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Transthoracic ultrasound localization microscopy of myocardial vasculature in patients
Jipeng Yan1, Biao Huang1, Johanna Tonko2
1Ultrasound Lab for Imaging and Sensing, Department of Bioengineering, Imperial College London, London, UK.
Insights
Transthoracic ultrasound localization microscopy can now image tiny heart vessels and blood flow. This breakthrough aids in understanding and managing cardiac microvascular diseases.
Area of Science:
- Cardiovascular Imaging
- Biomedical Engineering
- Microcirculation Research
Background:
- Cardiac microvascular diseases present challenges in diagnosis due to small vessel size and heart motion.
- Current imaging techniques struggle to visualize myocardial microvasculature and hemodynamics effectively.
Purpose of the Study:
- To demonstrate the feasibility of transthoracic ultrasound localization microscopy for in vivo imaging of myocardial microvasculature and hemodynamics.
- To overcome limitations in imaging small, moving cardiac structures.
Main Methods:
- Developed a customized ultrasound data-acquisition and processing pipeline.
- Utilized a cardiac phased-array probe with motion correction and tracking algorithms.
- Applied super-resolution imaging techniques to reconstruct microcirculation dynamics.
Main Results:
- Successfully imaged myocardial microvasculature and hemodynamics in explanted pig hearts and in human patients.
- Obtained super-resolution images of vascular structure and flow within a single breath hold in four patients.
- Demonstrated the technique's ability to visualize microcirculation even in patients with impaired myocardial function.
Conclusions:
- Transthoracic ultrasound localization microscopy is a feasible method for imaging myocardial microvasculature and hemodynamics.
- This technique offers a potential new tool for understanding cardiac microvascular diseases.
- May improve the management of patients with coronary heart disease symptoms but no obstructive coronary arteries.
Abstract:
Myocardial microvasculature and haemodynamics are indicative of potential microvascular diseases for patients with symptoms of coronary heart disease in the absence of obstructive coronary arteries. However, imaging microvascular structure and flow within the myocardium is challenging owing to the small size of the vessels and the constant movement of the patient's heart. Here we show the feasibility of transthoracic ultrasound localization microscopy for imaging myocardial microvasculature and haemodynamics in explanted pig hearts and in patients in vivo. Through a customized data-acquisition and processing pipeline with a cardiac phased-array probe, we leveraged motion correction and tracking to reconstruct the dynamics of microcirculation. For four patients, two of whom had impaired myocardial function, we obtained super-resolution images of myocardial vascular structure and flow using data acquired within a breath hold. Myocardial ultrasound localization microscopy may facilitate the understanding of myocardial microcirculation and the management of patients with cardiac microvascular diseases.
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