超聲造影PPT參考課件

1、Volumetric contrast-enhanced ultrasound imaging of renal perfusion,腎灌注的容積超聲造影顯像,1,2,一 Objective,Volumetric contrast-enhanced ultrasound (VCEUS) imaging has the potential to monitor changes in renal perfusion following vascular injury.,容積超聲造影顯像可以作為一種監(jiān)測(cè)血管損傷后腎臟灌注變化的潛在手段。,3,Current methods for quantifyi

2、ng AKI are searching for bio-markers indicative of kidney injury such as positive fluctuations in serum creatinine .However, serum creatinine levels lack the sensitivity and specificity necessary for early detection . Due to the nephrotoxic nature of both CT and MR contrast agents, other standard pe

3、rfusion imaging modalities are not suitable for diagnosis and monitoring of AKI.,目前確診AKI的方法主要通過尋找血液中腎臟損害的生物標(biāo)志物，例如血肌酐水平升高。但是血肌酐缺乏早期診斷的敏感性及特異性。由于CT及MR造影本身存在腎毒性，而其他標(biāo)準(zhǔn)灌注顯像模式不適合診斷及監(jiān)測(cè)AKI。,4,VCEUS could provide a more detailed idea of the actual percentage of ischemic tissue resulting from this renal compl

4、ication by identifying regions of ischemic tissue.,通過鑒別缺血組織區(qū)域，腎臟造影能夠?qū)τ捎谀I臟并發(fā)癥造成的缺血組織的實(shí)際百分比提供更加細(xì)致的理念。,5,The focus of this paper is to investigate the repeatability and robustness of VCEUS imaging for tracking perfusion changes in the healthy and injured kidney.,這篇文章主要致力于觀察超聲造影顯像追蹤正常及受損腎臟灌注變化的可重復(fù)性及穩(wěn)定性。

5、,6,二Method,VCEUS utilizes a series of planar image acquisitions, capturing the non-linear second harmonic signal from microbubble (MB) contrast agents flowing in the vasculature. Tissue perfusion parameters (peak intensity, IPK; time-to-peak intensity, TPK; wash-in rate, WIR; area under curve, AUC)

6、were derived from time-intensity curve data collected during in vitro flow phantom studies and in vivo animal studies of healthy and injured kidney.,容積超聲造影通過一系列的二維圖像采集，捕捉流入脈管系統(tǒng)的微氣泡造影劑形成的非線性二次諧波信號(hào)。在體外流速模型及體內(nèi)正常/受損腎臟的動(dòng)物研究中，收集來自時(shí)間-強(qiáng)度曲線的組織灌注參數(shù)（峰強(qiáng)度、達(dá)峰值強(qiáng)度時(shí)間、內(nèi)洗率、曲線下面積）。,7,For the flow phantom studies, eithe

7、r the concentration of MB contrast agent was held constant (10 L/L) with varying volumetric flow rates (10, 20, and 30 mL/min) or the flow rate was held constant (30 mL/min) and the contrast agent concentration was varied (5, 10, and 20 L/L).,在體外流速模型研究中，保證微氣泡濃度穩(wěn)定（10 L/L），改變?nèi)莘e流速率（10, 20, and 30 mL/mi

8、n），或者保證流速穩(wěn)定（30 mL/min），改變微氣泡濃度(5, 10, and 20 L/L)。,8,Animal studies were performed using either healthy rats or those that underwent renal ischemia-reperfusion injury. A series of renal studies were performed using healthy rats (N = 4) while the angle of the transducer was varied for each VCEUS imag

9、e acquisition (reference or 0, 45,and 90) to assess if repeated renal perfusion measures were isotropic and independent of transducer position. Blood serum biomarkers and immunohistology were used to confirm acute kidney injury.,動(dòng)物研究應(yīng)用健康小鼠及遭受缺血再灌注的小鼠來完成。用正常小鼠完成一系列腎臟研究，每次超聲造影圖像采集的傳感器角度是多變的（參考角度為0、45、

10、90），以便評(píng)估重復(fù)的腎臟灌注方法是等向性的，其獨(dú)立于傳感器方位。血漿生物標(biāo)記物及免疫組織學(xué)用來確診急性腎損害。,9,三Results,1. Flow phantom results revealed a linear relationship between MB concentrations injected into the flow system and the IPK, WIR, and AUC perfusion measures (R2 0.56, P 0.77, P 0.005).,1.血流模型結(jié)果提示注射入流速系統(tǒng)的微泡濃度與峰強(qiáng)度、內(nèi)洗率及曲線下面積呈線性相關(guān)（R20.56

11、，P 0.77, P 0.005)。,10,圖1a顯示固定容積流速，改變微泡造影劑濃度所形成的時(shí)間-強(qiáng)度曲線。三條時(shí)間強(qiáng)度曲線均在同一時(shí)間達(dá)到了峰強(qiáng)度。,Figure 1a shows time-intensity curves for three different MB concentrations for a fixed volumetric flow rate. All three time-intensity curves reach their peak intensity at the same time point。,The derived perfusion paramete

