Perfusion Measurements Research Articles

Central and Peripheral Circulation Differ during Off-Pump Coronary Artery Bypass Grafting.

Off-pump coronary artery bypass grafting (OPCAB) is an alternative to on-pump coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). During OPCAB, the temporary use of an intracoronary shunt and inotropic medication or catecholamines should keep the central hemodynamics constant. Nevertheless, the need for conversion to on-pump CABG often occurs unexpectedly, most likely due to circulation instability. Circulation instability can appear first in peripheral body parts; therefore, peripheral microcirculation might serve as a predictor for the upcoming conversion to on-pump CABG. We investigated the impact of coronary artery ligation and shunt insertion during OPCAB on cutaneous microcirculation (cLDP) with Laser Doppler Perfusion Technology and transcutaneous oxygen partial pressure ( ). In a pig model of OPCAB, peripheral circulation was evaluated after cLDP (N = 17) and (N = 6) monitoring. Systolic, diastolic, and mean arterial pressure were also observed to prove the independence of perfusion measurement results from hemodynamic parameters. Ligation time during cLDP and monitoring were 101 49 s and 83 33 s, respectively. Shunt time was 11 3 min during cLDP and 13 2 min during measurement. Ligation of the left anterior descending coronary artery (LAD) reduced cLDP significantly to 88 14% (p = 0.007) and to 71 25% (p = 0.038). Inserting a temporary shunt into the LAD significantly improved cLDP (p = 0.006) and (p = 0.015) compared to ligation. cLDP was restored to 99%, and was restored to 91% of the baseline level before ligation. All hemodynamic parameters remained stable and did not change significantly during OPCAB. Although hemodynamic parameters stayed constant, peripheral microcirculation was influenced markedly during OPCAB. Inserting a temporary shut into the LAD leads to a complete normalization of peripheral microcirculation, regarding evaluation by cLDP and .

Preclinical multi-physiologic monitoring of immediate-early responses to diverse treatment strategies in breast cancer by optoacoustic imaging.

Optoacoustic imaging enables the measurement of tissue oxygen saturation (sO2) and blood perfusion while being utilized for detecting tumor microenvironments. Our aim was to employ multispectral optoacoustic tomography (MSOT) to assess immediate-early changes of hemoglobin level and sO2 within breast tumors during diverse treatments. Mouse breast cancer models were allocated into four groups: control, everolimus (EVE), paclitaxel (PTX), and photodynamic therapy (PDT). Hemoglobin was quantified daily, as well as sO2 and blood perfusion were verified by immunohistochemical (IHC) staining. MSOT showed a temporal window of enhanced oxygenation and improved perfusion in EVE and PTX groups, while sO2 consistently remained below baseline in PDT. The same results were obtained for the IHC. Therefore, MSOT can monitor tumor hypoxia and indirectly reflect blood perfusion in a non-invasive and non-labeled way, which has the potential to monitor breast cancer progression early and enable individualized treatment in clinical practice.

Effects of endoluminal vacuum sponge therapy on the perfusion of gastric conduit in a porcine model for esophagectomy.

After esophagectomy, the postoperative rate of anastomotic leakage is up to 30% and is the main driver of postoperative morbidity. Contemporary management includes endoluminal vacuum sponge therapy (EndoVAC) with good success rates. Vacuum therapy improves tissue perfusion in superficial wounds, but this has not been shown for gastric conduits. This study aimed to assess gastric conduit perfusion with EndoVAC in a porcine model for esophagectomy. A porcine model (n = 18) was used with gastric conduit formation and induction of ischemia at the cranial end of the gastric conduit with measurement of tissue perfusion over time. In three experimental groups EndoVAC therapy was then used in the gastric conduit (- 40, - 125, and - 200 mmHg). Changes in tissue perfusion and tissue edema were assessed using hyperspectral imaging. The study was approved by local authorities (Project License G-333/19, G-67/22). Induction of ischemia led to significant reduction of tissue oxygenation from 65.1 ± 2.5% to 44.7 ± 5.5% (p < 0.01). After EndoVAC therapy with - 125 mmHg a significant increase in tissue oxygenation to 61.9 ± 5.5% was seen after 60 min and stayed stable after 120 min (62.9 ± 9.4%, p < 0.01 vs tissue ischemia). A similar improvement was seen with EndoVAC therapy at - 200 mmHg. A nonsignificant increase in oxygenation levels was also seen after therapy with - 40 mmHg, from 46.3 ± 3.4% to 52.5 ± 4.3% and 53.9 ± 8.1% after 60 and 120 min respectively (p > 0.05). An increase in tissue edema was observed after 60 and 120 min of EndoVAC therapy with - 200 mmHg but not with - 40 and - 125 mmHg. EndoVAC therapy with a pressure of - 125 mmHg significantly increased tissue perfusion of ischemic gastric conduit. With better understanding of underlying physiology the optimal use of EndoVAC therapy can be determined including a possible preemptive use for gastric conduits with impaired arterial perfusion or venous congestion.

