Volumetric Blood Flow Measurement Research Articles

Thermodilution-derived volumetric resting coronary blood flow measurement in humans.

Quantification of microvascular function requires the measurement of flow and resistance at rest and during hyperaemia. Continuous intracoronary thermodilution accurately measures coronary flow during hyperaemia. The aim of this study was to investigate whether continuous coronary thermodilution using lower infusion rates also enables volumetric coronary blood flow measurements (in mL/min) at rest. In 59 patients (88 arteries), the ratio of distal to proximal coronary pressure (Pd/Pa), as well as absolute blood flow (in mL/min) by continuous thermodilution, was recorded using a pressure/temperature guidewire. Saline was infused at rates of 10 and 20 mL/min. In 27 arteries, Doppler average peak velocity (APV) was measured simultaneously. Pd/Pa, APV, thermodilution-derived coronary flow reserve (CFRthermo) and coronary flow velocity reserve (CFVR) were assessed. In 10 arteries, simultaneous recordings were obtained at saline infusion rates of 6, 8, 10 and 20 mL/min. Compared to baseline, saline infusion at 10 mL/min did not change Pd/Pa (0.95±0.05 versus 0.94±0.05, p=0.49) or APV (22±8 versus 23±8 cm/s, p=0.60); conversely, an infusion rate of 20 mL/min induced a decrease in Pd/Pa and an increase in APV. Stable thermodilution tracings were obtained during saline infusion at 8 and 10 mL/min, but not at 6 mL/min. Mean values of CFRthermo and CFVR were similar (2.78±0.91 versus 2.76±1.06, p=0.935) and their individual values correlated closely (r=0.89, 95% CI: 0.78-0.95, p<0.001). In addition to hyperaemic flow, continuous thermodilution can quantify absolute resting coronary blood flow; therefore, it can be used to calculate coronary flow reserve and microvascular resistance reserve.

Open or closed: Changes in ductus arteriosus flow patterns at birth using 4D flow MRI in newborn piglets.

The ductus arteriosus (DA) functionally closes during the transition from fetal to postnatal life because of lung aeration and corresponding cardiovascular changes. The thorough and explicit measurement and visualization of the right and left heart output during this transition has not been previously accomplished. We combined 4D flow MRI (dynamic volumetric blood flow measurements) and T2 relaxometry (oxygen delivery quantification) in surgically instrumented newborn piglets to assess the DA. This was performed in Large White‐Landrace‐Duroc piglets (n = 34) spanning four age groups: term‐9 days, term‐3, term+1, and term+5. Subject's DA status was classified using 4D flow: closed DA, forward DA flow, reversed DA flow, and bidirectional DA flow. Over all states, vessel diameters and flows normalized to body weight increased with age (for example in the ascending aorta flow—term‐9: 126.6 ± 45.4; term+5: 260.2 ± 80.0 ml/min per kg; p = 0.0005; ascending aorta diameter—term‐9: 5.2 ± 0.8; term+5: 7.7 ± 0.4 mm; p = 0.0004). In subjects with reversed DA blood flow there was lower common carotid artery blood flow (forward: 37.5 ± 9.0; reversed: 20.0 ± 7.4 ml/min per kg; p = 0.032). Linear regression revealed that as net DA flow decreases, common carotid artery flow decreases (R2 = 0.32, p = 0.004), and left (R2 = 0.33, p = 0.003) and right (R2 = 0.34, p = 0.003) pulmonary artery flow increases. Bidirectional DA blood flow changed oxygen saturation as determined by MRI between the ascending and descending aorta (ascending aorta: 90.1% ± 8.4%; descending aorta: 75.6% ± 14.2%; p < 0.05). Expanded use of these techniques in preterm animal models will aid in providing new understandings of normal versus abnormal DA transition, as well as to test the effectiveness of related clinical interventions.

