1
|
Capdeville S, Gholson BA, Lindner JR. Contrast Echocardiography for Assessing Myocardial Perfusion. Curr Cardiol Rep 2023; 25:1581-1587. [PMID: 37787859 DOI: 10.1007/s11886-023-01970-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE OF REVIEW Improvements in ultrasound methods for detecting microbubble ultrasound enhancing agents have led to an increase in the use of perfusion imaging with myocardial contrast echocardiography (MCE). This technique is now beginning to play an important role in specific clinical scenarios, which is the focus of this review. RECENT FINDINGS MCE was originally conceived as a technique for detecting resting perfusion abnormalities related to ischemia at rest or during stress from coronary artery disease. More recently, MCE has increasingly been used in circumstances where the technique's ability to provide rapid, quantitative, or bedside assessment of perfusion is advantageous. Quantitative MCE is also increasingly being used as a research technique for evaluating pathobiology and therapy that involve changes in the myocardial microcirculation. While MCE was developed and validated decades ago, it is only now beginning to be used by an increasing number of clinicians due to improvements in imaging technology and recognition of specific situations where the technique is impactful.
Collapse
Affiliation(s)
- Sofia Capdeville
- Division of Cardiovascular Medicine and Robert M. Berne Cardiovascular Research Center, University of Virginia, 415 Lane Rd, Box 801394, Charlottesville, VA, 22903, USA
| | - Bethany A Gholson
- Division of Cardiovascular Medicine and Robert M. Berne Cardiovascular Research Center, University of Virginia, 415 Lane Rd, Box 801394, Charlottesville, VA, 22903, USA
| | - Jonathan R Lindner
- Division of Cardiovascular Medicine and Robert M. Berne Cardiovascular Research Center, University of Virginia, 415 Lane Rd, Box 801394, Charlottesville, VA, 22903, USA.
| |
Collapse
|
2
|
Leo I, Nakou E, Artico J, Androulakis E, Wong J, Moon JC, Indolfi C, Bucciarelli-Ducci C. Strengths and weaknesses of alternative noninvasive imaging approaches for microvascular ischemia. J Nucl Cardiol 2023; 30:227-238. [PMID: 35918590 DOI: 10.1007/s12350-022-03066-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/19/2022] [Indexed: 11/26/2022]
Abstract
Structural and functional abnormalities of coronary microvasculature are highly prevalent in several clinical settings and often associated with worse clinical outcomes. Therefore, there is a growing interest in the detection and treatment of this, often overlooked, disease. Coronary angiography allows the assessment of the Coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR). However, the measurement of these parameters is not always feasible because of limited technical availability and the need for a cardiac catheterization with a small but real risk of potential complications. Recent advances in non-invasive imaging techniques allow the assessment of coronary microvascular function with good accuracy and reproducibility. The objective of this review is to discuss the strengths and weaknesses of alternative non-invasive approaches used in the diagnosis of coronary microvascular dysfunction (CMD), highlighting the most recent advances for each imaging modality.
Collapse
Affiliation(s)
- Isabella Leo
- Royal Brompton and Harefield Hospitals, Guys's and St Thomas' NHS Foundation Trust, London, UK
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Eleni Nakou
- Royal Brompton and Harefield Hospitals, Guys's and St Thomas' NHS Foundation Trust, London, UK
| | - Jessica Artico
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK
- St Bartholomew's Hospital, Barts Heart Centre, West Smithfield, London, UK
| | - Emmanouil Androulakis
- Royal Brompton and Harefield Hospitals, Guys's and St Thomas' NHS Foundation Trust, London, UK
| | - Joyce Wong
- Royal Brompton and Harefield Hospitals, Guys's and St Thomas' NHS Foundation Trust, London, UK
| | - James C Moon
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK
- St Bartholomew's Hospital, Barts Heart Centre, West Smithfield, London, UK
| | - Ciro Indolfi
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Chiara Bucciarelli-Ducci
- Royal Brompton and Harefield Hospitals, Guys's and St Thomas' NHS Foundation Trust, London, UK.
- Faculty of Life Sciences and Medicine, School of Biomedical Engineering and Imaging Sciences, King's College University, London, UK.
| |
Collapse
|
3
|
Mechanisms of the "No-Reflow" Phenomenon After Acute Myocardial Infarction: Potential Role of Pericytes. JACC Basic Transl Sci 2023; 8:204-220. [PMID: 36908667 PMCID: PMC9998747 DOI: 10.1016/j.jacbts.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 11/20/2022]
Abstract
Pericytes contract during myocardial ischemia resulting in capillary constriction and no reflow. Reversing pericyte contraction pharmacologically reduces no reflow and infarct size. These findings open up an entire new venue of research aimed at altering pericyte function in myocardial ischemia and infarction.
Collapse
|
4
|
Pantea-Roșan LR, Bungau SG, Radu AF, Pantea VA, Moisi MI, Vesa CM, Behl T, Nechifor AC, Babes EE, Stoicescu M, Gitea D, Iovanovici DC, Bustea C. A Narrative Review of the Classical and Modern Diagnostic Methods of the No-Reflow Phenomenon. Diagnostics (Basel) 2022; 12:diagnostics12040932. [PMID: 35453980 PMCID: PMC9029120 DOI: 10.3390/diagnostics12040932] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/04/2022] [Accepted: 04/07/2022] [Indexed: 02/06/2023] Open
Abstract
The incidence of the no-reflow (NR) phenomenon varies depending on the diagnostic criteria used. If just the angiographic criteria are considered (i.e., a degree of thrombolysis in myocardial infarction ≤2), it will be found that the incidence of NR is quite low; on the other hand, when the myocardial NR is taken into account (i.e., a decrease in the quality of myocardial reperfusion expressed by the degree of myocardial blush), the real incidence is higher. Thus, the early establishment of a diagnosis of NR and the administration of specific treatment can lead to its reversibility. Otherwise, regardless of the follow-up period, patients with NR have a poor prognosis. In the present work, we offer a comprehensive perspective on diagnostic tools for NR detection, for improving the global management of patients with arterial microvasculature damage, which is a topic of major interest in the cardiology field, due to its complexity and its link with severe clinical outcomes.
Collapse
Affiliation(s)
- Larisa Renata Pantea-Roșan
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (L.R.P.-R.); (E.E.B.); (M.S.)
| | - Simona Gabriela Bungau
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania;
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania;
- Correspondence: (S.G.B.); (A.-F.R.)
| | - Andrei-Flavius Radu
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania;
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy of Oradea, University of Oradea, 410073 Oradea, Romania; (M.I.M.); (C.M.V.); (C.B.)
- Correspondence: (S.G.B.); (A.-F.R.)
| | - Vlad Alin Pantea
- Department of Dental Medicine, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
| | - Mădălina Ioana Moisi
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy of Oradea, University of Oradea, 410073 Oradea, Romania; (M.I.M.); (C.M.V.); (C.B.)
| | - Cosmin Mihai Vesa
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy of Oradea, University of Oradea, 410073 Oradea, Romania; (M.I.M.); (C.M.V.); (C.B.)
| | - Tapan Behl
- Department of Pharmacology, Chitkara College of Pharmacy, Chitkara University, Punjab 140401, India;
| | - Aurelia Cristina Nechifor
- Analytical Chemistry and Environmental Engineering Department, Polytechnic University of Bucharest, 011061 Bucharest, Romania;
| | - Elena Emilia Babes
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (L.R.P.-R.); (E.E.B.); (M.S.)
| | - Manuela Stoicescu
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (L.R.P.-R.); (E.E.B.); (M.S.)
| | - Daniela Gitea
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania;
| | - Diana Carina Iovanovici
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania;
| | - Cristiana Bustea
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy of Oradea, University of Oradea, 410073 Oradea, Romania; (M.I.M.); (C.M.V.); (C.B.)
| |
Collapse
|
5
|
Methner C, Cao Z, Mishra A, Kaul S. Mechanism and potential treatment of the "no reflow" phenomenon after acute myocardial infarction: role of pericytes and GPR39. Am J Physiol Heart Circ Physiol 2021; 321:H1030-H1041. [PMID: 34623177 DOI: 10.1152/ajpheart.00312.2021] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/07/2021] [Indexed: 11/22/2022]
Abstract
The "no reflow" phenomenon, where the coronary artery is patent after treatment of acute myocardial infarction (AMI) but tissue perfusion is not restored, is associated with worse outcome. The mechanism of no reflow is unknown. We hypothesized that pericytes contraction, in an attempt to maintain a constant capillary hydrostatic pressure during reduced coronary perfusion pressure, causes capillary constriction leading to no reflow and that this effect is mediated through the orphan receptor, GPR39, present in pericytes. We created AMI (coronary occlusion followed by reperfusion) in GPR39 knock out mice and littermate controls. In a separate set of experiments, we treated wild-type mice undergoing coronary occlusion with vehicle or VC43, a specific inhibitor of GPR39, before reperfusion. We found that no reflow zones were significantly smaller in the GPR39 knockouts compared with controls. Both no reflow and infarct size were also markedly smaller in animals treated with VC43 compared with vehicle. Immunohistochemistry revealed greater capillary density and larger capillary diameter at pericyte locations in the GPR39-knockout and VC43-treated mice compared with controls. We conclude that GPR39-mediated pericyte contraction during reduced coronary perfusion pressure causes capillary constriction resulting in no reflow during AMI and that smaller no reflow zones in GPR39-knockout and VC43-treated animals are associated with smaller infarct sizes. These results elucidate the mechanism of no reflow in AMI, as well as providing a therapeutic pathway for the condition.NEW & NOTEWORTHY The mechanism of "no reflow" phenomenon, where the coronary artery is patent after treatment of acute myocardial infarction but tissue perfusion is not restored, is unknown. This condition is associated with worse outcome. Here, we show that GPR39-mediated pericyte contraction during reduced coronary perfusion pressure causes capillary constriction resulting in no reflow. Smaller no-reflow zones in GPR39-knockout animals and those treated with a GPR39 inhibitor are associated with smaller infarct size. These results could have important therapeutic implications.