Quantitative and qualitative comparison of Rubidium-82 and Oxygen-15 water cardiac PET

BackgroundDifferences in tracer characteristics may influence the interpretation of positron emission tomography myocardial perfusion imaging (MPI). We compare the reading of MPIs with a low-extraction retention tracer (82Rb) and a high-extraction non-retention tracer (15O-water) in a selected cohort of patients with known coronary artery disease (CAD). MethodsThirty-nine patients with known CAD referred to 82Rb MPI due to angina underwent rest and stress imaging with both tracers and experienced MPI readers provided blinded consensus reads of all studies. In addition, a comparison of regional and global quantitative measures of perfusion was performed. ResultsThe results showed 74 % agreement in the reading of 82Rb and 15O-water MPI for regional reversible ischemia and global disease, and 82 % agreement for regional irreversible ischemia. The 15O-water MPI identified more cases of global disease (n = 12 (15O-water) vs n = 4 (82Rb), p = 0.03), whereas differences in reversible ischemia (n = 22 vs n = 16, p = 0.11) and, irreversible ischemia (n = 8 vs n = 11, p = 0.45) were not significant. The correlation between myocardial blood flow measured using the two tracers was similar to previous studies (R2 = 0.78) with wide limits of agreement (−0.93 to 0.84 ml/g/min). ConclusionsAgreement between consensus readings of 82Rb and 15O-water MPI was good in patients with known CAD. In this limited size study, no significant differences in the identification of reversible and irreversible ischemia found, whereas 15O-water MPI had a higher positive rate for suspected global disease.

Metabolic and vascular imaging markers for investigating Alzheimer's disease complicated by sleep fragmentation in mice.

Sleep problem is a common complication of Alzheimer's disease (AD). Extensive preclinical studies have been performed to investigate the AD pathology. However, the pathophysiological consequence of AD complicated by sleep problem remains to be further determined. To investigate brain metabolism and perfusion in an AD mouse model complicated by sleep problem, and subsequently identify potential imaging markers to better understand the associated pathophysiology. We examined the oxygen extraction fraction (OEF), cerebral metabolic rate of oxygen (CMRO2), and cerebral blood flow (CBF) using state-of-the-art MRI techniques in a cohort of 5xFAD model mice. Additionally, neuroinflammation, indicated by activated microglia, was assessed using histology techniques. Sleep fragmentation (SF) was utilized as a representative for sleep problems. SF was associated with significant increases in OEF (P = 0.023) and CMRO2 (P = 0.029), indicating a state of hypermetabolism. CBF showed a significant genotype-by-sleep interaction effect (P = 0.026), particularly in the deep brain regions such as the hippocampus and thalamus. Neuroinflammation was primarily driven by genotype rather than SF, especially in regions with significant interaction effect in CBF measurements. These results suggest that brain metabolism and perfusion measurements are promising markers for studying the co-pathogenesis of AD and SF.

