High frequency ultrasound device to investigate the acoustic properties of whole blood during coagulation

Diagnosis of diabetes mellitus using high frequency ultrasound and convolutional neural network

The incidence of diabetes mellitus has been increasing, prompting the search for non-invasive diagnostic methods. Although current methods exist, these have certain limitations, such as low reliability and accuracy, difficulty in individual patient adjustment, and discomfort during use. This paper presents a novel approach for diagnosing diabetes using high-frequency ultrasound (HFU) and a convolutional neural network (CNN). This method is based on the observation that glucose in red blood cells (RBCs) forms glycated hemoglobin (HbA1c) and accumulates on its surface. The study incubated RBCs with different glucose concentrations, collected acoustic reflection signals from them using a custom-designed 90-MHz transducer, and analyzed the signals using a CNN. The CNN was applied to the frequency spectra and spectrograms of the signal to identify correlations between changes in RBC properties owing to glucose concentration and signal features. The results confirmed the efficacy of the CNN-based approach with a classification accuracy of 0.98. This non-invasive diagnostic technology using HFU and CNN holds promise for in vivo diagnosis without the need for blood collection.

Micro-ultrasonic Assessment of Early Stage Clot Formation and Whole Blood Coagulation Using an All-Optical Ultrasound Transducer and Adaptive Signal Processing Algorithm

Abnormal formation of solid thrombus inside a blood vessel can cause thrombotic morbidity and mortality. This necessitates early stage diagnosis, which requires quantitative assessment with a small volume, for effective therapy with low risk to unwanted development of various diseases. We propose a micro-ultrasonic diagnosis using an all-optical ultrasound-based spectral sensing (AOUSS) technique for sensitive and quantitative characterization of early stage and whole blood coagulation. The AOUSS technique detects and analyzes minute viscoelastic variations of blood at a micro-ultrasonic spot (<100 μm) defined by laser-generated focused ultrasound (LGFU). This utilizes (1) a uniquely designed optical transducer configuration for frequency-spectral matching and wideband operation (6 dB widths: 7-32 MHz and d.c. ∼ 46 MHz, respectively) and (2) an empirical mode decomposition (EMD)-based signal process particularly adapted to nonstationary LGFU signals backscattered from the spot. An EMD-derived spectral analysis enables one to assess viscoelastic variations during the initiation of fibrin formation, which occurs at a very early stage of blood coagulation (1 min) with high sensitivity (frequency transition per storage modulus increment = 8.81 MHz/MPa). Our results exhibit strong agreement with those obtained by conventional rheometry (Pearson's R > 0.95), which are also confirmed by optical microscopy. The micro-ultrasonic and high-sensitivity detection of AOUSS poses a potential clinical significance, serving as a screening modality to diagnose early stage clot formation (e.g., as an indicator for hypercoagulation of blood) and stages of blood-to-clot transition to check a potential risk for development into thrombotic diseases.

Acoustic and Elastic Properties of a Blood Clot during Microbubble-Enhanced Sonothrombolysis: Hardening of the Clot with Inertial Cavitation

Stroke is the second leading cause of death worldwide. Existing therapies present limitations, and other therapeutic alternatives are sought, such as sonothrombolysis with microbubbles (STL). The aim of this study was to evaluate the change induced by STL with or without recombinant tissue-type plasminogen activator (rtPA) on the acoustic and elastic properties of the blood clot by measuring its sound speed (SoS) and shear wave speed (SWS) with high frequency ultrasound and ultrafast imaging, respectively. An in-vitro setup was used and human blood clots were submitted to a combination of microbubbles and rtPA. The results demonstrate that STL induces a raise of SoS in the blood clot, specifically when combined with rtPA (p < 0.05). Moreover, the combination of rtPA and STL induces a hardening of the clot in comparison to rtPA alone (p < 0.05). This is the first assessment of acoustoelastic properties of blood clots during STL. The combination of rtPA and STL induce SoS and hardening of the clot, which is known to impair the penetration of thrombolytic drugs and their efficacy.

