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PURPOSE: To study the feasibility o MRI for quantification of fluid flow in a tube model and the cerebral aqueduct (CA) in volunteers. VOLUNTEERS AND METHODS: All studies were performed on a 1.5 T MR scanner using a head coil and a FLASH 2D phase contrast sequence with a velocity encoding at 20 cm/s. Flow (real value, ml/sec) of a saline fluid was measured in a flexible tube model with different inside diameters: 0.75-3 mm. Three flow velocities were given (normal value). To test the reproducibility, three studies were done using a flow of 0.12 or 0.14 ml/sec and a tube diameter of 0.75 and 2.0 mm. The ratio of normal to real flow value was calculated (ideal ratio = 1). MRI of CA and flow quantification was done in 24 volunteers (28 +/- 4 years). RESULTS: Using tubes with a diameter of 0.75 and 1.5 mm the real flow was sometimes higher than the velocity encoding of the phase contrast sequences. Because of this measurements of the fluid flow and the flow velocities were impossible. There was agreement for fluid flow quantification in the tube of 3.0 mm and high agreement in the tube of 2.0 mm in diameter with reproducible results. The mean diameter of the CA in normal subjects was 2.0 +/- 0.3 mm, the mean cerebral flow was 0.04 +/- 0.02 ml/sec and the peak velocity 3.06 +/- 1.59 cm/sec. CONCLUSIONS: Reliable flow quantification with MRI is feasible if the diameter of the lumen is greater than 1.5 mm, and if the flow velocity is lower than the velocity encoding. In cases of smaller diameters and higher flow velocities the velocity encoding has to be changed. Because of this the quantification seems to be inaccurate in cases of aqueductal stenosis with the method we used.
OBJECTIVES: The purpose of this study was to develop a rational and objective method for selecting a region in the proximal flow field where the hemispheric formula for calculating regurgitant flow rates by the flow convergence technique is most accurate. BACKGROUND: A major obstacle to clinical implementation of the proximal flow convergence method is that it assumes hemispheric isovelocity contours throughout the Doppler color flow map, whereas contour shape depends critically on location in the flow field. METHODS: Twenty mitral regurgitant flow rate stages were produced in six dogs by implanting grommet orifices into the anterior mitral leaflet and varying driving pressures so that actual peak flow rate could be determined from the known effective regurgitant orifice times the orifice velocity. Because plotting flow rate calculated by using a hemispheric formula versus alias velocities produces underestimation near the orifice and overestimation far from it, this plot was fitted to a polynomial function to allow identification of an inflection point within a relatively flat intermediate zone, where factors causing overestimation and underestimation are expected to be unimportant or balanced. The accuracy of flow rate calculation by the inflection point was compared with unselective and selective averaging techniques. Clinical relevance, initial feasibility and correlation with an independent measure were tested in 13 consecutive patients with mitral regurgitation who underwent cardiac catheterization. RESULTS: 1) The accuracy of single-point calculations was improved by selecting points in the flat portion of the curve (y = 1.15x - 3.34, r = 0.87, SEE = 22.1 ml/s vs. y = 1.34x - 1.99, r = 0.71, SEE = 45.6 ml/s, p < 0.01). 2) Selective averaging of points in the flat portion of the curve further improved accuracy and decreased scatter compared with unselective averaging (y = 1.08x + 4.8, r = 0.96, SEE = 11.6 ml/s vs. y = 1.30x + 0.6, r = 0.90, SEE = 20.9 ml/s, p < 0.01). 3) The proposed algorithm for mathematically identifying the inflection point provided the best results (y = 0.96x + 4.5, r = 0.96, SEE = 9.9 ml/s), with a mean error of 1.6 +/- 9.7 ml/s vs. 11.4 +/- 11.7 ml/s for selective averaging (p < 0.01). In patients, the proposed algorithm identified an inflection point at which calculated regurgitant volume agreed best with invasive measurements (y = 1.1x - 0.61, r = 0.93, SEE = 17 ml). CONCLUSIONS: The accuracy of the proximal flow convergence method can be significantly improved by analyzing the flow field mathematically to identify the optimal isovelocity zone before using the hemispheric formula to calculate regurgitant flow rates. Because the proposed algorithm is objective, operator independent and, thus, suitable for automatization, it could provide the clinician with a powerful quantitative tool to assess valvular regurgitation.