Diagnostic confidence with quantitative cardiovascular magnetic resonance perfusion mapping increases with increased coverage of the left ventricle

BackgroundQuantitative cardiovascular magnetic resonance (CMR) first pass perfusion maps are conventionally acquired with 3 short-axis (SAX) views (basal, mid, and apical) in every heartbeat (3SAX/1RR). Thus, a significant part of the left ventricle (LV) myocardium, including the apex, is not covered. The aims of this study were 1) to investigate if perfusion maps acquired with 3 short-axis views sampled every other RR-interval (2RR) yield comparable quantitative measures of myocardial perfusion (MP) as 1RR and 2) to assess if acquiring 3 additional perfusion views (i.e., total of 6) every other RR-interval (2RR) increases diagnostic confidence. MethodsIn 287 patients with suspected ischemic heart disease stress and rest MP were performed on clinical indication on a 1.5T MR scanner. Eighty-three patients were examined by acquiring 3 short-axis perfusion maps with 1RR sampling (3SAX/1RR); for which also 2RR maps were reconstructed. Additionally, in 103 patients 3 short-axis and 3 long-axis (LAX; 2-, 3, and 4-chamber view) perfusion maps were acquired using 2RR sampling (3SAX + 3LAX/2RR) and in 101 patients 6 short-axis perfusion maps using 2RR sampling (6SAX/2RR) were acquired. The diagnostic confidence for ruling in or out stress-induced ischemia was scored according to a Likert scale (certain ischemia [2 points], probably ischemia [1 point], uncertain [0 points], probably no ischemia [1 point], certain no ischemia [2 points]). ResultsThere was a strong correlation (R = 0.99) between 3SAX/1RR and 3SAX/2RR for global MP (mL/min/g). The diagnostic confidence score increased significantly when the number of perfusion views was increased from 3 to 6 (1.24 ± 0.68 vs 1.54 ± 0.64, p < 0.001 with similar increase for 3SAX+3LAX/2RR (1.29 ± 0.68 vs 1.55 ± 0.65, p < 0.001) and for 6SAX/2RR (1.19 ± 0.69 vs 1.53 ± 0.63, p < 0.001). ConclusionQuantitative perfusion mapping with 2RR sampling of data yields comparable perfusion values as 1RR sampling, allowing for the acquisition of additional views within the same perfusion scan. The diagnostic confidence for stress-induced ischemia increases when adding 3 additional views, short- or long axes, to the conventional 3 short-axis views. Thus, future development and clinical implementation of quantitative CMR perfusion should aim at increasing the LV coverage from the current standard using 3 short-axis views.

Exploiting Dual-Wavelength Depolarization of Skin-tissues for Camera-based Perfusion Monitoring.

Perfusion index (PI), the ratio between variable pulsatile (AC) and non-pulsatile (DC) components in a photoplethysmographic (PPG) signal, is an indirect and non-invasive measure of peripheral perfusion. PI has been widely used in assessing sympathetic block success, and monitoring hemodynamics in anesthesia and intensive care. Based on the principle of dual-wavelength depolarization (DWD) of skin tissues, we propose to investigate its opportunity in quantifying the skin perfusion contactlessly. The proposed method exploits the characteristic changes in chromaticity caused by skin depolarization and chromophore absorption. The experimental results of DWD, obtained with the post occlusive reactive hyperemia test and the local cooling and heating test, were compared to the PI values obtained from the patient monitor and photoplethysmography imaging (PPGI). The comparison demonstrated the feasibility of using DWD for PI measurement. Clinical trials conducted in the anesthesia recovery room and operating theatre further showed that DWD is potentially a new metric for camera-based non-contact skin perfusion monitoring during clinical operations, such as the guidance in anesthetic surgery.

Novel wireless laser doppler flowmeter-based investigation of earlobe vascular dynamics in cardiopulmonary exercise testing.

[Purpose] A new wireless laser Doppler blood flowmeter has facilitated easier, more stable measurement of skin perfusion during exercise. However, earlobe blood flow during the cardiopulmonary exercise test remains unascertained. This study aimed to clarify the characteristics of earlobe blood flow during incremental exercise load in healthy individuals. [Participants and Methods] Among 25 healthy males (age 23.6 ± 2.5 years), cycle ergometer-based symptom-limited cardiopulmonary exercise test, after 4 minutes of rest, was conducted with a 4-minute 20W warm-up and a continuous 2W-increase in the work rate every 6 seconds; earlobe blood flow was measured using a wireless laser Doppler blood flowmeter. [Results] Compared with that at rest, earlobe blood flow increased significantly from 50% of exercise peak intensity to a maximum of 1.7 times, but decreased immediately after exercise. The earlobe blood flow %change did not significantly correlate with hemodynamic parameters and its inflection point 36.4% Loadpeak was significantly lower than the anaerobic metabolic threshold 58.1% Loadpeak. [Conclusion] In healthy participants, earlobe blood flow during cardiopulmonary exercise test increased gradually with low-intensity exercise from approximately 1.5 times the resting rate and approached the anaerobic metabolic threshold with a maximum of 1.7 times the resting earlobe blood flow, but decreased quickly after exercise.

