A majority of all cardiovascular diseases and disorders is related to hemodynamic dysfunction. For example, in congenital heart disease and subsequent surgical palliations, fluid shear stresses at the endothelial surface play a critical role in progression of diseases such as pulmonary hypertension. The focal distribution of atherosclerotic plaques in regions of vessel curvature, bifurcation, and branching also suggests that fluid dynamics and vessel geometry play a localizing role in the cause of plaque formation. Accurate measurement of fluid shear stress at the endothelial border in arteries and veins is essential in cardiovascular diagnostics both as a prognostic aid and for following disease and treatment progression. Furthermore, mapping time-resolved velocity fields at arterial bifurcations and other complex geometries should allow precise evaluation of the presence and extent of recirculation regions, flow separations, and secondary flows within the cardiovascular system, which may be especially important in following disease progression, examining the status of implanted prosthetics such as stents, vascular grafts, and prosthetic valves, or quantifying the level of flow adaptation after bypass or other type of shunt surgery.
The frequencies from the ‘top end’ of the AM band to the ‘bottom end’ of the VHF television band are part of the general range referred to as “radio frequencies” or RF. The term “ultrasonic” applied generically refers to that which is transmitted above the frequencies of audible sound, and nominally includes anything over 20,000 Hz. Frequencies generally used for medical diagnostic ultrasound extend in the RF range ˜1-20 MHz, having been produced by ultrasonic transducers. A wide variety of medical diagnostic applications use one or both the echo time and the Doppler shift of the reflected emissions to measure the distance to internal organs and structures and the speed of movement of those structures. Ultrasound imaging near the surface of the body has better resolution than that within the body, as resolution decreases with the depth of penetration. The use of longer wavelengths implies lower resolution since the maximum resolution of any imaging process is proportional to the wavelength of the imaging wave. Ultrasonic medical imaging is conventionally produced by applying the output of an electronic oscillator to a thin wafer of piezoelectric material, such as lead zirconate titanate.
A variety of methods have been examined for measurement of blood velocity components in vivo. Magnetic resonance imaging (MRI) velocimetry provides multiple components of velocity with good spatial resolution; however, the method is cumbersome to use since it requires breath-holds of the patient, collection of data over multiple cycles for ensemble averaging, and possesses relatively poor temporal resolution. Ultrasound Doppler measurement of local velocity has also been examined. Although this method provides greater temporal resolution, it is dependent on the angle between the ultrasound beam and the local velocity vector, only provides velocity along the ultrasound beam (1-D velocity), and has difficulty in measuring flow near the blood-wall interface.
The more-recent development of microbubbles to enhance ultrasound backscatter provides a potential ultrasound-based imaging solution for velocimetry of vascular and other opaque flows. This solution is based on the synthesis of two existing technologies: particle image velocimetry (PIV); and brightness-mode (B-mode) contrast ultrasound echo imaging. Particle image velocimetry (PIV) is a non-intrusive, full field optical measuring method for obtaining multi-component velocity vectors. It is a mature flow diagnostic useful in many areas from aerodynamics to biology. However, current PIV methods are limited to the measurement of flows in transparent media due to the requirement for optical transparency.
The synthesis of PIV and B-mode technologies has been termed, as identified in earlier work of the applicants Echo PIV. A very early stage application of PIV was first reported by Crapper et al., 2000; this publication describes use of a medical ultrasound scanner to image kaolin particles in a study of sediment-laden flows of mud in salt water. PIV was applied to B-mode video images, and speeds of up to 6 cm/s were obtained. Others have, since CRAPPER et al., 2000, used 2D ultrasound speckle velocimetry (USV), a combination of classical ultrasonic Doppler velocimetry and 2D elastography methods, for flow imaging. The USV method can provide velocity vectors by analyzing the acoustic speckle pattern of the flow field, which is seeded with a high concentration of scattering particles. However, this method is limited by the requirement for extremely fast acquisition systems, heterogeneous signals caused by polydispersed particles, and high noise induced by high concentration of scattering particles. The inherent necessity of very high scatterer particle concentrations in particular, seriously limits the application of USV in hemodynamics measurement in living creatures.
A couple of the applicants hereof, along with other(s), first implemented the early-stage Echo PIV on image data obtained using a commercial/conventional clinical ultrasound apparatus to produce velocity vectors for a rotating flow field created within a beaker driven by a stirring device using 0.01 ml Optison® microbubbles introduced into the flow. The maximum achievable frame rate of the conventional system was 500 image frames per second (fps) at reduced imaging window size. Using such frame rates, Kim et al., 2004 improved the measurable maximum velocity from 6 cm/sec, as reported by Crapper et al., 2000 to 50 cm/sec. In the early-stage studies reported by Kim et al., 2004, two phased array transducers were used. The first transducer had a center frequency of 3.5 MHz and average spatial resolution of 2.5 mm in the axial direction and 5 mm in the lateral direction and the second transducer had an axial resolution of 1.2 mm and lateral resolution of 1.7 mm. These resolutions allowed capture of 2D velocity vectors in steady and pulsating flows. These early-stage studies demonstrated that, for both the velocity range and spatial resolution (thus limiting the dynamic range and maximum value of measurable velocities, the ability to capture transient flow phenomena, and the density of the resulting PIV vector field), early-stage Echo PIV was insufficient for full range vascular blood flow imaging.
Ultrasound speckle velocimetry (USV) mentioned above, was originally suggested as a means to obtain multi-component vectors non-invasively. USV is a combination of classical ultrasonic imaging and 2D elastography methods and was proposed some 15 years ago. The USV method measures velocity indirectly by analyzing variations in the acoustic backscatter speckle pattern within the flow field. Several issues, including poor signal-to-noise ratio when using blood cells for backscatter or requirement of excessive contrast particle seeding density when using contrast agents for backscatter, and loss of correlation in regions of high flow shear, have precluded this method from clinical use.
Doppler has only gained acceptance as a marginally quantitative method for assessing vascular hemodynamics. Estimating shear stress using Doppler measurement of peak or mean velocity can significantly underestimate or overestimate shear values. Since vascular anatomy is frequently oriented parallel to the superficial skin surface, the vascular ultrasound Doppler imaging is inherently limited by the less-than-ideal imaging window where the ultrasound beam is directed almost perpendicularly to the flow direction, making flow measurements highly inaccurate. Even if one were able to gather accurate angle corrections using Doppler, it cannot resolve multi-component velocity vectors.