Collapse
Affiliation(s)
- Carmen Methner
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Zhiping Cao
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Anusha Mishra
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
- Department of Neurology, Jungers Center for Neurosciences Research, School of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Sanjiv Kaul
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| |
Collapse
|
6
|
Locorotondo G, Galiuto L, Porto I, Fedele E, Paraggio L, Rebuzzi AG, Crea F. Coronary microvascular dysfunction beyond microvascular obstruction in ST-elevation myocardial infarction: Functional and clinical correlates. Microcirculation 2021; 28:e12696. [PMID: 33780096 DOI: 10.1111/micc.12696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/13/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To retrospectively characterize clinical predictors and impact on left ventricular (LV) ejection fraction (EF) of microvascular dysfunction (MVD) beyond microvascular obstruction (MVO), in 49 consecutive patients (58 ± 11 years), with successfully treated ST-elevation myocardial infarction. METHODS By myocardial contrast echocardiography, MVD was considered as myocardial segments with delayed/patchy opacification, while MVO as areas without any opacification. Both MVD and MVO were planimetered and expressed as percentage of total LV wall area. Patients were divided into tertiles of MVO: I (MVO 0%), II (MVO 4-17%), and III (MVO 18-38%) groups. Cardiac troponin T (cTnT) values obtained at admission and at peak were considered for analysis. RESULTS MVD correlated inversely with EF in groups I and II (p = 0.025, p = 0.019, respectively), but not in group III. MVD was independently predicted by cTnT on admission (β = 1.85; 95%CI = 0.46-3.24, p = 0.011) and female sex (β for male sex = -14.46; 95% CI = -27.96-0.95), while MVO by anterior MI (β = 0.57; 95% CI = 0.26-0.88, p = 0.008) and peak cTnT (β = 0.97; 95%CI = 0.57-1.38, p < 0.001). Altogether, MVD plus MVO predicted EF (β = -0.18; 95%CI = -0.28--0.07, p = 0.002). CONCLUSIONS Even in patients with limited amount of MVO, EF may be impaired by MVD. MVO and MVD have different predictors, which probably reflect their different pathogenesis.
Collapse
Affiliation(s)
- Gabriella Locorotondo
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Leonarda Galiuto
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Italo Porto
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Elisa Fedele
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Lazzaro Paraggio
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio G Rebuzzi
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| |
Collapse
|
7
|
Cimorelli M, Flynn MA, Angel B, Reimold E, Fafarman A, Huneke R, Kohut A, Wrenn S. A Voltage-Sensitive Ultrasound Enhancing Agent for Myocardial Perfusion Imaging in a Rat Model. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2388-2399. [PMID: 32593498 DOI: 10.1016/j.ultrasmedbio.2020.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 05/13/2020] [Accepted: 05/19/2020] [Indexed: 06/11/2023]
Abstract
Echocardiographers with specialized expertise sometimes perform myocardial perfusion imaging using U.S. Food and Drug Administration-approved microbubbles in an off-label capacity, correlating microbubble replenishment in the near field with blood flow through the myocardium. This study reports the in vivo clinical feasibility of a voltage-sensitive ultrasound enhancing agent (UEA) for myocardial perfusion imaging. Four UEAs were injected into Sprague-Dawley rats while ultrasound images were collected to quantify brightness in the left ventricular (LV) cavity, septal wall, and posterior wall in systole and diastole. Formulation IV, a phase change agent nested within a negatively charged phospholipid bilayer, increased the tissue-to-cavity ratio in both systole and diastole in the septal wall, 6 dB, and in the posterior wall, 5 dB, while leaving the LV cavity at baseline. This outcome improves the signal of the myocardium relative to the LV cavity and shows promise as a myocardial perfusion UEA.
Collapse
Affiliation(s)
- Michael Cimorelli
- Chemical and Biological Engineering, Drexel University, Philadelphia, Pennsylvania, USA
| | - Michael A Flynn
- Chemical and Biological Engineering, Drexel University, Philadelphia, Pennsylvania, USA
| | - Brett Angel
- Cardiology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Emily Reimold
- University Laboratory Animal Resources, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Aaron Fafarman
- Chemical and Biological Engineering, Drexel University, Philadelphia, Pennsylvania, USA
| | - Richard Huneke
- University Laboratory Animal Resources, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Andrew Kohut
- Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Steven Wrenn
- Chemical and Biological Engineering, Drexel University, Philadelphia, Pennsylvania, USA.
| |
Collapse
|
8
|
Mathew RC, Bourque JM, Salerno M, Kramer CM. Cardiovascular Imaging Techniques to Assess Microvascular Dysfunction. JACC Cardiovasc Imaging 2020; 13:1577-1590. [PMID: 31607665 PMCID: PMC7148179 DOI: 10.1016/j.jcmg.2019.09.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 08/02/2019] [Accepted: 09/03/2019] [Indexed: 02/08/2023]
Abstract
The understanding of microvascular dysfunction without evidence of epicardial coronary artery disease pales in comparison with that of obstructive epicardial coronary artery disease. A primary limitation in the past had been the lack of development of noninvasive methods of detecting and quantifying microvascular dysfunction. This limitation has particularly affected the ability to study the pathophysiology, morbidity, and treatment of this disease. More recently, almost all of the noninvasive cardiac imaging modalities have been used to quantify blood flow and advance understanding of microvascular dysfunction.
Collapse
Affiliation(s)
- Roshin C Mathew
- Department of Medicine (Cardiology), University of Virginia Health System, Charlottesville, Virginia
| | - Jamieson M Bourque
- Department of Medicine (Cardiology), University of Virginia Health System, Charlottesville, Virginia; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia
| | - Michael Salerno
- Department of Medicine (Cardiology), University of Virginia Health System, Charlottesville, Virginia; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia; Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia
| | - Christopher M Kramer
- Department of Medicine (Cardiology), University of Virginia Health System, Charlottesville, Virginia; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia.
| |
Collapse
|
9
|
Kosareva A, Abou-Elkacem L, Chowdhury S, Lindner JR, Kaufmann BA. Seeing the Invisible-Ultrasound Molecular Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:479-497. [PMID: 31899040 DOI: 10.1016/j.ultrasmedbio.2019.11.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 06/10/2023]
Abstract
Ultrasound molecular imaging has been developed in the past two decades with the goal of non-invasively imaging disease phenotypes on a cellular level not depicted on anatomic imaging. Such techniques already play a role in pre-clinical research for the assessment of disease mechanisms and drug effects, and are thought to in the future contribute to earlier diagnosis of disease, assessment of therapeutic effects and patient-tailored therapy in the clinical field. In this review, we first describe the chemical composition and structure as well as the in vivo behavior of the ultrasound contrast agents that have been developed for molecular imaging. We then discuss the strategies that are used for targeting of contrast agents to specific cellular targets and protocols used for imaging. Next we describe pre-clinical data on imaging of thrombosis, atherosclerosis and microvascular inflammation and in oncology, including the pathophysiological principles underlying the selection of targets in each area. Where applicable, we also discuss efforts that are currently underway for translation of this technique into the clinical arena.
Collapse
Affiliation(s)
- Alexandra Kosareva
- Cardiovascular Molecular Imaging, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Lotfi Abou-Elkacem
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford, California, USA
| | - Sayan Chowdhury
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford, California, USA
| | - Jonathan R Lindner
- Knight Cardiovascular Institute, Portland, Oregon, USA; Oregon National Primate Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Beat A Kaufmann
- Cardiovascular Molecular Imaging, Department of Biomedicine, University of Basel, Basel, Switzerland; Department of Cardiology, University Hospital and University of Basel, Basel, Switzerland.
| |
Collapse
|
10
|
Ultrasound molecular imaging: insights into cardiovascular pathology. J Echocardiogr 2020; 18:86-93. [PMID: 32056137 PMCID: PMC7244457 DOI: 10.1007/s12574-020-00463-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/16/2020] [Accepted: 01/27/2020] [Indexed: 01/06/2023]
Abstract
Similar to what has already occurred in cancer medicine, the management of cardiovascular conditions will likely be improved by non-invasive molecular imaging technologies that can provide earlier or more accurate diagnosis. These techniques are already having a positive impact in pre-clinical research by providing insight into pathophysiology or efficacy of new therapies. Contrast enhanced ultrasound (CEU) molecular imaging is a technique that relies on the ultrasound detection of targeted microbubble contrast agents to examine molecular or cellular events that occur at the blood pool-endothelial interface. CEU molecular imaging techniques have been developed that are able to provide unique information on atherosclerosis, ischemia reperfusion injury, angiogenesis, vascular inflammation, and thrombus formation. Accordingly, CEU has the potential to be used in a wide variety of circumstances to detect disease early or at the bedside, and to guide appropriate therapy based on vascular phenotype. This review will describe the physical basis for CEU molecular imaging, and the specific disease processes for the pre-clinical translational research experience.
Collapse
|
11
|
Cai X, Jiang Y, Lin M, Zhang J, Guo H, Yang F, Leung W, Xu C. Ultrasound-Responsive Materials for Drug/Gene Delivery. Front Pharmacol 2020; 10:1650. [PMID: 32082157 PMCID: PMC7005489 DOI: 10.3389/fphar.2019.01650] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/16/2019] [Indexed: 12/15/2022] Open
Abstract
Ultrasound is one of the most commonly used methods in the diagnosis and therapy of diseases due to its safety, deep penetration into tissue, and non-invasive nature. In the drug/gene delivery systems, ultrasound shows many advantages in terms of site-specific delivery and spatial release control of drugs/genes and attracts increasing attention. Microbubbles are the most well-known ultrasound-responsive delivery materials. Recently, nanobubbles, droplets, micelles, and nanoliposomes have been developed as novel carriers in this field. Herein, we review advances of novel ultrasound-responsive materials (nanobubbles, droplets, micelles and nanoliposomes) and discuss the challenges of ultrasound-responsive materials in delivery systems to boost the development of ultrasound-responsive materials as delivery carriers.