Vascular territorial segmentation and volumetric blood flow measurement using dynamic contrast enhanced magnetic resonance angiography of the brain

This study proposes a method for territorial segmentation and volumetric flow rate (VFR) distribution measurement of cerebral territories based on time-resolved contrast enhanced magnetic-resonance-angiography (MRA). The method uses an iterative region-growing algorithm based on bolus-arrival-time with increased temporal resolution. Eight territories were segmented: (1) right and (2) left internal carotid arteries, including the middle cerebral artery (ICA+MCA), excluding the anterior cerebral arteries (ACA); (3) right and left ACA (R+L-ACA); (4) right and (5) left external carotid arteries (ECA); (6) right and (7) left posterior cerebral arteries (PCA); and (8) vertebrobasilar territory. VFR percentage, relative to the entire brain (rVFR), was measured based on territorial volume as a function of time. Mean rVFR values of fifteen healthy subjects were: ICA+MCA = 23 ± 2%, R + L-ACA = 17 ± 3%, ECA = 4 ± 2%, PCA = 12 ± 2%, and vertebrobasilar territory = 31 ± 4%. Excluding the ECA-rVFR, which is underestimated, these values are comparable to previously reported values. Six subjects were scanned twice, demonstrating comparable and even higher reproducibility than previously reported using phase-contrast, yet with faster scan time (∼1 min). This method was implemented in one patient with MCA occlusion and one with Moyamoya syndrome scanned before and after bypass surgery, demonstrating its clinical potential for quantitative assessment of the degree of occlusion and the effect of surgery.

Volumetric blood flow measurement using Doppler ultrasound: concerns about the technique.

Volumetric blood flow measurement using Doppler ultrasound: concerns about the technique.

Regional brain blood flow regulation during orthostatic stress: new insights from volumetric brain blood flow measurements

Regional brain blood flow regulation during orthostatic stress: new insights from volumetric brain blood flow measurements

Automated segmentation of blood-flow regions in large thoracic arteries using 3D-cine PC-MRI measurements

Quantitative analysis of vascular blood flow, acquired by phase-contrast MRI, requires accurate segmentation of the vessel lumen. In clinical practice, 2D-cine velocity-encoded slices are inspected, and the lumen is segmented manually. However, segmentation of time-resolved volumetric blood-flow measurements is a tedious and time-consuming task requiring automation. Automated segmentation of large thoracic arteries, based solely on the 3D-cine phase-contrast MRI (PC-MRI) blood-flow data, was done. An active surface model, which is fast and topologically stable, was used. The active surface model requires an initial surface, approximating the desired segmentation. A method to generate this surface was developed based on a voxel-wise temporal maximum of blood-flow velocities. The active surface model balances forces, based on the surface structure and image features derived from the blood-flow data. The segmentation results were validated using volunteer studies, including time-resolved 3D and 2D blood-flow data. The segmented surface was intersected with a velocity-encoded PC-MRI slice, resulting in a cross-sectional contour of the lumen. These cross-sections were compared to reference contours that were manually delineated on high-resolution 2D-cine slices. The automated approach closely approximates the manual blood-flow segmentations, with error distances on the order of the voxel size. The initial surface provides a close approximation of the desired luminal geometry. This improves the convergence time of the active surface and facilitates parametrization. An active surface approach for vessel lumen segmentation was developed, suitable for quantitative analysis of 3D-cine PC-MRI blood-flow data. As opposed to prior thresholding and level-set approaches, the active surface model is topologically stable. A method to generate an initial approximate surface was developed, and various features that influence the segmentation model were evaluated. The active surface segmentation results were shown to closely approximate manual segmentations.

Quantification of coronary microvascular resistance using angiographic images for volumetric blood flow measurement: in vivo validation

Structural coronary microcirculation abnormalities are important prognostic determinants in clinical settings. However, an assessment of microvascular resistance (MR) requires a velocity wire. A first-pass distribution analysis technique to measure volumetric blood flow has been previously validated. The aim of this study was the in vivo validation of the MR measurement technique using first-pass distribution analysis. Twelve anesthetized swine were instrumented with a transit-time ultrasound flow probe on the proximal segment of the left anterior descending coronary artery (LAD). Microspheres were injected into the LAD to create a model of microvascular dysfunction. Adenosine (400 μg·kg(-1)·min(-1)) was used to produce maximum hyperemia. A region of interest in the LAD arterial bed was drawn to generate time-density curves using angiographic images. Volumetric blood flow measurements (Q(a)) were made using a time-density curve and the assumption that blood was momentarily replaced with contrast agent during the injection. Blood flow from the flow probe (Q(p)), coronary pressure (P(a)), and right atrium pressure (P(v)) were continuously recorded. Flow probe-based normalized MR (NMR(p)) and angiography-based normalized MR (NMR(a)) were calculated using Q(p) and Q(a), respectively. In 258 measurements, Q(a) showed a strong correlation with the gold standard Q(p) (Q(a) = 0.90 Q(p) + 6.6 ml/min, r(2) = 0.91, P < 0.0001). NMR(a) correlated linearly with NMR(p) (NMR(a) = 0.90 NMR(p) + 0.02 mmHg·ml(-1)·min(-1), r(2) = 0.91, P < 0.0001). Additionally, the Bland-Altman analysis showed a close agreement between NMR(a) and NMR(p). In conclusion, a technique based on angiographic image data for quantifying NMR was validated using a swine model. This study provides a method to measure NMR without using a velocity wire, which can potentially be used to evaluate microvascular conditions during coronary arteriography.