Evaluation method of the degree of red blood cell aggregation considering ultrasonic propagation attenuation by analyzing ultrasonic backscattering properties

PURPOSE

Red blood cell (RBC) aggregation is one of the main factors that determines blood viscosity and an important indicator for evaluating blood properties. As a noninvasive and quantitative method for diagnosing blood properties, our research group estimated the size of RBC aggregates by fitting the scattered power spectrum from the blood vessel lumen with the theoretical scattering characteristics to evaluate the degree of RBC aggregation. However, it was assumed that the propagation attenuation of ultrasound in the vascular lumen was the same regardless of whether RBCs were aggregated or not, which caused systematic errors in the estimated size.

METHODS

To improve the size estimation accuracy, we calculated and corrected the attenuation of the blood vessel lumen during RBC aggregation and non-aggregation. The attenuation in the blood vessel lumen was calculated with the spectra acquired from two different depths.

RESULTS

In the basic experiments using microparticles, the estimation accuracy decreased as the concentration increased in the case of the conventional method, but the estimated size tended to approach the true size irrespective of the concentration, removing the propagation attenuation component with the proposed method. In the in vivo experiment on the human hand dorsal vein, the size was estimated to be larger during RBC aggregation and smaller during non-aggregation using the proposed method.

CONCLUSION

These results suggest that the proposed method can provide precise size estimation by considering the propagation attenuation component regardless of differences in blood conditions such as RBC concentration and degree of aggregation.

Microfluidics in Haemostasis: A Review

Haemostatic disorders are both complex and costly in relation to both their treatment and subsequent management. As leading causes of mortality worldwide, there is an ever-increasing drive to improve the diagnosis and prevention of haemostatic disorders. The field of microfluidic and Lab on a Chip (LOC) technologies is rapidly advancing and the important role of miniaturised diagnostics is becoming more evident in the healthcare system, with particular importance in near patient testing (NPT) and point of care (POC) settings. Microfluidic technologies present innovative solutions to diagnostic and clinical challenges which have the knock-on effect of improving health care and quality of life. In this review, both advanced microfluidic devices (R&D) and commercially available devices for the diagnosis and monitoring of haemostasis-related disorders and antithrombotic therapies, respectively, are discussed. Innovative design specifications, fabrication techniques, and modes of detection in addition to the materials used in developing micro-channels are reviewed in the context of application to the field of haemostasis.

Technology Advancements in Blood Coagulation Measurements for Point-of-Care Diagnostic Testing

In recent years, blood coagulation monitoring has become crucial to diagnosing causes of hemorrhages, developing anticoagulant drugs, assessing bleeding risk in extensive surgery procedures and dialysis, and investigating the efficacy of hemostatic therapies. In this regard, advanced technologies such as microfluidics, fluorescent microscopy, electrochemical sensing, photoacoustic detection, and micro/nano electromechanical systems (MEMS/NEMS) have been employed to develop highly accurate, robust, and cost-effective point of care (POC) devices. These devices measure electrochemical, optical, and mechanical parameters of clotting blood. Which can be correlated to light transmission/scattering, electrical impedance, and viscoelastic properties. In this regard, this paper discusses the working principles of blood coagulation monitoring, physical and sensing parameters in different technologies. In addition, we discussed the recent progress in developing nanomaterials for blood coagulation detection and treatments which opens up new area of controlling and monitoring of coagulation at the same time in the future. Moreover, commercial products, future trends/challenges in blood coagulation monitoring including novel anticoagulant therapies, multiplexed sensing platforms, and the application of artificial intelligence in diagnosis and monitoring have been included.

Control of fibrinolytic drug injection via real-time ultrasonic monitoring of blood coagulation

In the present study, we investigated the capabilities of a novel ultrasonic approach for real-time control of fibrinolysis under flow conditions. Ultrasonic monitoring was performed in a specially designed experimental in vitro system. Fibrinolytic agents were automatically injected at ultrasonically determined stages of the blood clotting. The following clots dissolution in the system was investigated by means of ultrasonic monitoring. It was shown, that clots resistance to fibrinolysis significantly increases during the first 5 minutes since the formation of primary micro-clots. The efficiency of clot lysis strongly depends on the concentration of the fibrinolytic agent as well as the delay of its injection moment. The ultrasonic method was able to detect the coagulation at early stages, when timely pharmacological intervention can still prevent the formation of macroscopic clots in the experimental system. This result serves as evidence that ultrasonic methods may provide new opportunities for real-time monitoring and the early pharmacological correction of thrombotic complications in clinical practice.