Collapse
Affiliation(s)
- Xiaowen Cai
- Key Laboratory of Molecular Target and Clinical Pharmacology, State Key Laboratory of Respiratory Disease, School of Pharmaceutical Sciences & Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yuan Jiang
- Key Laboratory of Molecular Target and Clinical Pharmacology, State Key Laboratory of Respiratory Disease, School of Pharmaceutical Sciences & Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Mei Lin
- Key Laboratory of Molecular Target and Clinical Pharmacology, State Key Laboratory of Respiratory Disease, School of Pharmaceutical Sciences & Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Jiyong Zhang
- Department of Pediatrics, Shenzhen Maternity and Child Health Care Hospital, Shenzhen, China
| | - Huanhuan Guo
- Key Laboratory of Molecular Target and Clinical Pharmacology, State Key Laboratory of Respiratory Disease, School of Pharmaceutical Sciences & Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Fanwen Yang
- Department of Biomedical Engineering, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou, China
| | - Wingnang Leung
- Asia-Pacific Institute of Aging Studies, Lingnan University, Tuen Mun, Hong Kong, Hong Kong
| | - Chuanshan Xu
- Key Laboratory of Molecular Target and Clinical Pharmacology, State Key Laboratory of Respiratory Disease, School of Pharmaceutical Sciences & Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| |
Collapse
|
12
|
Boutagy NE, Feher A, Alkhalil I, Umoh N, Sinusas AJ. Molecular Imaging of the Heart. Compr Physiol 2019; 9:477-533. [PMID: 30873600 DOI: 10.1002/cphy.c180007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Multimodality cardiovascular imaging is routinely used to assess cardiac function, structure, and physiological parameters to facilitate the diagnosis, characterization, and phenotyping of numerous cardiovascular diseases (CVD), as well as allows for risk stratification and guidance in medical therapy decision-making. Although useful, these imaging strategies are unable to assess the underlying cellular and molecular processes that modulate pathophysiological changes. Over the last decade, there have been great advancements in imaging instrumentation and technology that have been paralleled by breakthroughs in probe development and image analysis. These advancements have been merged with discoveries in cellular/molecular cardiovascular biology to burgeon the field of cardiovascular molecular imaging. Cardiovascular molecular imaging aims to noninvasively detect and characterize underlying disease processes to facilitate early diagnosis, improve prognostication, and guide targeted therapy across the continuum of CVD. The most-widely used approaches for preclinical and clinical molecular imaging include radiotracers that allow for high-sensitivity in vivo detection and quantification of molecular processes with single photon emission computed tomography and positron emission tomography. This review will describe multimodality molecular imaging instrumentation along with established and novel molecular imaging targets and probes. We will highlight how molecular imaging has provided valuable insights in determining the underlying fundamental biology of a wide variety of CVDs, including: myocardial infarction, cardiac arrhythmias, and nonischemic and ischemic heart failure with reduced and preserved ejection fraction. In addition, the potential of molecular imaging to assist in the characterization and risk stratification of systemic diseases, such as amyloidosis and sarcoidosis will be discussed. © 2019 American Physiological Society. Compr Physiol 9:477-533, 2019.
Collapse
Affiliation(s)
- Nabil E Boutagy
- Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, Section of Cardiovascular Medicine, New Haven, Connecticut, USA
| | - Attila Feher
- Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, Section of Cardiovascular Medicine, New Haven, Connecticut, USA
| | - Imran Alkhalil
- Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, Section of Cardiovascular Medicine, New Haven, Connecticut, USA
| | - Nsini Umoh
- Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, Section of Cardiovascular Medicine, New Haven, Connecticut, USA
| | - Albert J Sinusas
- Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, Section of Cardiovascular Medicine, New Haven, Connecticut, USA.,Yale University School of Medicine, Department of Radiology and Biomedical Imaging, New Haven, Connecticut, USA
| |
Collapse
|
13
|
Mohy-Ud-Din H, Boutagy NE, Stendahl JC, Zhuang ZW, Sinusas AJ, Liu C. Quantification of intramyocardial blood volume with 99mTc-RBC SPECT-CT imaging: A preclinical study. J Nucl Cardiol 2018; 25:2096-2111. [PMID: 28695406 PMCID: PMC5985225 DOI: 10.1007/s12350-017-0970-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 06/13/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Currently, there is no established non-invasive imaging approach to directly evaluate myocardial microcirculatory function in order to diagnose microvascular disease independent of co-existing epicardial disease. In this work, we developed a methodological framework for quantification of intramyocardial blood volume (IMBV) as a novel index of microcirculatory function with SPECT/CT imaging of 99mTc-labeled red blood cells (RBCs). METHODS Dual-gated myocardial SPECT/CT equilibrium imaging of 99mTc-RBCs was performed on twelve canines under resting conditions. Five correction schemes were studied: cardiac gating with no other corrections (CG), CG with attenuation correction (CG + AC), CG + AC with scatter correction (CG + AC + SC), dual cardiorespiratory gating with AC + SC (DG + AC + SC), and DG + AC + SC with partial volume correction (DG + AC + SC + PVC). Quantification of IMBV using each approach was evaluated in comparison to those obtained from all corrections. The in vivo SPECT estimates of IMBV values were validated against those obtained from ex vivo microCT imaging of the casted hearts. RESULTS The estimated IMBV with all corrections was 0.15 ± 0.03 for the end-diastolic phase and 0.11 ± 0.03 for the end-systolic phase. The cycle-dependent change in IMBV (ΔIMBV) with all corrections was 23.9 ± 8.6%. Schemes that applied no correction or partial correction resulted in significant over-estimation of IMBV and significant under-underestimation of ΔIMBV. Estimates of IMBV and ΔIMBV using all corrections were consistent with values reported in the literature using invasive techniques. In vivo SPECT estimates of IMBV strongly correlated (R2 ≥ 0.70) with ex vivo measures for the various correction schemes, while the fully corrected scheme yielded the smallest bias. CONCLUSIONS Non-invasive quantification of IMBV is feasible using 99mTc-RBCs SPECT/CT imaging, however, requires full compensation of physical degradation factors.
Collapse
Affiliation(s)
- Hassan Mohy-Ud-Din
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA.
- Shaukat Khanum Memorial Cancer Hospital and Research Center, 7-A, Block R-3, Johar Town, Lahore, 54000, Pakistan.
| | - Nabil E Boutagy
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - John C Stendahl
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Zhen W Zhuang
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Albert J Sinusas
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Chi Liu
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA.
| |
Collapse
|
14
|
Senior R, Becher H, Monaghan M, Agati L, Zamorano J, Vanoverschelde JL, Nihoyannopoulos P, Edvardsen T, Lancellotti P. Clinical practice of contrast echocardiography: recommendation by the European Association of Cardiovascular Imaging (EACVI) 2017. Eur Heart J Cardiovasc Imaging 2018; 18:1205-1205af. [PMID: 28950366 DOI: 10.1093/ehjci/jex182] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 06/20/2017] [Indexed: 12/16/2022] Open
Abstract
Contrast echocardiography is widely used in cardiology. It is applied to improve image quality, reader confidence and reproducibility both for assessing left ventricular (LV) structure and function at rest and for assessing global and regional function in stress echocardiography. The use of contrast in echocardiography has now extended beyond cardiac structure and function assessment to evaluation of perfusion both of the myocardium and of the intracardiac structures. Safety of contrast agents have now been addressed in large patient population and these studies clearly established its excellent safety profile. This document, based on clinical trials, randomized and multicentre studies and published clinical experience, has established clear recommendations for the use of contrast in various clinical conditions with evidence-based protocols.
Collapse
Affiliation(s)
- Roxy Senior
- Department of Cardiology, Royal Brompton Hospital, Imperial College, Sydney Street, London SW3 6NP, UK
| | | | | | | | - Jose Zamorano
- CIBERCV, University Hospital Ramón y Cajal, Madrid, Spain
| | | | | | | | - Patrizio Lancellotti
- University of Liege Hospital, GIGA Cardiovascular Science, Heart Valve Clinic, Imaging Cardiology, Liege, Belgium
| | | | | |
Collapse
|
15
|
Gliemann L, Mortensen SP, Hellsten Y. Methods for the determination of skeletal muscle blood flow: development, strengths and limitations. Eur J Appl Physiol 2018; 118:1081-1094. [PMID: 29756164 DOI: 10.1007/s00421-018-3880-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/26/2018] [Indexed: 11/26/2022]
Abstract
Since the first measurements of limb blood flow at rest and during nerve stimulation were conducted in the late 1800s, a number of methods have been developed for the determination of limb and skeletal muscle blood flow in humans. The methods, which have been applied in the study of aspects such as blood flow regulation, oxygen uptake and metabolism, differ in terms of strengths and degree of limitations but most have advantages for specific settings. The purpose of this review is to describe the origin and the basic principles of the methods, important aspects and requirements of the procedures. One of the earliest methods, venous occlusion plethysmography, is a noninvasive method which still is extensively used and which provides similar values as other more direct blood flow methods such as ultrasound Doppler. The constant infusion thermodilution method remains the most appropriate for the determination of blood flow during maximal exercise. For resting blood flow and light-to-moderate exercise, the non-invasive ultrasound Doppler methodology, if handled by a skilled operator, is recommendable. Positron emission tomography with radiolabeled water is an advanced method which requires highly sophisticated equipment and allows for the determination of muscle-specific blood flow, regional blood flows and estimate of blood flow heterogeneity within a muscle. Finally, the contrast-enhanced ultrasound method holds promise for assessment of muscle-specific blood flow, but the interpretation of the data obtained remains uncertain. Currently lacking is high-resolution methods for continuous visualization and monitoring of the skeletal muscle microcirculation in humans.
