WO2001089358A2 - Ultrasound apparatus and method for tissue resonance analysis - Google Patents
Ultrasound apparatus and method for tissue resonance analysis Download PDFInfo
- Publication number
- WO2001089358A2 WO2001089358A2 PCT/IB2001/000955 IB0100955W WO0189358A2 WO 2001089358 A2 WO2001089358 A2 WO 2001089358A2 IB 0100955 W IB0100955 W IB 0100955W WO 0189358 A2 WO0189358 A2 WO 0189358A2
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- signal
- echo
- brain
- patient
- ventricle
- Prior art date
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/46—Ultrasonic, sonic or infrasonic diagnostic devices with special arrangements for interfacing with the operator or the patient
- A61B8/461—Displaying means of special interest
- A61B8/463—Displaying means of special interest characterised by displaying multiple images or images and diagnostic data on one display
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/03—Detecting, measuring or recording fluid pressure within the body other than blood pressure, e.g. cerebral pressure; Measuring pressure in body tissues or organs
- A61B5/031—Intracranial pressure
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/40—Detecting, measuring or recording for evaluating the nervous system
- A61B5/4058—Detecting, measuring or recording for evaluating the nervous system for evaluating the central nervous system
- A61B5/4064—Evaluating the brain
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/40—Detecting, measuring or recording for evaluating the nervous system
- A61B5/4058—Detecting, measuring or recording for evaluating the nervous system for evaluating the central nervous system
- A61B5/407—Evaluating the spinal cord
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/08—Detecting organic movements or changes, e.g. tumours, cysts, swellings
- A61B8/0808—Detecting organic movements or changes, e.g. tumours, cysts, swellings for diagnosis of the brain
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/08—Detecting organic movements or changes, e.g. tumours, cysts, swellings
- A61B8/0808—Detecting organic movements or changes, e.g. tumours, cysts, swellings for diagnosis of the brain
- A61B8/0816—Detecting organic movements or changes, e.g. tumours, cysts, swellings for diagnosis of the brain using echo-encephalography
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
- A61B5/316—Modalities, i.e. specific diagnostic methods
- A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
- A61B5/346—Analysis of electrocardiograms
- A61B5/349—Detecting specific parameters of the electrocardiograph cycle
- A61B5/352—Detecting R peaks, e.g. for synchronising diagnostic apparatus; Estimating R-R interval
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
- A61B5/7232—Signal processing specially adapted for physiological signals or for diagnostic purposes involving compression of the physiological signal, e.g. to extend the signal recording period
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
- A61B5/7235—Details of waveform analysis
- A61B5/7242—Details of waveform analysis using integration
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
- A61B5/7235—Details of waveform analysis
- A61B5/7253—Details of waveform analysis characterised by using transforms
- A61B5/7257—Details of waveform analysis characterised by using transforms using Fourier transforms
Definitions
- the present invention relates to the field of ultrasound apparatuses and methods for non-invasive medical diagnostics and treatment.
- Dr. David Michaeli is also known as Dr. David Mikheslashvili and Dr. David Michelashvili.
- Isotope Diagnosis Isotope Diagnosis
- TCD Transcranial Doppler ultrasonography
- TCD is noninvasive and does give real-time measurement. However, the accuracy of the measurement is highly dependent upon the angle of the probe relative to the skull, and the skill of the operator. In addition, TCD does not measure the volumetric . velocity of the blood flow and does not give precise measurement of the contraction or dilation of blood vessels in the brain. This imprecision is caused by the fact that TCD can only be used to observe a sector or large area in the brain, instead of a localized point. In addition, TCD uses ultrasound waves at a frequency of 2 MHz, which, for an estimated 15-40% of the population, do not actually reach the interior of the cranium, because of high attenuation of the ultrasound waves in the bone tissue of the cranium.
- the acoustic reflections detected are only from the magistrial and proximal blood vessels.
- this method also detects reflections from the brain and from other, non-cranial, blood vessels. The result is a noisy signal that does not allow precise determination of the depth of the measurement point. This does not allow measurement of individual blood vessels or their blood flow with any precision.
- Use of ultrasound technology as a diagnostic tool is discussed, inter alia, in the book entitled “Textbook of Diagnostic Ultrasonography,” 4.sup.th edition, by Mosby, pages 682-686.
- This pressure is commonly referred to in the art as intra-cranial pressure.
- tissues in the body swell when traumatized. In order to heal, such tissues require oxygen.
- brain tissue There are special circumstances with respect to brain tissue which makes the situation even more critical.
- the brain rests inside a bone casing, and there is little or no room for it to expand. When the brain swells, it experiences more trauma. Because it is encased within the skull, the swelling of the brain causes parts of the brain to be compressed. This compression decreases the blood flow and oxygen to parts of the brain which, in turn, causes more swelling. The more damage the brain receives, the more oxygen it needs, and the more it swells. Swelling is caused, e.g., by leakage from blood vessels. This leads to a rise in pressure within the brain.
- brain swelling In response to a trauma, changes occur in the brain which require monitoring to prevent further damage.
- the size of the brain frequently increases after a severe head injury. This is referred to in the art as “brain swelling” and occurs when there is an increase in the amount of blood in the brain. Thereafter, water may collect in the brain (referred to in the art as “brain edema”). Both brain swelling and brain edema result in excessive pressure in the brain.
- the pressure in the brain is referred to in the art as intracranial pressure ('TCP"). It is essential that excessive ICP be identified and monitored so that it can be immediately treated. Treatment of brain swelling can be difficult, but it is very important because brain swelling in turn causes reduced amounts of both oxygen and glucose available to the brain tissue.
- the cranial cavity of the skull contains approximately 78% brain, 12% blood and vessels, and 10% cerebrospinal fluid (CSF).
- Intracranial volumes enclosed within the rigid container of the skull are fixed. An increase in the volume of one of these components requires an equivalent decrease in another of these components in order for the volume in pressure to remain constant. Increases in ICP occur as a result of this volume-pressure relationship.
- the body tries to compensate by reabsorbing CSF and decrease intracellular volume.
- Surgical procedures further include removing any hematomas (blood clots) which are pressing on the brain, or surgically repairing damaged blood vessels to stop any further bleeding.
- portions of the brain that have been damaged beyond recovery may be removed in order to increase chances of recovery for the healthy portions of the brain.
- a shunt or ventricular drain may be used to drain off excess fluids.
- the overall goal of the neurosurgeon is to maintain blood flow and oxygen to all parts of the brain, thereby minimizing the damage and increasing the prospect of survival and recovery.
- ICP intracranial pressure
- the normal values for intracranial pressure (ICP) at the level of foramen of Monro are approximately 90-210 mm of CSF in adults and 15-80 mm of CSF in infants.
- Increased ICP can occur as a result of an increased mass within the limited volume of the cranium. Examples include an increase in CSF volume, cerebral edema, and growing mass lesions such as tumors and hematomas. Cerebral edema is the increase in brain tissue water causing swelling. It may occur secondary to head injury, infarction or a response to adjacent hematoma or tumor. Uncorrected increased ICP can lead to further brain damage due to the pressure and inadequate blood perfusion of neurological tissues.
- the treatment for increased ICP includes removing the mass (tumor, hematoma) by surgery, draining CSF from the ventricles by a drain or a shunt, hyperventilation, steroids, osmotic dehydrating agents, and barbiturates.
- ICP ICP
- cerebral blood flow leading to ischemia. If blood flow is constricted for more than four minutes, an individual can experience irreversible brain damage. With constricted blood flow, cells become damaged, leading to more edema, causing more increased ICP.
- the principle causes of elevated ICP include traumatic head injury (e.g., edema, intracranial hemorrhage, and hydrocephalus), infection, and tumors.
- traumatic head injury e.g., edema, intracranial hemorrhage, and hydrocephalus
- Treatment of elevated ICP can be accomplished by CSF drainage; decreasing the edema via the use of strong drugs such as diuretics; ventilation (mechanical and hyperventilation); cerebral perfusion pressure control (blood pressure control, fluid restriction); and promoting venous blood return; and intracranial surgery.
- strong drugs such as diuretics
- ventilation mechanical and hyperventilation
- cerebral perfusion pressure control blood pressure control, fluid restriction
- promoting venous blood return and intracranial surgery.
- ICP In the case of a head trauma, ICP can change significantly in a matter of minutes. Significant changes in ICP may also occur hours, days, or weeks, from diagnosis of the underlying trauma or disease state. It is therefore advantageous to continually monitor the ICP of a patient in an emergency room setting, in a surgical setting, and at a patient's bedside.
- a needle is inserted at the base of the spinal column, to monitor the pressure of the fluid in the spinal column. This pressure may not reflect accurately the ICP, because there may be a blockage between the patient's head and the base of the patient's spinal column.
- a second invasive method of monitoring ICP is to make a burr hole 5-10 mm in diameter in the patient's skull and to introduce a catheter to one of the lateral ventricles via the hole.
- the pressure of the cerebrospinal fluid (CSF) in the ventricle is measured directly by a transducer via the catheter. This procedure may cause a hemorrhage that blocks the penetrated Ventricle.
- CSF cerebrospinal fluid
- the catheter is held in place by a threaded fitting that is screwed into the patient's skull.
- a saline solution is introduced to the catheter and the pressure of the saline solution is measured using an appropriate transducer. If insufficient care is taken to preserve antiseptic conditions, this procedure may lead to . infection of the patient's brain.
- the threaded fitting may penetrate the patient's brain, causing damage to the patient's brain.
- a fiber optic device with a sensor at the tip of a fiber optic cable (available from Codman, a Johnson & Johnson Company), is inserted in the patient's cerebral tissue, in the patient's subdural space, or in the patient's intraventricular and epidural space. If a blood clot forms on the sensor, or if the fiber optic cable bends too sharply or breaks, the device may give a spuriously high pressure reading.
