randomized to active or sham within each treatment arm. This interim sub-analysis only examined the sham group (n = 7). For each treatment, the shockwave device was already on in the exam room. When the subject was ready a curtain was suspended above his mid-section blocking the device, and noise cancelling headphones provided. When the probe was placed on the penis, a high-quality recording of shockwave sounds was activated for sham treatment. Twenty weeks after zero energy sham treatment, grayscale and DUS imaging using a 15.4 MHz probe under pharmacologic erection 3-4/4 hardness was performed before unblinding. Grayscale percent hypoechoic regions within the CC were assessed by computer-assisted histometry using Image J. (Fig 1) The IIEF was also administered to all patients at baseline and week 20. Grayscale data were analyzed by two-way repeated measures ANOVA. IIEF-EF scores and bloodflow values (PSV and EDV) were compared using the Wilcoxon matched-pairs signed rank test. Results Compared to baseline, there were no significant changes (p&amp;gt;0.7; see figure) at week 20 in hypoechoic area in the proximal, middle, and distal erect penile shaft. (Fig 2) Furthermore, there were no significant changes in PSV (p&amp;gt;0.15), EDV (p&amp;gt;0.2), or IIEF-EF (p&amp;gt;0.6) from baseline to week 20. Conclusions Using computer-assisted histometry to determine hypoechoic area in grayscale ultrasound images to assess penile erectile tissue heterogeneity, we demonstrated that a novel sham treatment protocol that ensures zero energy delivery does not change erectile tissue integrity. The lack of improvement in PSV, EDV, and IIEF-EF further support our findings with grayscale ultrasound. Future studies will assess the appropriateness of grayscale ultrasound image analysis as a primary endpoint in LiSWT clinical trials. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: TRT, Cynosure.

Characterization and implications of intracoronary hemodynamic assessment during coronary spasm provocation testing.

Current diagnostic criteria for coronary spasm are based on patient's symptoms, ECG shifts and epicardial vasoconstriction during acetylcholine (ACh) spasm testing. To assess the feasibility and diagnostic value of coronary blood flow (CBF) and resistance (CR) assessment as objective parameters during ACh testing. Eighty-nine patients who underwent intracoronary reactivity testing including ACh testing with synchronous Doppler wire-based measurements of CBF and CR were included. Coronary microvascular and epicardial spasm, respectively, were diagnosed based on COVADIS criteria. Patients were 63 ± 13years old, predominantly female (69%) and had preserved LV ejection fraction (64 ± 8%). Overall, assessment of CBF and CR during ACh testing revealed a decrease in CBF of 0.62 (0.17-1.53)-fold and an increase of CR of 1.45 [0.67-4.02]-fold in spasm patients compared to 2.08 (1.73-4.76) for CBF and 0.45 (0.44-0.63) for CR in patients without coronary spasm (both p < 0.01). Receiver operating characteristic revealed a high diagnostic ability of CBF and CR (AUC 0.86, p < 0.001, respectively) in identifying patients with coronary spasm. However, in 21% of patients with epicardial spasm and 42% of patients with microvascular spasm a paradoxical response was observed. This study demonstrates feasibility and potential diagnostic value of intracoronary physiology assessments during ACh testing. We observed opposite responses of CBF and CR to ACh in patients with positive vs. negative spasm test. While a decrease in CBF and an increase in CR during ACh seem pathognomonic for spasm, some patients with coronary spasm demonstrate paradoxical ACh response demanding further scientific investigations.

Perifocal Zone of Brain Gliomas: Application of Diffusion Kurtosis and Perfusion MRI Values for Tumor Invasion Border Determination.

(1) Purpose: To determine the borders of malignant gliomas with diffusion kurtosis and perfusion MRI biomarkers. (2) Methods: In 50 high-grade glioma patients, diffusion kurtosis and pseudo-continuous arterial spin labeling (pCASL) cerebral blood flow (CBF) values were determined in contrast-enhancing area, in perifocal infiltrative edema zone, in the normal-appearing peritumoral white matter of the affected cerebral hemisphere, and in the unaffected contralateral hemisphere. Neuronavigation-guided biopsy was performed from all affected hemisphere regions. (3) Results: We showed significant differences between the DKI values in normal-appearing peritumoral white matter and unaffected contralateral hemisphere white matter. We also established significant (p < 0.05) correlations of DKI with Ki-67 labeling index and Bcl-2 expression activity in highly perfused enhancing tumor core and in perifocal infiltrative edema zone. CBF correlated with Ki-67 LI in highly perfused enhancing tumor core. One hundred percent of perifocal infiltrative edema tissue samples contained tumor cells. All glioblastoma samples expressed CD133. In the glioblastoma group, several normal-appearing white matter specimens were infiltrated by tumor cells and expressed CD133. (4) Conclusions: DKI parameters reveal changes in brain microstructure invisible on conventional MRI, e.g., possible infiltration of normal-appearing peritumoral white matter by glioma cells. Our results may be useful for plotting individual tumor invasion maps for brain glioma surgery or radiotherapy planning.