Collapse
Affiliation(s)
- Lasse Gliemann
- Department of Nutrition Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Stefan P Mortensen
- Department of Cardiovascular and Renal Research, University of Southern Denmark, Odense, Denmark
| | - Ylva Hellsten
- Department of Nutrition Exercise and Sports, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
16
|
de Waard GA, Cook CM, van Royen N, Davies JE. Coronary autoregulation and assessment of stenosis severity without pharmacological vasodilation. Eur Heart J 2017; 39:4062-4071. [DOI: 10.1093/eurheartj/ehx669] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/20/2017] [Indexed: 01/10/2023] Open
Affiliation(s)
- Guus A de Waard
- Department of Cardiology, VU University Medical Center, de Boelelaan 1117, HV Amsterdam, The Netherlands
- National Heart and Lung Institute - Cardiovascular Science, Imperial College London, The Hammersmith Hospital, Du Cane Road, London, UK
| | - Christopher M Cook
- National Heart and Lung Institute - Cardiovascular Science, Imperial College London, The Hammersmith Hospital, Du Cane Road, London, UK
| | - Niels van Royen
- Department of Cardiology, VU University Medical Center, de Boelelaan 1117, HV Amsterdam, The Netherlands
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, GA, Nijmegen, The Netherlands
| | - Justin E Davies
- National Heart and Lung Institute - Cardiovascular Science, Imperial College London, The Hammersmith Hospital, Du Cane Road, London, UK
| |
Collapse
|
17
|
Feher A, Sinusas AJ. Quantitative Assessment of Coronary Microvascular Function: Dynamic Single-Photon Emission Computed Tomography, Positron Emission Tomography, Ultrasound, Computed Tomography, and Magnetic Resonance Imaging. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006427. [PMID: 28794138 DOI: 10.1161/circimaging.117.006427] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 06/26/2017] [Indexed: 01/09/2023]
Abstract
A healthy, functional microcirculation in combination with nonobstructed epicardial coronary arteries is the prerequisite of normal myocardial perfusion. Quantitative assessment in myocardial perfusion and determination of absolute myocardial blood flow can be achieved noninvasively using dynamic imaging with multiple imaging modalities. Extensive evidence supports the clinical value of noninvasively assessing indices of coronary flow for diagnosing coronary microvascular dysfunction; in certain diseases, the degree of coronary microvascular impairment carries important prognostic relevance. Although, currently positron emission tomography is the most commonly used tool for the quantification of myocardial blood flow, other modalities, including single-photon emission computed tomography, computed tomography, magnetic resonance imaging, and myocardial contrast echocardiography, have emerged as techniques with great promise for determination of coronary microvascular dysfunction. The following review will describe basic concepts of coronary and microvascular physiology, review available modalities for dynamic imaging for quantitative assessment of coronary perfusion and myocardial blood flow, and discuss their application in distinct forms of coronary microvascular dysfunction.
Collapse
Affiliation(s)
- Attila Feher
- From the Section of Cardiovascular Medicine, Department of Internal Medicine (A.F., A.J.S.) and Department of Radiology and Biomedical Imaging (A.J.S.), Yale University School of Medicine, New Haven, CT
| | - Albert J Sinusas
- From the Section of Cardiovascular Medicine, Department of Internal Medicine (A.F., A.J.S.) and Department of Radiology and Biomedical Imaging (A.J.S.), Yale University School of Medicine, New Haven, CT.
| |
Collapse
|
18
|
Kim DY, Choi JH, Hong GR, Rim SJ, Kim JY, Lee SC, Sohn IS, Chung WJ, Seo HS, Yoon SJ, Cho KI, Choi SW, Lee KJ. Impact of Contrast Echocardiography on Assessment of Ventricular Function and Clinical Diagnosis in Routine Clinical Echocardiography: Korean Multicenter Study. J Cardiovasc Ultrasound 2017; 25:28-33. [PMID: 28400933 PMCID: PMC5385314 DOI: 10.4250/jcu.2017.25.1.28] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 03/21/2017] [Accepted: 03/21/2017] [Indexed: 11/29/2022] Open
Abstract
Background Fundamental echocardiography has some drawbacks in patients with difficult-to-image echocardiograms. The aim of this study is to evaluate impact of contrast echocardiography (CE) on ventricular function assessment and clinical diagnosis in routine clinical echocardiography. Methods Two hundred sixty patients were prospectively enrolled over 3 years in 12 medical centers in Korea. General image quality, the number of distinguishable segments, ability to assess regional wall motion, left ventricular (LV) apex and right ventricle (RV) visualization, LV ejection fraction, changes in diagnostic or treatment plan were documented after echocardiography with and without ultrasound contrast agent. Results Poor or uninterpretable general image was 31% before contrast use, and decreased to 2% (p<0.05) after contrast use. The average number of visualized LV segments was 9.53 before contrast use, and increased to 14.46 (p<0.001) after contrast use. The percentage of poor or not seen LV regional wall motion was decreased from 28.4% to 3.5% (p<0.001). The percentage of poor or not seen LV apex and RV was decreased from 49.4% to 2.4% (p<0.001), from 30.5% to 10.5% (p<0.001), respectively. Changes in diagnostic procedure and treatment plan after CE were 30% and 29.6%, respectively. Conclusion Compared to fundamental echocardiography, CE impacted LV function assessment and clinical decision making in Korean patients who undergo routine echocardiography.
Collapse
Affiliation(s)
- Doo-Youp Kim
- Department of Internal Medicine, Bongseng Memorial Hospital, Busan, Korea
| | - Jung-Hyun Choi
- Division of Cardiology, Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Geu-Ru Hong
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Se-Joong Rim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jang-Young Kim
- Division of Cardiology, Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Sang-Chol Lee
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Il-Suk Sohn
- Department of Cardiology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Wook-Jin Chung
- Division of Cardiology, Heart Center, Gachon University Gil Hospital, Gachon University School of Medicine, Incheon, Korea
| | - Hye-Sun Seo
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital, Bucheon, Korea
| | - Se-Jung Yoon
- Division of Cardiology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Kyoung-Im Cho
- Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Korea
| | - Si-Wan Choi
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Kyung-Jin Lee
- Division of Cardiology, Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea
| |
Collapse
|
19
|
Keske MA, Dwyer RM, Russell RD, Blackwood SJ, Brown AA, Hu D, Premilovac D, Richards SM, Rattigan S. Regulation of microvascular flow and metabolism: An overview. Clin Exp Pharmacol Physiol 2016; 44:143-149. [DOI: 10.1111/1440-1681.12688] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 10/07/2016] [Accepted: 10/21/2016] [Indexed: 01/12/2023]
Affiliation(s)
- Michelle A Keske
- Menzies Institute for Medical Research University of Tasmania Hobart Tas. Australia
| | - Renee M Dwyer
- School of Medicine University of Tasmania Hobart Tas. Australia
| | - Ryan D Russell
- Menzies Institute for Medical Research University of Tasmania Hobart Tas. Australia
| | - Sarah J Blackwood
- Menzies Institute for Medical Research University of Tasmania Hobart Tas. Australia
| | - Aascha A Brown
- Menzies Institute for Medical Research University of Tasmania Hobart Tas. Australia
| | - Donghua Hu
- Menzies Institute for Medical Research University of Tasmania Hobart Tas. Australia
| | - Dino Premilovac
- School of Medicine University of Tasmania Hobart Tas. Australia
| | | | - Stephen Rattigan
- Menzies Institute for Medical Research University of Tasmania Hobart Tas. Australia
| |
Collapse
|
20
|
McDiarmid AK, Plein S, Ross HJ. Emerging imaging techniques after cardiac transplantation. J Heart Lung Transplant 2016; 35:1399-1411. [PMID: 27523792 DOI: 10.1016/j.healun.2016.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/13/2016] [Accepted: 06/22/2016] [Indexed: 10/21/2022] Open
Abstract
Improvements in survival after cardiac transplantation have in part been driven by improved graft surveillance. Graft surveillance relies mainly on 3 techniques: coronary angiography, endomyocardial biopsy and echocardiography. Developments in invasive and non-invasive imaging technology have revolutionized assessment of the heart in both health and disease, offering new insights into tissue composition and myocardial metabolism. Herein we aim to review the strengths and weaknesses of these techniques, and summarize the evidence in the following 5 fields of cardiac imaging after transplantation: cardiovascular magnetic resonance; computed tomography; positron emission tomography; single-photon emission computed tomography; and optical coherence tomography and molecular imaging techniques.
Collapse
Affiliation(s)
- Adam K McDiarmid
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada; Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Heather J Ross
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
21
|
Kopechek JA, Carson AR, McTiernan CF, Chen X, Klein EC, Villanueva FS. Cardiac Gene Expression Knockdown Using Small Inhibitory RNA-Loaded Microbubbles and Ultrasound. PLoS One 2016; 11:e0159751. [PMID: 27471848 PMCID: PMC4966949 DOI: 10.1371/journal.pone.0159751] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 07/07/2016] [Indexed: 01/29/2023] Open
Abstract
RNA interference has potential therapeutic value for cardiac disease, but targeted delivery of interfering RNA is a challenge. Custom designed microbubbles, in conjunction with ultrasound, can deliver small inhibitory RNA to target tissues in vivo. The efficacy of cardiac RNA interference using a microbubble-ultrasound theranostic platform has not been demonstrated in vivo. Therefore, our objective was to test the hypothesis that custom designed microbubbles and ultrasound can mediate effective delivery of small inhibitory RNA to the heart. Microbubble and ultrasound mediated cardiac RNA interference was tested in transgenic mice displaying cardiac-restricted luciferase expression. Luciferase expression was assayed in select tissues of untreated mice (n = 14). Mice received intravenous infusion of cationic microbubbles bearing small inhibitory RNA directed against luciferase (n = 9) or control RNA (n = 8) during intermittent cardiac-directed ultrasound at mechanical index of 1.6. Simultaneous echocardiography in a separate group of mice (n = 3) confirmed microbubble destruction and replenishment during treatment. Three days post treatment, cardiac luciferase messenger RNA and protein levels were significantly lower in ultrasound-treated mice receiving microbubbles loaded with small inhibitory RNA directed against luciferase compared to mice receiving microbubbles bearing control RNA (23±7% and 33±7% of control mice, p<0.01 and p = 0.03, respectively). Passive cavitation detection focused on the heart confirmed that insonification resulted in inertial cavitation. In conclusion, small inhibitory RNA-loaded microbubbles and ultrasound directed at the heart significantly reduced the expression of a reporter gene. Ultrasound-targeted destruction of RNA-loaded microbubbles may be an effective image-guided strategy for therapeutic RNA interference in cardiac disease.