Determining multi-dimensional velocity fields within opaque fluid flows has posed challenges in many areas of fluids research, ranging from the imaging of flows in complex shapes that are difficult to render in transparent media, to the demanding constraints of flow in the aerated surf zone. In the context of blood flow measurement in human body, the added requirements of measurements made in living creatures has traditionally limited the options and capabilities of flow field instrumentation, even further.
Non-invasive measurement of the multiple velocity components of blood flow is useful for hemodynamic diagnostics. Developments of many cardiovascular problems such as athermoma, intimal hyperplasia, thrombus and hemolysis have been shown to have a close relationship with arterial flow conditions. In particular, fluid shear stress is considered an important mediator in the development of the above problems. Thus, accurate measurement of fluid shear stress in arteries is essential both as a prognostic aid and for following disease and treatment progression. However, currently there is no direct means, with sufficient accuracy, of obtaining such information. Conventional Doppler has the problem of angulation error, which limits the measurement to only the component of velocity along the ultrasound beam, thus requiring parallel alignment of the ultrasound beam to the flow direction. While MRI is an attractive method for blood velocity measurements, since it provides multiple components of blood flow and has high spatial resolution, MRI is cumbersome by nature to obtain useful images, quite expensive, and has poor temporal resolution. Thus, a non-invasive method with good temporal and spatial resolution that can measure multiple velocity vectors (and thereby local shear stress) in real time is needed. Vascular and cardiac investigators find such a tool useful, as will those investigating non-biomedical environments, such as industrial flow, flow of complex polymers, flow near free surfaces and interfaces, and other applications where the opaque nature of the flow field limits the ability to measure multi-component velocity vectors.
In one embodiment, the invention is a method comprising:
seeding tracers within a flow field;
sweeping ultrasound beams through a desired flow field of view within the tracer-seeded flow;
receiving back-scattered ultrasound signals (RF data) from the tracers as the beams sweep the tracers;
obtaining brightness mode (B-mode) images from the RF data; and
analyzing the B-mode images to determine velocity vectors indicative of flow within the field.
In another embodiment, a system of the invention detects fluid flow. An ultrasound system comprises a signal generator providing ultrasound firing sequences applied to a linear array transducer. The transducer generates ultrasound energy applied to the fluid flow. A pre-processor comprises a digital RF data acquisition component receiving an RF signal from the transducer of back-scattered ultrasound energy and a B-mode image generation component for reconstructing images form the RF data. A post-processor generates velocity vectors indicative of the fluid flow.
For purposes of illustrating the innovative nature plus the flexibility of design and versatility of the system and associated method set forth herein, the following figures are included. One can readily appreciate the advantages as well as features that distinguish the instant invention from conventional systems and methods. The figures as well as the incorporated technical materials have been included to communicate the features of applicants' innovative system and method by way of example, only, and are in no way intended to limit the disclosure hereof.
Corresponding reference characters indicate corresponding parts throughout the drawings.
In general, the present invention relates to systems employing methods that couple ultrasound imaging using contrast agents with particle image velocimetry (PIV) methods developed specifically to address issues particular to ultrasound contrast imaging in an effort to characterize the flow of an opaque fluid, such as mammalian blood. More-particularly, the invention is directed to an improved hybrid ultrasound velocimetry method and system that couples PIV and ultrasound contrast imaging, Echo PIV, in a fashion to take advantage of the harmonic radio frequency (RF) backscatter content of contrast agents, such as microbubbles/spheres and other such hollow particles conventionally used—more, of late—as contrast agents (flow tracers) for ultrasound PIV. Components and combinations of features, both hardware and software/processing methods, are disclosed as contemplated herein, such that the system and associated method, not only provide clinicians with additional less-invasive diagnostic and treatment tools, but are also useful in non-clinical imaging applications where velocity fields within opaque structures are sought to be determined non-intrusively. Such applications include but are not limited to pipe flows of fluids, flow of complex fluids such as multi-phase fluids, polymers, etc., flows near free and bounded surfaces, and flows within micro-fabricated devices such as microelectro mechanical systems (MEMS).
Thus, in addition to use within a wide variety of applications related to medical/veterinary diagnostics and treatment of patients—such as for characterization of portions of the cardiovascular system (as further explained, below)—the method is useful for a broader range of industrial opaque flow imaging applications, such as: in the processing of petroleum, the manufacture and processing of beverages (e.g., carbonated liquids including beer and champagne, wine, juice, milk, soybean milk, soft drinks etc.), perfume, ink, water supply, dye, paste, glue, and certain plastics; chemical solution monitoring, for coastal engineering research and analysis; for environmental management of estuaries and coastlines; and so on. Furthermore, by employing high frequency ultrasound, the method can be used for opaque microfluidic imaging measurement, for use in the developing technical area of microfluidic bio-systems.
In one embodiment, the instant invention is directed to an improved method for multi-component blood flow velocimetry for peripheral vascular imaging using Echo PIV. The Echo PIV system developed provides opportunity for increased spatial resolution and dynamic range of measurable velocities. Echo PIV performance is quantified and characterized herein, in a way that optimizes the Echo PIV method to cover a broad range of blood flow, and other, applications. Whereas conventional PIV is centered-around mathematical manipulation of optical images, the combination of system components described and contemplated herein, utilize transducer devices (by way of example, transmit a narrow band ultrasound signal to energize the microbubbles/contrast agent within the flow undergoing examination, and receive the RF emission/backscatter using a broadband receiver transducer, that is to say, the transducer is specifically designed to transmit a narrow band signal and receive a wideband signal) with associated firing sequences and associated PIV analysis, etc. of the harmonic RF ultrasound backscatter content of the contrast agent (e.g., microbubbles by way of example).
In one embodiment, a system and associated method of the invention generates multi-component blood flow velocimetry for peripheral vascular imaging using Echo PIV.
The ultrasound beam is scattered by contrast microbubbles, which due to their buoyancy characteristics are excellent tracers of the flow field 14. Due to the large difference in impedance between the microbubble and surrounding fluid (collectively referred to by reference character 14), and pressure-induced non-linear resonance, the bubbles scatter strongly. This results in RF DATA 15 which is filtered and represents reconstructed B-mode image frames 16 of the particle positions. Two sequential image frames 16 are improved at 16A then subjected to PIV analysis: the images are divided into interrogation windows (sub-windows); a rough velocity estimation by cross-correlation 17 is performed on the sub-window images to provide the local displacement of the particles; extension of the cross-correlation to all sub-windows over the entire frame allows the velocity vector field 18 to be determined since the time between images (Δt) is known.
