Dynamic Doppler Ultrasound Assessment of Tissue Perfusion Is a Better Tool than a Single Vessel Doppler Examination in Differentiating Malignant and Inflammatory Pancreatic Lesions

Dynamic tissue perfusion measurement (DTPM) and single vessel flow measurement (SVFM) were assessed in differentiating inflammatory and malignant lesions of the pancreas. Sixty-nine patients (age 62.0 ± 14.7; 33 Female and 36 Men; 40 with malignant and 29 with inflammatory lesions) in whom during the endoscopic ultrasound (EUS) of focal pancreatic lesions it was possible to adequately evaluate the flow in the color Doppler, and then perform a biopsy, were qualified for the study. The assessed DTPM parameters flow velocity (TFV), perfusion intensity (TPI), and resistive index (TRI) as well as the following SVFM parameters: flow velocity (FV), volume flow (VolF), and resistive index (RI) differed significantly between the malignant and inflammatory lesions (p < 0.005). TFV and TPI have slightly better discriminatory properties than the corresponding FV and VolF parameters (p < 0.10). Considering the Doppler parameters usually evaluated in a given method, the TPI = 0.009 cm/s (sensitivity 79%, specificity 92%, AUC 0.899, p < 0.001) was significantly better (p = 0.014) in differentiating between inflammatory and malignant pancreatic lesions in comparison to FV = 2.526 cm/s (sensitivity 79%, specificity 70%, AUC 0.731, p < 0.001). Tissue perfusion has better discriminatory properties in the differentiation of solid pancreatic lesions than the Doppler blood flow examination in the single vessel within the tumor.

Quantitative Perfusion Measurements in a Novel Large Animal Stroke Model

<p><b>Stroke is a leading cause of death worldwide [1], and is the third leading cause of death and the leading cause of serious adult disability in New Zealand[2]. The aim of this project was to quantify perfusion changes in the brains of 20 sheep that underwent a novel surgical model of transient ischemic stroke. The sheep, with its large, gyrencephalic brain, presents a promising, potential animal model for stroke that could help to bridge the historical gap in translational research in stroke therapies [3]. However, we require that an animal model can replicate human patterns of disease in order for it to be a meaningful model for research into potential stroke therapies for humans. It was this replication of human patterns of disease, in terms of perfusion, thatwas under investigation in this project. Dynamic Contrast Enhanced (DCE) MRI images were obtained from each animal before stroke, and at 24 hours, 3 days, 6 days, and 28 days post-stroke. It was found that perfusion from the DCE-MRI series was quantifiable using the extended Tofts model in the form of the parameters Ktrans, ve and vp. The parameter values calculated from this project replicate known human patternsof disease in terms of global Ktrans changes in the affected hemisphere [4], which were found to increase by more than 60% in the stroke hemisphere,replicating the increased permeability following blood brain barrier breakdown.</b></p> <p>In manually selected regions of cytotoxic and vasogenic edema, it was found that the estimated parameters in these regions replicated known perfusionchanges in these types of edema in humans [5]. Finally, the peak post-stroke permeability time point, as determined by Ktrans, was found to align exactlywith when we would expect vasogenic edema, a type of cerebral swelling that causes increased barrier permeability, to dominate in humans [5].</p> <p>This thesis is the first time these DCE-MRI datasets have been analysed, and there remains a wealth of physiological and MRI data available forthis animal cohort. Avenues for future research include investigation into perfusion-diffusion mismatch in this animal model, further consideration ofindividual animal characteristics in analysis, and use of these results as a point of comparison for future research into pharmaceutical agents for treatment ofstroke, and in new non-contrast perfusion measurement techniques.</p>

Quantitative Perfusion Measurements in a Novel Large Animal Stroke Model

<p><b>Stroke is a leading cause of death worldwide [1], and is the third leading cause of death and the leading cause of serious adult disability in New Zealand[2]. The aim of this project was to quantify perfusion changes in the brains of 20 sheep that underwent a novel surgical model of transient ischemic stroke. The sheep, with its large, gyrencephalic brain, presents a promising, potential animal model for stroke that could help to bridge the historical gap in translational research in stroke therapies [3]. However, we require that an animal model can replicate human patterns of disease in order for it to be a meaningful model for research into potential stroke therapies for humans. It was this replication of human patterns of disease, in terms of perfusion, thatwas under investigation in this project. Dynamic Contrast Enhanced (DCE) MRI images were obtained from each animal before stroke, and at 24 hours, 3 days, 6 days, and 28 days post-stroke. It was found that perfusion from the DCE-MRI series was quantifiable using the extended Tofts model in the form of the parameters Ktrans, ve and vp. The parameter values calculated from this project replicate known human patternsof disease in terms of global Ktrans changes in the affected hemisphere [4], which were found to increase by more than 60% in the stroke hemisphere,replicating the increased permeability following blood brain barrier breakdown.</b></p> <p>In manually selected regions of cytotoxic and vasogenic edema, it was found that the estimated parameters in these regions replicated known perfusionchanges in these types of edema in humans [5]. Finally, the peak post-stroke permeability time point, as determined by Ktrans, was found to align exactlywith when we would expect vasogenic edema, a type of cerebral swelling that causes increased barrier permeability, to dominate in humans [5].</p> <p>This thesis is the first time these DCE-MRI datasets have been analysed, and there remains a wealth of physiological and MRI data available forthis animal cohort. Avenues for future research include investigation into perfusion-diffusion mismatch in this animal model, further consideration ofindividual animal characteristics in analysis, and use of these results as a point of comparison for future research into pharmaceutical agents for treatment ofstroke, and in new non-contrast perfusion measurement techniques.</p>

