title: Calibrating Doppler imaging of preterm intracerebral circulation using a microvessel flow phantom.
abstract: BACKGROUND
  Preterm infants are born during critical stages of brain development, in which the adaptive capacity of the fetus to extra-uterine environment is limited. Inadequate brain perfusion has been directly linked to preterm brain damage. Advanced high-frequency ultrasound probes and processing algorithms allow visualization of microvessels and depiction of regional variation. To assess whether visualization and flow velocity estimates of preterm cerebral perfusion using Doppler techniques are accurate, we conducted an in vitro experiment using a microvessel flow phantom.
  
  
  METHODS
  An in-house developed flow phantom containing two microvessels (inner diameter 200 and 700 μm) with attached syringe pumps, filled with blood-mimicking fluid, was used to generate non-pulsatile perfusion of variable flow. Measurements were performed using an Esaote MyLab70 scanner.
  
  
  RESULTS
  Microvessel mimicking catheters with velocities as low as 1 cm/s were adequately visualized with a linear ultrasound probe. With a convex probe, velocities <2 cm/s could not be depicted. Within settings, velocity and diameter measurements were highly reproducible [intra-class correlation 0.997 (95% CI 0.996-0.998) and 0.914 (0.864-0.946)]. Overall, mean velocity was overestimated up to threefold, especially in high velocity ranges. Significant differences were seen in velocity measurements when using steer angle correction and in vessel diameter estimation (p < 0.05).
  
  
  CONCLUSIONS
  Visualization of microvessel-size catheters mimicking small brain vessels is feasible. Reproducible velocity and diameter results can be obtained, although important overestimation of the values is observed. Before velocity estimates of microcirculation can find its use in clinical practice, calibration of the ultrasound machine for any specific Doppler purpose is essential. The ultimate goal is to develop a sonographic tool that can be used for objective study of regional perfusion in routine practice.
authors: Department of Neonatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels , Belgium.
authors: Fleur A
authors: FA
authors: Camfferman
authors: Department of Neonatology, Erasmus Medical Centre , Rotterdam , Netherlands.
authors: Ginette M
authors: GM
authors: Ecury-Goossen
authors: Department of Neonatology, Erasmus Medical Centre , Rotterdam , Netherlands.
authors: Jhuresy E
authors: JE
authors: La Roche
authors: Department of Biomedical Engineering, Erasmus Medical Centre , Rotterdam , Netherlands ; Department of Imaging Physics, Delft University of Technology , Delft , Netherlands.
authors: Nico
authors: N
authors: de Jong
authors: Department of Biomedical Engineering, Erasmus Medical Centre , Rotterdam , Netherlands.
authors: Willem
authors: W
authors: van 't Leven
authors: Department of Biomedical Engineering, Erasmus Medical Centre , Rotterdam , Netherlands ; Department of Imaging Physics, Delft University of Technology , Delft , Netherlands.
authors: Hendrik J
authors: HJ
authors: Vos
authors: Department of Imaging Physics, Delft University of Technology , Delft , Netherlands.
authors: Martin D
authors: MD
authors: Verweij
authors: Department of Biostatistics, Erasmus Medical Centre , Rotterdam , Netherlands.
authors: Kazem
authors: K
authors: Nasserinejad
authors: Department of Neonatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels , Belgium.
authors: Filip
authors: F
authors: Cools
authors: Department of Neonatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels , Belgium ; Department of Neonatology, Erasmus Medical Centre , Rotterdam , Netherlands.
authors: Paul
authors: P
authors: Govaert
authors: Department of Neonatology, Erasmus Medical Centre , Rotterdam , Netherlands ; Department of Radiology, Erasmus Medical Centre , Rotterdam , Netherlands.
authors: Jeroen
authors: J
authors: Dudink
keywords: Doppler; calibration; cerebral blood flow; cerebral circulation; cerebral perfusion; flow phantom; microcirculation; preterm brain
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