Time-scale detection of microemboli in flowing blood with Doppler ultrasound.

Small formed elements and gas bubbles in flowing blood, called microemboli, can be detected using Doppler ultrasound. In this application, a pulsed constant-frequency ultrasound signal insonates a volume of blood in the middle cerebral artery, and microemboli moving through its sample volume produce a Doppler-shifted transient reflection. Current detection methods include searching for these transients in a short-time Fourier transform (STFT) of the reflected signal. However, since the embolus transit time through the Doppler sample volume is inversely proportional to the embolus velocity (Doppler-shift frequency), a matched-filter detector should in principle use a wavelet transform, rather than a short-time Fourier transform, for optimal results. Closer examination of the Doppler shift signals usually shows a chirping behavior apparently due to acceleration or deceleration of the emboli during their transit through the Doppler sample volume. These variations imply that a linear wavelet detector is not optimal. We apply linear and quadratic time-frequency and time-scale detectors to a set of noise-corrupted embolus data. Our results show improvements of about 1 dB using the time-scale detectors versus an STFT-based detector signifying that embolus detection is best approached as a time-scale problem. A time-scale-chirp detector is also applied and is found to have the overall best performance by about 0.5-0.7 dB while coming fairly close (about 0.75 dB) to a theoretical upper bound.

Sizing emboli in blood using pulse Doppler ultrasound--I: Verification of the EBR model.

An experiment to verify a theory describing ultrasound backscattering from emboli in flowing blood is presented. The theoretical predictions for the backscattered power versus embolus size are based on the measurement of the embolus to blood ratio (EBR) of backscattered acoustic power. This tool is necessary for in vivo clinical application because it removes the need to characterize attenuation and reflection loss in heterogeneous tissue. The experiment presented utilizes a customized ultrasound pulse Doppler that is capable of interrogating a sample volume with two different frequencies concurrently. A flow circuit including a 3.6-mm-diameter conduit in polyacrylamide gel in which emboli are observed with the dual frequency Doppler is described. The flow within the circuit has acoustic backscatter coefficient similar to blood due to a calibrated concentration of 31.1-mu diameter polystyrene microspheres. Polystyrene microsphere "emboli" having nominal diameters of 161 and 239 mu are placed in this flow loop and time series Doppler shift signatures are recorded. These signatures are investigated and a refraction artifact hypothesis is proposed to explain systematic deviation of the signatures away from theoretically expected results. Results show that gross discrimination of embolus size is feasible.

Sizing emboli in blood using pulse Doppler ultrasound--II: Effects of beam refraction.

A theoretical and numerical study of the acoustic field intensity within a curved flow conduit having 1) diameter similar to the wavelength of the interrogating frequency and 2) speed of sound mismatch with the surrounding medium is presented. The field intensity is shown to vary significantly and in a monotonic fashion across the flow conduit. The resulting insonation of emboli transiting through the Doppler sample volume is explored with a Monte Carlo study of the behavior of the embolus to blood power ratio (EBR). The numerical simulation findings are shown to be in good agreement with previously reported experimental results. A method is explored for estimating embolus diameter when this refraction artifact is present, and shown to yield excellent results when applied to experimental data. Further work toward clinical application of these results is discussed.

Pulse Doppler ultrasound detection, characterization and size estimation of emboli in flowing blood.

A theory describing pulse Doppler ultrasound signals due to backscattering due to emboli in flowing blood is presented. From this theory, the minimum detectable size of a formed-element embolus can be established as a function of carrier frequency and vessel size. Emboli can be sized and characterized, based on the ratio of the amplitude of the Doppler signal during embolus passage through the sample volume to background bloodflow Doppler signal when no embolus is present. This ratio is defined as the "embolus to blood ratio" (EBR). Size estimation of emboli can be done by insonating an embolus with a single frequency and measuring the EBR, only if the embolus does not exceed a certain size, and if the vessel diameter and per cent hematocrit are known. Using two different frequencies, the vessel geometry (diameter and sample volume length) and per cent hematocrit can be eliminated from calculation of embolus size. Sources of uncertainty in the EBR and their effect on embolus size estimation are discussed. Discrimination between gas and formed-element emboli is described, given a detector with sufficient dynamic range, and use of three carrier frequencies. The theory presented here is in agreement with experimental findings of other investigators.

Relation between middle cerebral artery blood flow velocity and stump pressure during carotid endarterectomy.

BACKGROUND AND PURPOSE: Many patient monitoring techniques have been used for detecting cerebral hypoperfusion during carotid endarterectomy. We compared middle cerebral artery blood flow velocities with carotid artery stump pressures to evaluate the indications for common carotid artery cross-clamp shunting and the probable hemodynamic causes of cerebrovascular complications. METHODS: Blood flow velocities were monitored with transcranial Doppler ultrasound and carotid stump pressures were measured at the time of common carotid artery cross-clamping during 97 carotid endarterectomy procedures. Stump pressures measured with the gauge zero reference at the common carotid artery level were correlated with the percentage change of velocities. RESULTS: Middle cerebral artery blood flow velocities usually decreased upon common carotid artery cross-clamping, depending on collateral availability and the autoregulation response. The best fit of the data was to an exponential function concave to the pressure axis, with velocity as a percentage of the pre-cross-clamp value reaching zero at 15 mm Hg stump pressure (r = 0.85 and p less than 0.001). CONCLUSIONS: There is a less critical margin of error with percentage middle cerebral artery blood flow velocity decreases than with stump pressure measurements. This relation establishes changes in middle cerebral artery blood flow velocities as a reliable parameter for judging the effects of carotid cross-clamping on cerebral blood flow and providing an excellent indicator as to the necessity for shunting.