In one embodiment, the method includes identifying and tracking a flow tracer (e.g., ultrasound contrast microbubbles) within a flow field, and computing local velocity vectors using a cross-correlation algorithm. The particle image is obtained by sweeping a focused ultrasonic beam through the desired field of view of the fluid. The processing of RF backscatter data is preferably accomplished using: the RF data integrated to produce the signal intensity at that point in space and time; the RF data is filtered by analyzing and processing to extract only the fundamental harmonic component, which is then used to create the B-mode image so that other harmonic components, including but not limited to the sub-harmonic, the ultra-harmonic, or the second harmonic are eliminated or minimized.
In another embodiment, the method and associated system of obtaining multi-component vectors velocity within opaque flow utilizing ultrasound emissions, includes: identifying and tracking a flow tracer (ultrasound contrast microbubbles or other particulate contrast agent) within an opaque flow field, constructing particle images using digital RF data and computing particle displacements to obtain local velocity vectors over an area under investigation, and using a two dimensional (2D) domain cross-correlation function (such as an FFT) applied to interrogated particle images. This method produces an integrated anatomic and functional examination by providing multi-component velocity data that can be matched to produce an anatomic diagram of the area under investigation. Further, particle tracking can be used instead of particle velocimetry to follow individual traces when used with ultrasound systems imaging at high frequencies.
As noted above, the ultrasound beam is scattered by the ‘contrast agent’ which, by way of example, can include microbubbles of gas seeded into the fluid. Due to the large acoustic impedance mismatch between the bubble and fluid, the bubbles scatter strongly and ‘shine’ acoustically in the ultrasound field, resulting in a clear digital radio-frequency (RF) backscatter of the particle positions with excellent signal to noise ratio (SNR). These RF data are processed to yield the imaging frame for that particular scanning time sequence.
The processing of RF backscatter data is preferably accomplished using certain of the following: the RF data is integrated to produce the signal intensity at that point in space and time; the RF data is analyzed to extract only the fundamental harmonic component, which is then used to create the B-mode image; the RF data is processed to extract any of the harmonic components, including but not limited to the sub-harmonic, the ultra-harmonic, or the second harmonic. The use of contrast microbubbles produces harmonic signatures in the RF signal, which serve to delineate backscatter from bubbles separately from backscatter from tissue. The term Harmonic Echo PIV is used to refer to applications employing the harmonic content of RF.
Two such sequential particle images are, next, subjected to velocimetry analysis: the images are divided into interrogation sub-windows, and the corresponding interrogation windows within each of the two images are then cross-correlated in 2D Fourier space. The cross-correlation between the two images gives the displacement of the particles, allowing a velocity vector field to be determined based on the time between images. The ultrasound velocimetry system is designed to handle high frame rates (up to 2000 frames per second) and can measure real time multi-component flow velocity vectors with large dynamic velocity range up to 2 m/s. The Echo PIV method also provides information on anatomic structures, and thereby allows both structure and functional imaging by showing multi-component velocity data overlain on amplitude echo images of anatomy.
The cross-correlation system and method of the invention is different from the two dimensional ultrasound velocimetry which uses cross-correlation on received RF signals from directional beam forming previously proposed in U.S. Pat. No. 6,725,076. This previous method applies cross-correlation directly to backscattered RF data (not to the reconstructed images) to obtain velocity vectors. This previous method also does not note or take advantage of acoustically optimized tracer particles such as contrast bubbles. The previous method also does not show the type of firing and receiving protocols needed to control the transducer specifically for optimal particle image velocimetry measurements to be performed. It does not indicate use of harmonic content in the RF backscatter data. It does not use velocimetry algorithms using 2D cross-correlation of interrogated particle images in Fourier Space and velocity data that can be precisely matched with anatomic pictures. It also does not utilize any hybrid velocimetry methods such as combinations of particle tracking and particle image velocimetry. It also does not utilize various pre- and post-processing methods specifically developed to optimize the quality of the velocity vector data. Further, the previous method is not a 2D ultrasound multi-component velocimetry method where ultrasound contrast agents (microbubbles) are used as flow tracers for multi-component velocimetry imaging. Lastly, the previous method is not an ultrasound multi-component velocimetry system which has high frame rates (up to 2000 frame per second) and can measure real time multi-component flow velocity vectors with large dynamic velocity range up to 2 m/s.
Applications to Cardiovascular Blood Flow Imaging
Cardiovascular radiologists, interventionalists, surgeons, and diagnostic imaging experts serving both the adult and pediatric populations can use the invention as a tool: 1) the method and system of the invention provides real time noninvasive measurement of multi-component blood velocity vectors and mapping which is essential both as a prognostic aid and for many cardiovascular disease and treatment progression; 2) the method of the invention is suitable for incorporation into an imaging system having a compact/small footprint to facilitate clinical imaging on and off-site; 3) The method of the invention is adaptable for providing quantitative hemodynamics parameters such as shear stress, vorticity and flow pattern streamlines etc, which are useful in following disease progression to evaluate vulnerable plaques in carotid arteries, anastamotic hyperplasia in vascular grafts, predicting risk of rupture for vascular aneurysms, and so on.
General Opaque Flow Imaging Area
The system and associated method of the invention provides clinicians with additional less-invasive diagnostic and treatment tools, useful in non-clinical imaging applications where velocity fields within opaque structures are sought to be determined non-intrusively. Such applications of the invention include but are not limited to conduit (e.g., pipe) flows of fluids, flow of complex fluids such as multi-phase fluids, polymers, etc., flows near free and bounded surfaces, and flows within micro-fabricated devices such as MEMS.
The following non-limiting examples are provided to further illustrate embodiments of the present invention.
Imaging limits of conventional commercial systems revolve around spatial accuracy and resolution, as well as inherently low frame rates, in turn, limiting the range of measurable velocities, the ability to capture transient flow phenomena, and the density of the resulting PIV vector field. An overall schematic of the Echo PIV system is shown in
The Echo PIV system and method of the invention uses a much lower concentration of microbubbles than that used by conventional ultrasound contrast imaging: Microbubble concentration for the method can be 12×103 bubble/ml, roughly 105 times less than conventionally used in commercial concentrations.