- a fiber optic cable available from Codman, a Johnson & Johnson Company
- the prior art invasive methods of measuring ICP are unreliable, may lead to infection, and cannot be used for more than five consecutive days.
- TCD has been used to provide a non-invasive, qualitative indication of variations in intra-cranial pressure ("ICP").
- ICP intra-cranial pressure
- TCD only provides a qualitative indication of variations in ICP, and does not provide a quantitative measurement of ICP.
- Additional non-invasive methods for measuring ICP include "classical acoustic methods" based on the transfer of acoustic waves via the skull, as discussed in United States Patent Nos. 5,117,835 to Edvin et al, and in O. Pranevicius et al, Acta Neurol. Sound 1992:86:512-516; and the Pulse Phased Locked Loop (PPLL) method as discussed in United States Patent No. 4,984,567 to Kagaiama and in Uenot et al. "Acta Neurochir. Suppl.” Wien 1998:71 :66-9. These methods infer ICP by monitoring dura mater, a thick and dense inelastic fibrous membrane which lines the interior of the skull and extends inward to support and protect the brain.
- PPLL Pulse Phased Locked Loop
- midline shift In addition to ICP, it is also useful in medical diagnostics to diagnose and monitor midline shift.
- the presence of midline shift provides an indication that some space filling lesion has caused distortion of the brain contents and, upon identification of the particular responsible mass, is normally cause for prompt intervention. Acute insults would be expected to initially induce elevation of ICP, with midline shift occurring later.
- Midline shift and ICP are thought to be closely related indicators of functional brain status following head trauma. However, it is generally believed that midline shift is a somewhat less sensitive indicator of acute unilateral space filling lesions than ICP.
- midline shift could well be a more sensitive predictor of slowly developing lesions such as brain tumors, where it serves as a confirmatory diagnostic tool, secondary to CT and MRI scans.
- the brain sits in the middle of the cranial cavity equally distant from the outer limits of either hemisphere of the cavity.
- the brain is protected on all sides by cerebrospinal fluid.
- a patient can experience edema, hemorrhaging/hematoma or some other lesion in the brain that will result in a shift away from midline, away from the hemisphere where the mass has formed.
- the key events that can cause such, a shift are: traumatic head injury; post surgical hemorrhaging; infection; cerebrospinal fluid buildup; and/or the presence of a tumor.
- the shift may occur very quickly following the event or after a period of time.
- Midline shift is currently measured by CT Scan. Determining midline shift is considered an important diagnostic tool by both neurosurgeons and emergency medicine physicians. A patient in the emergency room of a hospital presenting with a head injury and a low Glasgow Coma Scale score (8 or less), would be sent for a CT Scan. If the CT Scan is abnormal, showing a mass with or without midline shift, the neurosurgeon would be consulted. Sometimes the initial CT Scan is normal and the patient needs to be monitored. The question always arises as to what point does the patient get a second or third CT Scan. CT Scans are expensive, and the patient is subjected to radio-opaque dyes and contrast agents.
- TCD intra-cranial vascular system
- P.I. and R.I. intra-cranial vascular system
- This mono-causal approach makes TCD inherently inaccurate because it fails to take into account that ICP is a multi-causal parameter which is dependent on the characteristics of different areas of intra-cranial space and the different physiological relations between them. These factors include the brain's tissue mass, the ventricular, cisternal and subarachnoid reserve space volume within the skull, the level of intra-cranial blood volume, and the input-output balance of intra-cranial blood flow.
- the present invention is derived, in part, from the recognition that the soft tissue and fluid compartments of the brain each exhibit characteristic resonant responses to arterial pressure pulses that radiate through the tissues of the body.
- tissue of interest When a tissue of interest is stimulated by an ultrasound pulse, the nature of the reflected ultrasound signal will depend upon the resonant state of the tissue. Therefore, by properly processing and interpreting the reflected signal, it is possible to derive information relating to the physiological state of the tissue of interest.
- an ultrasound probe is placed on the head of a patient, and is used to generate an ultrasound pulse which propagates through the skull and brain of the patient, and is reflected off of the skull and soft tissue lying in a path perpendicular to the ultrasound probe.
- the reflected signals are received by the ultrasound probe, and then processed in a known manner to generate an echo encephalogram (Echo EG) signal, which is plotted as a function of amplitude vs. distance.
- Echo EG echo encephalogram
- the distance ordinate is obtained by converting the time delay from transmission of the ultrasound pulse to receipt of the reflected signals to the . distance from the ultrasound probe to the point of reflection.
- a portion of the Echo EG signal is then selected, and the Echo EG signal is integrated over the selected portion to generate an echo pulsograph (EPG) signal.
- the selected position of the wave form corresponds to a selected distance from the ultrasound probe, and therefore corresponds to a discrete location in the brain which lies at a depth equal to the selected distance and in a path perpendicular to the probe.
- the selected portion has a width of 0.3 to 1.3 ⁇ s, preferably a 0.3 to 1 ⁇ s, and most preferably, a 0.5 to 0.7 ⁇ s (corresponding to approximately one pixel and a depth of resolution of 0.5 mm).
- An electrocardiograph (ECG) signal for the patient is also generated in a known manner. Using the ECG signal as a reference, the EPG signal is used to provide information regarding the physiological state of the tissue at a depth from the ultrasound probe corresponding to the selected portion of the Echo EG signal.
- the ultrasound probe is placed either on the forehead of a patient, or on the back of the skull. When placed on the forehead, it is most preferably placed between 2 and 6 cm above the bridge of the nose when the desired point of interest is the third ventricle.
- the ultrasound pulse preferably has a pulse width between about 100 and 1000 ns, and a output intensity between about 50 and 300 mW/cm 2 . It has been discovered that this pulse width and position provides a substantially improved reflected signal as compared to the prior art methods described above.
- the ultrasound probe is preferably a probe having a concave shaped transmitting and receiving surface.
- the concave shaped probe in accordance with the present invention focuses the ultrasound signal on a significantly smaller area of brain tissue.
- the concave probe has cylindrical surface with a diameter of 28 mm a circular concave shaped transmitting and receiving surface extending to a depth of 1.3 mm.
- This probe will focus the ultrasound signal on an area of about 0.5 x 1.5 mm (0.75mm 2) as compared with an area of 5mm 2 for a conventional flat probe of the same dimensions. Therefore, in the preferred embodiment described in more detail below, the concave shaped probe allows the system in accordance with the present invention to monitor an 0.5x1.5x 0.5 mm portion of the brain.
- the EPG signal is used to provide a quantitative measure of intra cranial pressure (ICP) at a location of interest in the brain.
- a frequency spectral and resonance analysis is performed on the EPG signal, and the second resonant frequency is used to more accurately identify the venous notch.
- the frequency spectral analysis is a discrete fourier transform.
- the second resonant frequency is preferably used to further refine the calculated value for ICP.
- ICP p(t/T)*[ t/T]
- ICP p(t/T)*[ t/T] - ⁇
- the EPG signal is used to determine the width and position of ventricles and blood vessels.
- opposing walls of a ventricle or blood vessel are identified by placing an ultrasound probe on an appropriate portion of the skull of a patient; transmitting an ultrasound pulse from the ultrasound probe into the skull of the patent; receiving a reflected signal from said ultrasound pulse; processing said reflected signal to generate a digital echo encephalogram signal; selecting a dominant portion of said echo encephalogram signal corresponding to the vessel or ventricle of interest; and integrating the echo encephalogram signal over the selected portion to generate an echo pulsogram signal, said echo pulsogram signal providing an indication of the pulsatility of a portion of the brain of the human patient corresponding to the selected portion of the echo encephalogram signal.
- the echo pulsogram signal is then identified as either a positive phase signal (i.e., a signal in which the maximum amplitude following a cardiac systole has a positive value) or a negative phase signal (i.e., a signal in which the maximum amplitude following a cardiac systole has a negative value). If the echo pulsogram signal has a positive phase, then the selected portion of the echo encephalogram is identified as corresponding the outer wall of the vessel or ventricle relative to the ultrasound probe. If the echo pulsogram signal has a negative phase, then the selected portion of the echo encephalogram is identified as corresponding the near wall of the vessel or ventricle relative to the ultrasound probe.
- a positive phase signal i.e., a signal in which the maximum amplitude following a cardiac systole has a positive value
- a negative phase signal i.e., a signal in which the maximum amplitude following a cardiac systole has a negative
- a second portion of the echoencephalogram signal is selected which corresponds to a location in the brain which is closer to the ultrasound probe than the dominant portion selected previously.
- the echo encephalogram signal is then integrated over the selected second portion to generate an echo pulsogram signal. If the echo pulsogram signal is a negative phase signal, then the second portion of the echoencephalogram is identified as corresponding to the near wall of the vessel or ventricle. If the echo pulsogram signal is a positive phase signal, then successive second portions of the encephalogram are selected, which correspond to locations in the brain which are successively closer to the ultrasound probe, until a negative phase signal is identified.
- a second portion of the echoencephalogram signal is selected which corresponds to a location in the brain which is farther from the ultrasound probe than the dominant portion selected previously.
- the echo encephalogram signal is then integrated over the selected another portion to generate an echo pulsogram signal. If the echo pulsogram signal is a positive phase signal, then the second portion of the echoencephalogram is identified as corresponding to the far wall of the vessel or ventricle. If the echo pulsogram signal is a negative phase signal, then successive second portions of the encephalogram are selected, which correspond to locations in the brain which are successively farther from the ultrasound probe, until a positive phase signal is identified.
- the echo encephalogram signal is a function of amplitude vs. distance from the probe to point of reflection of the ultrasound pulse. Therefore, the dominant portion of the echo encephalogram can be identified as corresponding to a first distance from the site of the probe, and the second portion of the echo encephalogram can be identified as corresponding to a second distance from the site of the probe. In this manner, both the position and width of the ventricle or vessel of interest are identified.