Effect of levetiracetam on ocular perfusion measure with optical coherence tomography angiography.

To evaluate using optical coherence tomography angiography the macular and optic nerve head blood flow in pediatric patients with epilepsy treated with levetiracetam for at least 12 months. This study included 33 pediatric patients with epilepsy and 30 sex- and age-matched healthy volunteer children were included in the study. Optical coherence tomography angiography was used to evaluate the optic nerve head and macular perfusion changes. The mean ocular perfusion pressures were also calculated. Patients who were using multiple antiepileptic drugs or had a prior history of using different drugs were excluded. The choriocapillaris flow area was significantly lower in the Study Group than in the Control Group (p=0.006). However, the foveal avascular zone and vessel densities of the macula in the superficial capillary plexus, deep capillary plexus, and optic nerve head of the study group were not significantly different from those of the control group (p>0.05). Moreover, no significant difference in means of mean ocular perfusion pressure was found between the two groups (p=0.211). No obvious correlation was found between treatment duration and optical coherence tomography angiography parameters or mean ocular perfusion pressure. Choroidal perfusion was reduced in children taking levetiracetam compared with that in the control group, whereas retinal perfusion was not affected in this optical coherence tomography angiography study.

Calculating Relative Lung Perfusion Using Fluoroscopic Sequences and Image Analysis: The Fluoroscopic Flow Calculator.

Maldistribution of pulmonary blood flow in patients with congenital heart disease impacts exertional performance and pulmonary artery growth. Currently, measurement of relative pulmonary perfusion can only be performed outside the catheterization laboratory. We sought to develop a tool for measuring relative lung perfusion using readily available fluoroscopy sequences. A retrospective cohort study was conducted on patients with conotruncal anomalies who underwent lung perfusion scans and subsequent cardiac catheterizations between 2011 and 2022. Inclusion criteria were nonselective angiogram of pulmonary vasculature, oblique angulation ≤20°, and an adequate view of both lung fields. A method was developed and implemented in 3D Slicer's SlicerHeart extension to calculate the amount of contrast that entered each lung field from the start of contrast injection and until the onset of levophase. The predicted perfusion distribution was compared with the measured distribution of pulmonary blood flow and evaluated for correlation, accuracy, and bias. In total, 32% (79/249) of screened studies met the inclusion criteria. A strong correlation between the predicted flow split and the measured flow split was found (R2=0.83; P<0.001). The median absolute error was 6%, and 72% of predictions were within 10% of the true value. Bias was not systematically worse at either extreme of the flow distribution. The prediction was found to be more accurate for either smaller and younger patients (age 0-2 years), for right ventricle injections, or when less cranial angulations were used (≤20°). In these cases (n=40), the prediction achieved R2=0.87, median absolute error of 5.5%, and 78% of predictions were within 10% of the true flow. The current study demonstrates the feasibility of a novel method for measuring relative lung perfusion using conventional angiograms. Real-time measurement of lung perfusion at the catheterization laboratory has the potential to reduce unnecessary testing, associated costs, and radiation exposure. Further optimization and validation is warranted.

Non-Invasive Measurement of Oxygen Metabolism. Part 2: New Techniques in PET and MRI

Oxygen metabolism is a key factor in the life of a living organism. The article is the second part of a review of methods for measuring oxygen metabolism.Purpose. The aim of this review is to provide an insight into newly developed perfusion measurement techniques based on MRI and CT comparing their accuracy with the “gold standard” H215O PET measurements and describing their role in today’s clinical practice.Materials and methods. More than 200 Pubmed publications were analyzed for the keywords “perfusion, MRI, CT, ASL, oxygen metabolism”. Relevant publications that do not contain these keywords or contain them in a different wording were also studied.Results. This review selected 49 publications describing CT and MR perfusion using contrast agents and MR ASL perfusion. Examples of the use of the described methods in fundamental research and applied medicine are given.Conclusion. The quantitative results obtained using novel non-invasive molecular imaging techniques are in most cases comparable to H215O PET data, which opens the way for broad use of MRI and CT perfusion and oxygen metabolism measurements in clinical practice.

