EP1963884A1 - Detection doppler d'un ecoulement sanguin pulsatile - Google Patents

Detection doppler d'un ecoulement sanguin pulsatile

Info

Publication number
EP1963884A1
EP1963884A1 EP06832152A EP06832152A EP1963884A1 EP 1963884 A1 EP1963884 A1 EP 1963884A1 EP 06832152 A EP06832152 A EP 06832152A EP 06832152 A EP06832152 A EP 06832152A EP 1963884 A1 EP1963884 A1 EP 1963884A1
Authority
EP
European Patent Office
Prior art keywords
doppler
flow
blood
ultrasound
pressure
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
EP06832152A
Other languages
German (de)
English (en)
Inventor
John Petruzzello
Eric Cohen-Solal
Benoit Dufort
Balasundara Raju
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Koninklijke Philips NV
Original Assignee
Koninklijke Philips Electronics NV
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Koninklijke Philips Electronics NV filed Critical Koninklijke Philips Electronics NV
Publication of EP1963884A1 publication Critical patent/EP1963884A1/fr
Ceased legal-status Critical Current

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Classifications

    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01S—RADIO DIRECTION-FINDING; RADIO NAVIGATION; DETERMINING DISTANCE OR VELOCITY BY USE OF RADIO WAVES; LOCATING OR PRESENCE-DETECTING BY USE OF THE REFLECTION OR RERADIATION OF RADIO WAVES; ANALOGOUS ARRANGEMENTS USING OTHER WAVES
    • G01S15/00—Systems using the reflection or reradiation of acoustic waves, e.g. sonar systems
    • G01S15/88—Sonar systems specially adapted for specific applications
    • G01S15/89—Sonar systems specially adapted for specific applications for mapping or imaging
    • G01S15/8906—Short-range imaging systems; Acoustic microscope systems using pulse-echo techniques
    • G01S15/8979—Combined Doppler and pulse-echo imaging systems
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/0048—Detecting, measuring or recording by applying mechanical forces or stimuli
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/06—Measuring blood flow
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/13—Tomography