- the presence or absence of midline shift in a brain of a human patient is identified by: placing an ultrasound probe on a temporal area of a first side of the skull of a patient; transmitting an ultrasound pulse from the ultrasound probe into the first side temporal area of the patent; receiving a reflected signal from said ultrasound pulse; processing said reflected signal to generate a digital echo encephalogram signal; selecting a first-side dominant portion of said echo encephalogram signal corresponding to a third ventricle of the patient; integrating the echo encephalogram signal over the selected portion to generate a first-side echo pulsogram signal, said echo pulsogram signal providing an indication of the pulsatility of a portion of the brain of the human patient corresponding to the selected portion of the echo encephalogram signal.
- the first-side echo pulsogram signal which corresponds to the first-side dominant portion, is then identified as a positive phase signal or a negative phase signal as described above.
- an ultrasound probe is placed on a second, opposite temporal area of a patient and an ultrasound pulse from the ultrasound probe is transmitted into the opposite temporal area of the patent.
- the reflected signal is then received and processed to generate a digital echo encephalogram signal, and a second-side dominant portion of said echo encephalogram signal is selected which corresponds to the third ventricle of the patient.
- the echo encephalogram signal is then integrated over the selected portion to generate an second-side echo pulsogram signal.
- the second-side echo pulsogram signal which corresponds to the second-side dominant portion, is then identified as a positive phase signal or a negative phase signal as described above.
- first and second side echo pulsograms have the same phase, then they are identified as corresponding to opposing walls of the third ventricle.
- the first-side dominant portion of the echo encephalogram can be identified as corresponding to a first distance from the first side temporal area
- the second-side dominant- portion of the echo encephalogram can be identified as corresponding to a second distance from the second side temporal area.
- the first distance should equal the second distance for a patient with no midline-shift.
- the midline shift in a patient can therefore be quantified as (first distance - second distance) ⁇ 2.
- the method also includes identifying the position of the opposing ventrical wall by locating the opposite phase signal (i.e. a positive phase signal if the dominant portion generated a negative phase signal, and vice versa) in the manner described above with regard to the method of identifying the width and position of a vessel or ventricle wall.
- the opposite phase signal i.e. a positive phase signal if the dominant portion generated a negative phase signal, and vice versa
- Figure 1 shows a prior art technique for invasively measuring infra cranial pressure.
- Figure 2(a) is a block diagram of a preferred apparatus for transmitting and receiving ultrasound waves, and generating EPG, Echo EG, and ECG waveforms.
- Figure 2(b) illustrates a preferred ultrasonic probe which may be used in conjunction with the apparatus of Figure 2(a).
- Figure 2(c) illustrates a waveform transmitted by the probe of Figure 2(b)
- Figure 3 is a plot of a representative Echo EG waveform.
- Figure 4 is an illustration of how the pulsatihty characteristics of the brain can be identified in an EPG waveform.
- Figure 5 is a graph of the variable p as a function of t/T, and as a function of different frequencies of the second resonant frequency of the EPG waveform.
- Figure 6a is a plot of an Echo EG waveform for the third ventricle which was received from the ultrasound probe of Figure 2 in response to a single ultrasound pulse generated from the ultrasound probe.
- Figure 6b is a plot of an EPG waveform generated from the plot of Figure 6a, along with a corresponding ECG waveform generated by the apparatus of Figure 2(a).
- Figure 6c is a plot of the Discrete Fourier Transform of the waveform of Figure 6b.
- Figures 7a is a plot of a reflectance (Echo EG) waveform for the third ventricle which was received from the ultrasound probe of Figure 2 in response to a single ultrasound pulse generated from the ultrasound probe.
- Echo EG reflectance
- Figure 7b is a plot of an EPG waveform generated from the plot of Figure 7a, along with a corresponding ECG waveform generated by the apparatus of Figure 2(a).
- Figure 7c is a plot of the Discrete Fourier Transform of the waveform of Figure 7b.
- Figures 8a is a plot of a reflectance (Echo ' EG) waveform for the third ventricle which was received from the ultrasound probe of Figure 2 in response to a single ultrasound pulse generated from the ultrasound probe, and a corresponding plot of an EPG waveform, ECG waveform, and respiratory wave.
- Echo ' EG reflectance
- Figure 8b is a magnified plot of an EPG waveform generated from the plot of Figure 8a, along with the corresponding ECG waveform generated by the apparatus of Figure , 2(a).
- Figure 8c is a plot of the Discrete Fourier Transform (DFT) of the waveform of Figure 8b.
- DFT Discrete Fourier Transform
- Figure 9a is a plot of a reflectance (Echo EG) waveform' which was received from the ultrasound probe of Figure 2 in response to a single ultrasound pulse generated from the ultrasound probe, with a gate depth of 100 mm, and a corresponding plot of an EPG waveform, ECG waveform, and respiratory wave.
- Figure 9b is a magnified plot of an EPG waveform generated from the plot of Figure 9a, along with a corresponding ECG waveform generated by the apparatus of Figure 2(a).
- Figure 9c is a plot of DFT of the waveform of Figure 9b.
- Figure 10 is an Echo EG waveform and corresponding EPG waveform for a patient with normal ICP.
- Figure 11 is an Echo EG waveform and corresponding EPG waveform for another patient with normal ICP.
- Figure 12 is an Echo EG waveform and corresponding EPG waveform for a patient with moderately high ICP.
- Figure 13 is an Echo EG waveform and corresponding EPG waveform for a patient with high ICP.
- Figure 14(a) shows an illustrative calibration device in accordance with an embodiment of the present invention.
- Figure 14(b) illustrates the generation of plateau waves with the device of Figure 14(a)
- Figure 15 is a plot of pump iterations vs. infra tissue pressure for the longEPG waveform which would be generated during calibration using the device of Figure 14(a).
- Figure 16 is an illustration of different EPG waveform responses to the application of increasing pressure to the jugular veins via the device of Figure 14(a).
- Figure 17 shows an Echo EG waveform for a patient gated at a depth of 91 mm, and a corresponding EPG waveform and respiratory wave before and after compression of the jugular veins with the device of Figure 14(a).
- Figure 18 shows a plot of pump iteration vs. infra-tissue pressure and jugular venous pressure for the patient of Figure 17.
- Figure 19 shows a relationship between EPG amplitude prior to (Al) and after (A2) compression of the jugular veins which can be used to calibrate the device of Figure 14(a).
- Figure 20 shows an Echo EG waveform for a patient gated at a depth of 69 mm from a right temporal area of the skull, along with a corresponding EPG waveform and respiratory wave, wherein the EPG waveform is a negative phase signal.
- Figure 21 shows an Echo EG waveform for the patient of Figure 20 gated at a depth of 68 mm from a left temporal area of the skull, along with a corresponding EPG waveform and respiratory wave, wherein the EPG waveform is a negative phase signal.
- Figure 22 shows an Echo EG waveform for the patient of Figure 20 gated at a depth of 72 mm from a right temporal area of the skull, along with a corresponding EPG waveform and respiratory wave, wherein the EPG waveform is a positive phase signal.
- Figure 23 shows an Echo EG waveform for the patient of Figure 20 gated at a depth of 72 mm from a right temporal area of the skull, along with a corresponding EPG waveform and respiratory wave, wherein the EPG waveform is a positive phase signal.
- Figure 24a illustrates the location of the walls of the third ventricle identified by the waveforms of Figures 20 and 22.
- Figure 24b illustrates the location of the walls of the third ventricle identified by the ' waveforms of Figures 21 and 23.
- Figure 24c illustrates the manner in which midline shift can be quantified from Figures 20 through 23.
- the present invention is directed in part to a novel ultrasonic technology which will be referred to herein as Tissue Resonance Analysis (TRA).
- This noninvasive technology provides information about the physical properties of body tissue and fluids.
- This TRA technology is capable of monitoring the functional status of tissues anywhere in the body, including tissues and fluids within the brain. Its ability to also monitor intracranial tissues and fluids constitutes a key advantage over other ultrasonic technologies whose signals cannot readily penetrate across the skull.
- the stimulation parameters, beam focusing, and sensor gates can all be modified to generate important diagnostic information about the physiological status of virtually any fluid space, tissue, or organ of interest.
- TRA technology makes use of the fact that all soft tissues and fluid compartments exhibit their own characteristic resonant responses to arterial pressure pulses that radiate through the tissues of the body.
- a target tissue is stimulated by specific ultrasound signals, the nature of the reflected ultrasound energy waves that bounce back from the tissue depends on the resonant state of the tissue.
- the pulsatile pattern of resonance responses of a tissue to specific ultrasonic stimulation is then collected and interpreted to provide information about the physiological state of the tissue of interest.
- the TRA technology described herein can deliver many different frequencies of ultrasound energy at different intensities.
- the beams can also be focused onto those tissues or structural surfaces of interest.
- Customized ultrasound stimulation profiles can be developed that can characterize the response status of the target. This information is then transformed into quantitative measurements of tissue volume, pressure, compliance, elasticity, or hydration state.
- TRA technology offers a noninvasive option of monitoring tissues and fluids within the central nervous system, and is an extremely versatile diagnostic tool that can be customized to provide quantitative information about the physiological status of essentially any soft tissues or fluid compartments of interest. This technology can be used for a wide variety of noninvasive diagnostic applications.
- Traumatic and Organic Damage of the Nervous System including but not limited to intracranial pressure, intracerebral pressure, regional perturbations, birth trauma, cerebral palsy, midline shift, space filling brain lesions, brain edema, intracellular and interstitial, severe headache, differential diagnosis,, spinal cord pathologies, disc prolapse, and cord stenosis);
- Blood Vessel Characteristics including but not limited to migraine (excessive vasoconstriction of vasodilation), brain vessel tension (vasospasm following subarachnoid hemorrhage (e.g., as a predictor of stroke risk), brain vessel diameter, brain vessel capacitance, and intracranial aneurysm;
- Blood Flow Dynamics including but not limited to linear blood flow, arterial volume blood velocity, venous blood flow velocity, brain death, coronary blood
- the Human Brain The brain is composed of the Cerebrum, Cerebellum, and Brain Stem. The brain is separated from the skull via dura mater.