Collapse
Affiliation(s)
- Jonathan A. Kopechek
- Dept. of Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
- Dept. of Bioengineering, University of Louisville, Louisville, KY, United States of America
| | - Andrew R. Carson
- Dept. of Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Charles F. McTiernan
- Dept. of Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Xucai Chen
- Dept. of Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Edwin C. Klein
- Dept. of Laboratory Animal Resources, University of Pittsburgh, Pittsburgh, PA, United States of America
| | | |
Collapse
|
22
|
Huynh E, Rajora MA, Zheng G. Multimodal micro, nano, and size conversion ultrasound agents for imaging and therapy. WILEY INTERDISCIPLINARY REVIEWS-NANOMEDICINE AND NANOBIOTECHNOLOGY 2016; 8:796-813. [PMID: 27006001 DOI: 10.1002/wnan.1398] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 01/30/2016] [Accepted: 02/02/2016] [Indexed: 12/20/2022]
Abstract
Ultrasound (US) is one of the most commonly used clinical imaging techniques. However, the use of US and US-based intravenous agents extends far beyond imaging. In particular, there has been a surge in the fabrication of multimodality US contrast agents and theranostic US agents for cancer imaging and therapy. The unique interaction of US waves with microscale and nanoscale agents has attracted much attention in the development of contrast agents and drug-delivery vehicles. The dimensions of the agent not only dictate how it behaves in vivo, but also how it interacts with US for imaging and drug delivery. Furthermore, these agents are also unique due to their ability to convert from the nanoscale to the microscale and vice versa, having imaging and therapeutic utility in both dimensions. Here, we review multimodality and multifunctional US-based agents, according to their size, and also highlight recent developments in size conversion US agents. WIREs Nanomed Nanobiotechnol 2016, 8:796-813. doi: 10.1002/wnan.1398 For further resources related to this article, please visit the WIREs website.
Collapse
Affiliation(s)
- Elizabeth Huynh
- Princess Margaret Cancer Center and Techna Institute, University Health Network, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Maneesha A Rajora
- Princess Margaret Cancer Center and Techna Institute, University Health Network, Toronto, Ontario, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Gang Zheng
- Princess Margaret Cancer Center and Techna Institute, University Health Network, Toronto, Ontario, Canada. .,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada. .,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
23
|
Orde S, McLean A. Bedside myocardial perfusion assessment with contrast echocardiography. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:58. [PMID: 26976127 PMCID: PMC4791932 DOI: 10.1186/s13054-016-1215-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency medicine 2016. Other selected articles can be found online at http://www.biomedcentral.com/collections/annualupdate2016. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.
Collapse
Affiliation(s)
- Sam Orde
- Nepean Hospital, Intensive Care Unit, 2747, Sydney, NSW, Australia.
| | - Anthony McLean
- Nepean Hospital, Intensive Care Unit, 2747, Sydney, NSW, Australia.,University of Sydney, Sydney Medical School, Sydney, Australia
| |
Collapse
|
24
|
Owen J, Stride E. Technique for the Characterization of Phospholipid Microbubbles Coatings by Transmission Electron Microscopy. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:3253-8. [PMID: 26361999 DOI: 10.1016/j.ultrasmedbio.2015.07.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 07/16/2015] [Accepted: 07/24/2015] [Indexed: 05/21/2023]
Abstract
Gas microbubbles stabilized by a surfactant or polymer coating are of considerable clinical interest because of their imaging and drug delivery potential under ultrasound exposure. The utility of microbubbles for a given application is intrinsically linked to their structure and stability. These in turn are highly sensitive to coating composition and fabrication techniques. Various methods including fluorescence and atomic force microscopy have been applied to characterize microbubble properties, but direct observation of coating structure at the nanoscale still poses a considerable challenge. Here we describe a transmission electron microscopy (TEM) technique to observe the surface of microbubbles. Images from a series of phospholipid-coated microbubble systems, including those decorated with nanoparticles, are presented. They indicate that the technique enables visualization of the coating structure, in particular lipid discontinuities and nanoparticle distribution. This information can be used to better understand how microbubble surface structure relates to formulation and/or processing technique and ultimately to functionality.
Collapse
Affiliation(s)
- Joshua Owen
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Eleanor Stride
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK.
| |
Collapse
|
25
|
Kaul S. Assessment of Myocardial Collateral Blood Flow with Contrast Echocardiography. Korean Circ J 2015; 45:351-6. [PMID: 26413100 PMCID: PMC4580691 DOI: 10.4070/kcj.2015.45.5.351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 04/02/2015] [Indexed: 12/02/2022] Open
Abstract
Humans have pre-formed collateral vessels that enlarge with ischemia. In addition, new vessels can be formed within ischemic zones from pre-formed endocardial arcades of vessels providing rich collateral flow. Collateral flow under resting conditions (if >25% of normal) is enough to maintain myocardial viability, but may be insufficient to prevent myocardial ischemia under stress. Coronary angiography is a poor tool for collateral flow assessment. Myocardial contrast echocardiography is arguably the gold standard for experimental and clinical measurement of collateral flow. This review describes several experimental and clinical studies that highlight the importance of the collateral circulation in coronary artery disease.
Collapse
Affiliation(s)
- Sanjiv Kaul
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
26
|
Zeisbrich M, Kihm LP, Drüschler F, Zeier M, Schwenger V. When is contrast-enhanced sonography preferable over conventional ultrasound combined with Doppler imaging in renal transplantation? Clin Kidney J 2015; 8:606-14. [PMID: 26413289 PMCID: PMC4581388 DOI: 10.1093/ckj/sfv070] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 07/10/2015] [Indexed: 12/18/2022] Open
Abstract
Conventional ultrasound in combination with colour Doppler imaging is still the standard diagnostic procedure for patients after renal transplantation. However, while conventional ultrasound in combination with Doppler imaging can diagnose renal artery stenosis and vein thrombosis, it is not possible to display subtle microvascular tissue perfusion, which is crucial for the evaluation of acute and chronic allograft dysfunctions. In contrast, real-time contrast-enhanced sonography (CES) uses gas-filled microbubbles not only to visualize but also to quantify renal blood flow and perfusion even in the small renal arterioles and capillaries. It is an easy to perform and non-invasive imaging technique that augments diagnostic capabilities in patients after renal transplantation. Specifically in the postoperative setting, CES has been shown to be superior to conventional ultrasound in combination with Doppler imaging in uncovering even subtle microvascular disturbances in the allograft perfusion. In addition, quantitative perfusion parameters derived from CES show predictive capability regarding long-term kidney function.
Collapse
Affiliation(s)
- Markus Zeisbrich
- Department of Nephrology , University Hospital , Heidelberg , Germany
| | - Lars P Kihm
- Department of Nephrology , University Hospital , Heidelberg , Germany
| | - Felix Drüschler
- Department of Nephrology , University Hospital , Heidelberg , Germany
| | - Martin Zeier
- Department of Nephrology , University Hospital , Heidelberg , Germany
| | - Vedat Schwenger
- Department of Nephrology , University Hospital , Heidelberg , Germany
| |
Collapse
|
27
|
Steinl DC, Kaufmann BA. Ultrasound imaging for risk assessment in atherosclerosis. Int J Mol Sci 2015; 16:9749-69. [PMID: 25938969 PMCID: PMC4463615 DOI: 10.3390/ijms16059749] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 04/09/2015] [Accepted: 04/09/2015] [Indexed: 01/28/2023] Open
Abstract
Atherosclerosis and its consequences like acute myocardial infarction or stroke are highly prevalent in western countries, and the incidence of atherosclerosis is rapidly rising in developing countries. Atherosclerosis is a disease that progresses silently over several decades before it results in the aforementioned clinical consequences. Therefore, there is a clinical need for imaging methods to detect the early stages of atherosclerosis and to better risk stratify patients. In this review, we will discuss how ultrasound imaging can contribute to the detection and risk stratification of atherosclerosis by (a) detecting advanced and early plaques; (b) evaluating the biomechanical consequences of atherosclerosis in the vessel wall;
Collapse
Affiliation(s)
- David C Steinl
- Department of Biomedicine, University Hospital Basel, Hebelstrasse 20, Basel 4031, Switzerland.
| | - Beat A Kaufmann
- Division of Cardiology, University Hospital Basel, Petersgraben 4, Basel 4031, Switzerland.
| |
Collapse
|
28
|
Abstract
Microbubbles are an excellent intravascular tracer, and both the rate of myocardial opacification (analogous to coronary microvascular perfusion) and contrast intensity (analogous to myocardial blood volume) provide unique insights into myocardial perfusion. A strong evidence base has been accumulated to show comparability with nuclear perfusion imaging and incremental diagnostic and prognostic value relative to wall motion analysis. This technique also provides the possibility to measure myocardial perfusion at the bedside. Despite all of these advantages, the technique is complicated, technically challenging, and has failed to scale legislative and financial hurdles. The development of targeted imaging and therapeutic interventions will hopefully rekindle interest in this interesting modality.
Collapse
Affiliation(s)
- Faraz Pathan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Thomas H Marwick
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
| |
Collapse
|
29
|
Cardozo S, Gunasekaran P, Patel H, McGorisk T, Toosi M, Faraz H, Zalawadiya S, Alesh I, Kottam A, Afonso L. Is bacteriostatic saline superior to normal saline as an echocardiographic contrast agent? Int J Cardiovasc Imaging 2014; 30:1483-9. [PMID: 25017710 DOI: 10.1007/s10554-014-0493-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 07/05/2014] [Indexed: 11/27/2022]
Abstract
Objective data on the performance characteristics and physical properties of commercially available saline formulations [normal saline (NS) vs. bacteriostatic normal saline (bNS)] are sparse. This study sought to compare the in vitro physical properties and in vivo characteristics of two commonly employed echocardiographic saline contrast agents in an attempt to assess superiority. Nineteen patients undergoing transesophageal echocardiograms were each administered agitated regular NS and bNS injections in random order and in a blinded manner according to a standardized protocol. Video time-intensity (TI) curves were constructed from a representative region of interest, placed paraseptally within the right atrium, in the bicaval view. TI curves were analyzed for maximal plateau acoustic intensity (Vmax, dB) and dwell time (DT, s), defined as time duration between onset of Vmax and decay of video intensity below clinically useful levels, reflecting the duration of homogenous opacification of the right atrium. To further characterize the physical properties of the bubbles in vitro, fixed aliquots of similarly agitated saline were injected into a glass well slide-cover slip assembly and examined using an optical microscope to determine bubble diameter in microns (µm) and concentration [bubble count/high power field (hpf)]. A higher acoustic intensity (a less negative dB level), higher bubble concentration and longer DT were considered properties of a superior contrast agent. For statistical analysis, a paired t test was conducted to evaluate the differences in means of Vmax and DT. Compared to NS, bNS administration was associated with superior opacification (video intensity -8.69 ± 4.7 vs. -10.46 ± 4.1 dB, P = 0.002), longer DT (17.3 ± 6.1 vs. 10.2 ± 3.7 s) in vivo and smaller mean bubble size (43.4 vs. 58.6 μm) and higher bubble concentration (1,002 vs. 298 bubble/hpf) in vitro. bNS provides higher intensity and more sustained opacification of the right atrium compared to NS. Higher bubble concentration and stability appear to be additional desirable rheological characteristics favoring bNS as a contrast agent.
