New technique for emboli detection and discrimination based on nonlinear characteristics of gas bubbles

[B-mode sonography visualizing microemboli flow in the main cerebral arteries]

In a patient with a mechanical prosthetic aortic valve admitted for transient amnesia, transcranial duplex Doppler and B-mode sonography visualized the transit of microemboli along the main cerebral arteries. Gaseous microemboli resulting from a cavitation phenomenon at valve closure were seen as high-intensity transient signals (HITS). To our knowledge, this is the first report of microemboli flow visualized in B-mode.

Distinguishing air from solid emboli using ultrasound: in-vitro study of the effect of Doppler carrier frequency

OBJECTIVE

To compare the ability of the signal relative-intensity and sample-volume-length (SVL) to discriminate air bubbles from solid spheres in an in-vitro model using two different carrier frequencies of the Doppler transducer.

METHODS

A gel ultrasound phantom was connected to a circuit in which blood-mimicking fluid circulated. Air bubbles (100-140 microm) and latex spheres (125 +/- 10 microm) were injected into the circuit and interrogated using 1- and 2-MHz transducers. High-intensity-transient-signals (HITS) were recorded with a dual-gated transcranial Doppler (TCD) system. Receiver-Operating-Characteristic curves determined the best cut-off points that would distinguish between embolic materials.

RESULTS

HITS from air bubbles had higher intensities and longer SVL than solid spheres with either transducer (P < .0001). Air bubbles (P < .0001) and microspheres (P= .049) showed higher intensities with the 1-MHz relative to the 2-MHz transducer. The intensity increase with the 1-MHz transducer was greater for air bubbles than microspheres (P < .0001). The discriminating efficacy of both the relative-intensity and SVL was similar between transducers (intensity, P= .201; SVL, P= .98).

CONCLUSIONS

The relative-intensity and SVL are equally effective to distinguish solid from air emboli using 1- and 2-MHz transducers. Our study indicates that using a lower carrier frequency does not improve the discrimination of air from solid emboli.

Multifrequency Transducer for Microemboli Classification and Sizing

The classification of circulating microemboli as gaseous or particulate matter is essential to establish the relevance of the detected embolic signals. Until now, Doppler techniques have failed to determine unambiguously the nature of circulating microemboli. Recently, a new approach based on the analysis of radio frequency (RF) signal and using the nonlinear characteristics of gaseous bubbles to classify emboli was investigated. The main limitation of these studies was the requirement of two separate transducers for transmission and reception. This paper presents a multi-frequency transducer with two independent transmitting elements and a separate receiving part with a wide frequency band. The transmitting elements are positioned in a concentric design and cover a frequency band between 100 and 600 kHz. The receiving part consists of a polyvinylidene fluoride layer. The new transducer has been tested in vitro using gaseous emboli. It could correctly classify and size air emboli with diameters ranging from 10 microm to 105 microm.

Solid or gaseous circulating brain emboli: are they separable by transcranial ultrasound?

High-intensity transient signals (HITS) detected by transcranial Doppler (TCD) ultrasound may correspond to artifacts or to microembolic signals, the latter being either solid or gaseous emboli. The goal of this study was to assess what can be achieved with an automatic signal processing system for artifact/microembolic signals and solid/gas differentiation in different clinical situations. The authors studied 3,428 HITS in vivo in a multicenter study, i.e., 1,608 artifacts in healthy subjects, 649 solid emboli in stroke patients with a carotid stenosis, and 1,171 gaseous emboli in stroke patients with patent foramen ovale. They worked with the dual-gate TCD combined to three types of statistical classifiers: binary decision trees (BDT), artificial neural networks (ANN), and support vector machines (SVM). The sensitivity and specificity to separate artifacts from microembolic signals by BDT reached was 94% and 97%, respectively. For the discrimination between solid and gaseous emboli, the classifier achieved a sensitivity and specificity of 81% and 81% for BDT, 84% and 84% for ANN, and 86% and 86% for SVM, respectively. The current results for artifact elimination and solid/gas differentiation are already useful to extract data for future prospective clinical studies.

Emboli detection using a new transducer design

We have presented, in a previous study, a new approach to detect, characterize and estimate the size of gaseous emboli, based on the nonlinear behavior of gaseous bubbles. In this study, a specific transducer design has been developed to be used for such a purpose. It is composed of two separate transmitting and receiving capabilities. The transmit part, consisting of a lead zirconate-titanate (PZT) material, emits at a frequency of 500 kHz and could generate pressures up to 410 kPa. On the top of the transmit surface, a thin polyvinylidene difluoride (PVDF) layer is glued and used for receiving frequencies from 250 kHz (f0/2) up to 2.5 MHz (5 f0). To evaluate this new design, ultrasonic measurements were carried out with gas bubbles with diameters ranging from 10 microm up to 90 microm and solid particles between 350 microm and 550 microm. The experimental results confirmed our previous findings: gaseous emboli with a diameter close to the resonance size scatter significantly at higher harmonic components (from the second harmonic up to the fifth), and bubbles with a diameter around twice the resonance size produce a subharmonic and/or an ultraharmonic component. Meanwhile, solid particles and other bubble sizes behave only linearly and their scattered spectrum appeared without any harmonics. The study demonstrates the utility of this approach in using a single transducer to detect and characterize selective gaseous emboli from other particles using their nonlinear behavior.

Subharmonic and ultraharmonic emissions for emboli detection and characterization

Emboli detection and characterization is of importance for different patients, such as those undergoing carotid or cardiac surgery. The emboli occur as particulate or gaseous matters. To select the appropriate treatment and reduce the risk of embolism, it is essential to first detect and then classify and, ultimately, size the emboli. We propose, in this study, an approach to characterize and size the emboli based on the nonlinear properties of the emboli. Gaseous emboli were produced by generating single and uniform air bubbles. These bubbles had diameters ranging from 40 microm to 120 microm. Acoustic measurements were carried out and special attention was devoted to the generation of subharmonic and first ultraharmonic components for gas bubbles of different sizes and at different acoustic pressures. For the scanning frequency and the applied acoustic pressures used in this study, only bubbles ranging from 58 microm up to 110 microm are capable of generating a subharmonic and an ultraharmonic frequency component. However, gas emboli outside this range behave differently. In conclusion, such an approach can be used to provide information needed to classify and size emboli.