12、rs from time-intensity curve data (i.e., IPK,TPK, WIR, and AUC) are described in Figure 1a.,從時(shí)間強(qiáng)度曲線中可以得出IPK/TPK/WRI/AUC等灌注參數(shù)。,11,IPK revealed a linear relationship with the concentration of contrast agent used (Figure 2e, R2 = 0.56, P 0.85) as well as IPK with respect to flow speed (Figure 2a, P 0.0

13、6).,12,2. No significant difference was found between the transducer angle during data acquisition and any of the derived renal perfusion measures (P 0.60).,2. 數(shù)據(jù)獲取期間傳感器角度與所有腎臟灌注參數(shù)之間無顯著性相關(guān)性(P 0.60)。,13,Figure 3 illustrates the time intensity curves obtained at different transducer orientations: 0(or

14、igin), 45, and 90. Importantly, a strong correlation was found between time intensity curves acquired at the various transducer scanning angles ( 0.98, P 0.001).,圖3為傳感器在0、45及90三個(gè)不同角度所獲得的時(shí)間強(qiáng)度曲線。從圖中可以看出不同傳感器角度獲得的時(shí)間強(qiáng)度曲線存在顯著相關(guān)性。,14,Figure 4 describes the perfusion parameters versus changes in image acqu

15、isition angle. There was no statistical difference between all three angles in any of the four parameters investigated (P 0.48).,圖4提示灌注參數(shù)與接收器角度變化之間的關(guān)系。從圖中可以看出四個(gè)灌注參數(shù)與與傳感器角度無統(tǒng)計(jì)學(xué)差異(P 0.48)。,15,3. After induction of renal ischemia-reperfusion injury in a rat animal model (N = 4), VCEUS imaging of the in

16、jured kidney revealed an initial reduction in renal perfusion when compared to control animals followed by a progressive recovery of vascular function.,3.建立老鼠腎臟缺血再灌注損害動(dòng)物模型后，與持續(xù)血管功能恢復(fù)的對(duì)照組動(dòng)物模型組相比，受損腎臟的容積超聲造影圖像顯示腎臟灌注顯著降低。,16,Figure 5 depicts the relative difference between the percent change of the mea

17、n values for each of the perfusion measurement obtained in control kidneys and those subjected to acute ischemic conditions. Early US measurements indicate that perfusion was considerably lower in the injured kidneys.,圖5描述對(duì)照組腎臟及缺血再灌注腎臟組兩組間每個(gè)灌注值的均數(shù)值變化的相對(duì)偏差。早期提示灌注的超聲參數(shù)，腎損傷組較對(duì)照組明顯下降。,17,Specifically, t

18、he IPK parametric measurement was the most disparate at the 5-hr time point and most similar at the 48-hr time point. This data suggests that postsurgery the injury group was less perfused than the control group, and by the 48-hr time point limited reperfusion had occurred. Similar results were foun

19、d for TPK, WIR, and AUC demonstrating a peak difference at either the 5-hr or 24-hr time point with an increase in similarity to control measures by the 48-hr time point.,尤其是灌注參數(shù)IPK，在第5小時(shí)是最不同的，在48小時(shí)是最相似的。這組數(shù)據(jù)說明，與對(duì)照組相比，術(shù)后腎損害組存在低灌注，在48小時(shí)時(shí)出現(xiàn)有限的再灌注。其它灌注參數(shù)也有相似結(jié)果，與對(duì)照組相比，TPK、WIR及AUC在5小時(shí)或24小時(shí)時(shí)達(dá)到峰值差異，在48小時(shí)時(shí)逐

20、步增加到對(duì)照組參數(shù)相似值。,18,This was also supported by serum creatinine levels, as shown in Figure 6, where there was a peak in the difference between mean serum creatinine values from control rats and rats subjected to ischemic injury at the 24-hr time point and then had partially recovered by 48 hr.,圖6中血漿肌酐水

21、平能支持上述結(jié)果，在24小時(shí)時(shí)，對(duì)照組小鼠及缺血再灌注小鼠肌酐水平均數(shù)差值達(dá)到最大，在48小時(shí)時(shí)有部分恢復(fù)。,19,四Discussion,Enhancing methods for detecting severity of AKI has the potential of improving patient outcome by increasing the information, knowledge and understanding of how to treat the disease. The strategies investigated here are intended t

22、o supplement current methods to gain a more informative description of AKI where portions of the tissue become is-chemic.,通過優(yōu)化提高探知AKI嚴(yán)重性的方法，增加對(duì)怎樣治療AKI的信息、知識(shí)和理解，為提高患者預(yù)后提供可能性。本文目的是為目前的方法提供補(bǔ)充，以便對(duì)由缺血造成的AKI提供更加詳盡的描述。,20,五Conclusion,Acute kidney injury is a serious disease in need of more methods to help diagnose ext