Mean Volume Flow Estimation in Pulsatile Flow Conditions

To verify a previously reported three-dimensional (3D) ultrasound method for the measurement of time-average volumetric blood flow, experiments were performed under pulsatile flow conditions, including in vivo investigations, and results were compared with accepted, but invasive, “gold standard” techniques. Results showed that volume averaging results in the correct time-average volume flow without the need for cardiac gating. Unlike other currently employed methods, this method is independent of Doppler angle, flow profile and vessel geometry. A GE Logiq 9 ultrasound system (GE Medical Systems, Milwaukee, WI, USA) and a four-dimensional (4D) 10L and 4D 16L probe were used to acquire 3D Doppler measurements in the femoral and carotid arteries of four canines. Two invasive blood flow meters were used (electromagnetic for one canine and ultrasonic for three canines) as the gold standard techniques. Transcutaneous color flow measurements were taken to obtain 3D volume data sets encompassing the vessel. Constant depth planes were used to integrate color flow pixels encompassing the entire vessel cross-section. Power Doppler data were used to correct for partial volume effects. An artificial stenosis was induced to vary the ambient volume flow. Unrestricted, bidirectional flow was measured as high as 400 mL min -1. Several flow restrictions were imposed that decreased the measured volumetric flow rate to as low as 30 mL min -1. All flow rate estimates ( n = 38) were plotted against results obtained via the gold standards. A general line fit resulted in y = 0.926 x - 0.87 (r 2 = 0.95), which corresponds to a 0.6% flow offset relative to the average flow rate of 142 mL min -1, as well as a 7.4% error in the linearity of our estimate. A secondary curve fit was performed that required the slope to be 1 and the intercept to be 0, which yielded an r 2-value of 0.93. The percent-error distribution was computed and fitted to a Gaussian function, which yielded μ = -7.04% and σ = 9.52%. Theoretical studies were conducted to estimate the expected error in our volume flow measurements as a function of number of samples (N) used for averaging pulsatile waveforms. Experiments showed the same 1 / N dependence as theory. Direct comparisons of volume flow rate estimates using volumetric color Doppler and independent standards showed that our method has good accuracy under in vivo pulsatile blood flow conditions. (E-mail: greentom@umich.edu)

1522: Pre-Clinical Studies of the Measurement of Volumetric Blood Flow

Verify a previously reported non–invasive, angle independent, 3-D Doppler ultrasound method for measurement of volumetric blood flow in vivo with comparison to an accepted, but invasive, standard method. A GE Logiq 9 with a 4D10L probe acquired 3D Doppler of the femoral and carotid arteries in a canine model. Color flow volume spanned a 6 by 4 cm axial-lateral field of view with a 29° elevational sweep, encompassing the vessel in <7 s. Constant depth planes were used to integrate color flow pixels and power Doppler data was used to correct partial volume effects. An artificial stenosis varied the ambient volume flow by restricting the vessel using a pneumatic cuff. An ultrasonic blood flowmeter with flow probe around the vessel served as the invasive gold standard. Unrestricted, bidirectional, flow was measured as high as 400 mL/min with flow restrictions as low as 20 mL/min. All flow rate estimates (N=23 from 4 animals) were plotted against the gold standard yielding a general line fit of y=0.926x-0.87 (R2=0.95). The percent-error distribution was computed and fitted to a gaussian function with a mean=-7.04% and sigma=9.52%. A secondary curve fit with the slope = 1 and the intercept = 0 yielded R2=0.93. Direct comparison of volume flow rate estimates using volumetric color Doppler and an independent standard showed good accuracy under in vivo pulsatile blood flow conditions. Subsequent comparisons under clinical conditions will demonstrate possible applications.