A transient, suddenly started, vortex ring was also imaged using the Echo PIV system and method of the invention. Such a transient flow is difficult to capture using conventional opaque flow velocimetry methods, such as ultrasound Doppler or MRI velocimetry due to the inherently transient nature of the flow and the existence of multi-component velocity vectors.
The system of
The dynamic velocity range of an Echo PIV system is defined as the difference between the maximum and minimum blood velocities the system can measure. Since blood velocity varies dramatically both around the circulatory system and within a single blood vessel, it is preferable to have ‘wide’ dynamic velocity range for more-optimal performance in different vascular velocimetry applications. Dynamic velocity range is related to both frame rate and spatial resolution. Increasing frame rates allows higher velocities to be measured, while increasing spatial resolution allows lower velocities and higher spatial velocity gradients to be discerned, as is more-fully discussed below, in connection with an example peripheral vascular imaging application.
Specifications for Peripheral Vascular Echo PIV
Peripheral vascular imaging include blood velocity measurements in vessels such as the carotid, brachial, femoral, popliteal, iliac, aortic, and renal arteries, as well as central and peripheral veins. Peripheral vascular imaging using Echo PIV may be accomplished by the system depicted in
Spatial Resolution
Both axial and lateral resolution impact Echo PIV data quality. Axial resolution is heavily dependent on system bandwidth, including that of the transducer. Lateral resolution is determined by the beam width, which in turn is determined by ultrasound frequency, the size of the transducer aperture, the degree of focusing and the imaging depth. As mentioned earlier, the minimum axial resolution preferred is approximately 1/10 of vessel diameter; however, it is advantageous to maximize axial resolution as this will increase Echo PIV vector density within the vessel and increase the accuracy of derivative calculations such as shear stress. For the general vascular Echo PIV imaging characteristics, an axial resolution of ˜200 microns is targeted to provide both good Echo PIV data density and application to a wide range of blood vessel sizes. This level of resolution is obtained by a high frequency (>5 MHz), high bandwidth (>50%) transducer.
Dynamic Velocity Range
The dynamic velocity range, as used herein in connection with the Echo PIV system and method of the invention, is defined as the achievable velocity range between the maximum and minimum resolvable velocity measurement for a fixed set of instrument parameters. As identified in connection with the first-generation Echo PIV system of the applicants, a dynamic velocity range of 1 to 60 cm/sec was reported; this is too low for general vascular imaging use. As identified above, dynamic velocity range is determined by frame rate and spatial resolution of the Echo PIV system. The frame rate is manipulated through flexible control of system parameters, as discussed subsequently. Given the frame rate and spatial resolution, a good estimate for dynamic velocity range is derived employing a velocity calculation algorithm of Echo PIV. Like optical PIV analysis, Echo PIV analysis is based on a cross-correlation method using the FFT algorithm. Certain criteria that apply to optical PIV, has been followed in Echo PIV. Others have carried out Monte-Carlo simulations to determine the requirements for experimental parameters needed to yield optimal optical PIV performance. One recommendation was that in-plane displacement of the particle image should be less than or equal to a quarter of the diameter of the interrogation window (one-quarter rule). The one-quarter rule sets the upper bound of particle displacements in two sequential image frames subject to PIV analysis, and thus determines the maximum velocity the system can measure given a certain frame rate. Since then, other algorithms that move the second window to capture the positions of particles at the later time have evolved. These ‘window offsetting’ methods are limited by the correlation length of the flow itself. The instant Echo PIV system and associated method, do not use such methods.
In one embodiment, the Echo PIV system as set forth in
Spatial Resolution
Although dynamic focusing has been adopted in ultrasound imaging for purposes of improving image clarity in a large field of view, for vascular blood velocity measurements using Echo PIV, dynamic focusing has not been used. Dynamic focusing decreases the maximum frame rate. Since the diameters of blood vessels are relatively small when compared with imaging depth, and the lateral resolution is quite uniform with depth at the designated focal point where the blood vessel is located, further exploration of dynamic focusing is necessary to determine its usefulness for Echo PIV. An approximate measure of the lateral resolution at the focal point is the Rayleigh resolution criterion which gives the distance from the beam peak to the first zero and is equal to
r=f#λ Eqn. (1)
where f# is defined as the focal depth divided by the aperture width (OAKLEY, 1991). From equation (1) with f#≈2.5 to 5 and λ≈0.2 mm, the lateral resolution of the linear array transducer at different focal depths can be calculated, which ranges approximately from 0.5 mm to 1 mm. The axial resolution Δ is determined generally by the wavelength λ of the incident ultrasound beam and the number N of cycles in the excitation pulse: Δ=λN/2. For our Echo PIV system, with N=2, the axial resolution is about 0.23 mm when the transducer operates at its center frequency of 7.8 MHz.
Temporal Resolution
Frame rate of the Echo PIV system is determined by FOV and several other system parameters, including the beam line density (BLD) and system hardware response time Th. BLD is the number of scan lines generated within one transducer element width (Wele) in the B-mode image. The larger the BLD, the larger the number of scan lines composing one image, and the better the lateral spatial resolution. However, there is a tradeoff: higher BLDs require longer times to generate one image and result in decreased frame rates.
In one preferred embodiment, BLD options for the Echo PIV system are 0.5, 1, 2 and 4. The hardware response time Th is the time period between receipt of the most distant echo and transmission of the next beam. For example, Echo PIV system has Th=3 μs. The FOV of the linear array transducer is rectangular-shaped. The width (WFOV) of the FOV is determined by Wele and the number of activated transducer elements (Nele), which ranges from 16 to 128 creating a narrow or wide image. The length of the FOV is determined by the imaging depth (D) required, ranging from 30 mm to 90 mm. Frame rate is directly affected by FOV, since it is inversely proportional to the product of the number of scan lines and the scan time Tt for each ultrasound beam, which ranges from 70 μs to 120 μs as the depth increases. The time for generating one imaging frame is:
Tf=BLD×Tt×Nele Eqn. (2)
and the frame rate (FR) is:
From Eqn. (3), note that frame rate is directly related to the width and length of FOV by Nele and Tt, illustrated by
Dynamic Velocity Range
In 2D flow field model, a velocity vector may have components in the axial direction and in the lateral direction. For blood velocity measurements, the accuracy of the lateral velocity component is important because the blood vessels will be usually roughly parallel to the transducer scan direction, that is, the primary blood velocity component will usually be in the lateral direction. A derivation of the lateral dynamic velocity range follows below; the same principle applies in the axial direction. The following analysis uses the entire width of the image for a single interrogation window. Applying the one-quarter rule, the maximum lateral displacement of particles in two successive frames is WFOV/4. Given frame rate, maximum lateral velocity that can be measured by for this embodiment of the Echo PIV system is:
Given the frame rate, a conservative estimate for the minimum detectable velocity in the lateral direction Vlmin is likewise derived. Thus, a particle image must appear in different beam lines in the second frame for a displacement to be detected: Vlmin is actually determined by the spacing of two adjacent beam lines:
The minimum detectable velocity in the axial direction is smaller than Vlmin since the axial particle displacement is not discretized by beam lines.