Intracranial Pressure, Autoregulation, and Cerebral Perfusion in Infants With Nonsyndromic Craniosynostosis at the Time of Surgical Correction

BACKGROUND AND OBJECTIVE: Although an increased intracranial pressure (ICP) is a known problem in children with syndromic craniosynostosis, it remains unclear whether elevated ICP and impaired cerebral perfusion exist in nonsyndromic synostosis and should be defined as targets of primary treatment. This study aimed to investigate ICP, cerebral autoregulation (CAR), and brain perfusion in infants with nonsyndromic craniosynostosis at first surgical intervention. METHODS: Forty-three infants were prospectively included. The patients underwent perioperative measurement of mean arterial blood pressure, ICP, and brain perfusion before and after cranial vault decompression. Physiological parameters with possible influences on ICP and autoregulation/brain perfusion were standardized for age. CAR was assessed by the pressure reactivity index (PRx), calculated using the mean arterial blood pressure and ICP. RESULTS: Biparietal decompression was performed in 29 infants with sagittal synostosis (mean age, 6.1 ± 1.3 months). Fronto-orbital advancement was performed in 10 and 4 infants with metopic and unilateral coronal synostosis, respectively (mean age, 11.6 ± 2.1 months). An elevated ICP (&gt;15 mm Hg) was found in 20 of 26 sagittal (mean, 21.7 ± 4.4 mm Hg), 2 of 8 metopic (mean, 17.1 ± 0.4 mm Hg), and 2 of 4 unilateral coronal synostosis cases (mean, 18.9 ± 2.5 mm Hg). Initial ICP was higher in sagittal synostosis than in metopic/coronal synostosis (P = .002). The postdecompression ICP was significantly reduced in sagittal synostosis cases (P &lt; .001). The relative cerebral blood flow and blood flow velocity significantly increased after decompression. Impaired CAR was found in infants with a mean ICP &gt;12 mm Hg (PRx, 0.26 ± 0.32), as compared with those with a mean ICP ≤ 12 mm Hg (PRx, −0.37 ± 0.07, P = .001). CONCLUSION: Contrary to common belief, an elevated ICP and significantly impaired CAR can exist early in single suture synostosis, particularly sagittal synostosis. Because an influence of raised ICP on long-term cognitive development is known in other diseases, we suggest that preventing increased ICP during the phase of maximal brain development may be a goal for decompressive surgery, at least for sagittal synostosis cases.

Switchable LED-based laparoscopic multispectral system for rapid high-resolution perfusion imaging.

Multispectral imaging (MSI) is an approach for real-time, quantitative, and non-invasive tissue perfusion measurements. Current laparoscopic systems based on mosaic sensors or filter wheels lack high spatial resolution or acceptable frame rates. To develop a laparoscopic system for MSI-based color video and tissue perfusion imaging during gastrointestinal surgery without compromising spatial or temporal resolution. The system was built with 14 switchable light-emitting diodes in the visible and near-infrared spectral range, a 4K image sensor, and a 10mm laparoscope. Illumination patterns were created for tissue oxygenation and hemoglobin content monitoring. The system was calibrated to a clinically approved laparoscopic hyperspectral system using linear regression models and evaluated in an occlusion study with 36 volunteers. The root mean squared errors between the MSI and reference system were 0.073 for hemoglobin content, 0.039 for oxygenation in deeper tissue layers, and 0.093 for superficial oxygenation. The spatial resolution at a working distance of 45mm was . The effective frame rate was 20fps. High-resolution perfusion monitoring was successfully achieved. Hardware optimizations will increase the frame rate. Parameter optimizations through alternative illumination patterns, regression, or assumed tissue models are planned. Intraoperative measurements must confirm the suitability during surgery.