PURPOSE: To determine the effect of age, sex, and presence of carotid atheromatous disease on the presence of aortic spiral blood flow pattern using two-dimensional flow quantitative magnetic resonance imaging (MRI). MATERIALS AND METHODS: Sixty subjects (37 women, 23 men) were examined. Prospective phase contrast flow quantitative MRI (1.5 T, Siemens Symphony) sequences in the plane of the aortic arch, and three-dimensional contrast-enhanced MR angiography of the vessels from the aortic arch to the circle of Willis, were performed. Flow quantitative analysis, using circular regions of interest, in the root, apex, and descending aortic arch to determine the presence of a spiral blood flow pattern was undertaken. The results were correlated with the subjects age, sex, and presence of significant carotid arterial disease. RESULTS: A spiral blood flow pattern was seen during diastole in 43 of 50 (86%), 42 of 48 (88%), and in 26 of 28 (93%) subjects in the root, apex, and descending aortic arch, respectively. Spiral flow was seen during systole in 14 of 35 (40%), 20 of 47 (42%), and 11 of 31 (35%) subjects in the root, apex, and descending aortic arch, respectively. There was no clear effect of age or sex on the presence of spiral flow. Carotid disease was associated with a significant reduction in the prevalence of systolic spiral flow from 51%-19% subjects (P < 0.05). CONCLUSION: Spiral flow pattern can be seen in the arch of the aorta in clinical practice using flow quantitative MRI. The prevalence of spiral flow pattern does not appear affected by subject age or sex. Carotid atheromatous disease is associated with a reduction in prevalence of systolic spiral flow pattern in the aortic arch.
The separation of wide molecular mass (Mr) ranges of macromolecules using frit inlet asymmetrical flow field-flow fractionation (FI-AFlFFF) has been improved by implementing a combination of field and flow programming. In this first implementation, field strength (governed by the cross flow-rate through the membrane-covered accumulation wall) is decreased with time to obtain faster elution and improved detection of the more strongly retained (high Mr) materials. The channel outlet flow-rate is optionally held constant, increased, or decreased with time. With circulation of the flow exiting the accumulation wall to the inlet frit, the dual programming of cross flow and channel outlet flow could be implemented using just two pumps. With this flow configuration, the channel outlet flow-rate is always equal to the channel inlet flow-rate, and these may be programmed independently of the cross flow-rate through the membrane. FI-AFlFFF retains its operational advantage over conventional asymmetrical flow FFF (AFlFFF). Unlike conventional AFlFFF, FI-AFlFFF does not require time consuming, and experimentally inconvenient, sample focusing and relaxation steps involving valve switching and interruption of sample migration. The advantages of employing dual programming with FI-AFlFFF are demonstrated for sets of polystyrene sulfonate standards in the molecular mass range of 4 to 1000 kDa. It is shown that programmed FI-AFlFFF successfully expands the dynamic separation range of molecular mass.