Ultrasound scattering by aggregated red blood cells in patients with diabetes

PURPOSE

To develop methods for noninvasively and quantitatively measuring blood glucose levels.

METHODS

In the present study, we evaluated the degree of red blood cell (RBC) aggregation at a low shear rate robustly by introducing two new parameters determined from changes in the scattering power spectrum of the echoes from the intravascular lumen before and after cessation of blood flow. We also considered the clinical significance of these parameters and the change in sizes estimated by the conventional method by comparing them with the blood glucose level obtained just before the ultrasonic measurements. We performed the measurements in one healthy subject and 11 diabetic patients.

RESULTS

A correlation was found between one of the proposed parameters and the blood glucose level. However, the p value was not very high, and one of the reasons for the decline of the correlation will be that some factors other than blood glucose also affect RBC aggregation.

CONCLUSION

The proposed method has potential for clinical application after elucidation of the various factors affecting RBC aggregation.

A novel ultrasonic method for evaluation of blood clotting parameters

PURPOSE

For long time, blood clot retraction was measured only by thromboelastographic or platelet contractile force measurement techniques. The purpose of the present study was development of a novel ultrasonic method based on simultaneous monitoring of variations in the ultrasound velocity and the frequency spectrum of the signal propagating in clotting blood and its application for automatic evaluation of blood clotting parameters.

METHODS

Simultaneous measurement of ultrasound velocity and variations in the frequency spectrum of wideband ultrasonic signals in clotting blood samples was performed. All measurements were performed in pulse-echo mode. Standard clinical data were obtained using routine clinical laboratory methods.

RESULTS

The amplitudes of ultrasonic signals during native blood coagulation varied up to ten times for different frequencies. The measurement results of the start and duration of blood clot retraction differed between patient samples: different components of the blood coagulation system had significant impact on the blood clot retraction process.

CONCLUSIONS

Our results showed that during blood clotting, the ultrasound velocity and variations in frequency spectrum should be used simultaneously to determine the beginning and duration of blood clot retraction. Our results also showed that blood clot retraction is controlled by the activity of factor XIII.

Ultrasonic method for monitoring the clotting process during whole blood coagulation

The purpose of this work was to develop a multichannel ultrasonic measurement method for monitoring a spatially non-uniform blood clotting process. This novel method is based on simultaneous multi-channel measurements of ultrasound propagation velocities in different horizontal cross-sections of clotting blood. The most common method used for determining blood-clotting time is the capillary tube method. For this purpose ultrasonic methods based on measurements of the velocities of ultrasound waves in clotting blood are also used. Measurement results essentially depend on the propagation path of the ultrasonic wave in a blood sample. The ultrasound velocity changes as fresh blood transforms into clot plus serum. The objective of this work was to develop a measurement method that allows one to measure ultrasound velocity and its evolution in time and space in an evolving clot while avoiding the influence of serum. To achieve this objective, a novel method has been proposed that is based on ultrasound propagation velocity measurements in different horizontal cross-sections of clotting blood using a pulse-echo mode. Such a technique enables researchers to monitor the clotting process and a clot's spatial structure, which are different in different layers due to the influence of gravity. The four-channel measurement chamber utilizing this method has been designed and manufactured. For the generation and reception of ultrasonic waves of high frequency, wide band (3-20MHz at -6dB) ultrasonic transducers were developed. To verify that the multi-channel measurement system was operational, a special procedure based on monitoring of a polymerisation process in the acrylamide solution was proposed. Performance of the developed method was investigated by measuring clotting blood (sample volumes of less than 0.6ml) at the frequency of 12MHz. The results revealed that a clot structure indeed varies within a blood sample due to the influence of gravity; clotting times are different in different horizontal layers of the clot and range from 9 to 15min, defined by the standard capillary method. Clotting times are determined precisely from abrupt increases in ultrasound velocity. Uncertainty of the ultrasound velocity measurements was less than ±0.05m/s. The experiments were performed at 36.90±0.01°C. The proposed method may be exploited for monitoring polymerisation reactions in the chemistry field, as well.