Collapse
Affiliation(s)
- Shaun Cardozo
- Division of Cardiology, Department of Internal Medicine, Detroit Medical Center, Harper University Hospital, Wayne State University, 3990 John R, 8 Brush, Detroit, MI, 48201, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Kaul S. The "no reflow" phenomenon following acute myocardial infarction: mechanisms and treatment options. J Cardiol 2014; 64:77-85. [PMID: 24799155 DOI: 10.1016/j.jjcc.2014.03.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 03/27/2014] [Indexed: 01/24/2023]
Abstract
If 'no reflow' is observed within 45min of reperfusion using balloon angioplasty or stent, it is probably related to microthromboemboli, which may also contribute to the extension of the 'no reflow' zone by converting 'low reflow' areas into necrotic ones even when reperfusion is achieved more than 45min after the onset of coronary occlusion. Since 'no reflow' is noted when 45min of coronary occlusion has elapsed even in the absence of a thrombus, 'no reflow' late after reperfusion is predominantly due to tissue necrosis and unlikely to be resolved unless methods to reduce infarct size are used. Attempts at reducing the intracoronary thrombus burden during a coronary procedure for acute myocardial infarction (AMI) have been shown to reduce 'no reflow' and improve clinical outcome, as has the use of potent antithrombotic agents. Drugs that can reduce infarct size, when given intracoronary or intravenous in conjunction with a coronary intervention during AMI can also reduce 'no reflow' and improve outcomes in patients with AMI. The prognostic importance of 'no reflow' post-AMI is related to its close correspondence with infarct size. Although several imaging and non-imaging methods have been used to assess 'no reflow' or 'low reflow' myocardial contrast echocardiography remains the ideal method for its assessment both in and outside the cardiac catheterization laboratory.
Collapse
Affiliation(s)
- Sanjiv Kaul
- Knight Cardiovascular Institute UHN-62, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, USA.
| |
Collapse
|
31
|
Schlesinger D, Benedict S, Diederich C, Gedroyc W, Klibanov A, Larner J. MR-guided focused ultrasound surgery, present and future. Med Phys 2014; 40:080901. [PMID: 23927296 DOI: 10.1118/1.4811136] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
MR-guided focused ultrasound surgery (MRgFUS) is a quickly developing technology with potential applications across a spectrum of indications traditionally within the domain of radiation oncology. Especially for applications where focal treatment is the preferred technique (for example, radiosurgery), MRgFUS has the potential to be a disruptive technology that could shift traditional patterns of care. While currently cleared in the United States for the noninvasive treatment of uterine fibroids and bone metastases, a wide range of clinical trials are currently underway, and the number of publications describing advances in MRgFUS is increasing. However, for MRgFUS to make the transition from a research curiosity to a clinical standard of care, a variety of challenges, technical, financial, clinical, and practical, must be overcome. This installment of the Vision 20∕20 series examines the current status of MRgFUS, focusing on the hurdles the technology faces before it can cross over from a research technique to a standard fixture in the clinic. It then reviews current and near-term technical developments which may overcome these hurdles and allow MRgFUS to break through into clinical practice.
Collapse
Affiliation(s)
- David Schlesinger
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia 22908, USA.
| | | | | | | | | | | |
Collapse
|
32
|
Trindade MLZHD, Vieira MLC, Rodrigues ACT, Francisco Neto MJ, Fischer CH, Morhy SS. Contrast echocardiography in myocardial infarction. EINSTEIN-SAO PAULO 2014; 11:392-7. [PMID: 24136771 PMCID: PMC4878603 DOI: 10.1590/s1679-45082013000300023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 06/09/2013] [Indexed: 12/11/2022] Open
Abstract
The contrast agents used in ultrasound are approved for several clinical situations. New echocardiographic techniques, such as harmonic imaging and power pulse inversion imaging, can improve the visualization of microbubbles. In this article we discuss the early development of contrast echocardiography, new technologies that help improve image acquisition and its practical role in the assessment of myocardial infarction.
Collapse
|
33
|
Declèves AE, Rychak JJ, Smith DJ, Sharma K. Effects of high-fat diet and losartan on renal cortical blood flow using contrast ultrasound imaging. Am J Physiol Renal Physiol 2013; 305:F1343-51. [PMID: 24049144 DOI: 10.1152/ajprenal.00326.2013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Obesity-related kidney disease occurs as a result of complex interactions between metabolic and hemodynamic effects. Changes in microvascular perfusion may play a major role in kidney disease; however, these changes are difficult to assess in vivo. Here, we used perfusion ultrasound imaging to evaluate cortical blood flow in a mouse model of high-fat diet-induced kidney disease. C57BL/6J mice were randomized to a standard diet (STD) or a high-fat diet (HFD) for 30 wk and then treated either with losartan or a placebo for an additional 6 wk. Noninvasive ultrasound perfusion imaging of the kidney was performed during infusion of a microbubble contrast agent. Blood flow within the microvasculature of the renal cortex and medulla was derived from imaging data. An increase in the time required to achieve full cortical perfusion was observed for HFD mice relative to STD. This was reversed following treatment with losartan. These data were concurrent with an increased glomerular filtration rate in HFD mice compared with STD- or HFD-losartan-treated mice. Losartan treatment also abrogated fibro-inflammatory disease, assessed by markers at the protein and messenger level. Finally, a reduction in capillary density was found in HFD mice, and this was reversed upon losartan treatment. This suggests that alterations in vascular density may be responsible for the elevated perfusion time observed by imaging. These data demonstrate that ultrasound contrast imaging is a robust and sensitive method for evaluating changes in renal microvascular perfusion and that cortical perfusion time may be a useful parameter for evaluating obesity-related renal disease.
Collapse
Affiliation(s)
- Anne-Emilie Declèves
- Center for Renal Translational Medicine, Division of Nephrology-Hypertension, 405 Stein Clinical Research Bldg., MC 0711, Univ. of California San Diego, La Jolla, CA, 92093.
| | | | | | | |
Collapse
|
34
|
Renal retention of lipid microbubbles: a potential mechanism for flank discomfort during ultrasound contrast administration. J Am Soc Echocardiogr 2013; 26:1474-81. [PMID: 24035699 DOI: 10.1016/j.echo.2013.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND The etiology of flank pain sometimes experienced during the administration of ultrasound contrast agents is unknown. The aim of this study was to investigate whether microbubble ultrasound contrast agents are retained within the renal microcirculation, which could lead to either flow disturbance or local release of vasoactive and pain mediators downstream from complement activation. METHODS Retention of lipid-shelled microbubbles in the renal microcirculation of mice was assessed by confocal fluorescent microscopy and contrast-enhanced ultrasound imaging with dose-escalating intravenous injection. Studies were performed with size-segregated microbubbles to investigate physical entrapment, after glycocalyx degradation and in wild-type and C3-deficient mice to investigate complement-mediated retention. Urinary bradykinin was measured before and after microbubble administrations. Renal contrast-enhanced ultrasound in human subjects (n = 13) was performed 7 to 10 min after the completion of lipid microbubble administration. RESULTS In both mice and humans, microbubble retention was detected in the renal cortex by persistent contrast-enhanced ultrasound signal enhancement. Microbubble retention in mice was linearly related to dose and occurred almost exclusively in cortical glomerular microvessels. Microbubble retention did not affect microsphere-derived renal blood flow. Microbubble retention was not influenced by glycocalyx degradation or by microbubble size, thereby excluding lodging, but was reduced by 90% (P < .01) in C3-deficient mice. Urinary bradykinin increased by 65% 5 min after microbubble injection. CONCLUSIONS Lipid-shelled microbubbles are retained in the renal cortex because of complement-mediated interactions with glomerular microvascular endothelium. Microbubble retention does not adversely affect renal perfusion but does generate complement-related intermediates that are known to mediate nociception and could be responsible for flank pain.
Collapse
|
35
|
Yi K, Ji S, Kim J, Yoon J, Choi M. Contrast-enhanced ultrasound analysis of renal perfusion in normal micropigs. J Vet Sci 2013; 13:311-4. [PMID: 23000588 PMCID: PMC3467407 DOI: 10.4142/jvs.2012.13.3.311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Contrast-enhanced ultrasound is one of method for evaluating renal perfusion. The purpose of this project was to assess perfusion patterns and dynamics in normal micropig kidney using ultrasonographic contrast media. Eight young healthy micropigs were included in this study. Micropigs were anesthetized with propofol and received an intravenous bolus of microbubble contrast media through an ear vein. Time/mean pixel value (MPV) curves were generated for selected regions in the right renal cortex and medulla. The parenchyma was enhanced in two phases. The cortex was first enhanced followed by a more gradual enhancement of the medulla. A significant difference in perfusion was detected between the cortex and medulla. Following the bolus injection, the average upslope was 0.68 ± 0.27 MPV/sec, downslope was -0.27 ± 0.13 MPV/sec, baseline was 73.9 ± 16.5 MPV, peak was 84.6 ± 17.2 MPV, and time-to-peak (from injection) was 17.5 ± 6.6 sec for the cortex. For the medulla, the average upslope was 0.50 ± 0.24 MPV/sec, downslope was -0.12 ± 0.06 MPV/sec, baseline was 52.7 ± 7.0 MPV, peak was 65.2 ± 9.3 MPV, and time-to-peak (from injection) was 27.5 ± 5.0 sec. These data can be used as normal reference values for studying young micropigs.