Doppler echocardiographic methods for measuring volumetric flow through the aortic, pulmonary and mitral valves provide the cardiologist with several potentially interchangeable noninvasive methods for determining cardiac output. In addition, comparison of flow differences through individual valves offers the potential to quantitate shunt flow and regurgitant volumes. To date, however, no study has compared the relative accuracies of each of these flow measurements in a controlled experimental setting. Therefore, in this study, Doppler echocardiography was used to measure aortic, pulmonary and mitral valve flows in seven open chest dogs on right atrial bypass where forward cardiac output was precisely controlled with a roller pump. Correlations with roller pump output were better for Doppler measurements of aortic (r = 0.98, SD = 0.3) and mitral (r = 0.97, SD = 0.3) than for pulmonary (r = 0.93, SD = 0.5) valve flow. Interobserver reproducibility was also better for aortic (r = 0.94) and mitral (r = 0.97) than for pulmonary (r = 0.88) valve flow measurements. All valves showed flow-related increases in cross-sectional area, but the slope of this response was variable: 0.05, 0.16 and 0.21 for the aortic, the pulmonary and the mitral valve, respectively. Increased forward flow through the aortic valve, therefore, was manifested primarily by an increase in velocity, whereas increasing flow through the pulmonary and mitral valves produced more significant area changes with correspondingly smaller increases in the velocity component. Recalculation of Doppler-determined outputs, assuming a fixed valve area for the entire range of flows, resulted in a decreased correlation with roller pump output. Both velocity and valve area should be measured at each flow rate for greatest accuracy in volumetric flow calculations.
STUDY OBJECTIVE: To characterize insufflator CO2 gas flow performance to predict gas flow rate with standard cannulas. DESIGN: Prospective, observational study (Canadian Task Force classification II-2). SETTING: Laboratory of university clinic. PATIENTS: None. Intervention. Gas flow (L/min) and average pressure (mm Hg) inside an abdomen model were measured at 12 mm Hg nominal pressure during steady state. MEASUREMENTS AND MAIN RESULTS: An abdomen box model for laboratory measurements was designed with different entrance and exit diameters simulated with hole disks from 0.5 to 7.6 mm. With a computer-based data-acquisition model, five insufflators (Olympus 9L and 16L, Storz 10L and 30L, HiTec 16L) were evaluated with 150 disk combinations. Flow performance in three-dimensional profiles showed different flow rates for all insufflators depending on resistance and leakage combination, maximum flow rate, and insufflation principle. Maximum flow was reached without resistance only in the insufflation system at high leakage rates. Low-pressure principle is more affected by resistance. Cannula flow rates at 12 mm Hg and 15 L/minute leakage ranged from 4.8 (Origin) to 6.0 L/minute (Storz HiCap) for Olympus 9-L insufflators and from 5.4 (Origin) to 15.10 L/minute (Storz HiCap) for Storz 30-L Thermoflator. Reusable cannulas have more flow efficacy than disposable ones, especially with high-flow insufflators, because of larger diameter at insufflation supply. CONCLUSION: Gas flow depends not only on maximum flow of insufflators but also on resistance of cannulas and leakage rate. With this model it is possible to predict the real, available flow of insufflator-cannula combinations for the first time. Improved resistance of all components can save insufflation time.
A quantitative Doppler color flow imaging was employed to measure the two-dimensional distribution of blood flow velocity and flow rate in a large vessel. Regional blood flow velocity was determined by converting the color intensity at the respective pixel into corresponding flow velocity and correcting the flow velocity for spatial ultrasound beam incident angle. Instantaneous flow rate was determined precisely from the image of velocity distribution on the cross-section of the flow tract in a steady flow model circuit. In clinical application, the differences in phasic changes in two-dimensional velocity distribution in the ascending aorta, between normal subjects and the patient with aortic regurgitation, were clearly depicted. The quantitative color flow imaging may have great potential to determine noninvasively and real-timely the two-dimensional distribution of flow velocity as well as flow rate in a large vessel.
Endothelial cells (ECs) are activated in response to high-flow. Our previous studies using arteriovenous fistula (AVF) model have demonstrated that high-flow in blood vessels induces an early and rapid proliferation of ECs before arterial dilatation. Here, we investigated the proliferation of ECs, which had once been stimulated by high-flow loading, in a situation without the influence of high-flow. First, we induced high-flow in the rabbit common carotid artery by using AVF. Then, we removed the influence of high-flow by normalization of high-flow with the closure of AVF or by removal of flow itself with tissue isolation and organ culture or with cell culture of ECs, at the timing considered that ECs began to proliferate. Kinetics of ECs was investigated by a laser scanning confocal microscopy, phase-contrast microscopy and light microscopy using bromodeoxyuridine labeling method. We found that ECs, which had once been stimulated by high-flow, transiently proliferated even after normalization of high-flow or removal of flow. We assume that proliferation of ECs is promised when these cells start to proliferate after high-flow loading.