- Dura mater is a thick and dense inelastic fibrous membrane which lines the interior of the skull. Its outer surface is rough and fibrillated, and adheres closely to the inner surface of the bones. The dura mater extends into the cavity of the skull to support and protect the brain.
- the Cerebrum the part of the brain which is responsible for higher mental function, consists of two hemispheres separated by a longitudinal fissure, which, in a normal patient, is located at the mid-line of the skull.
- the mid-line of the skull is a vertically extending plane equidistant between the left and right temporal areas of the skull.
- each hemisphere includes a respective frontal lobe, parietal lobe, temporal lobe, and occipital lobe, the names of which correspond the bones of the skull lying superficial to them. Functionally, however, there are significant differences between the right and left sides of the brain.
- the hemispheres are connected by a large C-shaped bundle of fibers carrying impulses between them, the Corpus Callosum, and the Brain Stem. Almost at right angles to the longitudinal fissure, crossing the Cerebrum lateral and downward, is the Central Sulcus. Below the end of this Sulcus is the horizontal lateral fissure.
- the Frontal Lobe lies above the lateral fissure in front of the Central Sulcus. Behind the Central Sulcus is the Parietal Lobe and behind that the Occipital Lobe, although there is no specific boundary between them laterally. Medially they are separated by the Parieto-Occipital Fissure.
- the Temporal Lobe is located below the lateral fissure and anterior to the Occipital Lobe.
- the Cerebrum has an outer layer of gray matter, composed primarily of nerve cells, called the Cortex. Below this layer lie large bundles of nerve call processes, or fibers, the white matter. Embedded deep within the white matter are the Basal Ganglia, or Corpus Striatum, a group of nuclei which serve to coordinate motor and sensory impulses.
- the Cortex is occupied by association areas, which are devoted to integration of motor and sensory phenomena, advanced intellectual activities, such as abstract thinking, comprehension and execution of language, and memory storage and recall.
- association areas which are devoted to integration of motor and sensory phenomena, advanced intellectual activities, such as abstract thinking, comprehension and execution of language, and memory storage and recall.
- the Precentral Gyrus the center for voluntary motor movements.
- Postcenfral Gyrus the somatic sensory area, or Postcenfral Gyrus, set aside for conscious perception of general sensory phenomena.
- Cortical areas for vision Above and below the Calcarine Sulcus on the medial side of the Occipital Lobe are the Cortical areas for vision. Auditory phenomena are localized to the upper part of the Temporal Lobe, opposite the somatic sensory area. Smell, or olfactory sensation, are associated with the inferior surface of the Temporal Lobe, although the Olfactory Nerve ends in the inferior portion of the Frontal Lobe.
- the Cerebral hemispheres are hollow, each containing a lateral ventricle.
- the ventricles contain a vascular membrane, the Choroid Plexus, that secretes cerebrospinal fluid.
- Each lateral ventricle includes an anterior horn, a central part, a posterior horn, and an inferior horn.
- the anterior horn is anterior to the interventricular foramen. Its roof and anterior border are formed by the corpus callosum, its vertical medial wall by the septum pellucidum.
- the floor is formed by the head of the caudate nucleus.
- the central part extends from the splenium of the corpus callosum; medially, by the posterior part of the septum pellucidum; and below, by parts of the caudate nucleus, thalamus, choroid plexus and fornix.
- the posterior horn extends into the occipital lobe. Its roof is formed by fibers of the corpus callosum.
- the inferior (or temporal) horn traverses the temporal lobe. Its roof is formed by the white substance of the cerebral hemisphere.
- the amygdaloid nucleus bulges into the terminal part of the inferior horn.
- the floor and the medial wall are formed by the fimbria, the hippocampus and the collateral eminence.
- the third ventricle is a narrow, vertical cleft between the two lateral ventricles.
- the lateral ventricles communicate with the third ventricle (which is the cavity of the Diencephalon), by way of interventricular Foramina.
- the Diencephalon, embedded in the inferior aspect of the Cerebrum, is situated on either side of the slit-like third ventricle.
- a thin membrane (the Tela Choroidea) and attached Choroid Plexus roofs the third ventricle.
- the inferior portion of the Diencephalon forms the floor of the third ventricle and is named the Hypothalamus in relation to the Thalamus, the largest part of the Diencephalon, which lies above it.
- the third ventricle is located at the midline of the skull, at approximately the height of the temporal areas. .
- Hypothalamus Projecting from the Hypothalamus (which forms the floor of the third ventricle) on a slender stalk, or J-nfundibulum, is the Hypophysis.
- the Hypothalamus and Hypophysis are closely related and regulate many important body functions, such as temperature, water and fat metabolism, sleep, sexual activity and emotional control.
- the Thalamus receives nearly all sensory impulses from the peripheral nervous system and relays them to the Cerebral Cortex.
- the Mesencephalon (midbrain) is the smallest part of the Brain Stem, being about 2cm in length. Its narrow cavity, the Cerebral Aqueduct connects the third and fourth ventricles. In the midbrain, the narrow cerebral aqueduct connects the third and fourth ventricles.
- the Choroid Plexus which roofs the third ventricle, produces cerebrospinal fluid, which is a clear watery fluid that both supports the brain and provides its extracellular fluid.
- the fourth ventricle is located between the Pons, Cerebellum and Medulla. It communicates with the Cerebral Aqueduct, the cenfral canal of the spinal cord and the subarachnoid space which surrounds the central nervous system.
- the roof of the fourth ventricle caudal to the Cerebellum, the Tela Choroidea is thin like that of the, third ventricle and has a Choroid Plexus. It is perforated by a small median aperture and two lateral apertures that allow cerebrospinal fluid to exit the ventricular system and bathe the brain and spinal cord. Cerebrospinal fluid is a watery, alkaline fluid, similar in constitution to blood plasma.
- the cerebrospinal spinal fluid bathes the surface of the brain and spinal cord, providing a fluid suspension and a valuable shock absorber around these organs of the nervous system.
- the fluid has a pressure of about 100 mm of water, which is intermediate between that of the peripheral arterial and venous sinus pressure.
- Cerebrospinal fluid readily passes through the thinned out membrane of the arachnoidal granulations and the Endothelial lining of the Dural sinuses and joins the venous blood of the sinus. A smaller part of the fluid is returned to the vascular system by way of the lymphatics of the cranial nerves and via ependima of ventricles.
- the Cerebral Peduncles are prominent fiber bundles connecting centers above and below the Mesencephalon (the mid-brain). Dorsally, two superior and two inferior Colliculi, collectively referred to as Corpora Quadrigemina, are found. These are relay centers in the optic and auditory systems, respectively.
- the Pons Caudal to the Mesencephalon lie the Pons ventrally and the Cerebellum dorsally, with the fourth ventricle situated between them.
- the Pons consists superficially of large transverse fiber bundles which connect the two Cerebellar hemispheres. Deep within the Pons lie longitudinal fiber bundles, which carry impulses up and down the brain stem, and scattered nuclei.
- the Cerebellum is a solid mass of tissue. Like the Cerebrum, it is covered by a layer of gray matter, the Cortex, overlaying white matter and the surface is thrown into a series of parallel folds, here called Folia. It has two hemispheres, a midline vermis and several nuclei internally. Three sets of Peduncles, lying superior, lateral and inferior to the fourth ventricle, connect the Cerebellum to the Mesencephalon, Pons and Medulla Oblongata. The Cerebellum is a coordination center for muscular activity, particularly walking. It is the only part of the central nervous system that does not give rise to peripheral nerves.
- FIG. 1 shows a standard prior art device for invasively measuring intra cranial pressure (ICP).
- ICP intra cranial pressure
- a hole is drilled in the skull of the patient as shown.
- a catheter is then inserted through the skull and directed in the lateral plane towards the external auditory meatus and in the AP plane towards the inner canthus to a depth of approximately 7 cm below the scalp.
- the catheter is filled with saline, and is coupled to a pressure transducer, which, in turn, is coupled to a chart recorder.
- This procedure provides an accurate measurement of the ICP at the lateral ventricle of a patient, but has the disadvantage of being traumatic to the patient.
- FIG. 2(a) is a block diagram of a preferred apparatus 100 in accordance with the present invention for transmitting and receiving ultrasound waves, and generating Echo Encephalogram (Echo EG), Electrocardiogram (ECG), and Echopulsogram (EPG) waveforms.
- the apparatus 100 includes an ultrasound probe 101, a computer 107, an Analog to Digital (AID) converter 106, an ulfrasound signal controller and processor 112, a gating circuit 104, and a Electrocardiograph 105 with corresponding electrodes 204.
- AID Analog to Digital
- the apparatus also includes a suitable low- voltage power supply 109 to provide power to these circuits and a high-voltage power supply 108 to supply the Ultrasound Transmitter 113 which drives the probe 101.
- a display terminal 110 and printer 111 are also illustrated.
- the apparatus 100 may, for example, comprise the apparatus described in United States Patent No. 5,840,018, described above, and incorporated herein by reference.
- the ultrasound probe 101 is held in contact with the skull of a patient.
- the • probe 101 is held in contact with the forehead of the patient for measurement of ICP at the third ventricle.
- the probe 101 is placed 2-6 cm above the bridge of the nose of a patient.
- the probe 101 serves as both a transmitter and receiver of ulfrasound waves.
- the ECG probes 204 are secured to the patient in a conventional manner in order to generate a conventional ECG signal. If desired, a respiratory wave signal can also be generated by demodulating the EPG waveform, with the carrier signal providing a representation of the respiratory wave.
- the apparatus 100 generates a pulse signal having a constant pulse width and constant power to produce an EPG and Echo EG waveform.
- the pulse width and power will be adjusted to determine a suitable constant power and wavelength for each patient.