BASIL: A toolbox for perfusion quantification using arterial spin labelling

Abstract Arterial Spin Labelling (ASL) MRI is now an established non-invasive method to quantify cerebral blood flow and is increasingly being used in a variety of neuroimaging applications. With standard ASL acquisition protocols widely available, there is a growing interest in advanced options that offer added quantitative precision and information about haemodynamics beyond perfusion. In this article, we introduce the BASIL toolbox, a research tool for the analysis of ASL data included within the FMRIB Software Library (FSL), and explain its operation in a variety of typical use cases. BASIL is not offered as a clinical tool, and nor is this work intended to guide the clinical application of ASL. Built around a Bayesian model-based inference algorithm, the toolbox is designed to quantify perfusion and other haemodynamic measures, such as arterial transit times, from a variety of possible ASL input data, particularly exploiting the information available in more advanced multi-delay acquisitions. At its simplest, the BASIL toolbox offers a graphical user interface that provides the analysis options needed by most users; through command line tools, it offers more bespoke options for users needing customised analyses. As part of FSL, the toolbox exploits a range of complementary neuroimaging analysis tools so that ASL data can be easily integrated into neuroimaging studies and used alongside other modalities.

Long-term prognostic value of [15O]H2O PET imaging in patients suspected for cerebral hemodynamic insufficiency

ObjectivesQuantitative regional cerebral perfusion (rCBF) measurements using [15O]H2O PET with arterial cannulation and acetazolamide (ACZ) challenge have been reserved to identify high-risk patients that are candidates for by-pass operation. We aimed to assess the prognostic value of various parameters in quantitative [15O]H2O PET measurements in patients not subsequently undergoing surgery. MethodsWe identified 32 eligible patients who underwent [15O]H2O brain PET imaging for suspicion of hemodynamic insufficiency between 2009 and 2020. Cerebrovascular events were defined as new ischemic lesions on MRI, stroke, transient ischemic attack, vascular dementia. Follow-up period was 91 months (range: 26-146). rCBF before (rCBFbase) and after (rCBFacz) ACZ challenge and the relative increase (CVR), were examined in the anterior (ACA), middle (MCA), and posterior (PCA) cerebral artery territories of the affected hemisphere, and the most recent MRI scans were scored for infarcts and white matter lesions. ResultsReceiver operating characteristic (ROC) curve analysis showed higher prognostic accuracy for rCBFacz(AUC:0.82) compared to CVR (AUC:0.72) and rCBFbase (AUC:0.77). ROC AUC, optimal thresholds (and corresponding sensitivity/specificity/accuracy) for rCBFacz after ACZ in individual territories were 0.79 and 37.8 mL 100g−1 min−1 (0.81/0.63/0.72) for the ACA, 0.84 and 32 mL 100g−1 min−1 (0.81/0.75/0.78) for the MCA, and 0.70 and 43.9 ml/(mL 100g−1 min−1 (0.81/0.43/0,62) for the PCA. Kaplan Meier survival curve showed longer event-free survival in patients with rCBFacz below cut-off (p=0.007). In multivariate analysis rCBFacz remained a significant predictor when correcting for age. ConclusionQuantitative rCBF measurements after ACZ challenge with [15O]H2O PET provided high prognostic value for future cerebrovascular events.

Advances in Dynamic Light Scattering Imaging of Blood Flow

AbstractDynamic light scattering (DLS) is a well known experimental approach uniquely suited for the characterization of small particles undergoing Brownian motion in randomly inhomogeneous turbid scattering medium, including water suspension, polymers in solutions, cells cultures, and so on. DLS is based on the illuminating of turbid medium with a coherent laser light and further analyzes the intensity fluctuations caused by the motion of the scattering particles. The DLS‐based spin‐off derivative techniques, such laser Doppler flowmetry (LDF), diffusing wave spectroscopy (DWS), laser speckle contrast imaging (LSCI), and Doppler optical coherence tomography (DOCT), are exploited widely for non‐invasive imaging of blood flow in brain, skin, muscles, and other biological tissues. The recent advancements in the DLS‐based imaging technologies in frame of their application for brain blood flow monitoring, skin perfusion measurements, and non‐invasive blood micro‐circulation characterization are overviewed. The fundamentals, breakthrough potential, and practical findings revealed by DLS‐based blood flow imaging studies, including the limitations and challenges of the approach such as movement artifacts, non‐ergodicity, and overcoming high scattering properties of studied medium, are also discussed. It is concluded that continued research and further technological advancements in DLS‐based imaging will pave the way for new exciting developments and insights into blood flow diagnostic imaging.