This study compared the effects of low-flow sevoflurane, high-flow sevoflurane and low-flow isoflurane on hepatorenal function during and after more than 10 hours of anaesthesia. Twenty-five patients scheduled for elective orthopaedic surgery were categorized into three groups; low-flow sevoflurane (fresh gas flow at 1 litre/min, n = 9), high-flow sevoflurane (5 l/rmin, n = 7), or low-flow isoflurane (1 l/min, n=9). Inspiratory compoundA concentrations were measured. The groups had similar duration of anaesthesia and exposure to anaesthetic agents. The area under the curve of concentration (mean, SD) of compound A in the low-flow sevoflurane group (359.8, 106.1 ppm.h) was greater than that in the high-flow sevoflurane group (61.1, 29.3 ppm.h; P<0.01). All groups showed normal plasma creatinine and creatinine clearance, and transient postoperative increases in plasma alanine aminotransferase and alpha glutathione-S-transferase, as well as urinary glucose and alpha glutathione-S-transferase, with no significant differences between groups. There were no significant relationships between the area under the curve of concentration of compound A and the biomarkers. These findings suggest that prolonged anaesthesia with low-flow sevoflurane has similar effects on hepatorenal function to prolonged anaesthesia with high-flow sevoflurane and low-flow isoflurane.
To evaluate the in vivo accuracy of color Doppler flow-convergence methods for determining transmitral flow volumes and effective orifice areas in mitral stenosis, we studied two models for flow-convergence surface geometry, a hemispheric (HS) model and an oblate hemispheroid (OH) model in a chronic animal model with quantifiable mitral flows. Color Doppler flow mapping of the proximal flow-convergence region has been reported to be useful for evaluation of intracardiac flows. Flow-convergence methods in patients with mitral stenosis that use HS assumption for the isovelocity surface have resulted in underestimation of actual flows. Chronic mitral stenosis was created surgically in six sheep with annuloplasty rings (group 1) and 11 sheep with bioprosthetic porcine valves (group 2). Hemodynamic and echocardiographic/Doppler studies (n = 18 in group 1; n = 21 in group 2) were performed 20 to 34 weeks later. Left ventricular inflow obstruction was of varied severity, with mean transmitral valve gradients in group 1 ranging from 1.3 to 18 mm Hg and in group 2 ranging from 6.3 to 25.6 mm Hg. Although transmitral flows derived by both geometric flow convergence models showed significant correlations with reference cardiac outputs, the correlations for the OH model were better than those for the HS model (group 1, r = 0.86 for the OH model vs r = 0.72 for the HS model; group 2; r = 0.84 for the OH model vs r = 0.62 for the HS model). The OH model was also superior to the HS model in determining effective orifice areas compared to reference orifice areas determined by postmortem planimetry of anatomic orifices (group 1 only, r = 0.64 for OH vs 0.58 for HS), by the Gorlin and Gorlin formula (group 1, r = 0.63 for OH vs 0.72 for HS; group 2, r = 0.82 for OH vs 0.76 for HS), and by the Doppler pressure half-time method (group 1, r = 0.76 for OH vs 0.69 for HS; group 2, r = 0.84 for OH vs 0.62 for HS).(ABSTRACT TRUNCATED AT 400 WORDS)
1. In studying forearm skeletal muscle substrate exchange, an often applied method for estimating skeletal muscle blood flow is strain gauge plethysmography. A disadvantage of this method is that it only measures total blood flow through a segment of forearm and not the flow through the individual parts such as skin, adipose tissue and muscle. 2. In the present study the contribution of forearm subcutaneous adipose tissue blood flow to total forearm blood flow was evaluated in lean (% body fat 17.0 +/- 2.2) and obese males (% body fat 30.9 +/- 1.6) during rest and during infusion of the non-selective beta-agonist isoprenaline. Measurements were obtained of body composition (hydrostatic weighing), forearm composition (magnetic resonance imaging) and of total forearm (venous occlusion plethysmography), skin (skin blood flow, laser Doppler), and subcutaneous adipose tissue blood flow (133Xe washout technique). 