Definitions

  • This invention relates to the detection of blood flow by Doppler methods and, in particular, to assisted ultrasonic Doppler detection of pulsatile blood flow.
  • Ultrasonic Doppler diagnosis is performed when a clinician desires to acquire information about the flow of blood of a patient.
  • the display of flow velocity may be done by means of a spectral Doppler display in which velocities are displayed graphically, or by a color Doppler display in which velocities are displayed in shades or hues of color.
  • the detection of the flow alone can be used to locate the blood vessels containing the flow as described in US Pat. 5,474,073, "ULTRASONIC DIAGNOSTIC SCANNING FOR THREE DIMENSIONAL DISPLAY, " by Schwartz et al .
  • By imaging the sources of Doppler flow signals the locations of the vessels containing the flow can be inferred. Such techniques are useful when ascertaining the effectiveness of organ transplants or other surgical repair of the vascular system.
  • the use of the Doppler flow signals to locate blood vessels can be applied to other diagnostic or surgical situations when greater locational precision is required. For instance identification of the center of the lumen of a blood vessel can be needed when subtle characteristics of laminar flow are being explored, or placement of a catheter or needle in a blood vessel is necessary.
  • the flow of blood in the venous system can limit the ability of Doppler detection. Buffered as they are by the capillary bed from the direct pressure of the left ventricle, the flow rate in veins can exhibit very low pressure and be uneven and low in velocity. In some circumstances veins with these characteristics can virtually collapse. These low flow conditions with little or no discernable pulsatility can make identification of the vessels by Doppler means difficult if not impossible. Accordingly it is desirable to be able to locate low flow vessels such as veins with Doppler ultrasound even under these adverse conditions.
  • an apparatus and method are provided for inducing pulsatile flow in blood vessels which assists detection of the flow by ultrasonic Doppler techniques.
  • pulsatile means a series of one or more periodic or aperiodic changes in flow rate. Blood flow in a vessel is occluded as by applying pressure to the blood vessel. While the pressure is applied pressure is developed from blood flow to the occlusion. When the pressure is released and the vessel is again open the occluded blood flow will suddenly surge through the vessel. This sudden change in flow is more readily detected by Doppler ultrasound and the source of the change in flow identifies the location of the blood vessel.
  • an automated blood pressure pump and cuff are utilized to apply a sequence of pressure occlusions and releases which produce a unique pulsatile flow pattern in a blood vessel which can be readily distinguished from the arterial pulsatile flow produced by the heart.
  • FIGURE 1 illustrates in block diagram form an ultrasound system constructed in accordance with the principles of the present invention in conjunction with a pressure cuff that occludes peripheral blood vessels.
  • FIGURE 2 illustrates several Doppler displays of an ultrasound system.
  • FIGURES 3a, 3b, and 3c are graphical illustrations of the control signal for a pressure cuff and Doppler flow characteristics of the pulsatility of an occluded vessel and an unoccluded artery.
  • An ultrasound probe 10 includes an ultrasonic transducer array 12 which transmits ultrasonic waves and receives ultrasonic echo signals, all under control of an acquisition beamformer 14.
  • the received echo signals may be at the same frequency as the transmit frequency, or at a higher or lower harmonic of the transmit frequency.
  • Control of the transducer transmission and processing of the received echo signals is provided by an acquisition beamformer 14.
  • the transmitted and received beams may be steered over a planar region for two dimensional imaging or steered over a volumetric region for three dimensional imaging.
  • the coherent echo signals may be detected and processed for B mode display, may be coupled to Doppler processors 16 and 18 for spectral and/or colorflow display, or may be used for both B mode and Doppler display as described in U.S. Patent 6,139,501 (Roundhill et al . )
  • the processed B mode and Doppler signals are coupled to an image processor 22 where they are processed for display in the desired image format and are then displayed on an image display 26.
  • Sequences of real time images may be captured and stored in a Cineloop memory 24 in r.f., estimate, native, or composite display form, from which they may be replayed for more detailed analysis or reprocessing.
  • FIGURE 2 illustrates an image display showing the types of images which may be produced by a Doppler -A -
  • FIGURE 2 shows a colorflow Doppler image 40 which is used to image the blood flow velocities of the portion of a vessel 50 which is inside a color box 42.
  • the colorflow image is produced by overlaying a B mode image of tissue structure with a color Doppler image of flow over the same region as the image, thereby producing and overlay of two spatially corresponding images.
  • the color overlay is not laid over the entire B mode image but only the color box area 42, obviating the need to gather Doppler information outside the color box 42 and thereby increasing the frame rate of display.
  • a spectral analysis of flow at a point in the anatomy shown in the colorflow image 40 is initiated by positioning a sample volume 52 over the center of the blood vessel 50.
  • a flow direction cursor 54 is set to be aligned with the direction of blood flow for angle correction.
  • the flow direction cursor setting and angle correction are performed automatically as described in U.S. Patent 6,464,637 (Criton et al . )
  • Doppler data is acquired from the sample volume location 52 at a high rate and used to produce a spectral Doppler display 72, shown at the bottom of the drawing.
  • Each vertical line in the spectral display indicates the range of instantaneous velocity values at the sample volume location as plotted along the horizontal time axis of the spectral display.
  • the peak velocity values 70 and the mean velocity values 62 may be automatically traced by the ultrasound system as described in US Pat. 5,287,753 (Routh et al .
  • a color bar 60 Adjacent to the colorflow image 40 on the display screen is a color bar 60, which depicts the mapping of the flow colors to a range of velocity values.
  • positive (with reference to the probe) velocities extend from green (G) to yellow (Y) in color and negative velocities extend from light blue (LB) to dark blue (DB) , where the zero velocity point between green and yellow is the color baseline .
  • the ultrasound system of FIGURE 1 includes apparatus for occluding blood flow and thereby artificially inducing pulsatile flow.
  • a pressure controller 20 is coupled to the acquisition beamformer 14, the spectral and colorflow Doppler processors 16 and 18, the image processor 22, and an inflation pump 28.
  • the connections to the other areas of the ultrasound system provide time markers indicating the times at which pressure is applied and/or relieved by pressure cuff 80 attached to a patient. Cuff pressure is increased to occlude a vessel in the limb to which the cuff is attached by actuating the pump 28 to pump air into the cuff.
  • a valve in the pressure line to the cuff 80 is opened under control of the pressure controller 20 to relieve the pressure.
  • fluids other than air may alternatively be used.
  • a fluid which is less compressive than air can enable more rapid application of pressure to the limb, but requires a fluid reservoir for its closed system when pressure is relieved.
  • An air system is also immune from the possibility of troublesome seals in the pump and leaks .
  • FIGURE 1 illustrates communication and synchronization between the occlusion system and the rest of the ultrasound system, this need not be the case.
  • the occlusion system including the pressure controller 20, the pump 28, and the pressure cuff 80 can be entirely separate and independent from the ultrasound system.
  • the separate system can be free- running, periodically inflating and deflating the cuff at a rate and times of occurrence which are completely independent of the operation of the ultrasound system.