The above derivation addresses the case where the whole FOV is employed as an interrogation window for cross-correlation analysis, and only one velocity vector will be generated in the interrogation window, which represents the average particle velocity in this area. It is desirable to know local velocities over the entire field so that a detailed velocity vector map of the flow field can be generated. Echo PIV can generate such maps by dividing the FOV into many sub-windows. The size of the sub-window is determined by the flow characteristics and the level of resolution needed in the vector map. These issues are offset by the requirement for sufficient number of particles within each sub-window. The typical interrogation window sizes we use are 1.8 mm×1.8 mm, 2.7 mm×2.7 mm, 3.6 mm×3.6 mm, 3.6 mm×1.8 mm etc. 5-10 particle images are preferably needed in each interrogation window. Assuming the interrogation window has a width Ws, the maximum velocity in the lateral direction that can be measured is:
Thus, Vslmax is reduced from the single window estimate by a factor equal to the number of subwindows used.
Focal Depth
Bubble Concentration
According to one embodiment of the invention, a cross-correlation index (CCI) is used, having been produced by the cross-correlation function (to indicate effectiveness of the pattern-matching between the two sub-windows). Normal CCI values for quality PIV data are within the range of 0.2˜0.8.
As a result, the system according to the invention, depending on the embodiment, provides one or more of the following:
Due to some or all of the factors mentioned above, the coefficients of cross-correlation of B-mode microbubble images may be much lower than those of optical PIV, which may cause erroneous velocity vectors when standard cross-correlation is directly applied. In one embodiment of the invention, the pre-processing and post-processing and improved algorithms provide accuracy improvement in echo PIV method.
In one embodiment, the ECHO PIV analysis includes the primary analysis (e.g.,
The primary analysis of
As shown in
In one embodiment, a hybrid EPTV/EPIV analysis may be employed for post processing as illustrated in
In another embodiment, an adaptive EPIV analysis may be employed as illustrated in
In one embodiment, the selecting or marking of an area may be accomplished as illustrated in
In one embodiment, vector filters may be applied as indicated in
In one embodiment, a vector field quality report may be generated as illustrated in
In some embodiments, several areas of improvement are seen. First, since Echo PIV is a correlation-based method, it is sensitive to local microbubble concentration; the number of microbubbles within the interrogation window can affect cross-correlation quality and subsequently the accuracy of the derived velocity. Second, conventional PIV has relatively low dynamic range. Although this can be improved using advanced methods such as adaptive window offset and use of sub-pixel or ultra-resolution methods, these algorithms are time-consuming.
Echo PTV was evaluated in vitro using rotating flow and in a model of a vascular aneurysm. Results show that the proposed echo PTV method is less influenced by bubble concentration compared to echo PIV and has a larger dynamic range.
One embodiment of a detailed procedure, from RF data to velocity map, includes: (1) Pre-processing the RF data to minimize noise; (2) reconstructing the B-mode particle image from processed RF data; (3) image improvement and initial velocity estimation via cross-correlation using a larger window size, and vector outlier correction; (4) applying a variety of filters to refine local bubble images; (5) estimating, with sub-pixel resolution, bubble positions in two consecutive images; (6) pre-shifting microbubbles in the second image using previously estimated information, and obtaining the final bubble displacement by matching bubble positions between the two images.
Effect of Bubble Concentration on EPIV and EPTV
Variable bubble concentrations affect both Echo PIV and Echo PTV results. The following relates to a rotating flow model controlled in rotating flow in order to compare the performances of PTV and PIV.
As shown in
Conventional particle tracking methods possess smaller dynamic range in velocity measurement. This may be overcome by combining PIV and PTV approaches of the invention to create a hybrid Echo PIV/PTV method that maintains the robustness in velocity vector measurement seen in Echo PTV with the larger dynamic range found in Echo PIV. This hybrid method was used to measure velocity vectors within a vascular aneurysm model, which contained a wide range of velocity magnitudes (0.1-10 cm/sec) within the flow field.
RF Data Filtering Methods
Referring to
Some conventional image filters can be employed to enhance the quality of particle images, such as low pass filter (median, moving average or wiener filters) to reduce the noise by smoothing the images, and high pass filter to enhance the particle edge. However, we found that such conventional image filters can not work effectively in the processing of echo PIV particle images due to the high noise levels inherent in ultrasound-based imaging.
It is noted that our purpose of image processing is to improve the velocity vector map, not the image itself. Many image processing methods have been utilized for ultrasound imaging to improve ultrasound image quality; however, these do not necessarily increase the quality of the velocity vectors using Echo PIV. By applying the cross-correlation algorithm, we found, in fact, that the vector map is not improved either by the low pass filter or high pass filter. FIGS. 20A2, 20B2 and 20C2 show the velocity vector maps from FIGS. 20A1, 20B1 and 20C1, respectively. FIGS. 20A3 and 20C3 are exploded portions of FIGS. 20A2 and 20C2, respectively. Contrarily, the vector map is even worse in some regions after high-pass filtering. This is because the edge enhancement by high-pass filter produced some incorrect information in the high-noise-level part in
Since conventional image processing methods did not perform well on echo particle images, it is necessary to find better methods to improve the B-mode particle images for Echo PIV processing. As is known, the images for conventional velocimetry methods such as digital PIV (DPIV) or OPIV come directly from digital video cameras; however, the images for echo PIV are reconstructed from ultrasound RF data, in which significant amount of additional information is included. This characteristic provides more flexible methods to improve velocity vector quality through optimized image processing.
The commonly used filter in B-mode RF signals processing is the band-pass filter. Since the spectrum of echo pulse from microbubbles contains a range of frequencies around the exciting signal frequency for the transducer, the noise outside this band could be eliminated by applying a band-pass filter. However, the drawback of this type of filter is that the noise in the band is unaffected. Therefore, we present a wiener filter for pre-processing of our echo PIV images (see Appendix A for design details). To appreciate the performance of this filter, we compared the performances of the wiener filter and the band-pass filter. Again, it must be understood that the particular characteristics of this wiener filter are to optimize Echo PIV velocity vectors, not the ultrasound image per se.