Quantitative Ultrasound for Nondestructive Characterization of Engineered Tissues and Biomaterials

Non-invasive, non-destructive technologies for imaging and quantitatively monitoring the development of artificial tissues are critical for the advancement of tissue engineering. Current standard techniques for evaluating engineered tissues, including histology, biochemical assays and mechanical testing, are destructive approaches. Ultrasound is emerging as a valuable tool for imaging and quantitatively monitoring the properties of engineered tissues and biomaterials longitudinally during fabrication and post-implantation. Ultrasound techniques are rapid, non-invasive, non-destructive and can be easily integrated into sterile environments necessary for tissue engineering. Furthermore, high-frequency quantitative ultrasound techniques can enable volumetric characterization of the structural, biological, and mechanical properties of engineered tissues during fabrication and post-implantation. This review provides an overview of ultrasound imaging, quantitative ultrasound techniques, and elastography, with representative examples of applications of these ultrasound-based techniques to the field of tissue engineering.

Effect of fibrinogen on blood coagulation detected by optical coherence tomography

Our previous work demonstrated that an optical coherence tomography (OCT) technique and the parameter 1/e light penetration depth (d1/e) were able to characterize the whole blood coagulation process in contrast to existing optical tests that are performed on plasma samples. To evaluate the feasibility of the technique for quantifying the effect of fibrinogen (Fbg) on blood coagulation, a dynamic study of d1/e of blood in various Fbg concentrations was performed in static state. Two groups of blood samples of hematocrit (HCT) in 35, 45, and 55% were reconstituted of red blood cells with: 1) treated plasma with its intrinsic Fbg removed and commercial Fbg added (0-8 g L(-1)); and 2) native plasma with commercial Fbg added (0-8 g L(-1)). The results revealed a typical behavior due to coagulation induced by calcium ions and the clotting time is Fbg concentration-dependent. The clotting time was decreased by the increasing amount of Fbg in both groups. Besides, the blood of lower HCT with various levels of Fbg took shorter time to coagulate than that of higher HCT. Consequently, the OCT method is a useful and promising tool for the detection of blood-coagulation processes induced with different Fbg levels.

Noninvasive Quantitative Imaging of Collagen Microstructure in Three-Dimensional Hydrogels Using High-Frequency Ultrasound

Collagen I is widely used as a natural component of biomaterials for both tissue engineering and regenerative medicine applications. The physical and biological properties of fibrillar collagens are strongly tied to variations in collagen fiber microstructure. The goal of this study was to develop the use of high-frequency quantitative ultrasound to assess collagen microstructure within three-dimensional (3D) hydrogels noninvasively and nondestructively. The integrated backscatter coefficient (IBC) was employed as a quantitative ultrasound parameter to detect, image, and quantify spatial variations in collagen fiber density and diameter. Collagen fiber microstructure was varied by fabricating hydrogels with different collagen concentrations or polymerization temperatures. IBC values were computed from measurements of the backscattered radio-frequency ultrasound signals collected using a single-element transducer (38-MHz center frequency, 13-47 MHz bandwidth). The IBC increased linearly with increasing collagen concentration and decreasing polymerization temperature. Parametric 3D images of the IBC were generated to visualize and quantify regional variations in collagen microstructure throughout the volume of hydrogels fabricated in standard tissue culture plates. IBC parametric images of corresponding cell-embedded collagen gels showed cell accumulation within regions having elevated collagen IBC values. The capability of this ultrasound technique to noninvasively detect and quantify spatial differences in collagen microstructure offers a valuable tool to monitor the structural properties of collagen scaffolds during fabrication, to detect functional differences in collagen microstructure, and to guide fundamental research on the interactions of cells and collagen matrices.