  • the cuff 80 is slipped onto a limb of the patient and the ultrasound probe 10 is placed at a point where diagnosis is to be performed on a vessel passing through or connected to a vessel passing through the cuff 80.
  • the point 52 where such a vessel is to be examined is in the arm distal to the location of the cuff 80.
  • the pressure controller 20 controls the pump 28 to periodically inflate and deflate the cuff 80, thereby producing an artificially induced modulation of the flow velocity in the vessel being examined.
  • a typical control signal for the pump 28 is shown in FIGURE 3a, which is a simple on-off square wave 102.
  • the pump inflates the cuff 80 to wholly or partially occlude the flow of blood to and from vessels in the limb distal to the cuff, and on each negative-going transition such as 104 and 106 the pressure valve is opened, allowing the occluded vessels to open and pent-up blood pressure to surge through the formerly occluded vessels.
  • This will cause a momentary increase in flow velocity through the formerly occluded vessels which can be detected by Doppler ultrasound as shown in FIGURE 3b by velocity peaks 114 and 116 corresponding in time to the negative-going inflation pressure transitions 104 and 106.
  • FIGURE 3a is a Doppler waveform 120 of arterial blood flow typically produced by a Doppler ultrasound system.
  • the regular nature of the pulsatility of the velocity peaks with each heartbeat is clearly seen in this waveform.
  • the distinctly different pulsatility pattern of the pressure cuff induced peaks of FIGURE 3b illustrate how the artificially induced pulsatility of a vein, for instance, can be clearly distinguished from the regular pulsatility of an artery.
  • the artificial pulsatility of FIGURE 3b differs from the heartbeat pulsatility both in frequency and in regularity. Either can be sufficient to distinguish the artificial waveform, as can a change in flow intensity which can be detected by Doppler power processing.
  • the pressure device 80 is situated proximally and the ultrasound probe 10, 52 is situated distally relative to the heart. This configuration can be used in three different modes.
  • a blood vessel In a first mode, the position of a blood vessel is desired, either a vein or an artery.
  • the blood flow in the vessels both veins and arteries
  • the pressure is released, the blood rushes back into the veins and arteries, displaying a characteristic velocity peak when measured with a Doppler instrument focused on one of the vessels. Normal flow resumes in the veins and arteries until pressure is applied again. The cycle is then repeated.
  • An algorithm that can identify the velocity peaks of the Doppler waveform as described above is used to locate the ultrasound signal coming from the center of a vessel. Due to the laminar flow of blood the highest peak velocity will be found at the center of the vessel. When the pressure is applied in a known pattern, it is easy to correlate the velocity peaks with the applied pattern.
  • a vein In a second mode, the position of a vein is desired.
  • suitable pressure below systolic pressure but above venous pressure is applied, , the blood flow in the veins is temporarily stopped, but the flow in the arteries is relatively unaffected.
  • the pressure is released, the blood rushes back into the veins, displaying a characteristic velocity peak when measured with a Doppler instrument focused on one of the veins. Normal flow resumes in the veins until pressure is applied again and the cycle is repeated.
  • An algorithm that can identify the Doppler velocity peaks is used to identify the ultrasound signal coming from the center of a vein. Since the pressure is applied in a known pattern, it is easy to correlate the velocity peaks in the veins with the applied pattern.
  • the arteries will display the characteristic heartbeat pattern, which is different from the applied pressure pattern, and will be differentiated by the algorithm.
  • a third mode the position of an artery is desired.
  • the blood flow in the arteries and veins is temporarily stopped.
  • the pressure is released partially (below systolic pressure, but above venous pressure)
  • the blood rushes back into the arteries, but not the veins which remain occluded, and the blood flow displays a characteristic velocity peak when measured with a Doppler instrument focused on an artery.
  • Flow returns in the arteries until pressure is applied again, at which time the cycle is repeated.
  • An algorithm that can identify the velocity peaks is used to identify the ultrasound signal coming from the center of an artery. Since the pressure is applied in a known pattern, it is easy to correlate the velocity peaks in the arteries with the applied pattern. The veins will not display any pattern, since their flow is stopped, and will be differentiated by the algorithm.
  • the pressure device 80 is situated distally and the ultrasound probe 10 is situated proximally relative to the heart.
  • the pressure device 80 when pressure is applied, blood in the veins is accelerated for a short period and then the flow returns to normal.
  • the pressure is released, no significant change is detected, until the pressure is applied again and the cycle repeats.
  • the nature of the ultrasound system will depend on the amount of information required on the vessel position. If only the lateral position on the skin surface is needed without depth information, then a continuous-wave (CW) ultrasound system can be used. If the depth of the vein center is also required, then a pulsed-wave (PW) ultrasound system is required for variable depth scanning and identification.
  • the PW system can be used with different depth gating to identify the depth of the vessel.
  • different transducer configurations can be used. The simplest one consists of a single transducer moved mechanically on the patient limb. Another configuration would use an array of transducers that are selected or scanned electronically. A combination of both is also possible, where an array is moved mechanically.
  • the pressure controller 20 can have. several functions. First it delivers a signal to the pressure cuff 80 in order to apply adequate pressure depending on whether the position of an artery or a vein is desired. The change in pressure should be done in such a way which limits the tissue movement in the patient limb, since patient motion can interfere with the Doppler flow signal.
  • the pressure controller is coupled to the ultrasound system to enhance system performance.
  • the connection to the beamformer 14 causes the beamformer to increase it transmission rate (PRF) at the time of a pressure transition to improve the precision with which a velocity change can be detected.
  • the connection 56 to the spectral and colorflow Doppler processors 16 and 18 causes optimization of the Doppler processing at these times.
  • the coupling of the pressure controller to the image processor enables the times of velocity modulation to be colored or otherwise enhanced in the scrolling spectral display 72. While, as mentioned above, these connections, synchronism, and enhancement are optional, they may be employed in a constructed system in order to improve the localization of the blood vessel under scrutiny.
  • the pressure controller or other part of the system should provide feedback to the user on the localization of the vessel under scrutiny. This can be done as simply as a light, or more complex display such as giving the coordinates of the vessel and/or vessel center, or displaying an image and spectrogram traces with a location marked as shown in FIGURE 2.
  • an audio- augmented system or simply audio alone, can be used.
  • a single or paired Doppler transducer can be moved over the skin of the patient and the resulting modulated Doppler signal played as a Doppler tone. The user moves the transducer over the body while the modulation is underway until a maximum tone intensity or pitch informs the user that the vessel with flow modulation has been located.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Physics & Mathematics (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Pathology (AREA)
  • Remote Sensing (AREA)
  • Biophysics (AREA)
  • Radar, Positioning & Navigation (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Surgery (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Radiology & Medical Imaging (AREA)
  • Acoustics & Sound (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
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  • General Physics & Mathematics (AREA)
  • Ultra Sonic Daignosis Equipment (AREA)