A 3rd order Butterworth band pass filter (6.5˜8 MHz) and the wiener filter were applied on the RF signals, respectively. The spectra of the RF signals after applying band-pass filtering is shown in
The differences can also be seen from the particle echo signals, as shown in
These could be further proved by comparing the particle images in
The improvement of the bubble images leads to the accuracy improvement of vector map obtained from cross-correlation, as shown in
In order to quantitatively evaluate the performance of our wiener filtering method on improving the vector field, a laminar flow experiment was carried out. The tube diameter is about 10 mm with a flow peak velocity around 10 cm/s. The unprocessed and processed B-mode images are shown in
Echo Particle Image Reconstruction—Correlation-Based Template Matching (CBTM) Background
In Echo PIV method, the microbubbles are seeded in flows and traced by ultrasound B-mode imaging method, the successive microbubble images from which are cross-correlated to generate the velocity vectors showing the flow pattern. The initial in vitro studies showed the utility of this method in accurately measuring two-dimensional velocity vectors in a variety of opaque flows. Although this method appears promising, some issues are present. One of them is the high noise level of ultrasound images. Since Echo PIV method is based on correlation between ultrasound particle images, the signal to noise ratio (SNR) in images has great effect on the measurement accuracy of this method. Although there are a many filtering methods to improve the SNR of ultrasound images, such as the band pass filter, matched filter, inverse filter or deconvolution method, the echo particle images still remain a high noise level due to the strong interferences and nonlinear vibration of microbubbles. In one embodiment, a correlation-based template matching filter such as a filter employing correlation-based template matching (CBTM) is used in order to improve the SNR of echo particle images.
The correlation-based template matching (CBTM) method comes from the area of digital communication, in which a matched filter (convolution of a template signal with the received noisy signal) is used to detect the transmitted pulses in the noisy received signal. In the CBTM method, however, the cross-correlation between a template signal and the target signal rather than convolution is involved. The target signal is the particle echoed (RF) signal and the template signal is a standard Gaussian weighted pulse, as shown in
In the initial stage of one embodiment, we only take the standard Gaussian signal as a template, which does not consider any nonlinear effects of microbubbles. However, as another embodiment, in order to represent the particle echoed pulse more accurately, the measured bubble-echo signal could be employed.
Static Microbubbles Results
Moving Microbubbles Results
Not only does the CBTM method improve the SNR of particle images but it also allows identification of additional particles, which will further contribute to velocity measurement accuracy. In
The accuracy of center velocity measurement in
An CBTM method according to one embodiment of the invention is described to improve the echo particle images. The initial studies show its ability to enhance the SNR and spatial resolution of particle images, and the ability to reveal more particle information from noisy signals. A simple rotating flow experiment demonstrates the improvement of echo PIV measurement accuracy coming from the improved particle images.
Representative Templates Description
There are several types of templates that could be employed in our developed template matching filter. (The center frequency is 7.5 MHz).
As noted above, the procedures of template matching by cross-correlation:
As noted above, a convolution operation is applied between the target signal and the template signal.
The images processed by template matching filter with convolution and cross-correlation are compared with the original image. Both convolution and cross-correlation can improve the bubble images. After the convolution method, the bubble images (
Correction of Non-Uniform Intensity Distribution
Similarly to optical PIV, the ultrasound image also has a problem of non-uniform intensity distribution, which is mainly caused by the non-uniformity of the beam line. In the axial direction, the beam line is well focused at the focal region, introducing strong acoustic energy; however, at the near and far focal zones the energy is dispersed along the lateral direction. Such a B-mode particle image is shown in
Post-Processing: Improvement of Vector Field
The task of post processing is to increase the velocity measurement accuracy, the dynamic velocity range and the velocity map resolution. In the past twenty years, there are numerous studies in conventional or digital PIV areas, which significantly improved the quality of the resultant velocity vectors. However, these have relied on the high quality image sources seen in optical imaging. What we are interested in is how and how much the echo PIV method and the echo PIV vector field can be improved. In this section, we adapted the previous PIV methods into our echo PIV methods, in order to systematically investigate the factors influencing the improvement of echo PIV velocity map, and demonstrate the possibility of improving this method, using by way of example, several types of flow, such as rotating flows, tube flows and flows through abdominal aortic aneurysm (AAA) models.
Improvement of Velocity Vector Accuracy
As discussed in the previous section, the pre-processing on B-mode images can improve, to some extent, the measurement accuracy. However, there are still some obviously incorrect vectors remaining in the vector field, introducing errors to the measured flow velocities. To eliminate those outliers, the vector field is smoothed by numerous customized neighborhood filters, which are followed by interpolation methods.
Although some outliers could be found by using global and local filters, it is obvious that these two filters are not enough to detect all of the inaccurate vectors. Generally, the generation of outliers is quite related with the SNR of the cross-correlation map, thereby a SNR filter is designed to identify those vectors with a noisy correlation map. The design details are expanded upon in Appendix B.
Enhancement of Velocity Field Resolution
The accuracy of the cross-correlation of two images depends on many factors for echo PIV, including the spatial resolution of two images, the noise level, the bubble concentration, the gradient of velocity, and also the interrogation window size. Among all of the factors, the interrogation window size is quite important for the quality of cross-correlation, since the detection of either a valid or a spurious vector directly depends on the number and distribution of the particle images inside the interrogation area. For Echo PIV images, generally it is not completely possible to find 10 particle images and four matched image pairs in each interrogation window, since a low bubble concentration is required. The larger interrogation window size brings more particle image pairs, thereby the accuracy of cross-correlation is improved to some extent. However, this is not always true. In the regions with large velocity gradients, the local velocities in differing directions may appear as a small average or even no velocity with a large standard derivation. In such cases, velocity measurement accuracy generally deteriorates. On the other hand, the window size should be as small as possible in order to maximize the spatial resolution of the vector field. However, decreasing window size too far will not provide enough image pairs in each interrogation area; therefore the quality of the vector map will also deteriorate. Thus, the optimal window size arises from a tradeoff between generating sufficient vector accuracy and sufficient vector field resolution.