- the pulse width is initially varied from 100 . ns to 1000 ns to determine the proper pulse width for monitoring a structure of interest in the brain for a particular patient.
- the power can vary from 50 mW/cm 2 to 300 mW/cm 2 .
- Figure 3 is a plot of an Echo EG signal received by the probe 101 in response to a transmitted pulse, and digitized and displayed, for example, on display screen ' 110 as a function of distance from the probe 101.
- the distance ordinate is obtained by converting the time delay from transmission of the ultrasound pulse to receipt of the reflected signals to the distance from the ultrasound probe to the point of reflection based upon a typical speed of propagation of an ultrasound signal through skull and brain tissue.
- the various portions of the reflected waveforms can be identified with various structures in the brain and skull which lie in a path perpendicular to the probe 101.
- the peaks identified as 401 in Figure 3 correspond to waves reflected from the front portion of the skull
- the peaks identified as 402 in Figure 3 correspond to waves reflected from the rear portion of the skull
- the reflections 406 correspond to waves reflected from the interior soft tissue in the brain. Therefore, by estimating the distance from the probe to a site of interest in the brain (e.g., the third ventricle), it is possible to estimate which of the soft tissue reflections are reflections from the site of interest.
- a gating circuit such as the gating circuit 104 described in United States Patent No. 5,840,018 (described above), can then be used to examine a small portion of the Echo EG reflected signal.
- the gating circuit gates a 0.3 to 1.3 ⁇ s portion of the waveform.
- the gating circuit gates a 0.3 to 1 ⁇ s portion, and most preferably, a 0.5 to 0.7 ⁇ s portion of the waveform (corresponding to approximately one pixel and a depth of resolution of 0.5 mm).
- FIG. 4 is a plot of an EPG waveform which is derived from a corresponding Echo EG signal (not shown) and an ECG waveform generated from the ECG electrodes.
- EPG is defined as the integral of the Echo EG waveform across the gated portion of the Echo EG waveform:
- EPG EG(t), wherein t is extends from gl to g2, and wherein gl is the
- the ECG waveform is used to identify the cardiac systole (i.e. contraction of the heart), and provides a reference point for interpreting the EPG waveform.
- a corresponding peak in the EPG waveform following a cardiac systole can be divided into a number of regions of interest.
- a first, initial portion 403 of the EPG peak extends from the beginning of brain (e.g. cerebral) pulsatility (point "A") following the cardiac systole and exhibits a rapid rise time, provides an indication of the tension of the vessel walls.
- the beginning of brain pulsatility (A) can be estimated as the minimum of the EPG waveform following the cardiac systole.
- the end of the first portion 403 is defined as the maximum df/dt of the EPG waveform.
- the first portion 403 corresponds to the time period in which blood flow from the preceding cardiac systole has reached the blood vessels at the site of interest, but has not yet caused the blood vessels to expand significantly. Therefore, the longer the duration in time of the first portion 403, the less tension there is in the blood vessels.
- the next, second portion 404 of the EPG waveform which extends from the end of the first portion to the maximum of (-d 2 f/d 2 t), provides an indication of the elasticity of the vessel walls. In this regard, the greater the time from Max (df/dt) to Max (-d 2 f/d 2 t), the greater the elasticity of the vessel walls.
- the next, third portion 405 of the EPG waveform which extends from the end of the second portion 404 to the absolute maximum of f(t) (point C), provides an indication of the elasticity of the brain tissue. In this regard, the greater the time to the peak in the waveform, the greater the elasticity of the brain tissue.
- a venous output notch (point "B"), which is characterized by a notch in the waveform between the peak and a subsequent cardiac systole, identifies a point in time at which the flow of blood through the brain tissue at the gated location is primarily exiting the brain tissue.
- the EPG waveform is used to provide a quantitative indication of infra cranial pressure (ICP).
- ICP is defined as follows:
- ICP minimum p(t 2 /T)*[ t 2 /T]
- T is the time period between cardiac systoles
- t_ is the time from the beginning of brain (e.g. cerebral) pulsatility (point “A") to the peak (point “C") following the venous notch (point “B")
- ⁇ is the time from the beginning of brain pulsatility (point “A”) to a first point following the peak ("C") which has the same amplitude as the venous notch (point “B”)
- ⁇ is a constant having a value of 9 mm H 2 O
- p(t/T) where t is t t or t 2 , is a function which is characteristic of the particular brain tissue being monitored.
- Figure 5 is a plot of p for p 0 , p commerce p 2 , or p 3 as a function of t/T.
- p 0 is used as the value for p when the second resonance frequency of EPG waveform is less than 4 Hz
- p t is used as the value for p when the second resonance frequency of EPG waveform is between 4 Hz and 16 Hz
- p 2 is used as the value for p when the second resonance frequency of EPG waveform is between 16 Hz and 20 Hz
- p_ is used as the value for p when the second resonance frequency of EPG waveform is greater than 20 Hz.
- the second resonance frequency is identified by performing a discrete fourier transform (DFT) of the EPG signal across one cardiac systole.
- DFT discrete fourier transform
- These plots of p can be used to calculate ICP for the third ventricle of the brain, the central cerebral vein, the suprasellar cistern, and lateral ventricle trigon.
- function p(t/T) shown in Figure 5 can be used in to calculate the ICP in other regions of the brain, provided that an EPG waveform having the characteristics of Figure 4 (i.e. ⁇ portions 403, 404, 405 and point B) can be identified.
- the function p(t/T) can not always be used to calculate ICP in the superior sagittal sinus or the inferior sagittal sinus.
- FIG. 2(b) shows a concave probe 101' which is preferably used as the probe 101 in the apparatus of Figure 2(a).
- the concave probe 101' focuses the transmitted ultrasound signal on an area of approximately 0.5 x 1.5 mm (.75 mm 2 ).
- the probe 101' includes a concave transmitting/receiving surface 1011, a piezoelectric transducer 1013, and a dampening material 1012 disposed adjacent thereto.
- the diameter across the surface 1010 is 28 mm, and the surface 1010 has a circular concave shape which extends to a depth of 1.3 mm perpendicularly from an imaginary plane 1020 extending across the face of the surface 1010.
- the piezoelectric transducer 1013 oscillates around a principal frequency of between 0.8 and 1.2 MHz, and most preferably around a principal self-frequency of about 1.0 MHz.
- the pulse width of ultrasound signal transmitted by the probe 101' can be varied between 100 ns to 1000 ns as described above.
- the trigger pulse repetition frequency is preferably at least about 3 KHz.
- the general nature of the transmitted waveform is illustrated in Figure 2b.
- the concave probe 1011' allows the apparatus i accordance with the present invention to provide an analysis of a portion of the brain with an area of 0.75 mm 2 and a depth of 0.5 mm as illustrated in Figure 2a.
- Figure 6(a) shows an Echo EG waveform for a patient generated with a concave probe 101'.
- the Echo EG waveform shows the waves reflected from the skull and brain of the patient in an area of 0.75 mm 2 extending perpendicularly from the probe 101 ' through the front skull ⁇ and brain tissue to the back skull of the patient.
- the Echo EG signal has been gated at 97 mm (as indicated by the vertical line in Figure 6(a) at 97 mm), which corresponds to the location of the third ventricle of the patient. Therefore, the gated portion of the Echo EG signal corresponds to a portion of the brain of the patient at a depth of approximately 97 mm, which has an area of 0.75 mm 2 and a depth of approximately 0.1 mm.
- Figure 6c shows a Discrete Fourier Transform of the EPG signal over the cardiac cycle. Referring to Figure 6c, it is apparent that only the first resonance . frequency (at 2 Hz) is visible.
- Figure 7a shows an Echo EG waveform for a patient with normal ICP which was generated with a concave probe 101'.
- the Echo EG waveform shows the waves reflected from the skull and brain of the patient in an area of 0.75 mm 2 extending perpendicularly from the probe 101' through the front skull and brain tissue to the back skull of the patient.
- the Echo EG signal has been gated at about 71 mm (as indicated by the vertical line in Figure 6(a) at about 71 mm), which corresponds to the location of the third ventricle of the patient.
- the gated portion of the Echo EG signal corresponds to a portion of the brain of the patient at a depth of approximately 71 mm, which has an area of 0.75 mm 2 and a depth of approximately 0.1 mm.
- the ICP for this patient measured invasively using the device and method of Figure 1, was between 10 and 12 mm Hg.
- Figure 7b shows the corresponding EPG waveform (generated by integrating the Echo EG waveform across the gate interval) and ECG waveform for the patient, plotted as a function of time.
- Figure 8a shows an Echo EG waveform (upper plot) for a patient with moderately high ICP which was generated with a concave probe 101'.
- the Echo EG waveform shows the waves reflected from the skull and brain of the patient in an area of 0.75 mm 2 extending perpendicularly from the probe 101' through the front skull and brain tissue to the back skull of the patient.
- the Echo EG signal has een gated at about 96 mm (as indicated by the vertical line in Figure 8(a) at about 96 mm), which' corresponds to the location of the third ventricle of the patient.
- the gated portion of the Echo EG signal corresponds to a portion of the brain of the patient at a depth of approximately 96 mm, which has an area of 0.75 mm 2 and a depth of approximately 0.1 mm.
- the ICP for this patient measured invasively using the device and method of Figure 1, was 21 mm Hg.
- the lower plot of Figure 8(a) shows the corresponding EPG and ECG waveforms, along with a plot of the patient's respiratory wave.
- the respiratory wave can be obtained from the EPG waveform by plotting the successive point A's (or successive point C's) of Figure 4 or via conventional demodulation techniques.
- the respiratory wave provides an indication of the modulation of the EPG signal which is caused by the patient's respiration. In evaluating the EPG signal, it is important to take this modulation into consideration.
- Figure 8b shows a magnified view of the EPG waveform of Figure 8(a) (generated by integrating the Echo EG waveform across the gate interval) and ECG waveform for the patient, plotted as a function of time.