Estimating cell concentration in three-dimensional engineered tissues using high frequency quantitative ultrasound

Histology and biochemical assays are standard techniques for estimating cell concentration in engineered tissues. However, these techniques are destructive and cannot be used for longitudinal monitoring of engineered tissues during fabrication processes. The goal of this study was to develop high-frequency quantitative ultrasound techniques to nondestructively estimate cell concentration in three-dimensional (3-D) engineered tissue constructs. High-frequency ultrasound backscatter measurements were obtained from cell-embedded, 3-D agarose hydrogels. Two broadband single-element transducers (center frequencies of 30 and 38 MHz) were employed over the frequency range of 13-47 MHz. Agarose gels with cell concentrations ranging from 1 × 10(4) to 1 × 10(6) cells mL(-1) were investigated. The integrated backscatter coefficient (IBC), a quantitative ultrasound spectral parameter, was calculated and used to estimate cell concentration. Accuracy and precision of this technique were analyzed by calculating the percent error and coefficient of variation of cell concentration estimates. The IBC increased linearly with increasing cell concentration. Axial and lateral dimensions of regions of interest that resulted in errors of less than 20% were determined. Images of cell concentration estimates were employed to visualize quantitatively regional differences in cell concentrations. This ultrasound technique provides the capability to rapidly quantify cell concentration within 3-D tissue constructs noninvasively and nondestructively.

Assessing blood coagulation status with laser speckle rheology

We have developed and investigated a novel optical approach, Laser Speckle Rheology (LSR), to evaluate a patient's coagulation status by measuring the viscoelastic properties of blood during coagulation. In LSR, a blood sample is illuminated with laser light and temporal speckle intensity fluctuations are measured using a high-speed CMOS camera. During blood coagulation, changes in the viscoelastic properties of the clot restrict Brownian displacements of light scattering centers within the sample, altering the rate of speckle intensity fluctuations. As a result, blood coagulation status can be measured by relating the time scale of speckle intensity fluctuations with clinically relevant coagulation metrics including clotting time and fibrinogen content. Our results report a close correlation between coagulation metrics measured using LSR and conventional coagulation results of activated partial thromboplastin time, prothrombin time and functional fibrinogen levels, creating the unique opportunity to evaluate a patient's coagulation status in real-time at the point of care.

Ultrasound imaging and characterization of biofilms based on wavelet de-noised radiofrequency data

The ability to non-invasively image and characterize bacterial biofilms in children during nasopharyngeal colonization with potential otopathogens and during acute otitis media would represent a significant advance. We sought to determine if quantitative high-frequency ultrasound techniques could be used to achieve that goal. Systematic time studies of bacterial biofilm formation were performed on three preparations of an isolated Haemophilus influenzae (NTHi) strain, a Streptococcus pneumoniae (Sp) strain and a combination of H. influenzae and S. pneumoniae (NTHi + Sp) in an in vitro environment. The process of characterization included conditioning of the acquired radiofrequency data obtained with a 15-MHz focused, piston transducer by using a seven-level wavelet decomposition scheme to de-noise the individual A-lines acquired. All subsequent spectral parameter estimations were done on the wavelet de-noised radiofrequency data. Various spectral parameters-peak frequency shift, bandwidth reduction and integrated backscatter coefficient-were recorded. These parameters were successfully used to map the progression of the biofilms in time and to differentiate between single- and multiple-species biofilms. Results were compared with those for confocal microscopy and theoretical evaluation of form factor. We conclude that high-frequency ultrasound may prove a useful modality to detect and characterize bacterial biofilms in humans as they form on tissues and plastic materials.

Time-dependent hardening of blood clots quantitatively measured in vivo with shear-wave ultrasound imaging in a rabbit model of venous thrombosis

OBJECTIVE

Provide in vivo blood clot hardening evolution with ultrasound using supersonic imaging of shear waves.

