Evaluation of feline renal perfusion with contrast-enhanced ultrasonography and scintigraphy

Contrast-enhanced ultrasound (CEUS) is an emerging technique to evaluate tissue perfusion. Promising results have been obtained in the evaluation of renal perfusion in health and disease, both in human and veterinary medicine. Renal scintigraphy using Tc-99m-Mercaptoacetyltriglycine (MAG(3)) is another non-invasive technique that can be used to evaluate renal perfusion. However, no data are available on the ability of CEUS or Tc-99m-MAG(3) scintigraphy to detect small changes in renal perfusion in cats. Therefore, both techniques were applied in a normal feline population to evaluate detection possibilities of perfusion changes by angiotensin II (AT II). Contrast-enhanced ultrasound using a bolus injection of commercially available contrast agent and renal scintigraphy using Tc-99m-MAG(3) were performed in 11 healthy cats after infusion of 0,9% NaCl (control) and AT II. Angiotensin II induced changes were noticed on several CEUS parameters. Mean peak enhancement, wash-in perfusion index and wash-out rate for the entire kidney decreased significantly after AT II infusion. Moreover, a tendency towards a lower wash-in area-under-the curve was present. Renal scintigraphy could not detect perfusion changes induced by AT II. This study shows that CEUS is able to detect changes in feline renal perfusion induced by AT II infusion

Inter-study reproducibility of arterial spin labelling magnetic resonance imaging for measurement of renal perfusion in healthy volunteers at 3 Tesla

Background: Measurement of renal perfusion is a crucial part of measuring kidney function. Arterial spin labelling magnetic resonance imaging (ASL MRI) is a non-invasive method of measuring renal perfusion using magnetised blood as endogenous contrast. We studied the reproducibility of ASL MRI in normal volunteers.<p></p> Methods: ASL MRI was performed in healthy volunteers on 2 occasions using a 3.0 Tesla MRI scanner with flow-sensitive alternating inversion recovery (FAIR) perfusion preparation with a steady state free precession (True-FISP) pulse sequence. Kidney volume was measured from the scanned images. Routine serum and urine biochemistry were measured prior to MRI scanning.<p></p> Results: 12 volunteers were recruited yielding 24 kidneys, with a mean participant age of 44.1 ± 14.6 years, blood pressure of 136/82 mmHg and chronic kidney disease epidemiology formula estimated glomerular filtration rate (CKD EPI eGFR) of 98.3 ± 15.1 ml/min/1.73 m2. Mean kidney volumes measured using the ellipsoid formula and voxel count method were 123.5 ± 25.5 cm3, and 156.7 ± 28.9 cm3 respectively. Mean kidney perfusion was 229 ± 41 ml/min/100 g and mean cortical perfusion was 327 ± 63 ml/min/100 g, with no significant differences between ASL MRIs. Mean absolute kidney perfusion calculated from kidney volume measured during the scan was 373 ± 71 ml/min. Bland Altman plots were constructed of the cortical and whole kidney perfusion measurements made at ASL MRIs 1 and 2. These showed good agreement between measurements, with a random distribution of means plotted against differences observed. The intra class correlation for cortical perfusion was 0.85, whilst the within subject coefficient of variance was 9.2%. The intra class correlation for whole kidney perfusion was 0.86, whilst the within subject coefficient of variance was 7.1%.<p></p> Conclusions: ASL MRI at 3.0 Tesla provides a repeatable method of measuring renal perfusion in healthy subjects without the need for administration of exogenous compounds. We have established normal values for renal perfusion using ASL MRI in a cohort of healthy volunteers.<p></p&gt

Evaluation of renal perfusion in hyperthyroid cats before and after radioiodine treatment

Background: Hyperthyroidism and chronic kidney disease (CKD) are common in elderly cats. Consequently, both diseases often occur concurrently. Furthermore, renal function is affected by thyroid status. Because changes in renal perfusion play an important role in functional renal changes in hyperthyroid cats, investigation of renal perfusion may provide novel insights. Objectives: To evaluate renal perfusion in hyperthyroid cats with contrast-enhanced ultrasound (CEUS). Animals: A total of 42 hyperthyroid cats was included and evaluated before and 1 month after radioiodine treatment. Methods: Prospective intrasubject clinical trial of contrast-enhanced ultrasound using a commercial contrast agent (SonoVue) to evaluate renal perfusion. Time-intensity curves were created, and perfusion parameters were calculated by off-line software. A linear mixed model was used to examine differences between pre-and post-treatment perfusion parameters. Results: An increase in several time-related perfusion parameters was observed after radioiodine treatment, indicating a decreased blood velocity upon resolution of the hyperthyroid state. Furthermore, a small post-treatment decrease in peak enhancement was present in the renal medulla, suggesting a lower medullary blood volume. Conclusions and Clinical Importance: Contrast-enhanced ultrasound indicated a higher cortical and medullary blood velocity and higher medullary blood volume in hyperthyroid cats before radioactive treatment in comparison with 1-month post-treatment control

Experimental study on coronary perfusion with selective brain cooling for direct aortic surgery

1. Retrograde coronary perfusion in combination with selective brain cooling by irrigation was investigated in dogs, in comparison with direct coronary artery perfusion. 2. High incidence of ventricular fibrillation was seen in both methods in hypothermic state. Operation at the normal temperature using extracorporeal circulation is desirable, 3. In view of the above results optimal perfusion pressure appears 30 mm Hg. in retroperfusion, while 100 mm Hg. in direct coronary artery perfusion. 4. The right ventricle anoxia is an undesirable feature in retroperfusion, while the left ventricle showed a tendency to slight anoxia in both methods.</p