- Figure 9a shows an Echo EG waveform (upper. plot) for a patient with high ICP which was generated with a concave probe 101', along with the corresponding EPG, ECG, and respiratory waveforms (lower plot) for the patient.
- the Echo EG waveform shows the waves reflected from the skull and brain of the patient in an area of 0.75 mm 2 extending perpendicularly from the probe 101' through the front skull and brain tissue to the back skull of the patient.
- the Echo EG signal has been gated at 100 mm (as indicated by the vertical line in Figure 11(a) at 100 mm), which corresponds to the location of the third ventricle of the patient.
- the gated portion of the Echo EG signal corresponds to a portion of the brain of the patient at a depth of approximately 100 mm, which has an area of 0.75 mm 2 and a depth of approximately 0.1 mm.
- the ICP for this patient measured invasively using the device and method of Figure 1, was between 49 and 52 mm Hg.
- Figure 9c shows a Discrete Fourier Transform of the EPG signal over the cardiac cycle.
- a qualitative measure of ICP can also be obtained through the use of the- device of Figure 2(a) by analyzing a compressed EPG.waveform.
- a compressed EPG waveform can be in the form of: A- waves, which are indicative of low ICP (under 8 mm Hg); B-waves, which are indicative of normal ICP (8-12 mm Hg); C-waves, which are indicative of relatively high ICP (18-30 mm Hg), and D-waves which are indicative of high ICP (over 50 mm Hg).
- A-waves are defined as compressed ICP waves which exhibit about one peak per minute
- B-waves are defined as compressed EPG waves which exhibit about 6-10 peaks per minute
- C-waves are defined as compressed EPG waves which are a combination of substantially flat waves, and waves exhibiting about 18 peaks per minute
- D waves are defined as compressed EPG waves which exhibit about 1 peak every 15-20 minutes.
- Figures 6(d), 10, 11, 12, and 13 each shows a compressed EPG waveform (generated by integrating the Echo EG waveform across the gate interval) and a compressed ECG waveform.
- the compressed EPG waveform is in the form of "A-waves" because it exhibits peaks about once every minute, and is therefore indicative of an ICP under 8 mm Hg.
- the patient in Figure 6(a) had an invasively measured ICP of 2 mm Hg.
- the compressed EPG waveforms of figures 10 and 11 which exhibit 10 peaks and 11 peaks every minute, respectively, are in the form of "B-waves", and are therefore indicative of an ICP between 10-12 mm Hg (normal value of ICP).
- FIG. 12 shows a compressed EPG waveform for a patient, having an invasively measured ICP of 21 . mm Hg.
- the compressed EPG waveform is a combination of flat waves and waves having about 16-20 peaks per minute, which is indicative of C waves and an ICP between 18 and 30 mm Hg.
- Figure 13 shows ' an alternative C-wave waveform, also indicative of ICP between 18 and 30 mm Hg, which is characterized by higher frequency waves of about 20-30 peaks per minute.
- the present invention it is possible to monitor, non-invasively, the pulsatility of specific areas of the brain. This is significant because, in any given patient, the pulsatility in one area of the brain may not be the same as the pulsatility in another area of the brain, because local damage of brain tissue, for example, the presence of tumors, blood clots, contusions and other anomalies.
- FIG 14(a) shows a preferred device 800 for calibrating the device 100 of Figure 2 for the measurement of ICP.
- the device 800 includes a constant volume pump 8 for transmitting a constant volume of a medium (such as air, water, oil, etc) through a chamber 900, which leads to chambers 910 and 920 respectively.
- Chambers 910 and 920 terminate in respective bladders 11 and 12 in neck collar 930.
- the bladders 11 and 12 are positioned on the interior side of the neck collar 930 so that they are adjacent the external jugular vein and the internal jugular vein when the neck collar is secured around the neck of a patient.
- a pressure display device 10 is also coupled to the chamber 900 for monitoring the pressure in the chambers 900, 910, 920.
- the pump 801, chambers 900, 910, 920, and bladders 11, 12 are constructed in such a manner as to apply pressure to the jugular veins 501, 502 in constant increments as the pump 801 is operated.
- the chambers 806-808 may be constructed of hollow tubes made of polyethylene plastic
- the bladders 804-805 may be made of a substantially non-elastic nylon or polyethylene membrane
- the medium may be air.
- the pump 801 and the display device 802 may be of any known type.
- the material chosen for the bladders 804-805 and the chambers 806-807 should be materials which will not cause hysteresis during operation.
- ultrasound measurements are taken with the probe 101, gated on the third ventricle of the patient, to produce an EPG signal as described above.
- a compressed EPG waveform is used which includes only the minimum and maximum EPG waveform values for each cardiac cycle.
- the constant volume pump is used to apply a constant volume of fluid or gas to the bladders 804 and 805, thereby increasing the pressure on the interior and exterior jugular veins at a constant rate.
- the pump 801 increases the pressure in increments of 2 mm Hg per rotation of the pump actuator.
- FIG. 15 schematically illustrates the relationship between pump iterations (at 2 mm Hg per iteration) and infra tissue pressure on the neck.
- the crisis point is identified at 4 mm Hg.
- Figure 17 illustrates an Echo EG signal for a patient gated at 91 mm, and a corresponding EPG signal.
- the constant volume pump is used to apply a constant volume of fluid to the bladders 804 and 805, thereby increasing the pressure on the interior and exterior jugular veins at a constant rate until the baseline level (the average EPG amplitude corrected for the respiratory wave) of the Long-EPG signal falls .
- This "crisis point" value is taken as an estimation of the pressure required to compress the skin in the neck without compressing the jugular vein.
- the crisis point is 6 mm Hg, as shown in Figure 18.
- this procedure will require no more than a 50% osculation of the jugular veins for 3 seconds to 15 seconds. Calibration is preferably repeated every 2 days for each patient.
- each calibration may involve performing the procedure described above three or four times to obtain an average value for ICP.
- the procedure is performed at least once during inspiration, at least one during expiration,, and at least once during normal breathing to provide an average value.
- the device 800 is also useful, in and of itself , as a diagnostic tool. For example, as described above, it can be used to measure ICP in a patient in cases in which frequent or extended monitoring of ICP is not desired.
- the device 800 can also be used to provide an indication of vascular patency.
- the constant volume pump is used to increase the pressure on the interior and exterior jugular veins until the EPG signal changes to a plateau wave as shown in Figure 14(b).
- the time from the last incremental pressure increase from pump 802 until the onset of plateau waves ( ⁇ ) can then be used as an indication of venous or vascular patency, or of the available reserve intracranial space or compensatory capacity.
- a short ⁇ time is indicative of low patency and/or less available reserve space (or compensatory capacity) within the skull, while a longer ⁇ is indicative of of high patency and/or more available reserve space (or compensatory capacity).
- the apparatus 1 and EPG, Echo EG, and ECG waveforms are generated and interpreted manually by a technician , in the manner described above in order to monitor pulsatility in the brain, and to, for example, determine the ICP at particular brain regions.
- this procedure can be further automated as described below.
- the apparatus is configured to allow a technician to select a broad gate range, for example 40-60 mm, and to gate the Echo EG waveform at multiple depths within that range to provide multiple EPG waveforms.
- a broad gate range for example 40-60 mm
- the apparatus could provide gates at intervals of 1 mm (totaling 20 gates), 2 mm (10 gates), or 4 mm (5 gates).
- the technician could then review the EPG waveforms at each gate to determine which provides the optimal EPG waveform for a site of interest in the brain.
- a typical EPG waveform for a site of interest could be stored on the computer 107.
- Each of the gated waveforms could then be compared to the stored waveform, and the gated waveform which most closely resembles the stored waveform could be identified to the technician.
- the multiple gating feature could be implemented in a number of ways. For example, it could be implemented entirely in software using the single gating circuit 104 of Figure 1.
- the Echo EG signal is gated only once during each transmitted ultrasound pulse, and the gated location is incremented (e.g. by 1, 2, or 4 mm) during each successive ultrasound pulse until an EPG waveform is generated for each gate within the gate range.
- a plurality of gating circuits 104 could be provided, allowing the Echo EG signal to be gating at plurality of depths in parallel to produce a plurality of EPG waveforms from a single transmitted ultrasound pulse.
- these techniques are not mutually exclusive.
- an apparatus could employ multiple gating circuits (for example 4), and also allow serial incrementing of gate locations, thereby providing the capability to gate at 20 locations with only 5 ultrasound pulses.
- the DFT or FFT techniques described above with regard to Figures 9 through 12 may be used to further automate the determination of ICP.
- the EPG signal is used to determine the width and position of ventricles and blood vessels.
- the opposing walls of a ventricle or blood vessel are identified from the EPG and Echo EG waveforms.
- Figures 20 through 23 illustrate a preferred method for identifying the width and position of the third ventricle of a patient. Once the position of the third ventricle is identified, the existence and extent of midline shift for a patient can be calculated as a displacement of the third ventricle relative to the centerline of the skull.
- Figure 20 shows an Echo EG waveform for a patient in an upper plot, along with a corresponding EPG waveform, ECG waveform and respiratory wave in a lower plot.
- an ultrasound probe 101, or 101' is placed on the right temporal area of the skull of a patient and an ulfrasound pulse is transmitted from the ultrasound probe into the skull of the patent in the manner described above.
- the reflected signal from said ultrasound pulse is then received, and processed to generate the Echo EG signal shown on the upper plot of Figure 20.
- a dominant portion of said echo encephalogram signal corresponding to the third ventricle is then selected at a gate depth of 69 mm, and the Echo EG signal is integrated across the gate to generate the
- an EPG signal displayed in the lower plot of Figure 20.
- the phase of the EPG signal is noted.
- an EPG signal is identified as a positive phase signal if the maximum amplitude of the signal following a cardiac systole has a positive value, and as a negative phase signal if the maximum amplitude of the signal following a cardiac systole has a negative value.