METHODS

We conducted a prospective study in flow stasis-induced venous thrombosis within jugular veins of white female New Zealand rabbits. Blood clot elasticity was noninvasively measured in vivo using the Young's modulus (in kilopascals), on a 2-hour and a 2-week periods after thrombus induction. Monitoring was followed by a necropsy and ex vivo mechanical characterization to validate the existence and elasticity of explanted thrombi.

RESULTS

Stagnant blood in the region of interest underwent clotting and progressive hardening with thrombus aging. The mean Young's moduli varied from 1.0 ± 0.6 kPa (at 10 min) to 5.3 ± 1.6 kPa (at 2 hours), then to 25.0 ± 6.8 kPa (at 14 days) post-surgery. Mean ex vivo moduli of 6.2 ± 0.7 kPa at 2 hours and 29.0 ± 2.4 kPa at 2 weeks agreed with in vivo measures.

CONCLUSIONS

Supersonic imaging of shear waves provides consistent quantitative non-invasive elasticity measurements not available with standard compression ultrasound imaging for diagnosing and following venous thromboembolism. This information translatable to humans could aid in determining whether continued anticoagulant treatment is necessary, especially in the setting of unprovoked venous thromboembolism.

Shear wave elastography quantification of blood elasticity during clotting

Deep venous thrombosis (DVT) affects millions of people worldwide. A fatal complication occurs when the thrombi detach and create a pulmonary embolism. The diagnosis and treatment of DVT depends on clot's age. The elasticity of thrombi is closely related to its age. Blood was collected from pigs and anticoagulated using ethylenediaminetetraacetic acid (EDTA). Coagulation was initiated using calcium ions. Supersonic shear wave imaging was used to generate shear waves using 100 μs tone bursts of 8 MHz. Tracking of the shear waves was done by ultrafast imaging. Postprocessing of the data was done using Matlab(®). Two-dimensional (2-D) maps of elasticity were obtained by calculating the speed of shear wave propagation. Elasticity varied with time from around 50 Pa at coagulation to 1600 Pa at 120 min after which the elasticity showed a natural decreased (17%) because of thrombolytic action of plasmin. Ejection of the serum from the clot showed a significant decrease in the elasticity of the clot next to the liquid pool (65% decrease), corresponding to the detachment of the clot from the beaker wall. The use of a thrombolytic agent (Urokinase) on the coagulated blood decreased the shear elasticity close to the point of injection, which varied with time and distance. Supersonic imaging proved to be useful mapping the 2-D clot's elasticity. It allowed the visualization of the heterogeneity of mechanical properties of thrombi and has potential use in predicting thrombi breakage as well as in monitoring thrombolytic therapy.

High frequency ultrasound imaging of whole blood gelation and retraction during in vitro coagulation

Blood coagulation is a series of biochemical reactions resulting in the mechanical transformation of liquid blood into a gel. As a consequence, ultrasound, being mechanical waves, can provide specific details on the dynamics of coagulation. In fact, previous high-frequency ultrasound monitoring studies have shown drastic changes in ultrasound velocity and attenuation during whole blood coagulation and a model discussing the observed mechanical transformations was proposed. In this paper, a technique of visualization of the clotting mechanism is introduced, which complements and revises the previous hypotheses. This method is based on the monitoring of scatterers (red blood cells) movement through a time correlation of 20 MHZ rf signals. It allows the computing of both a displacement map revealing local details and disparities and a parameter quantifying the global structural behavior. Qualitative results for two typical samples show that the technique provides new insights on the gelation dynamics. A quantitative analysis computed from 12 healthy subjects found that the changes in the structural parameters are significantly correlated to the changes in velocity and attenuation, both dependent on the mechanical transformations in the sample. The previous model is therefore revised and a new way to measure gel and retraction times is proposed.