3. The absolute forearm area and the relative amount of fat (% of forearm area) were significantly higher in obese as compared to lean subjects, whereas the relative amounts of muscle and skin were similar. 4. During rest, the percentage contribution of adipose tissue blood flow to total forearm blood flow was significantly higher in lean compared with obese subjects (19 vs 12%, P < 0.05), whereas there were no differences in percentage contribution between both groups during isoprenaline infusion (10 vs 13%). Furthermore, the contribution of adipose tissue blood flow to total forearm blood flow was significantly lower during isoprenaline infusion than during rest in lean subjects (P < 0.05), whereas in the obese this value was similar during rest and during isoprenaline infusion.(ABSTRACT TRUNCATED AT 250 WORDS)
BACKGROUND: Strain Rate Imaging shows the filling phases of the left ventricle to consist of a wave of myocardial stretching, propagating from base to apex. The propagation velocity of the strain rate wave is reduced in delayed relaxation. This study examined the relation between the propagation velocity of strain rate in the myocardium and the propagation velocity of flow during early filling. METHODS: 12 normal subjects and 13 patients with treated hypertension and normal systolic function were studied. Patients and controls differed significantly in diastolic early mitral flow measurements, peak early diastolic tissue velocity and peak early diastolic strain rate, showing delayed relaxation in the patient group. There were no significant differences in EF or diastolic diameter. RESULTS: Strain rate propagation velocity was reduced in the patient group while flow propagation velocity was increased. There was a negative correlation (R = -0.57) between strain rate propagation and deceleration time of the mitral flow E-wave (R = -0.51) and between strain rate propagation and flow propagation velocity and there was a positive correlation (R = 0.67) between the ratio between peak mitral flow velocity / strain rate propagation velocity and flow propagation velocity. CONCLUSION: The present study shows strain rate propagation to be a measure of filling time, but flow propagation to be a function of both flow velocity and strain rate propagation. Thus flow propagation is not a simple index of diastolic function in delayed relaxation.
A transfontanellar range-gated ultrasound Doppler technique for recording blood flow velocity in an artery on the base of the skull was validated in eight anesthetized newborn lambs during hypo-, normo-, and hypercarbia. Blood flow velocity was linearly related to PaCO2 from 20 to 80 mm Hg; mean blood flow velocity (Vmean) (r = 0.86, p less than 0.001), peak systolic blood flow velocity (r = 0.83, p less than 0.001), and end-diastolic blood flow velocity (r = 0.87, p less than 0.001). Vmean changed 2.0% per mm Hg of PaCO2. A linear relationship was demonstrated between brain blood flow (BBF), as determined by the microsphere method, and PaCO2 (r = 0.91, p less than 0.001), with BBF changing 3.6%/mm Hg of PaCO2. Blood flow velocity was linearly related to BBF in the PaCO2 range studied; Vmean (r = 0.89, p less than 0.001), peak systolic blood flow velocity (r = 0.87, p less than 0.001), and end-diastolic blood flow velocity (r = 0.87, p less than 0.001). However, Vmean predicted only approximately 55% of the change in BBF, which suggests a concomitant change in the cross-sectional area of the artery being studied. Despite this limitation, these data suggest that blood flow velocity, recorded by a transfontanellar range-gated Doppler technique from one of the two main arteries perfusing the brain, provides qualitative information on changes in BBF.