- the selected portion of the echo encephalogram is identified as corresponding the far wall of the vessel or ventricle relative to the ultrasound probe. If the echo pulsogram signal has a negative phase, then the selected portion of the echo encephalogram is identified as corresponding the near wall of the vessel or ventricle relative to the ultrasound probe.
- the EPG for the patient at a gate depth of 69 mm is a negative phase signal
- the position of the near ( wall of the third ventricle (relative to the probe) is estimated at 69 mm from the right temporal area of the patient as shown in Figure 24(a).
- the Echo EG signal is gated at a location farther from the ultrasound probe.
- a physician or technician selects a depth which corresponds to a typical width of the third ventricle.
- the echo EG signal is then integrated across the gate to generate an EPG signal. If the EPG signal is a positive phase signal, then the gate of the echo EG is identified as corresponding to the far wall of the third ventricle. If the EPG signal is a negative phase signal, then successive gates of the Echo EG are selected, which correspond to locations in the brain which are successively farther from the ultrasound probe, until a positive phase signal is identified.
- the echo EG signal (upper plot) is gated at a depth of 72 mm, and is integrated across the gate to obtain an EPG signal (lower plot).
- Figure 21 shows the Echo EG and EPG, ECG, and respiratory waveforms for the patient of Figure 20, with the ultrasound probe 101, or 101' placed on the left temporal area of the skull of a patient, and the Echo EG waveform gated at 68 mm.
- amplitude of the EPG signal rises in a positive direction to point A (the beginning of brain (arterial, venous, ventricular, cisternal) pulsatility), then falls in a negative direction to point C (absolute maximum f(t)). Therefore, the EPG for the patient at a gate depth of 68 mm is a. negative phase signal, and the position of the near wall of the third ventricle (relative to the left temporal area) is estimated at 68 mm from the left temporal area of the patient, as " shown in Figure 24(b).
- Figure 22 shows the Echo EG and EPG, ECG, and respiratory waveforms for the patient of Figure 20, with the ultrasound probe 101, or 101' placed on the left temporal area of the skull of a patient, and the Echo EG waveform gated at 72 mm.
- amplitude of the EPG signal falls in a negative direction to point A (the beginning of venous pulsatility), then rises in a positive direction to point C (absolute maximum f(t)).
- the EPG for the patient at a gate depth of 72 mm is a positive phase signal
- the position of the far wall of the third ventricle is estimated at 72 mm from the left temporal area of the patient, as shown in Figure 24(b).
- the presence, and extent, of midline shift can be determined from the above data as follows. Referring to. Figure 23(c), based upon the assumption that the third ventricle is substantially symmetrical, if the third ventricle is located exactly at the midline (M), the distance from a probe on the left side temporal area to the nearest wall of the third ventricle (i.e., the left side ventricle wall) should be equal to the distance from a probe on the right side temporal area to the nearest wall of the third ventricle (i.e., the right side ventricle wall).
- the midline shift can additionally be based upon the measured distance to the farthest wall from the left and right side temporal areas.
- the distance from a probe on the left side temporal area to the farthest wall of the third ventricle i.e., the right side ventricle wall
- the method in accordance with the present invention for identifying the presence and extent of midline shift preferably includes locating the position of each lateral wall of the third ventricle (as described above), it is also possible to identify the presence and extent of midline shift by, for example, simply locating the nearest third ventricle wall to an ultrasound probe placed on one temporal area of the skull and then locating the nearest third ventricle wall to an ultrasound probe placed on the opposing temporal area.
- the TRA technology of the present invention may also be used for the diagnosis and monitoring of other conditions and characteristics.
- the present invention can be utilized to diagnose traumatic or organic injury to the nervous system such as lateral ventricle shift, fourth ventricle shift, shift of different vessels, brain edema, birth trauma, spinal cord diseases, intramuscular pressure, and severe headache; to monitor blood vessel tension, blood vessel capacitance, linear blood flow velocity, arterial volume blood flow velocity (arterial and venous), coronary blood flow, cardiac output, cardiac excitation-contraction coupling, and intraocular pressure; pupiledema, water content of different tissues and to diagnose intracranial vessels aneurysms, and brain death.
- traumatic or organic injury to the nervous system such as lateral ventricle shift, fourth ventricle shift, shift of different vessels, brain edema, birth trauma, spinal cord diseases, intramuscular pressure, and severe headache
- to monitor blood vessel tension blood vessel capacitance, linear blood flow velocity, arterial volume blood flow velocity (arterial and venous), coronary blood flow
Abstract
Description
Claims
Priority Applications (6)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
AU58699/01A AU5869901A (en) | 2000-05-26 | 2001-05-24 | Ultrasound apparatus and method for tissue resonance analysis |
EP01932025A EP1289408A4 (en) | 2000-05-26 | 2001-05-24 | Ultrasound apparatus and method for tissue resonance analysis |
IL15298201A IL152982A0 (en) | 2000-05-26 | 2001-05-24 | Ultrasound apparatus and method for tissue resonance analysis |
MXPA02011496A MXPA02011496A (en) | 2000-05-26 | 2001-05-24 | Ultrasound apparatus and method for tissue resonance analysis. |
CA002409850A CA2409850A1 (en) | 2000-05-26 | 2001-05-24 | Ultrasound apparatus and method for tissue resonance analysis |
JP2001585606A JP2004519259A (en) | 2000-05-26 | 2001-05-24 | Ultrasonic device and method for tissue resonance analysis |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US09/578,881 | 2000-05-26 | ||
US09/578,881 US6328694B1 (en) | 2000-05-26 | 2000-05-26 | Ultrasound apparatus and method for tissue resonance analysis |
Publications (2)
Publication Number | Publication Date |
---|---|
WO2001089358A2 true WO2001089358A2 (en) | 2001-11-29 |
WO2001089358A3 WO2001089358A3 (en) | 2002-04-04 |
Family
ID=24314690
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/IB2001/000955 WO2001089358A2 (en) | 2000-05-26 | 2001-05-24 | Ultrasound apparatus and method for tissue resonance analysis |
Country Status (8)
Country | Link |
---|---|
US (2) | US6328694B1 (en) |
EP (1) | EP1289408A4 (en) |
JP (1) | JP2004519259A (en) |
AU (1) | AU5869901A (en) |
CA (1) | CA2409850A1 (en) |
IL (1) | IL152982A0 (en) |
MX (1) | MXPA02011496A (en) |
WO (1) | WO2001089358A2 (en) |
Cited By (4)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US6875176B2 (en) | 2000-11-28 | 2005-04-05 | Aller Physionix Limited | Systems and methods for making noninvasive physiological assessments |
JP2006230504A (en) * | 2005-02-22 | 2006-09-07 | Micro-Star Internatl Co Ltd | Method for measuring intracranial pressure and system |
US7547283B2 (en) | 2000-11-28 | 2009-06-16 | Physiosonics, Inc. | Methods for determining intracranial pressure non-invasively |
US7682310B2 (en) | 2005-03-03 | 2010-03-23 | Micro-Star Int'l Co., Ltd. | Method and related system for measuring intracranial pressure |
Families Citing this family (49)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US7789841B2 (en) * | 1997-02-06 | 2010-09-07 | Exogen, Inc. | Method and apparatus for connective tissue treatment |
US5904659A (en) * | 1997-02-14 | 1999-05-18 | Exogen, Inc. | Ultrasonic treatment for wounds |
US7211060B1 (en) * | 1998-05-06 | 2007-05-01 | Exogen, Inc. | Ultrasound bandages |
US6887199B2 (en) | 1999-09-23 | 2005-05-03 | Active Signal Technologies, Inc. | Brain assessment monitor |
US7037267B1 (en) * | 1999-11-10 | 2006-05-02 | David Lipson | Medical diagnostic methods, systems, and related equipment |
US6328694B1 (en) * | 2000-05-26 | 2001-12-11 | Inta-Medics, Ltd | Ultrasound apparatus and method for tissue resonance analysis |
US6702743B2 (en) * | 2000-05-26 | 2004-03-09 | Inta-Medics, Ltd. | Ultrasound apparatus and method for tissue resonance analysis |
WO2002026117A2 (en) * | 2000-09-29 | 2002-04-04 | New Health Sciences, Inc. | Systems and methods for assessing vascular health |
US7104958B2 (en) * | 2001-10-01 | 2006-09-12 | New Health Sciences, Inc. | Systems and methods for investigating intracranial pressure |
US6955648B2 (en) * | 2000-09-29 | 2005-10-18 | New Health Sciences, Inc. | Precision brain blood flow assessment remotely in real time using nanotechnology ultrasound |
AU3267902A (en) * | 2000-10-25 | 2002-05-27 | Exogen Inc | Transducer mounting assembly |
US7022077B2 (en) * | 2000-11-28 | 2006-04-04 | Allez Physionix Ltd. | Systems and methods for making noninvasive assessments of cardiac tissue and parameters |
US20060079773A1 (en) * | 2000-11-28 | 2006-04-13 | Allez Physionix Limited | Systems and methods for making non-invasive physiological assessments by detecting induced acoustic emissions |