Collapse
Affiliation(s)
- Kangjae Yi
- Department of Veterinary Medical Imaging, and Research Institute for Veterinary Science, College of Veterinary Medicine, Seoul National University, Seoul 151-742, Korea
| | | | | | | | | |
Collapse
|
36
|
Cosyns B, Roossens B, Hernot S, El Haddad P, Lignian H, Pierard L, Lancellotti P. Use of contrast echocardiography in intensive care and at the emergency room. Curr Cardiol Rev 2013; 7:157-62. [PMID: 22758614 PMCID: PMC3263480 DOI: 10.2174/157340311798220467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 03/04/2011] [Accepted: 04/07/2011] [Indexed: 12/13/2022] Open
Abstract
Bedside echocardiography in emergency room (ER) or in intensive care unit (ICU) is an important tool for managing critically ill patients, to obtain a timely accurate diagnosis and to immediately stratify the risk to the patient’s life. It may also render invasive monitoring unnecessary. In these patients, contrast echocardiography may improve quality of imaging and also may provide additional information, especially regarding myocardial perfusion in those with suspected coronary artery disease. This article focuses on the principle of contrast echocardiography and the clinical information that can be obtained according to the most frequent presentations in ER and ICU.
Collapse
Affiliation(s)
- Bernard Cosyns
- UZ Brussel, Cardiology, Free University of Brussels, Belgium.
| | | | | | | | | | | | | |
Collapse
|
37
|
Chuang YH, Cheng PW, Li PC. Combining radiation force with cavitation for enhanced sonothrombolysis. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2013; 60:97-104. [PMID: 23287916 DOI: 10.1109/tuffc.2013.2541] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The use of acoustic radiation force has been suggested for enhancing the delivery of therapeutic substances, whereas sonothrombolysis has been developed for years as treatment by itself, or in combination with thrombolytic agents or ultrasound contrast agents. We have examined the efficacy of using acoustic radiation force to enhance the targeting of microbubbles in cavitation-induced sonothrombolysis in a flow phantom system. A clot was targeted by microbubbles using avidin-biotin binding, and the process was observed using a confocal microscope. We found that the experimental group in which radiation force was combined with cavitation showed an additional 3% to 9% weight reduction of the thrombus relative to the cavitation group. We also found that the fluorescence intensity of the clot increased with the microbubble concentration at each acoustic setting. Microbubbles traveled 10 to 20 μm further than the control group after being exposed to radiation force, cavitation, or both. These observations confirm that radiation force helps microbubbles to distribute into a clot (as does cavitation). Therefore, combining radiation force with cavitation would provide additional thrombolysis effects (based on clot weight measurements) relative to cavitation alone. A local delivery method based on acoustic radiation force has the potential to improve the safety and efficacy of sonothrombolysis.
Collapse
Affiliation(s)
- Yueh-Hsun Chuang
- Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan
| | | | | |
Collapse
|
38
|
Gregg CL, Butcher JT. Quantitative in vivo imaging of embryonic development: opportunities and challenges. Differentiation 2012; 84:149-62. [PMID: 22695188 DOI: 10.1016/j.diff.2012.05.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 05/03/2012] [Accepted: 05/04/2012] [Indexed: 10/28/2022]
Abstract
Animal models are critically important for a mechanistic understanding of embryonic morphogenesis. For decades, visualizing these rapid and complex multidimensional events has relied on projection images and thin section reconstructions. While much insight has been gained, fixed tissue specimens offer limited information on dynamic processes that are essential for tissue assembly and organ patterning. Quantitative imaging is required to unlock the important basic science and clinically relevant secrets that remain hidden. Recent advances in live imaging technology have enabled quantitative longitudinal analysis of embryonic morphogenesis at multiple length and time scales. Four different imaging modalities are currently being used to monitor embryonic morphogenesis: optical, ultrasound, magnetic resonance imaging (MRI), and micro-computed tomography (micro-CT). Each has its advantages and limitations with respect to spatial resolution, depth of field, scanning speed, and tissue contrast. In addition, new processing tools have been developed to enhance live imaging capabilities. In this review, we analyze each type of imaging source and its use in quantitative study of embryonic morphogenesis in small animal models. We describe the physics behind their function, identify some examples in which the modality has revealed new quantitative insights, and then conclude with a discussion of new research directions with live imaging.
Collapse
Affiliation(s)
- Chelsea L Gregg
- Department of Biomedical Engineering, Cornell University, Ithaca, NY 14853, USA
| | | |
Collapse
|
39
|
Contrast-enhanced ultrasound evaluation of peripheral microcirculation in diabetic patients: effects of cigarette smoking. Radiol Med 2012; 118:206-14. [PMID: 22580811 DOI: 10.1007/s11547-012-0830-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 09/26/2011] [Indexed: 10/28/2022]
Abstract
PURPOSE Cigarette smoking and diabetes mellitus predisposes to vascular disease. Our study aimed to evaluate the chronic effects of cigarette smoking on peripheral microcirculation assessed with contrast-enhanced ultrasound (CEUS) in diabetic patients. MATERIALS AND METHODS The study population comprised ten smoker (7/3 M/W, age 42-76 years) and 16 nonsmoker (8/8 men/women, age 47-80 years) diabetic patients. The ankle-brachial index (ABI) was determined, and colour Doppler ultrasound (CDUS) of the lower legs was performed to determine the presence of peripheral arteriopathy disease (PAD). Microvascular blood flow in the gastrocnemius muscle was evaluated with CEUS. RESULTS No differences were observed in ABI and CDUS examination between smokers and nonsmokers. Smoking had a significant effect on microcirculatory function. Timeto-peak (TTP), arrival time in tissue (ATt) and artery/ tissue transit time (A/Ttt) were significantly prolonged in smokers (TTP 43.76 ± 9.38 s vs. 34.12 ± 6.8 s, p=0.011, ATt 28.9 ± 7.5s vs. 22.4 ± 6.4 s, p=0.017 and A/Ttt 6.81 ± 4.52 s vs. 3.25 ± 3.27 s, p=0.02), with no significant differences between patients with and without PAD. CONCLUSIONS The long-term exposure to cigarette smoke affects microcirculatory function. Contrast imaging is a noninvasive technique that can document these effects.
Collapse
|
40
|
Molecular imaging of disease with targeted contrast ultrasound imaging. Transl Res 2012; 159:140-8. [PMID: 22340763 PMCID: PMC3285422 DOI: 10.1016/j.trsl.2011.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 12/01/2011] [Accepted: 12/01/2011] [Indexed: 10/14/2022]
Abstract
To enhance clinical care for patients, methods for noninvasive imaging of specific disease-related molecular changes are being developed to expand and improve diagnostic capabilities. These new techniques are used in research programs to characterize pathophysiology and as a surrogate end point for therapeutic efficacy. Molecular imaging with contrast-enhanced ultrasound relies on the detection of microbubbles or other acoustically active particulate agents that are targeted to and retained at sites of disease. This review describes the progress that has been made in the development and testing of methods for contrast ultrasound molecular imaging with a specific focus on cardiovascular disease. Specific topics addressed include probe development, detection methods, and specific biologic processes that are important in clinical cardiovascular medicine and that have been targeted with microbubble contrast agents.
Collapse
|
41
|
Liu J, Zhang P, Liu P, Zhao Y, Gao S, Tan K, Liu Z. Endothelial Adhesion of Targeted Microbubbles in Both Small and Great Vessels Using Ultrasound Radiation Force. Mol Imaging 2012. [DOI: 10.2310/7290.2011.00027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jia Liu
- From the Department of Ultrasound, Xinqiao Hospital, The Third Military Medical University, and Institute of Ultrasound Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ping Zhang
- From the Department of Ultrasound, Xinqiao Hospital, The Third Military Medical University, and Institute of Ultrasound Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ping Liu
- From the Department of Ultrasound, Xinqiao Hospital, The Third Military Medical University, and Institute of Ultrasound Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Zhao
- From the Department of Ultrasound, Xinqiao Hospital, The Third Military Medical University, and Institute of Ultrasound Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shunji Gao
- From the Department of Ultrasound, Xinqiao Hospital, The Third Military Medical University, and Institute of Ultrasound Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kaibin Tan
- From the Department of Ultrasound, Xinqiao Hospital, The Third Military Medical University, and Institute of Ultrasound Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zheng Liu
- From the Department of Ultrasound, Xinqiao Hospital, The Third Military Medical University, and Institute of Ultrasound Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
42
|
Lazarova N, Causey PW, Lemon JA, Czorny SK, Forbes JR, Zlitni A, Genady A, Foster FS, Valliant JF. The synthesis, magnetic purification and evaluation of 99mTc-labeled microbubbles. Nucl Med Biol 2011; 38:1111-8. [DOI: 10.1016/j.nucmedbio.2011.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 04/22/2011] [Accepted: 04/25/2011] [Indexed: 10/18/2022]
|
43
|
Wei K. Future applications of contrast ultrasound. J Cardiovasc Ultrasound 2011; 19:107-14. [PMID: 22073319 PMCID: PMC3209588 DOI: 10.4250/jcu.2011.19.3.107] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 08/04/2011] [Accepted: 08/17/2011] [Indexed: 12/13/2022] Open
Abstract
Contrast agents are currently used during echocardiography for enhancement of structure and function, as well as for perfusion imaging. The next frontiers in contrast ultrasonography are targeted imaging, and using microbubbles for therapeutic purposes. Targeted imaging is the detection of specific components of cardiovascular disease in vivo, with microbubbles which may non-specifically attach to diseased endothelial cells, or with microbubbles which have been specifically designed to detect a pathologic process. Therapeutic applications of contrast ultrasonography include the use of microbubbles to enhance delivery of agents (like drugs, genes, growth factors, etc.) to the endothelium or perivascular cells. This review will discuss differences in contrast agents used for current applications versus targeted imaging, technical considerations required to achieve site-specific imaging, and potential applications of this technology. The potential for contrast ultrasonography to enhance drug and gene delivery to tissue will also be discussed.