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OBJECTIVES: This study sought to assess the reliability of pressure-derived coronary flow reserve (CFR) compared with flow- or velocity-derived CFR. BACKGROUND: Coronary flow reserve has been reported to have important clinical implications for the evaluation and treatment of coronary artery disease. METHODS: Using a pressure guide wire, coronary pressure distal to the stenosis was measured at rest and during hyperemia in seven dogs with various degrees of stenosis and in 30 patients with angina (29 and 34 stenoses in total, respectively). Pressure at the tip of the guiding catheter was also recorded with a fluid-filled transducer system. Pressure-derived CFR was calculated by the square root of the pressure gradient across the stenosis (DeltaP) during hyperemia divided by DeltaP at rest, using a proprietary software system. At the same time, coronary flow was monitored proximal to the stenosis with a flow meter in the experimental dogs, and coronary flow velocity distal to the stenosis was assessed using a Doppler guide wire in patients with angina. Flow-derived (or velocity-derived) CFR was compared with pressure-derived CFR. RESULTS: Except for one stenosis that showed no DeltaP at rest, a significant correlation was obtained between pressure- and flow-derived CFR in the animal study (y = 1.05x - 0.03, r = 0.92, p = 0.0001). A significant correlation was also seen between pressure- and velocity-derived CFR in the human study, except in three stenoses with no resting DeltaP (y = 0.70x + 0.37, r = 0.85, p = 0.0001). CONCLUSIONS: Similar to flow (or velocity) measurement, CFR can be assessed by pressure measurement, except in stenoses with minor resting DeltaP.
We have evaluated a mechanical glottis in healthy volunteers and in patients with bulbar motor neurone disease. In healthy volunteers, the mechanical glottis increased peak flow rate and decreased the time to peak flow during forced expiration, but cough produced even higher flow rates and shorter times to peak flow. In patients, the mechanical glottis increased peak flow rate and decreased the time to peak flow. The mechanical glottis also produced higher peak flow rates when compared to the cough manoeuvres, and the time to peak flow was also significantly shorter with the mechanical glottis. We have shown that the use of a mechanical glottis tends to convert the airflow profile of a peak expiratory flow manoeuvre into that of a cough in both healthy volunteers and patients with motor neurone disease. Its potential role as an aid to clearance of airway secretions in patients with impaired laryngeal function remains to be seen.
Partitioning a daily mechanical stimulus into discrete loading bouts enhances bone formation in rat tibiae (J. Bone Mineral Res. 15(8) (2000) 1596). We hypothesized that a refractory period exists in primary rat osteoblastic cells, during which fluid-flow-induced [Ca(2+)](i) oscillations are insensitive to additional short bouts (2 min) of fluid flow. Because the frequency of [Ca(2+)](i) oscillations is believed to be important for regulating cellular activity and long-term fluid flow alters gene expression in bone cells, we also hypothesized that long-term (15 min) oscillating fluid flow produces multiple [Ca(2+)](i) oscillations in osteoblastic cells. Primary osteoblastic cells from rat long bones were exposed to 2 min of oscillating fluid flow that produced shear stresses of 2 Pa at 2 Hz. After a rest period of 5, 30, 60, 300, 600, 900, 1800, or 2700 s, the cells were exposed to a second 2-min bout of flow. A 600 s rest period was required to recover the percentage of cells responding to fluid flow and a 900 s rest period was required to recover the [Ca(2+)](i) oscillation magnitude. The magnitude and shape of the two [Ca(2+)](i) oscillations were strikingly similar for individual cells after a 900 s rest period. During 15 min of continuous oscillating flow, some individual cells displayed between 1 and 9 oscillations subsequent to the initial [Ca(2+)](i) oscillation. However, only 54% of the cells that responded initially displayed subsequent [Ca(2+)](i) oscillations during long-term flow and the magnitude of the subsequent oscillations was only 28% of the initial response.