Ultrasound, photoacoustic, and magnetic resonance imaging to study hyperacute pathophysiology of traumatic and vascular brain injury.

Cerebrovascular dynamics and pathomechanisms that evolve in the minutes and hours following traumatic vascular injury in the brain remain largely unknown. We investigated the pathophysiology evolution in mice within the first 3hours after closed-head traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH), two significant traumatic vascular injuries. We took a multimodal imaging approach using photoacoustic imaging, color Doppler ultrasound, and MRI to track injury outcomes using a variety of metrics. Brain oxygenation and velocity-weighted volume of blood flow (VVF) values significantly decreased from baseline to 15minutes after both TBI and SAH. TBI resulted in 19.2% and 41.0% ipsilateral oxygenation and VVF reductions 15minutes postinjury, while SAH resulted in 43.9% and 85.0% ipsilateral oxygenation and VVF reduction (p<.001). We found partial recovery of oxygenation from 15minutes to 3hours after injury for TBI but not SAH. Hemorrhage, edema, reduced perfusion, and altered diffusivity were evident from MRI scans acquired 90-150minutes after injury in both injury models, although the spatial distribution was mostly focal for TBI and diffuse for SAH. The results reveal that the cerebral oxygenation deficits immediately following injuries are reversible for TBI and irreversible for SAH. Our findings can inform future studies on mitigating these early responses to improve long-term recovery.

Disappearance of hemichorea as the initial presentation of moyamoya disease after revascularization surgery regardless of residual hypoperfusion evaluated by quantitative N-isopropyl-p-123I-iodoamphetamine SPECT

Background and importanceAlthough hypoperfusion of the basal ganglia or the frontal subcortical matter is suspected, the pathology of chorea in moyamoya disease remains unclarified. Herein, we report a case of moyamoya disease presenting with hemichorea and evaluate pre- and postoperative perfusion using single photon emission computed tomography with N-isopropyl-p-123I-iodoamphetamine (123I-IMP SPECT). Clinical presentationAn 18-year-old woman presented with choreic movement of her left limbs. Magnetic resonance imaging revealed an ivy sign, and 123I-IMP SPECT demonstrated decreased cerebral blood flow (CBF) and cerebral vascular reserve (CVR) values in the right hemisphere. The patient underwent direct and indirect revascularization surgery to improve cerebral hemodynamic impairment. The choreic movements entirely resolved immediately after surgery. Although CBF and CVR values in the ipsilateral hemisphere demonstrated by quantitative SPECT increased, these did not reach the normal values threshold. ConclusionChoreic movement in moyamoya disease may be related to cerebral hemodynamic impairment. Further studies are required to elucidate its pathophysiological mechanisms.

Combining amide proton transfer-weighted and arterial spin labeling imaging to differentiate solitary brain metastases from glioblastomas

PurposeTo evaluate the clinical utility of amide proton transfer-weighted imaging (APTw) and arterial spin labeling (ASL) in differentiating solitary brain metastases (SBMs) from glioblastomas (GBMs). MethodsForty-eight patients diagnosed with brain tumors were enrolled. All patients underwent conventional MRI, APTw, and ASL scans on a 3.0 T MRI system. The mean APTw value and mean cerebral blood flow (CBF) value were measured. The differences in various parameters between GBMs and SBMs were assessed using the independent-samples t-test. The quantitative performance of these MRI parameters in distinguishing between GBMs and SBMs was evaluated using receiver operating characteristic (ROC) curve analysis. ResultsGBMs exhibited significantly higher APTw and CBF values in peritumoral regions compared with SBMs (P < 0.05). There was no significant difference between SBMs and GBMs in tumor cores. APTw MRI had a higher diagnostic efficiency in differentiating SBMs from GBMs (area under the curve [AUC]: 0.864; 75.0% sensitivity and 81.8% specificity). Combined use of APTw and CBF value increased the AUC to 0.927. ConclusionAPTw may be superior to ASL for distinguishing between SBMs and GBMs. Combination of APTw and ASL showed better discrimination and a superior diagnostic performance.

