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Contrast-Enhanced Brain Ultrasound Perfusion Metrics in the EXTra-Uterine Environment for Neonatal Development (EXTEND): Correlation With Hemodynamic Parameters.

子宫外环境下新生儿发育的对比增强脑超声灌注指标 (EXTEND): 与血流动力学参数的相关性。

  • 影响因子:1.57
  • DOI:10.1002/jum.15642
  • 作者列表:"Lawrence KM","Coons BE","Sridharan A","Davey MG","Flake AW","Didier RA
  • 发表时间:2021-01-29
Abstract

OBJECTIVES:Contrast-enhanced ultrasound (CEUS) can provide quantitative perfusion metrics and may be useful to detect cerebral pathology in neonates and premature infants, particularly in extrauterine environments. The effect of hemodynamics on cerebral perfusion metrics is unknown, which limits the clinical application of this technology. We aimed to determine associations between systemic hemodynamics and concurrently measured brain perfusion parameters in an animal model of extrauterine support. METHODS:Nine fetal lambs were transferred to an extrauterine support device. Lumason® ultrasound contrast (0.1-0.3 ml) was administered via the umbilical vein and 90-second cine clips were obtained. Time-intensity-curves (TICs) were generated and time-dependent and area-under-curve (AUC) parameters were derived. Associations between brain perfusion metrics and hemodynamics including heart rate (HR) and mean arterial pressure (MAP) were evaluated by multilevel linear mixed-effects models. RESULTS:Eighty-six ultrasound examinations were performed and 72 examinations were quantifiable. Time-dependent measurements were independent of all hemodynamic parameters (all p ≥.05). Oxygen delivery and mean blood flow were correlated with AUC measurements (all p ≤.01). Physiologic HR and MAP were not correlated with any measurements (all p ≥.05). CONCLUSION:Detected aberrations in time-dependent CEUS measurements are not correlated with hemodynamic parameters and are thought to reflect the changes in cerebral blood flow, thus providing a promising tool for evaluation of brain perfusion. CEUS brain perfusion parameters are not correlated with physiologic HR and MAP, but AUC-dependent measurements are correlated with oxygen delivery and blood flow, suggesting that CEUS offers additional value over standard monitoring. Overall, these findings enhance the applicability of this technology.

摘要

目的: 超声造影 (CEUS) 可以提供定量灌注指标,并可能有助于检测新生儿和早产儿的脑部病理,特别是在宫外环境中。血流动力学对脑灌注指标的影响尚不清楚,限制了该技术的临床应用。我们的目的是在宫外支持动物模型中确定全身血流动力学和同时测量的脑灌注参数之间的关联。 方法: 将9只胎儿羔羊转移至宫外支持装置。Lumason®经由脐静脉施用超声造影剂 (0.1-0.3 ml),并获得90秒电影剪辑。生成时间-强度-曲线 (tic) 并导出时间依赖性和曲线下面积 (AUC) 参数。通过多水平线性混合效应模型评估脑灌注指标与包括心率 (HR) 和平均动脉压 (MAP) 在内的血流动力学之间的关联。 结果: 共行超声检查86例,可量化检查72例。时间依赖性测量独立于所有血流动力学参数 (均p ≥.05)。氧输送和平均血流量与AUC测量值相关 (所有p ≤.01)。生理HR和MAP与任何测量值均不相关 (均p ≥.05)。 结论: 时间依赖性CEUS测量中检测到的像差与血流动力学参数不相关,被认为反映了脑血流的变化,从而为评价脑灌注提供了一个有前途的工具。CEUS脑灌注参数与生理HR和MAP不相关,但AUC依赖性测量与氧递送和血流量相关,表明CEUS提供了超过标准监测的附加值。总体而言,这些发现增强了该技术的适用性。

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