Advancing cardiotomy suction practices for coronary surgery via multidisciplinary collaborative learning

ObjectiveProfessional standards recommend stopping cardiotomy suction at the termination of cardiopulmonary bypass before protamine administration based on perceived safety concerns. This study evaluated a multidisciplinary collaborative quality-improvement intervention promoting this agreed-upon cardiotomy suction practice during coronary artery bypass grafting (CABG). MethodsA statewide intervention (eg, unblinded surgeon and perfusionist feedback, evidence-based lectures, evaluating barriers to change) involved 32 centers participating in the PERForm (ie, Perfusion Measures and Outcomes) Registry to standardize cardiotomy suction practices at cardiopulmonary bypass termination during CABG. Four non-Michigan registry participating centers were not exposed to collaborative learning. Cardiotomy suction practice was defined as the absence of or stopping cardiotomy suction before protamine administration. The practice changes attributed to the intervention, including Michigan and non-Michigan comparisons, were evaluated with the change of time effect modeled using splines. Multivariable regression was used to evaluate the intervention's associated impact (eg, mortality, reoperation, transfusion). ResultsAmong 10,394 patients undergoing CABG at Michigan centers, 80.7% achieved agreed-upon cardiotomy suction practices. The Michigan centers had nonsignificant changes in agreed-upon cardiotomy suction practices during the preintervention period (P = .24), with significant increased monthly change in practice thereafter, absent adjusted morbidity and mortality increases. The Michigan centers achieved a significantly greater adjusted monthly improvement in agreed-upon practices relative to non-Michigan centers within 7 months after the intervention (adjusted odds ratio for change of trends: 2.53, P < .001). ConclusionsThis initiative demonstrates the effectiveness of multidisciplinary collaborative quality improvement in advancing agreed-upon cardiotomy suction practices without negatively impacting clinical outcomes.

OGC O08 Quantification of fluorescence angiography for visceral perfusion assessment in gastric conduit reconstruction: measuring agreement between two software algorithms

Abstract Background Building evidence suggests that fluorescence angiography is capable of reducing anastomotic leakage rates. Many software-based quantification algorithms have been developed aiming to obtain an objective measure for intraoperative visceral perfusion at the anastomotic site. Validation and comparison of these models in the current literature is scarce. The aim of this study was to measure agreement between two independently developed software algorithms for the quantitative assessment of visceral perfusion using indocyanine green fluorescence angiography. Methods 81 video recordings from patients who underwent fluorescence angiography-guided Ivor Lewis esophagectomy with gastric conduit reconstruction between August 2020 and February 2022 were available for analysis. In this dataset, we standardized patient, theatre, camera and imaging display variables. Recordings were analyzed retrospectively based on intraoperatively selected regions of interest using two software based-quantification algorithms (AMS and CPH). Quantitative parameters derived from the fluorescence time curve (FTC) were recorded. The comparison focused on the predefined primary outcome variable for quantitative perfusion assessment "normalized maximum slope". Agreement between the two software algorithms was evaluated in a Bland-Altman analysis. Quantitative parameters in patients with anastomotic leakage were compared to those without. Results Out of 81 video recordings, 70 could be processed using both algorithms. The output values for the normalized maximum slope from the AMS and the CPH software held a moderate-to-strong correlation in a linear regression model (R-squared: 0.544, p&amp;lt;0.001). The Bland-Altman plot indicated a mean±SD difference of 0.037±0.018 arbitrary units for the normalized maximum slope, with significant differences between the two software measurements (p&amp;lt;0.001). Proportional bias was observed using linear regression in the Bland-Altman plot (R-squared=0.715, p&amp;lt;0.001). Disparities between the two measurement methods became proportionally larger among higher mean values. Neither of the two software methods showed a significant difference in perfusion measurement between the anastomotic leakage and no leakage groups (p=0.32 and p=0.51). Differences in signal processing, such as smoothing techniques and window selection, were identified as potential factors contributing to the disparity in outcomes. Conclusions The two software-based quantification methods for visceral perfusion demonstrated significant differences. Varying agreement among quantification methods should be considered while interpreting studies that report quantitative parameters and derived thresholds for clinical endpoints, as there may be a limited external validity.