Abstract

La méthode Doppler à ondes pulsées est une technique ultrasonore connue utilisée pour quantifier le débit sanguin dans le système circulatoire. Il permet d'estimer la vitesse du sang dans un volume restreint à l'intérieur du corps par l'émission de brèves rafales d'ultrasons et la mesure du déplacement des fréquences de l'écho renvoyé. L'écoulement du sang artériel présente un schéma caractéristique qui est modulé par le battement du coeur. Les veines en revanche présentent un écoulement de nature beaucoup plus imprévisible, continu la plupart du temps, mais parfois pulsatile. Dans certaines occasions, le veine est affaissée et aucun écoulement ne peut être détecté. Ainsi la détection et la différentiation des veines et des artères s'avère difficile en raison de cet écoulement imprévisible dans les veines. La présente invention permet de remédier à cette nature imprévisible de l'écoulement sanguin en modulant l'écoulement de manière qu'il présente un schéma reconnaissable qui peut être identifié par des techniques Doppler à ultrasons. Les artères et les veines peuvent alors être différenciées du fait qu'elles peuvent présenter des schémas de modulation d'écoulement différents selon la pression appliquée.
EP06832152A 2005-12-14 2006-12-07 Detection doppler d'un ecoulement sanguin pulsatile Ceased EP1963884A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US75065105P 2005-12-14 2005-12-14
PCT/IB2006/054670 WO2007069155A1 (fr) 2005-12-14 2006-12-07 Detection doppler d'un ecoulement sanguin pulsatile

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EP1963884A1 true EP1963884A1 (fr) 2008-09-03

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JP (1) JP2009519079A (fr)
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CN102551791B (zh) * 2010-12-17 2016-04-27 深圳迈瑞生物医疗电子股份有限公司 一种超声成像方法和装置
CN104188688A (zh) * 2014-09-23 2014-12-10 杭州远想医疗设备有限公司 周围血管综合检查仪
WO2016083379A1 (fr) * 2014-11-25 2016-06-02 Koninklijke Philips N.V. Système de surveillance de l'utilisation d'un dispositif médical
US20200029891A1 (en) * 2017-02-27 2020-01-30 Koninklijke Philips N.V. Venipuncture and arterial line guidance via signal variation amplification
KR102624614B1 (ko) * 2018-03-21 2024-01-15 삼성메디슨 주식회사 초음파 진단 장치 및 그 제어 방법
RU2740364C1 (ru) * 2020-08-14 2021-01-13 Федеральное государственное бюджетное научное учреждение "Научный центр неврологии" (ФГБНУ НЦН) Способ диагностики периферических нарушений вестибулярной и слуховой функций, обусловленные нарушением венозного оттока из внутренней яремной вены
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CN116458925B (zh) * 2023-06-15 2023-09-01 山东百多安医疗器械股份有限公司 一种便携式无盲区多模态超声心电系统

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CN101326447A (zh) 2008-12-17
WO2007069155A1 (fr) 2007-06-21
JP2009519079A (ja) 2009-05-14

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