Hyperspectral Imaging to Study Dynamic Skin Perfusion after Injection of Articaine-4% with and without Epinephrine—Clinical Implications on Local Vasoconstriction

This study aimed to investigate the dynamic skin perfusion via hyperspectral imaging (HSI) after application of Articaine-4% ± epinephrine as well as epinephrine only. After the subcutaneous injection of (A100) Articaine-4% with epinephrine 1:100,000, (A200) Articaine-4% with epinephrine 1:200,000, (Aw/o) Articaine-4% without epinephrine, and (EPI200) epinephrine 1:200,000, into the flexor side of the forearm in a split-arm design, dynamic skin perfusion measurement was performed over 120 min by determining tissue oxygen saturation (StO2) using HSI. After injection, all groups experienced a reactive hyperaemia. With A200, it took about three min for StO2 to drop below baseline. For Aw/o and EPI200, perfusion reduction when compared to baseline was seen at 30 min with vasoconstriction >120 min. A100 caused vasodilation with hyperaemia >60 min. After three minutes, the perfusion pattern differed significantly (p < 0.001) between all groups except Aw/o and EPI200. The vasoactive effect of epinephrine-containing local anaesthetics can be visualised and dynamically quantified via StO2 using HSI. Aw/o + epinephrine 1:100,000 and 1:200,000 leads to perfusion reduction and tissue ischaemia after 30 min, which lasts over 120 min with no significant difference between both formulations. When using Aw/o containing epinephrine in terms of haemostasis for surgical procedures, a prolonged waiting time before incision of 30 or more min can be recommended.

Combining perfusion and angiography with a low-dose cardiac CT technique: a preliminary investigation in a swine model

Morphological and physiological assessment of coronary artery disease (CAD) is necessary for proper stratification of CAD risk. The objective was to evaluate a low-dose cardiac CT technique that combines morphological and physiological assessment of CAD. The low-dose technique was evaluated in twelve swine, where three of the twelve had coronary balloon stenosis. The technique consisted of rest perfusion measurement combined with angiography followed by stress perfusion measurement, where the ratio of stress to rest was used to derive coronary flow reserve (CFR). The technique only required two volume scans for perfusion measurement in mL/min/g; hence, four volume scans were acquired in total; two for rest with angiography and two for stress. All rest, stress, and CFR measurements were compared to a previously validated reference technique that employed 20 consecutive volume scans for rest perfusion measurement combined with angiography, and stress perfusion measurement, respectively. The 32 cm diameter volumetric CT dose index ($${\text{CTDI}}_{\text{vol}}^{32}$$ CTDI vol 32 ) and size-specific dose estimate (SSDE) of the low-dose technique were also recorded. All low-dose perfusion measurements (PLOW) in mL/min/g were related to reference perfusion measurements (PREF) through regression by PLOW = 1.04 PREF − 0.08 (r = 0.94, RMSE = 0.32 mL/min/g). The $${\text{CTDI}}_{\text{vol}}^{32}$$ CTDI vol 32 and SSDE of the low-dose cardiac CT technique were 8.05 mGy and 12.80 mGy respectively, corresponding to an estimated effective dose and size-specific effective dose of 1.8 and 2.87 mSv, respectively. Combined morphological and physiological assessment of coronary artery disease is feasible using a low-dose cardiac CT technique.

Noninvasive Renal Perfusion Measurement Using Arterial Spin Labeling (ASL) MRI: Basic Concept

The kidney is a complex organ involved in the excretion of metabolic products as well as the regulation of body fluids, osmolarity, and homeostatic status. These functions are influenced in large part by alterations in the regional distribution of blood flow between the renal cortex and medulla. Renal perfusion is therefore a key determinant of glomerular filtration. Therefore the quantification of regional renal perfusion could provide important insights into renal function and renal (patho)physiology. Arterial spin labeling (ASL) based perfusion MRI techniques, can offer a noninvasive and reproducible way of measuring renal perfusion in animal models. This chapter addresses the basic concept of ASL-MRI.This chapter is based upon work from the COST Action PARENCHIMA, a community-driven network funded by the European Cooperation in Science and Technology (COST) program of the European Union, which aims to improve the reproducibility and standardization of renal MRI biomarkers. This introduction chapter is complemented by two separate chapters describing the experimental procedure and data analysis.