The effects of different interrogation window sizes on vector resolution and vector accuracy were investigated by employing the rotating flow model, in which both optical PIV and echo PIV were measured simultaneously in order to validate the results of echo PIV.
Since the conventional PIV analysis could not improve the resolution of vector field while maintaining good measurement accuracy, advanced methods are introduced. The adaptive window size and discrete window offset algorithms, commonly used in PIV techniques but adapted to account for the higher SNR and lower resolutions of ultrasound imaging, are employed to improve both the accuracy and resolution of our echo PIV method. The results are shown in
Improvement of Dynamic Velocity Range
Another important criterion to evaluate a velocimetry method is the dynamic velocity range (DVR). The DVR is defined as the ratio between the maximum measurable velocity range and the minimum resolvable velocity measurement. For the conventional cross-correlation algorithm, the ratio is determined by the interrogation window size. For example, if a 32×32 pixel window size is selected, the maximal displacement that could be correctly measured is around 4˜5 pixels (about one fourth of window size), and the minimal displacement should be one pixel. So the DVR is about 4˜5, which is too low for a velocimetry method. However, if using peak-interpolation schemes in the correlation plane, sub-pixel accuracy can be obtained. Therefore, the DVR could be enhanced to a value about 40˜50. This DVR is generally sufficient for medical in vivo applications.
Using by way of example flow through the aneurysm model, we compared the DVRs before and after application of the sub-pixel interpolation algorithm.
Example Of Echo PIV Measurement on Abdominal Aortic Aneurysm Models
Abdominal aortic aneurysms (AAAs) are localized balloon-shaped expansions commonly found in the infrarenal segment of the abdominal aorta, between the renal arteries and the iliac bifurcation. Abdominal aortic aneurysm rupture has been estimated to occur in as much as 3%-9% of the population, and represents the 13th leading cause of death in the United States, producing more than 10,000 deaths annually. Thus, determining the significant factors for aneurysm growth and rupture has become an important clinical goal. From a biomechanical standpoint, AAA rupture risk is related to certain mechanical and hemodynamic factors such as localized flow fields and velocity patterns, and flow-induced stresses within the fluid and in the aneurysm structure. Disturbed flow patterns at different levels have also been found to trigger responses within medial and adventitial layers by altering intercellular communication mechanisms. Thus, localized hemodynamics proximal, within and distal to AAA formations play an important role in modulating the disease process, and non-invasive and easy-to-implement methods to characterize and quantify these complex hemodynamics would be tremendously useful. Echo PIV measurement on abdominal aortic aneurysm models.
Experimental Methods
The custom-designed Echo PIV system was applied to in vitro fusiform AAA models under steady flow conditions. A centrifugal pump was employed to circulate water through a plastic aneurysm model between two containers with a fixed head differential, with flow rate adjusted between 0.2-0.6 L/min using a shunt valve. The aneurysm model was embedded in a tissue phantom. It has non-dilated inlet and outlet tubes with diameter of 8 mm and length of 200 mm, and has a bulge with length of 28 mm and a maximum diameter of 24 mm. The ultrasonic transducer was well aligned so that the scan plane coincided with the vessel centerline. Ultrasound contrast microbubbles (Optison®, Amersham, UK) were used as flow tracers and seeded into the flows. B mode particle images were acquired by the system at a frame rate of 150 fps with a focal depth of 24 mm and FOV of 40 mm (depth) by 27 mm (width).
At the same time, a 3D computational aneurysm model with similar dimensions was constructed by using SOLIDWORKS (Solidworks Corp., MA). To maintain a well developed flow before the entrance to the aneurysm region and minimize the flow disturbance downstream, we made the vessels proximal and distal to the aneurysm as long as 150 mm with a diameter of 8 mm. The maximum diameter of the aneurysm was 24 mm and it was smoothly translated to straight vessels using fillet at conjunction areas. This solid model was then imported into ICEM-CFD (ANSYS Inc., PA) and meshed by using 35,000 hexahedral elements. Detailed mesh distribution is presented in
Results
B-mode images were constructed from the acquired RF data for the flows in AAA model and a cross correlation was performed on these images to calculate the local velocities in the flow field.
Transducer and Advanced Transducer Driving Methods for Echo PIV
For peripheral vascular imaging using Echo PIV, such as carotid artery imaging, the diameter of the vessel is about 0.5-1 cm, the maximum blood velocity is about 1 m/s and the imaging depth is usually less than 5 cm. To obtain clear images of blood vessel boundaries and contrast agents, high frequency transducers (center frequency around 10 MHz) are preferred to achieve good spatial resolution. Also, the transducer bandwidth should be large (≧70%) so that advanced imaging methods, such as 2nd harmonic imaging, sub-harmonic imaging and ultra-harmonic imaging can be employed to maximize the bubble detection in tissue structure.
Tissue is relatively incompressible and responds linearly to ultrasound. The non-linear behavior of ultrasound contrast agents cause the highly compressible bubbles to act as active scatterers with significant components in the sub and higher harmonics of the incident frequency. Examination of the harmonic frequencies can thus separate the echo signal due to microbubbles from that due to tissue. Broad bandwidth transducers can be operated efficiently in a large frequency range thus allow the receiving of the sub or 2nd harmonic content of the transmitted ultrasound pulses to improve the bubble detection.
Here we introduce a driving method for Echo PIV harmonic imaging: triangular pulse driving. Rectangular pulses are commonly used as the input signals for ultrasound transducers because they can be easily implemented through hardware. A triangular pulse carries less power than rectangular pulse, which minimizes the possibility of bubble rupture and reduces ultrasound intensity especially at high frame rates. Also, a triangular pulse is very efficient in triggering strong backscatter from the contrast agents, especially the sub and higher harmonic contents.
Parallel Beams Scanning Method for Improving Echo PIV Frame Rate in a Large FOV
The commonly used method for improving ultrasound imaging frame rate is to reduce the imaging depth and the number of scan lines since the ultrasound velocity in tissue media limits the pulse repetition frequency, and a small number of scan lines require less time for backscatter data acquisition. This method works well for peripheral vascular imaging, since the location of vascular is relatively shallow and the bubble image in a small window may provide enough information for successful Echo PIV measurements. However, for cardiac imaging and deep vascular imaging, the field of view (FOV) needed is relatively large, and alternative methods must be proposed to increase the frame rate.