The therapeutic utility of combining dynamic contrast-enhanced magnetic resonance imaging with arterial spin labeling in the staging of nasopharyngeal carcinoma

BackgroundTo research the pathological and clinical staging uses of arterial spin labeling (ASL) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI).Materials and methods64 newly diagnosed nasopharyngeal carcinoma (NPC) patients were enrolled from December 2020 to January 2022, and 3.0 T MRI (Discovery 750W, GE Healthcare, USA) were used for ASL and DCE-MRI scans. The DCE-MRI and ASL raw data were processed post-acquisition on the GE image processing workstation (GE Healthcare, ADW 4.7, USA). The volume transfer constant (Ktrans), blood flow (BF), and accompanying pseudo-color images were generated automatically. Draw the region of interest (ROIs), and the Ktrans and BF values for each ROI were recorded separately. Based on pathological information and the most recent AJCC staging criteria, patients were divided into low T stage groups = T1–2 and high T stage groups = T3–4, low N stage groups = N0–1 and high N stage groups = N2–3, and low AJCC stage group = stage I–II and high AJCC stage group = stage III–IV. The association between the Ktranst and BF parameters and the T, N, and AJCC stages was compared using an independent sample t-test. Using a receiver operating characteristic (ROC) curve, the sensitivity, specificity, and AUC of Ktranst, BFt, and their combined use in T and AJCC staging of NPC were investigated and assessed.ResultThe tumor-BF (BFt) (t = − 4.905, P < 0.001) and tumor-Ktrans (Ktranst) (t = − 3.113, P = 0.003) in the high T stage group were significantly higher than those in the low T stage group. The Ktranst in the high N stage group was significantly higher than that in the low N stage group (t = − 2.071, P = 0.042). The BFt (t = − 3.949, P < 0.001) and Ktranst (t = − 4.467, P < 0.001) in the high AJCC stage group were significantly higher than those in the low AJCC stage group. BFt was moderately positively correlated with the T stage (r = 0.529, P < 0.001) and AJCC stage (r = 0.445, P < 0.001). Ktranst was moderately positively correlated with T staging (r = 0.368), N staging (r = 0.254), and AJCC staging (r = 0.411). There was also a positive correlation between BF and Ktrans in gross tumor volume (GTV) (r = 0.540, P < 0.001), parotid (r = 0.323, P < 0.009) and lateral pterygoid muscle (r = 0.445, P < 0.001). The sensitivity of the combined application of Ktranst and BFt for AJCC staging increased from 76.5 and 78.4 to 86.3%, and the AUC value increased from 0.795 and 0.819 to 0.843, respectively.ConclusionCombining Ktrans and BF measures may make it possible to identify the clinical stages in NPC patients.

Prognostic value of myocardial flow reserve in patients with heart failure with preserved ejection fraction

Aim. To study the prognostic value of myocardial blood flow (MBF) and myocardial flow reserve (MFR) parameters in patients with heart failure with preserved ejection fraction (HFpEF) and non-obstructive coronary artery disease (CAD) in risk stratification of HFpEF progression during a 12-month follow-up.Materials and methods. The study included 58 patients with non-obstructive CAD and HFpEF (LVEF 62 [58; 66]%). Dynamic CZT-SRECT was used to evaluate MFR and MBF at rest (rest-MBF) and stress (stress-MBF). NT-proBNP levels were determined by the enzyme immunoassay. Diastolic dysfunction parameters were measured using 2D transthoracic echocardiography. Left ventricular systolic global longitudinal strain (GLS) was assessed using 2D speckle tracking.Results. After a 12-month follow-up, the patients were retrospectively divided into 2 groups: group 1 (n = 11) included patients with an unfavorable course of HFpEF, group 2 (n = 47) encompassed patients with a favorable course of the disease. In group 1, the level of NT-proBNP was 3.8 times higher than in group 2 (284.5 [183.42; 716.73] and 1,071.4 [272.4; 2,168.1] pg / ml, respectively). MFR values in group 1 were lower by 45.4%(p &lt; 0.001) than in group 2 (1.19 [0.86; 1.55] vs. 2.18 [1.7; 2.55], respectively). In group 1, rest-MBF levels were higher by 23.6% (p = 0.046) and stress-MBF was lower by 28.2% (p = 0.046) than in group 2. The multivariate regression analysis revealed that NT-proBNP levels (odds ratio (OR) 3.23; p = 0.008), GLS (OR 2.27; p = 0.012), and MFR (OR 8.09; p &lt; 0.001) were independent predictors of adverse outcomes in HFpEF. Based on the ROC analysis, MFR levels ≤ 1.62 (AUC = 0.827; p &lt; 0.001), GLS ≤–18 (AUC = 0.756; p = 0.002), and NT-proBNP≥ 760.5 pg / ml (AUC = 0.708; p = 0.040) may be considered as markers of adverse outcomes. However, the combined determination of NT-proBNP and MFR had a greater significance (AUC 0.935; p &lt; 0.001) in risk stratification compared with the monomarker model, while the addition of GLS did not increase the significance of the analysis.Conclusion. Levels of NT-proBNP, GLS, and MFR may be used as non-invasive markers of an adverse course of HFpEF in patients with non-obstructive CAD, while the combined determination of NT-proBNP and MBF increases the prognostic value of the analysis.