Simultaneous measurement of red blood cell aggregation and whole blood coagulation using high-frequency ultrasound

This study aims to investigate the feasibility of using high-frequency ultrasound (HFUS) for simultaneous monitoring of blood coagulation and red blood cell (RBC) aggregation. Using a 35-MHz ultrasound scanner, ultrasound speckle data were acquired from whole blood samples of three experimental groups of rats, including 4,4'-diisothiocyanatostilbene-2,2'-disulfonic acid (DIDS)-treated, noncoagulation and normal control groups. The variations of blood echogenicity, the shape parameters of probability distribution of speckle intensity (skewness and kurtosis) and the correlation coefficient between two consecutive speckle data were calculated as a function of time starting from immediately after taking blood. The blood echogenicity increases rapidly to plateaus at the early stage of measurement for all the experimental groups caused by the formation of RBC aggregates. The DIDS-treated group exhibits the lowest echogenicity level due to the inhibitory effect of DIDS on RBC aggregation. The correlation analysis between consecutive speckle patterns seems to be useful to examine the variation of blood fluidity and the progress of clot formation. Whole blood coagulation is observed to be accelerated by DIDS treatment. In addition, the results of skewness and kurtosis analysis indicated that RBC aggregates may be disrupted during blood coagulation. The present study suggests that HFUS has good potential for simultaneous monitoring of RBC aggregation and blood coagulation to examine the relationship between them.

Optical coherence tomography to investigate optical properties of blood during coagulation

This study investigates the optical properties of human blood during the coagulation process under statics using optical coherence tomography (OCT). OCT signal slope (OCTSS) and 1∕e light penetration depth (d(1∕e)) were obtained from the profiles of reflectance versus depth. Results showed that both OCTSS and d(1∕e) were able to sensitively differentiate various stages of blood properties during coagulating. After 1 h clotting, OCTSS decreased by 47.0%, 15.0%, 13.7%, and 8.5% and d(1∕e) increased by 34.7%, 29.4%, 24.3%, and 22.9% for the blood samples at HCT of 25%, 35%, 45%, and 55%, respectively. The slope of d(1∕e) versus time (S(r), ×10(-4) mm∕s), associated with clot formation rate decreased from 6.0 ± 0.3, 3.7 ± 0.5 to 2.3 ± 0.4 with the increasing of HCT from 35%, 45%, to 55%. The clotting time (t(c)) from the d(1∕e) evolution curves was estimated to be 1969 ± 92 s, 375 ± 12 s, 455 ± 11 s, and 865 ± 47 s for the blood of 25%, 35%, 45%, and 55%. This study demonstrates that the parameters (t(c) and S(r)) from the variations in d(1∕e) had better sensitivity and smaller standard deviation. Furthermore, blood hematocrit affecting backscattering properties of blood during coagulation was capable of being discerned by OCT parameters. It is concluded that OCT is a potential technique to quantify and follow the liquid-gel transition of blood during clotting.

Coagulation dynamics of a blood sample by multiple scattering analysis

We report a new technique to measure coagulation dynamics on whole-blood samples. The method relies on the analysis of the speckle figure resulting from a whole-blood sample mixed with coagulation reagent and introduced in a thin chamber illuminated with a coherent light. A dynamic study of the speckle reveals a typical behavior due to coagulation. We compare our measured coagulation times to a reference method obtained in a medical laboratory.

Characterization of blood clot viscoelasticity by dynamic ultrasound elastography and modeling of the rheological behavior