Collapse
Affiliation(s)
- Kevin Wei
- Cardiovascular Division, Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
44
|
Kaul S. What is coronary blood flow reserve? Insights using myocardial contrast echocardiography. J Echocardiogr 2011; 10:1-7. [PMID: 27277922 DOI: 10.1007/s12574-011-0100-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Accepted: 08/11/2011] [Indexed: 11/30/2022]
Abstract
This review will briefly describe the principles of myocardial contrast echocardiography, and then discuss the clinical and experimental observations that led to the use of this approach to investigate the pathophysiological basis of coronary blood flow reserve. The insights offered by myocardial contrast echocardiography are unique and novel, and highlight the importance of the myocardial capillaries in determining coronary blood flow reserve in health and disease.
Collapse
Affiliation(s)
- Sanjiv Kaul
- Cardiovascular Division, UHN 62, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.
| |
Collapse
|
45
|
Chan A, Kovatchev BP, Anderson SM, Breton MD. Systematic method to assess microvascular recruitment using contrast-enhanced ultrasound. Application to insulin-induced capillary recruitment in subjects with T1DM. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2011; 102:219-226. [PMID: 20434788 PMCID: PMC2916075 DOI: 10.1016/j.cmpb.2010.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2009] [Revised: 03/10/2010] [Accepted: 03/13/2010] [Indexed: 05/29/2023]
Abstract
Contrast-enhanced ultrasound (CEU) is an ultrasound imaging technique used to assess tissue perfusion. Analysis of microvascular recruitment necessitates the definition of a region of interest (ROI) containing exclusively the tissues to be studied. Conventional ROI selection requires examining the images and drawing the ROI by hand, making the analysis of CEU images non-reproducible and analyst-dependent. We have designed a systematic ROI selection method that is both reproducible and analyst-independent. Microvascular blood volume (MBV) assessed in 21 sequences of images was used to correlate the systematic ROI selection method with the conventional method performed by two independent analysts (correlation of 0.88 and 0.87 respectively) and the MBV sample distribution from the systematic method was not significantly different from those obtained from the conventional one. Using the systematic method, we found no significant insulin-induced capillary recruitment in subjects with type 1 diabetes mellitus, which might be related to the observed low glucose uptake during the hyperinsulinemic euglycemic clamp compared to healthy patients.
Collapse
Affiliation(s)
- Alice Chan
- Diabetes Technology Center, University of Virginia Health System, P.O. 400 888, Charlottesville, VA 22908-4888, USA.
| | | | | | | |
Collapse
|
46
|
Patil AV, Rychak JJ, Klibanov AL, Hossack JA. Real-time technique for improving molecular imaging and guiding drug delivery in large blood vessels: in vitro and ex vivo results. Mol Imaging 2011; 10:238-47. [PMID: 21521555 DOI: 10.2310/7290.2011.00002] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Accepted: 09/12/2010] [Indexed: 11/18/2022] Open
Abstract
Ultrasound-based molecular imaging employs targeted microbubbles to image vascular pathology. This approach also has the potential to monitor molecularly targeted microbubble-based drug delivery. We present an image-guided drug delivery technique that uses multiple pulses to translate, image, and cavitate microbubbles in real time. This technique can be applied to both imaging of pathology in large arteries (sizes and flow comparable to those in humans) and guiding localized drug delivery in blood vessels. The microbubble translation (or pushing) efficacy of this technique was compared in a variety of flow media: saline, viscous saline (4 cp), and bovine blood. It was observed that the performance of this approach was marginally better (by 6, 4, and 2 dB) in viscous saline than in bovine blood with varying levels of hematocrit (40%, 30%, and 10%). The drug delivery efficacy of this technique was evaluated by in vitro and ex vivo experiments. High-intensity pulses mediated fluorophore (DiI) deposition on endothelial cells (in vitro) without causing cell destruction. Ex vivo fluorophore delivery experiments conducted on swine carotids of 2 and 5 mm cross-section diameter demonstrated a high degree of correspondence in spatial localization of the fluorophore delivery between the ultrasound and composite fluorescence microscopy images of the arterial cross sections.
Collapse
Affiliation(s)
- Abhay V Patil
- Department of Biomedical Engineering and Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA 22903, USA
| | | | | | | |
Collapse
|
47
|
Stress perfusion imaging using cardiovascular magnetic resonance: a review. Heart Lung Circ 2011; 19:697-705. [PMID: 20869310 DOI: 10.1016/j.hlc.2010.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 08/09/2010] [Accepted: 08/11/2010] [Indexed: 01/25/2023]
Abstract
Stress perfusion CMR can provide both excellent diagnostic and important prognostic information in the context of a comprehensive assessment of cardiac anatomy and function. This coupled with the high spatial resolution, and the lack of both attenuation artefacts and ionising radiation, make CMR stress perfusion imaging a highly attractive stress imaging modality. It is now in routine use in many centres, and shows promise in evaluating patients with clinical problems beyond those of epicardial coronary disease.
Collapse
|
48
|
Chadderdon SM, Kaul S. Myocardial contrast echocardiography in coronary artery disease. J Cardiovasc Echogr 2011. [DOI: 10.1016/j.jcecho.2011.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
49
|
Carson AR, McTiernan CF, Lavery L, Hodnick A, Grata M, Leng X, Wang J, Chen X, Modzelewski RA, Villanueva FS. Gene therapy of carcinoma using ultrasound-targeted microbubble destruction. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:393-402. [PMID: 21256666 PMCID: PMC4111473 DOI: 10.1016/j.ultrasmedbio.2010.11.011] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 11/17/2010] [Accepted: 11/23/2010] [Indexed: 05/05/2023]
Abstract
When microbubble contrast agents are loaded with genes and systemically injected, ultrasound-targeted microbubble destruction (UTMD) facilitates focused delivery of genes to target tissues. A mouse model of squamous cell carcinoma was used to test the hypothesis that UTMD would specifically transduce tumor tissue and slow tumor growth when treated with herpes simplex virus thymidine kinase (TK) and ganciclovir. UTMD-mediated delivery of reporter genes resulted in tumor expression of luciferase and green fluorescent protein (GFP) in perivascular areas and individual tumor cells that exceeded expression in control tumors (p=0.02). The doubling time of TK-treated tumors was longer than GFP-treated tumors (p=0.02), and TK-treated tumors displayed increased apoptosis (p=0.04) and more areas of cellular drop-out (p=0.03). These data indicate that UTMD gene therapy can transduce solid tumors and mediate a therapeutic effect. UTMD is a promising nonviral method for targeting gene therapy that may be useful in a spectrum of tumors.
Collapse
Affiliation(s)
- Andrew R. Carson
- Center for Ultrasound Molecular Imaging and Therapeutics, Cardiovascular Institute, University of Pittsburgh Medical Center
| | - Charles F. McTiernan
- Center for Ultrasound Molecular Imaging and Therapeutics, Cardiovascular Institute, University of Pittsburgh Medical Center
| | - Linda Lavery
- Center for Ultrasound Molecular Imaging and Therapeutics, Cardiovascular Institute, University of Pittsburgh Medical Center
| | - Abigail Hodnick
- Center for Ultrasound Molecular Imaging and Therapeutics, Cardiovascular Institute, University of Pittsburgh Medical Center
| | - Michelle Grata
- Center for Ultrasound Molecular Imaging and Therapeutics, Cardiovascular Institute, University of Pittsburgh Medical Center
| | - Xiaoping Leng
- Center for Ultrasound Molecular Imaging and Therapeutics, Cardiovascular Institute, University of Pittsburgh Medical Center
| | - Jianjun Wang
- Center for Ultrasound Molecular Imaging and Therapeutics, Cardiovascular Institute, University of Pittsburgh Medical Center
| | - Xucai Chen
- Center for Ultrasound Molecular Imaging and Therapeutics, Cardiovascular Institute, University of Pittsburgh Medical Center
| | | | - Flordeliza S. Villanueva
- Center for Ultrasound Molecular Imaging and Therapeutics, Cardiovascular Institute, University of Pittsburgh Medical Center
| |
Collapse
|
50
|
Sboros V, Averkiou M, Lampaskis M, Thomas DH, Silva N, Strouthos C, Docherty J, McNeilly AS. Imaging of the ovine corpus luteum microcirculation with contrast ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:59-68. [PMID: 21144958 DOI: 10.1016/j.ultrasmedbio.2010.10.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 09/21/2010] [Accepted: 10/09/2010] [Indexed: 05/30/2023]
Abstract
Ultrasound contrast agents have been the subject of microvascular imaging research. The sheep corpus luteum (CL) is a microvascular tissue that provides a natural angiogenic and antiangiogenic process, which changes during the luteal phase of the estrous cycle of the ewe. It can also be controlled and monitored endocrinologically, providing a very attractive in vivo model for the study and development of microvascular measurement. The perfusion of the fully developed CL between days 8 and 12 of the estrous cycle was studied in six ewes. A Philips iU22 ultrasound scanner (Bothell, WA, USA) with the linear array probe L9-3 was used to capture contrast-enhanced images after an intravenous bolus injection of 2.4 mL SonoVue (Bracco S.P.A., Milan, Italy). Time-intensity curves of a region of interest inside the CL were formed from linearized image data. A lagged-normal model to simulate the compartmental kinetics of the microvascular flow was used to fit the data, and the wash-in time was measured. Good contrast enhancement was observed in the CLs of all animals and the wash-in time averaged at 5.5 s with 9% uncertainty. The regression coefficient was highly significant for all fits. These data correlated with stained endothelial area in the histology performed postmortem. Two ewes were injected with prostaglandin F2alpha to induce CL regression, which resulted in an increase of wash-in time after a few hours. The CL of the ewe is thus proposed as an ideal model for the study and development of microvascular measurements using contrast ultrasound. Our initial results demonstrate a highly reproducible model for the study of the microvascular hemodynamics in a range of tissues and organs.
Collapse
Affiliation(s)
- Vassilis Sboros
- Medical Physics and Centre for Cardiovascular Sciences, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK.
| | | | | | | | | | | | | | | |
Collapse
|