Volumetric Blood Flow Measurement in the Ophthalmic Artery Using Colour Doppler

Herewith we present a new method for measurement of the volumetric blood flow in absolute units in the ophthalmic artery. A Philips EnVisor HD ultrasound unit with a 12 - 3 MHz linear transducer was used to measure flow in the ophthalmic artery in 8 healthy young subjects. The transducer was mounted on a custom-made holder which enabled precise and reproducible positioning in 3 axes as well as in rotation angle. Blood flow velocity and vessel diameter were measured during 10 consecutive heartbeats. The measurements were ECG-gated. Blood vessel diameter and blood flow velocity were calculated in an average heartbeat cycle. Hence blood volume over time within a heartbeat cycle as well as blood flow in mL/min were determined. Simultaneously, cardiovascular parameters have been recorded by Finapres. Short time reproducibility (5 measurements on day 1) and long time reproducibility (5 days once daily) as well as interindividual coefficient of variation were evaluated. Average blood flow in the ophthalmic artery in all measurements was 39.7 mL/min. The short-term intraindividual coefficient of variation was 24.1 +/- 9.2 %, the long-term coefficient 32.0 +/- 13.8 %. Interindividual coefficient of variation was 32.8 %. Our method allows volumetric blood flow measurements in the ophthalmic artery in absolute units, reproducible to a limited extent.

Direct Volumetric Blood Flow Measurement in Coronary Arteries by Thermodilution

This study sought to validate a new method for direct volumetric blood flow measurement in coronary arteries in animals and in conscious humans during cardiac catheterization. Direct volumetric measurement of blood flow in selective coronary arteries would be useful for studying the coronary circulation. Based on the principle of thermodilution with continuous low-rate infusion of saline at room temperature, we designed an instrumental setup for direct flow measurement during cardiac catheterization. A 2.8-F infusion catheter and a standard 0.014-inch sensor-tipped pressure/temperature guidewire were used to calculate absolute flow (Q(thermo)) in a coronary artery from the infusion rate of saline, temperature of the saline at the tip of the infusion catheter, and distal blood temperature during infusion. The method was tested over a wide range of flow rates in 5 chronically instrumented dogs and in 35 patients referred for physiological assessment of a coronary stenosis or for percutaneous coronary intervention. Thermodilution-derived flow corresponded well with true flow (Q) in all dogs (Q(thermo) = 0.73 Q + 42 ml/min; R(2) = 0.72). Reproducibility was excellent (Q(thermo,)(1) = 0.96 x Q(thermo,)(2) + 3 ml/min; R(2) = 0.89). The measurements were independent of infusion rate and sensor position as predicted by theory. In the humans, a good agreement was found between increase of thermodilution-derived volumetric blood flow after percutaneous coronary intervention and increase of fractional flow reserve (R(2) = 0.84); reproducibility of the measurements was excellent (Q(thermo,)(1) = 1.0 Q(thermo,)(2) + 0.9 ml/min, R(2) = 0.97), and the measurements were independent of infusion rate and sensor position. Using a suitable infusion catheter and a 0.014-inch sensor-tipped guidewire for measurement of coronary pressure and temperature, volumetric blood flow can be directly measured in selective coronary arteries during cardiac catheterization.

406 Volumetric Blood Flow Measurement by three-dimensional transoesophageal Doppler-echocardiography

406 Volumetric Blood Flow Measurement by three-dimensional transoesophageal Doppler-echocardiography

Validating Volume Flow Measurements From a Novel Semiautomated Four-Dimensional Doppler Ultrasound Scanner