Abstract 11609: Developing a Novel Method for Measuring Relative Lung Perfusion at the Catheterization Laboratory

Background: Maldistribution of pulmonary blood flow (Qp) is common in patients with congenital heart disease and is associated with worse clinical outcomes. Currently, measurement of Qp-split can only be performed outside the catheterization laboratory, using either lung perfusion scans or cardiac magnetic resonance imaging. Aim: We sought to develop and evaluate a tool for measuring Qp-split using readily available fluoroscopy sequences. Methods: A retrospective cohort study of patients with conotruncal anomalies who underwent perfusion scan and subsequent cardiac catheterization. Inclusion criteria were non-selective angiogram of pulmonary vasculature, oblique angulation ≤20°, and an adequate view of both lung fields. A method was developed and implemented in 3D Slicer to calculate the amount of contrast that entered each lung field from the start of contrast-injection and until the onset of levophase. The predicted perfusion distribution was compared to the distribution measured by lung scan. Results: In total 32% (79/249) of screened studies met inclusion criteria. There was strong correlation between the predicted Qp-split and the measured Qp-split (R 2 =0.83, p&lt;0.001) with median absolute error (MAE) of 6%. Bias was not systematically worse at either extreme of flow distribution. Factors associated with better prediction were smaller BSA, younger age, right ventricle (vs. pulmonary artery) angiograms, and cranial angulations ≤20°. In cases with one or more of these conditions (n=40), the prediction achieved R 2 =0.87, MAE of 5.5%, and 78% of predictions were within 10% of true flow. Conclusions: Data from conventional angiograms can be used to provide accurate real-time measurement of relative perfusion of the left and right lungs. This has the potential to reduce unnecessary testing, associated costs, and radiation exposure.

Abstract 16514: Head-to-Head Comparison of Quantitative Image Quality on Rubidium-82 Myocardial Perfusion Positron Emission Tomography Between a Digital Silicon Photomultiplierand Conventional Scanner

Introduction: The purpose of this study was to compare rubidium-82 positron emission tomography ( 82 Rb PET) myocardial perfusion imaging (MPI) findings and quantitative image quality measures between the digital silicone photomultipliers (SiPM) scanner and a conventional scanner. Methods: We studied 24 consecutive patients (mean age 71.2±2.2 years) who underwent two clinically indicated rest/stress 82 Rb PET MPI examinations on two scanners, one using a SiPM-based PET scanner (Biograph Vision, Siemens Healthineers) and the other using a conventional photomultiplier tube (PMT)-based PET scanner (Discovery 710, GE Healthcare). Inclusion criteria were: 1) interval between the scans &lt;2 yr (median 1.1 yr, 95% CI: 0.9-1.4), 2) no interval revascularization, and 3) no interval symptom changes. Stress and imaging protocols were the same. 82 Rb doses were 925 MBq at rest and stress. Image quality was assessed using blood background coefficient-of-variation (COV), myocardium to blood signal to noise ratio (SNR) and contrast to noise ratio (CNR) calculated from the 82 Rb images. Results: Between two scanners, there were no significant differences in perfusion and functional measures, including summed stress score (SiPM: 1.6 ± 0.7 vs. PMT: 1.8 ± 0.8, p=0.21), summed rest score (SiPM: 2.7 ± 1.0 vs. PMT: 3.1 ± 1.2, p=0.34), LV function (LVEF, SiPM: 62.6 ± 2.8 vs. PMT: 61.4 ± 2.8, p=0.82) and volumes (LVEDV, SiPM: 62.6 ± 2.8 vs. PMT: 61.4 ± 2.8, p=0.51). Image quality measures significantly improved (Figure), with lower COV (SiPM: 15.3 ± 0.8 vs. PMT: 19.3 ± 1.1, p=0.006), higher SNR (SiPM; 26.4 ± 1.8 vs. PMT; 20.5 ± 1.5, p&lt;0.001) and CNR (SiPM; 14.2 ± 1.2 vs. PMT; 11.4 ± 1.1, p=0.02). Conclusions: 82 Rb PET MPI performed with SiPM-based a PET scanner showed significantly better image contrast and less noise compared to a PMT-based PET scanner. These findings suggest that the SiPM based PET scanner provides more previse evaluations for patients undergoing 82 Rb PET MPI.