Dynamic elastography (DE) is a new tool to study mechanical behavior of soft tissues via their motion response to propagating shear waves. This technique characterized viscoelasticity of 9 porcine whole blood samples (3 animals) during coagulation for a shearing frequency of 70Hz, and after complete clot formation between 50 and 160Hz. Clot storage (G') and loss (G″) moduli were calculated from shear wave velocity and attenuation. Temporal evolutions of G' and G″ during coagulation were typified with 4 parameters: maximum change in elasticity (G' slope(max)), elasticity after 120min of coagulation (G'(max)), time occurrence of G″ maximum (t(e)) and G″ at the plateau (G″(plateau)). G' and G″ frequency dependence of completely formed blood clots was fitted with 5 standard rheological models: Maxwell, Kelvin-Voigt, Jeffrey, Zener and third-order generalized Maxwell. DE had sufficient sensitivity to follow the coagulation kinetics described by a progressive increase in G', while G″ transitory increased followed by a rapid stabilization. Inter- and intra-animal dispersions (InterAD and IntraAD) of G'(max) (InterAD=15.9%, IntraAD=9.1%) showed better reproducibility than G' slope(max) (InterAD=40.4%, IntraAD=21.9%), t(e) (InterAD=27.4%, IntraAD=18.7%) and G″(plateau) (InterAD=58.6%, IntraAD=40.2%). G' evolution within the considered range of frequency exhibited an increase, followed by stabilization to a plateau, whereas G″ presented little variations with convergence at a quasi-constant value at highest frequencies. Residues χ(⁎), describing the goodness of fit between models and experimental data, showed statistically (p<0.05) that the Kelvin-Voigt model was less in agreement with experimental data than other models. The Zener model is recommended to predict G' and G″ dispersion of coagulated blood over the explored frequency range.

Evaluation of the sensitivity of an in vitro high frequency ultrasound device to monitor the coagulation process: study of the effects of heparin treatment in a murine model

This study evaluates the sensitivity of a new in vitro high frequency ultrasound test of the whole blood coagulation process. A rat model of anticoagulant treatment is reported. Many recent studies of the role of red blood cells in the whole blood coagulation process have revealed an increasing demand for global tests of the coagulation process performed on whole blood instead of plasma samples. In contrast to existing optical tests, high frequency ultrasound presents the advantages of characterizing the mechanical properties of whole blood clotting. Ultrasound longitudinal wave velocity and integrated attenuation coefficient (IAC) were simultaneously assessed in a 10 to 30 MHz frequency range during the whole blood coagulation process in vitro in rats under anticoagulant therapy. Differences between humans and rats were also clearly emphasized in non-clotting blood and in clotting blood using specific criteria deduced from acoustic parameters (ultrasound velocity for non-clotting blood:=1574+/-2m/s for rats and 1583+/-3m/s for humans and IAC=2.25+/-0.14 dB/cm for rats and 1.5+/-0.23 dB/cm for humans). We also measured the coagulation time t(0) from the acoustic velocity (t(0) =11.15+/-7 min for control rat blood and 43.3+/-11.4 min for human blood). Different doses of heparin were administered to rats. The sensitivity of the ultrasound device to the effects of heparin was evaluated. Differences between non-treated rats and chronically and acutely treated rats were recorded and quantified. We particularly noted that the slope S and the amplitude I of the variations in acoustic velocity were linked to clot retraction, which is a good indicator of the platelet function. The amplitude of the variations in S was between (20+/-8) x1 0(-3) m/s(2) for control group rats, and (0.92+/-0.35) x 10(-3) m/s(2) for chronic heparin-treated group rats. The values of I were 15 times higher for control group rats than for chronic heparin-treated group rats.

Interest of the attenuation coefficient in multiparametric high frequency ultrasound investigation of whole blood coagulation process

Previous studies [R. Libgot, F. Ossant, Y. Gruel, P. Lermusiaux, and F. Patat, Proc.-IEEE Utrason. Symp. 4, 2259-2262 (2005); R. Libgot-Calle, F. Ossant, Y. Gruel, P. Lermusiaux, and F. Patat, Ultrasound Med. Biol. 34, 252-264 (2008); F. Ossant, R. Libgot, P. Coupe, P. Lermusiaux, and F. Patat, Proc.-IEEE Ultrason. Symp. 2, 846-849 (2004)] showed the potential of an in vitro high frequency ultrasound (beyond 20 MHz) device to describe the blood clotting process. The parameters were simultaneously estimated in double transmission (DT) with the calculation of the velocity of longitudinal waves and in backscattering (BS) modes with the estimation of the integrated BS coefficient and the effective scatterer size. The aim of the present study was to show how the integrated attenuation coefficient (IAC) assessed in DT mode could provide additional information on this process, especially regarding the fibrin polymerization which is an important part of the coagulation process. A characteristic time t(a) of the variations in IAC that could be linked to fibrin formation was identified.