Accurate measurement of blood volume flow (in ml/min) is an important clinical goal. This project compared in vitro and in vivo volume flow measurements obtained with a novel, real-time three-dimensional (i.e., four-dimensional) ultrasound scanner (Encore PV; Vuesonix Sensors, Wayne, PA) with those from an invasive transit time flowmeter. A flow pump was used to generate pulsatile flow rates from 60 to 600 ml/min. The Encore detected absolute blood velocity vectors within a volume. The scanner determined the centerline of the vessel and volume flow was then automatically calculated. Results were compared with those of an invasive technique for volumetric blood flow measurements utilizing a transit-time flowmeter (TS420; Transonic Systems Inc., Ithaca, NY). In vivo, 10 second datasets of the volume flow in the distal aorta of six rabbits were obtained simultaneously with the Encore PV and the flowmeter. Data were compared using linear regression and Bland-Altman analysis (due to the lack of independence). In vitro, Encore and flowmeter measurements both matched the flow pump (r2 > 0.99; P < .0001) with mean errors of -11.8% and -0.3%, respectively. Marked underestimation of the true flow rates was encountered with the Encore at the lowest pump setting. In vivo mean volume flows between 10.6 and 79.3 ml/min were measured. Mean and maximum volume flows obtained with the two techniques correlated significantly (P < .0001) with r2 values of 0.86 and 0.62, respectively. The corresponding root-mean-square errors were 6.9% for mean flow and 61.2% for maximum volume flow measurements. A new semiautomated four-dimensional Doppler device has been tested in vitro and in vivo. Mean volume flow measurements with this unit are comparable to those of an invasive flowmeter.

MEASUREMENTS OF COMMON ILIAC ARTERIAL BLOOD FLOW IN ANURANS USING DOPPLER ULTRASOUND

Color Doppler ultrasonography was used to determine time-average mean velocity and cross-sectional area of the common iliac artery in bullfrogs (Rana catesbeiana) and marine toads (Bufo marinus). Volumetric blood flow and weight-adjusted blood flow measurements were calculated from this data. Volumetric flow rates of frogs (31.8 ml/min) and toads (23.6 ml/min) did not differ statistically. However, when flow rates were adjusted for body mass, toads displayed a significantly greater flow rate of 238.1 ml/min/kg compared to 114.4 ml/min/kg for frogs.

Regional volumetric coronary blood flow measurement by digital angiography: In vivo validation 1

Rationale and objectives There are well-known limitations to the use of visual estimation to assess the severity of coronary artery disease and luminal stenosis. This is especially true in the case of an intermediate coronary lesion (30%–70% diameter stenosis), where coronary arteriography is very limited in distinguishing ischemia-producing intermediate coronary lesions from non-ischemia-producing ones. For this reason, a functional measure of stenosis severity is desirable. The goal of this study is to validate a video densitometry technique for quantitative assessment of regional volumetric coronary blood flow. Materials and methods Coronary arteriography was performed in eight swine (body weight, 25–50 kg) after power injection of contrast material into the left main coronary artery. Phase-matched subtracted images were used to quantify regional coronary blood flow using a video densitometry technique. The in vivo regional flow measurements were validated using a transit time ultrasound flow probe. Results In 44 measurements, the ultrasound (Q US) and video densitometry (Q VD) regional flow measurements were related by Q VD = 0.98 Q US + 0.11 mL/min ( r = 0.98). The results of mean regional coronary blood flow measurements for repeated coronary arteriograms of the first (Q VD1) and second (Q VD2) measured flows were related by Q VD1 = 1.04 Q VD2 + 0.05 mL/min ( r = 0.97). Conclusions A video densitometry technique for quantification of regional coronary blood flow was validated using a swine animal model. The results demonstrated the feasibility and potential utility of the video densitometry technique for accurate measurement of regional coronary blood flow, in vivo. This study provides an angiographic method that can potentially be used to evaluate intermediate coronary lesions during routine coronary arteriography.

A novel in vivo procedure for volumetric flow measurements

We report on a novel procedure for invasive volumetric blood flow measurements using a commercially available Doppler flow wire system, which could, until now, only measure flow velocity. We here describe a method applicable in vivo to generate both velocity and cross-sectional area information from the same pulsed-wave Doppler signal for volumetric flow assessment. We demonstrate its feasibility and validation in vivo in pig coronary arteries. Our Doppler-derived volumetric flow measurements were compared with the respective transit-time flow and showed an excellent correlation (r = 0.969; p < 0.0001). Agreement between transit-time and Doppler-derived flow measurements could be observed for flow conditions ranging from 30 to 180 mL/min. The mean values for the two methods were 71.4 ± 43.7 mL/min and 71.3 ± 42.2 mL/min, respectively. We conclude that this technique might possibly be introduced into future clinical practice as an invasive procedure of choice for the assessment of volumetric blood flow. (E-mail: karjer@usz.unizh.ch)