A miniaturized bioreactor system for the evaluation of cell interaction with designed substrates in perfusion culture

In tissue engineering, the chemical and topographical cues within three-dimensional (3D) scaffolds are normally tested using static cell cultures but applied directly to tissue cultures in perfusion bioreactors. As human cells are very sensitive to the changes of culture environment, it is essential to evaluate the performance of any chemical, and topographical cues in a perfused environment before they are applied to tissue engineering. Thus the aim of this research was to bridge the gap between static and perfusion cultures by addressing the effect of perfusion on cell cultures within 3D scaffolds. For this we developed a scale down bioreactor system, which allows to evaluate the effectiveness of various chemical and topographical cues incorporated into our previously developed tubular ε-polycaprolactone scaffold under perfused conditions. Investigation of two exemplary cell types (fibroblasts and cortical astrocytes) using the miniaturized bioreactor indicated that: (1) quick and firm cell adhesion in 3D scaffold was critical for cell survival in perfusion culture compared with static culture, thus cell seeding procedures for static cultures might not be applicable. Therefore it was necessary to re-evaluate cell attachment on different surfaces under perfused conditions before a 3D scaffold was applied for tissue cultures, (2) continuous medium perfusion adversely influenced cell spread and survival, which could be balanced by intermittent perfusion, (3) micro-grooves still maintained its influences on cell alignment under perfused conditions, while medium perfusion demonstrated additional influence on fibroblast alignment but not on astrocyte alignment on grooved substrates. This research demonstrated that the mini-bioreactor system is crucial for the development of functional scaffolds with suitable chemical and topographical cues by bridging the gap between static culture and perfusion culture

Contrast-enhanced ultrasound examination for the assessment of renal perfusion in cats with chronic kidney disease

Background: Contrast-enhanced ultrasound examination (CEUS) is a functional imaging technique allowing noninvasive assessment of tissue perfusion. Studies in humans show that the technique holds great potential to be used in the diagnosis of chronic kidney disease (CKD). However, data in veterinary medicine are currently lacking. Objectives: To evaluate renal perfusion using CEUS in cats with CKD. Animals: Fourteen client-owned cats with CKD and 43 healthy control cats. Methods: Prospective case-controlled clinical trial using CEUS to evaluate renal perfusion in cats with CKD compared to healthy control cats. Time-intensity curves were created, and perfusion parameters were calculated using off-line software. A linear mixed model was used to examine differences between perfusion parameters of cats with CKD and healthy cats. Results: In cats with CKD, longer time to peak and shorter mean transit times were observed for the renal cortex. In contrast, a shorter time to peak and rise time were seen for the renal medulla. The findings for the renal cortex indicate decreased blood velocity and shorter total duration of enhancement, likely caused by increased vascular resistance in CKD. Increased blood velocity in the renal medulla has not been described before and may be because of a different response to regulatory factors in cortex and medulla. Conclusions and Clinical Importance: Contrast-enhanced ultrasound examination was capable of detecting perfusion changes in cats with CKD. Further research is warranted to assess the diagnostic capabilities of CEUS in early stage of the disease process

Automated Detection of Regions of Interest for Brain Perfusion MR Images

Images with abnormal brain anatomy produce problems for automatic segmentation techniques, and as a result poor ROI detection affects both quantitative measurements and visual assessment of perfusion data. This paper presents a new approach for fully automated and relatively accurate ROI detection from dynamic susceptibility contrast perfusion magnetic resonance and can therefore be applied excellently in the perfusion analysis. In the proposed approach the segmentation output is a binary mask of perfusion ROI that has zero values for air pixels, pixels that represent non-brain tissues, and cerebrospinal fluid pixels. The process of binary mask producing starts with extracting low intensity pixels by thresholding. Optimal low-threshold value is solved by obtaining intensity pixels information from the approximate anatomical brain location. Holes filling algorithm and binary region growing algorithm are used to remove falsely detected regions and produce region of only brain tissues. Further, CSF pixels extraction is provided by thresholding of high intensity pixels from region of only brain tissues. Each time-point image of the perfusion sequence is used for adjustment of CSF pixels location. The segmentation results were compared with the manual segmentation performed by experienced radiologists, considered as the reference standard for evaluation of proposed approach. On average of 120 images the segmentation results have a good agreement with the reference standard. All detected perfusion ROIs were deemed by two experienced radiologists as satisfactory enough for clinical use. The results show that proposed approach is suitable to be used for perfusion ROI detection from DSC head scans. Segmentation tool based on the proposed approach can be implemented as a part of any automatic brain image processing system for clinical use

Investigation of Lower-limb Tissue Perfusion during Loading

An extant tissue indentor used for amputee residual limb tissue indentation studies was modified to include laser Doppler flowmetry (LDF) to enable measurement of tissue perfusion during indentation. This device allows quantitative assessment of the mechanical and physiological response of soft tissues to load, as demonstrated by indentation studies of the lower-limb tissues of young healthy subjects. Potential measures of interest include the relative change in tissue perfusion with load and the time delays associated with the perfusion response during tissue loading and unloading. Such measures may prove useful in future studies of residual limb tissues, improving our understanding of tissue viability risk factors for individuals with lower-limb amputation