Here, we introduce the parallel beam scanning concept into Echo PIV to improve the frame rate. For conventional linear arrays, a certain number of transducer elements will be fired in sequence to form focused ultrasound beams to scan through the whole FOV In parallel beam scanning, several groups of transducer elements will be fired simultaneously, and several focused ultrasound beams will be generated at the same time to scan through a relatively small FOV, thus improving the frame rate by a factor of the number of simultaneous beams.
A typical B-mode microbubble image is shown in
The goal of our custom-designed wiener filter is to filter out the noise that has corrupted a signal. Typically the wiener filter is designed in frequency domain, where it has the traditional form,
where,
H(w) is the Fourier transform of the point-spread function (PSF), Ps(w) and Pn(w) are the power spectrums of the signal and the noise process, respectively, obtained by taking the Fourier transform of the signal and noise autocorrelation.
Therefore, it is generally assumed that the spectral properties of the original signal and the noise are known. However, in the obtained RF echo signals, it is difficult to exactly estimate the spectral properties of signal and noise. So we design the wiener filter in such a form,
where σ is signal-noise factor, not dependant on the frequency.
Although the wiener filtering is generally not used in the reconstruction of B-mode images with many reflection objects, the advantage in echo PIV images is that the microbubble image comprises many bubbles with similar properties, that is, the echoed pulses from the bubbles are similar.
We approximate the PSF by estimating the echoed pulse from a steady fluid with very low concentration of microbubbles, in the uttermost extent to reduce the noise effect and the interferences between bubbles. The echo pulse and its spectrum are shown in
In this way, we obtain the approximated wiener filter from Eq.A2, which is dependant on signal-noise factor σ (typically between 1˜100 for the echo PIV images).
Global Filter
For the real flow field, generally it can be assumed that the velocity difference between the neighboring velocity vectors is smaller than a certain threshold εthresh,
|U(i,j)−Uavg|>εthresh (Eq.B1)
where U(i,j) is the velocity at each position (i,j), Uavg is the average value of total vectors in the flow field, and εthresh=Cg·Ustd, in which, Cg is a constant (assigned by the user) and Ustd is the standard deviation of vector values within the flow field.
The vector is identified as an outlier if its value U(i,j) meets the requirement in Eq.B1. Therefore, the global filter applies physical limitations to remove all the impossible data, located beyond the range [Uavg−C·Ustd, Uavg+C·Ustd]. The constant Cg depends on the velocity distribution and the quality of cross-correlation, with the recommended values listing in Table B1.
Note*:
For global and local filters, the smaller the threshold value, the more vectors will be identified as outliers; for, SNF, the greater the value, the more vectors will be detected.
In addition to assigning the constant C value, the upper and lower limit could also be determined manually by choosing four points (limits for u and v component of velocity) on the u-v velocity map. This method works better when some flow information is known a-priori, for example when u or/and v component has only positive or negative values in some regions.
Local Filter
The local filter aims to detect those erroneous vectors that could not be detected by the global filter (i.e., their values are in the possible range), but are surrounded by some correct vectors. In this way, these vectors could be detected by comparing their values with the surrounding values. Typically, a 3×3 pixel neighborhood with eight nearest vectors or 5×5 with 24 neighbors is selected. The velocity vector is deemed erroneous and rejected if the following condition is satisfied:
|U(i,j)−Un|>εn,thresh (B2)
where n represents the nth unit in the vector field, U(i,j) is the value of detected vector at position (i,j) in the unit, Un is the mean or median value of the surrounding vectors of vector (i,j), and εn,thresh is the threshold for the nth unit, defined as εn,thresh=Cl·Un,std, in which, Cl is a constant selected by the user (see Table B1 for recommended value range) and Un,std is the standard derivation of the neighbor vectors. Typically, depending on the definition Un, the local filter has two types: local mean filter and local median filter.
Signal to Noise Filter
The global and local filter, in most cases, cannot detect all of the erroneous vectors in the vector field, for example, when there is a region with some outliers being together. For this reason, a signal to noise filter (SNF) is designed to especially detect those groups of erroneous vectors from bad cross-correlation due to the noise or particle mismatching. The vector will be re-classified as an outlier if the following criterion is satisfied:
Cpeak/C′peak<εSNF (B3)
where Cpeak is the peak value in the cross-correlation map, from which a displacement of particle movement is determined, and C′peak is the peak value of the regions excluding the highest peak region (a small region near Cpeak, typically a 4×4˜6×6 pixels depending on the interrogation window size), εSNF is the threshold with a general value range listed in Table B1.
Actually, considering the fact that the cross-correlation quality is related to both the peak value of cross-correlation map and the shape of the peak profile, we could also define the SNF as,
Cpeak/(C′peak·Rarea)>εSNF (B4)
where Cpeak and C′peak are the same with those in Eq. (B3), and Rarea is the ratio between the pixel areas with cross-correlation values greater than the half of the peak value and the whole pixel areas in cross-correlation map.
While certain representative embodiments and details have been shown for the purpose of illustrating features of the invention, those skilled in the art will readily appreciate that various modifications, whether specifically or expressly identified herein, may be made to these representative embodiments without departing from the core teachings or scope of this technical disclosure. Accordingly, all such modifications are intended to be included within the scope of the claims. Although the commonly employed preamble phrase “comprising the steps of” may be used herein, or hereafter, in a method claim, the applicants do not intend to invoke 35 U.S.C. § 112 ¶6 in a manner that unduly limits rights to its innovation. Furthermore, in any claim that is filed herewith or hereafter, any means-plus-function clauses used, or later found to be present, are intended to cover at least all structure(s) described herein as performing the recited function and not only structural equivalents but also equivalent structures.
When introducing elements of the present invention or the preferred embodiments(s) thereof, the articles “a”, “an”, “the” and “said” are intended to mean that there are one or more of the elements. The terms “comprising”, “including” and “having” are intended to be inclusive and mean that there may be additional elements other than the listed elements.
In view of the above, it will be seen that the several objects of the invention are achieved and other advantageous results attained.
As various changes could be made in the above constructions, products, and methods without departing from the scope of the invention, it is intended that all matter contained in the above description and shown in the accompanying drawings shall be interpreted as illustrative and not in a limiting sense.
This invention disclosed herein was made with U.S. government support awarded by National Science Foundation (NSF) award No. CTS-0421461 and National Institute of Health (NIH-HLBI) award R21 HLO79868. Accordingly, the U.S. Government has certain rights in this invention.
Number | Date | Country | |
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60830880 | Jul 2006 | US | |
60936220 | Jun 2007 | US |