Volume flow measurement using doppler and grey-scale decorrelation

A technique for volumetric blood flow measurement was developed by combining standard Doppler measurements with grey-scale decorrelation. Steered Doppler is used to determine the in-plane velocities, which are then used to extract the out-of-plane velocities from the temporal A-line decorrelation. As a result, a three-dimensional (3-D) vector flow field can be computed over the imaging plane using a single clinical transducer without knowledge of the vessel orientation. Volume flow is computed by integrating the out-of-plane flow over the vessel cross-section. The algorithm was tested using a scattering-enhanced fluid in a 6.4-mm diameter dialysis tubing. For a wide range of transducer angles, the volume flow was accurately measured to within 28% in these preliminary tests. (E-mail: tuthill@umich.edu)

Velocity Profiles in Mitral Blood Flow Based on Three-dimensional Freehand Colour Flow Imaging Acquired at High Frame Rate

To describe the mitral blood flow velocity distribution, we applied a freehand dynamic three-dimensional (3D) colour flow method using a moving sample surface that followed the mitral apparatus during diastole. Nineteen healthy volunteers were studied. The ultrasound data were captured from 10-20 heartbeats at high frame rate (mean 46 frames/s) while freely tilting the transducer in an apical position. A magnetic position sensor system recorded the spatial position and orientation of the probe. Blood flow velocities were integrated across a spherical surface. In volumetric blood flow measurements this would yield angle independence of the Doppler beam. Raw digital data were analysed off-line with no loss of temporal resolution. The ratio of the maximum velocity time integral (VTI) to the mean VTI was mean 1.3 (range 1.1-1.6). At the time of peak flow the ratio of the maximum to the mean velocity was mean 1.5 (range 1.2-2.6). The blood flow velocity profile was non-uniform. By using a single sample volume in Doppler measurements of the maximum VTI errors ranging from 10 to 60% may be introduced in calculations of stroke volumes.

In vitro validation of volumetric blood flow measurement using Doppler flow wire

Determination of any volumetric blood flow requires assessment of mean blood flow velocity and vessel cross-sectional area. For evaluation of coronary blood flow and flow reserve, however, assessment of average peak velocity alone is widely used, but changes in velocity profile and vessel area are not taken into account. We studied the feasibility of a new method for calculation of volumetric blood flow by Doppler power using a Doppler flow wire. An in vitro model with serially connected silicone tubes of known lumen diameters (1.5, 2.0, 2.5, 3.0, 3.5 and 4.0 mm) and pulsatile blood flow ranging from 10 to 200 mL/min was used. A Doppler flow wire was connected to a commercially available Doppler system (FloMap®, Cardiometrics) for online calculation of the zeroth ( M 0) and the first ( M 1) Doppler moment, as well as mean flow velocity ( V m). Two different groups of sample volumes (at different gate depths) were used: 1. two proximal sample volumes lying completely within the vessel were required to evaluate the effect of scattering and attenuation on Doppler power, and 2. distal sample volumes intersecting completely the vessel lumen to assess the vessel cross-sectional area. Area (using M 0) and V m (using M 1/ M 0) obtained from the distal gates were corrected for scattering and attenuation by the data obtained from the proximal gates, allowing calculation of absolute volumetric flow. These results were compared to the respective time collected flow. Correlation between time collected and Doppler-derived flow measurements was 0.98 ( p < 0.0001), with a regression line close to the line of equality indicating an excellent agreement of the two measurements in each individual tube. The mean paired flow difference between the two techniques was 1.5 ± 9.0 mL/min (ns). Direct volumetric blood flow measurement from received Doppler power using a Doppler flow wire system is feasible. This technique may potentially be of great clinical value because it allows an accurate assessment of coronary flow and flow reserve with a commercially available flow wire system.

Volumetric Blood Flow Measurement with the Use of Dynamic 3-Dimensional Ultrasound Color Flow Imaging

Volumetric Blood Flow Measurement with the Use of Dynamic 3-Dimensional Ultrasound Color Flow Imaging