WO2002071923A2 (en) * | 2001-03-12 | 2002-09-19 | Active Signal Technologies | Brain assessment monitor |
US7150737B2 (en) * | 2001-07-13 | 2006-12-19 | Sci/Med Life Systems, Inc. | Methods and apparatuses for navigating the subarachnoid space |
US7455666B2 (en) * | 2001-07-13 | 2008-11-25 | Board Of Regents, The University Of Texas System | Methods and apparatuses for navigating the subarachnoid space |
CA2474309A1 (en) * | 2002-01-28 | 2003-08-07 | New Health Sciences, Inc. | Detecting, assessing, and diagnosing sleep apnea |
US20030220556A1 (en) * | 2002-05-20 | 2003-11-27 | Vespro Ltd. | Method, system and device for tissue characterization |
US6663571B1 (en) * | 2002-05-28 | 2003-12-16 | Philip Chidi Njemanze | Transcranial doppler ultrasound device for odor evaluation |
AU2003280416A1 (en) * | 2002-07-01 | 2004-01-19 | Allez Physionix | Systems and methods for making noninvasive assessments of cardiac tissue and parameters |
US7147605B2 (en) | 2002-07-08 | 2006-12-12 | Uab Vittamed | Method and apparatus for noninvasive determination of the absolute value of intracranial pressure |
EP2392262A1 (en) | 2003-06-03 | 2011-12-07 | PhysioSonics, Inc. | Methods and systems for locating and acoustically illuminating a desired target area |
US7611465B2 (en) * | 2003-07-15 | 2009-11-03 | Board Of Regents, The University Of Texas System | Rapid and accurate detection of bone quality using ultrasound critical angle reflectometry |
US7520862B2 (en) | 2004-02-03 | 2009-04-21 | Neuro Diagnostic Devices, Inc. | Cerebral spinal fluid shunt evaluation system |
US20080214951A1 (en) * | 2004-02-03 | 2008-09-04 | Neuro Diagnostic Devices, Inc. | Cerebrospinal Fluid Evaluation Systems |
AU2005220794A1 (en) | 2004-03-06 | 2005-09-22 | Calisto Medical, Inc. | Methods and devices for non-invasively measuring quantitative information of substances in living organisms |
US7491169B2 (en) * | 2004-03-22 | 2009-02-17 | The United States Of America As Represented By The Administrator Of The National Aeronautics And Space Administration | Ultrasonic apparatus and method to assess compartment syndrome |
US7381186B2 (en) * | 2004-08-02 | 2008-06-03 | The United States Of America As Represented By The Administrator Of The National Aeronautics And Space Administration | Method and apparatus to assess compartment syndrome |
CN1312487C (en) * | 2004-09-01 | 2007-04-25 | 崔志国 | Ultrasonic detecting device and its detecting method |
AU2005205820B2 (en) * | 2004-09-04 | 2011-04-14 | Smith & Nephew Plc | Ultrasound device and method of use |
US7033321B1 (en) | 2004-10-25 | 2006-04-25 | Artann Laboratories, Inc. | Ultrasonic water content monitor and methods for monitoring tissue hydration |
US20080004527A1 (en) * | 2006-04-05 | 2008-01-03 | Coleman D Jackson | High-resolution ultrasound spectral and wavelet analysis of vascular tissue |
WO2008017998A2 (en) * | 2006-08-11 | 2008-02-14 | Koninklijke Philips Electronics, N.V. | Ultrasound system for cerebral blood flow imaging and microbubble-enhanced blood clot lysis |
US20080125653A1 (en) * | 2006-11-27 | 2008-05-29 | Board Of Regents, The University Of Texas System | Density and porosity measurements by ultrasound |
US8109880B1 (en) | 2006-12-26 | 2012-02-07 | Osvaldas Pranevicius | Noninvasive method to measure intracranial and effective cerebral outflow pressure |
CN101743565B (en) * | 2007-03-06 | 2012-08-08 | 皇家飞利浦电子股份有限公司 | Filtering of image sequences |
US8043217B1 (en) | 2007-07-10 | 2011-10-25 | Bioquantetics, Inc. | Method and apparatus to quantify specific material properties of objects using real-time ultrasound burst spectrography technique |
CN101569540B (en) * | 2008-04-29 | 2011-05-11 | 香港理工大学 | Wireless ultrasonic scanning system |
DE112009001381T5 (en) * | 2008-06-06 | 2011-05-05 | Bedrock Inventions, LLC (A California Corporation), MENLO PARK | Method and apparatus for targeted device placement in the brain ventricles or other intracranial targets |
EP2310094B1 (en) * | 2008-07-14 | 2014-10-22 | Arizona Board Regents For And On Behalf Of Arizona State University | Devices for modulating cellular activity using ultrasound |
RU2011102338A (en) * | 2008-07-30 | 2012-09-10 | РАППАПОРТ Артур (US) | METHOD FOR MEASURING INTRA CRANIAL ELASTICITY |
US8764672B2 (en) * | 2009-02-17 | 2014-07-01 | Preston K. Manwaring | System, method and device for monitoring the condition of an internal organ |
US20110092955A1 (en) | 2009-10-07 | 2011-04-21 | Purdy Phillip D | Pressure-Sensing Medical Devices, Systems and Methods, and Methods of Forming Medical Devices |
US8597192B2 (en) * | 2009-10-30 | 2013-12-03 | Warsaw Orthopedic, Inc. | Ultrasonic devices and methods to diagnose pain generators |
US20110184284A1 (en) * | 2010-01-28 | 2011-07-28 | Warsaw Orthopedic, Inc. | Non-invasive devices and methods to diagnose pain generators |
US8622912B2 (en) | 2010-07-13 | 2014-01-07 | Fabrico Technology, Inc. | Transcranial doppler apparatus |
CN102830436B (en) * | 2012-09-26 | 2015-03-04 | 上海海事大学 | Underground non-metal pipeline distribution probing device and method based on ultrasonic sensor |
CN105115592B (en) * | 2015-09-02 | 2018-02-16 | 东莞市中光通信科技有限公司 | Cranial cavity method for detecting vibration and device |
US11013489B2 (en) | 2016-08-09 | 2021-05-25 | Axel ROSENGART | Detection and quantification of brain motion and pulsatility |
Citations (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4984567A (en) | 1986-09-27 | 1991-01-15 | Hitachi Construction Machinery Co., Ltd. | Apparatus for measuring intracranial pressure |
US5117835A (en) | 1990-07-31 | 1992-06-02 | Mick Edwin C | Method and apparatus for the measurement of intracranial pressure |
US5617873A (en) | 1994-08-25 | 1997-04-08 | The United States Of America As Represented By The Administrator, Of The National Aeronautics And Space Administration | Non-invasive method and apparatus for monitoring intracranial pressure and pressure volume index in humans |
US5840018A (en) | 1996-11-15 | 1998-11-24 | Inta Medics Ltd. | Non-invasive real time diagnosis of migraine |
WO1999063890A1 (en) | 1998-06-12 | 1999-12-16 | Children's Medical Center Corporation | Non-invasive in vivo pressure measurement |
Family Cites Families (15)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
CA973632A (en) | 1973-05-29 | 1975-08-26 | Arthur C. Hudson | Echoencephalograph |
SU776603A1 (en) | 1977-10-03 | 1980-11-07 | Рижский Медицинский Институт | Method of diagnosis of brain hemodynamics disorders |
SU753426A1 (en) | 1978-07-10 | 1980-08-07 | Ленинградский Ордена Трудового Красного Знамени Научно-Исследовательский Нейрохирургический Институт Им.Проф.А.Л.Поленова | Method of determining brain ventricles situs |
SU904670A1 (en) | 1980-03-14 | 1982-02-15 | Ленинградский Ордена Трудового Красного Знамени Научно-Исследовательский Нейрохирургический Институт Им. Проф. А.Л.Поленова | Method of determining subdural intraganial pressure |
SU1142106A1 (en) | 1983-05-25 | 1985-02-28 | Украинский Институт Усовершенствования Врачей | Method of determining intraventricular pressure |
EP0413816B1 (en) * | 1986-09-27 | 1994-12-07 | Hitachi Construction Machinery Co., Ltd. | Method for recording intracranial pressure |
DE3633080A1 (en) * | 1986-09-29 | 1988-03-31 | Mueller Wickop Juergen Dr | Device for monitoring a liquid volume |
SU1734695A1 (en) | 1989-06-22 | 1992-05-23 | Украинский Институт Усовершенствования Врачей | Method for examining intracranial structures of the brain |
US5388583A (en) | 1993-09-01 | 1995-02-14 | Uab Vittamed | Method and apparatus for non-invasively deriving and indicating of dynamic characteristics of the human and animal intracranial media |
DE19606687A1 (en) * | 1996-02-22 | 1997-08-28 | Nicolet Biomedical Inc | Method and device for measuring the intracranial pressure in a skull of a test subject |
US5919144A (en) | 1997-05-06 | 1999-07-06 | Active Signal Technologies, Inc. | Apparatus and method for measurement of intracranial pressure with lower frequencies of acoustic signal |
JPH10328189A (en) | 1997-05-29 | 1998-12-15 | Matsushita Electric Ind Co Ltd | Ultrasonic blood flow measuring instrument |
US5873840A (en) | 1997-08-21 | 1999-02-23 | Neff; Samuel R. | Intracranial pressure monitoring system |
US6231509B1 (en) * | 1997-12-05 | 2001-05-15 | Royce Johnson | Apparatus and method for monitoring intracranial pressure |
US6328694B1 (en) * | 2000-05-26 | 2001-12-11 | Inta-Medics, Ltd | Ultrasound apparatus and method for tissue resonance analysis |
-
2000
- 2000-05-26 US US09/578,881 patent/US6328694B1/en not_active Expired - Fee Related
-
2001
- 2001-05-24 AU AU58699/01A patent/AU5869901A/en not_active Abandoned
- 2001-05-24 MX MXPA02011496A patent/MXPA02011496A/en unknown
- 2001-05-24 EP EP01932025A patent/EP1289408A4/en not_active Withdrawn
- 2001-05-24 WO PCT/IB2001/000955 patent/WO2001089358A2/en not_active Application Discontinuation
- 2001-05-24 IL IL15298201A patent/IL152982A0/en unknown
- 2001-05-24 CA CA002409850A patent/CA2409850A1/en not_active Abandoned
- 2001-05-24 JP JP2001585606A patent/JP2004519259A/en active Pending
- 2001-11-12 US US10/012,679 patent/US20030013956A1/en not_active Abandoned
Patent Citations (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4984567A (en) | 1986-09-27 | 1991-01-15 | Hitachi Construction Machinery Co., Ltd. | Apparatus for measuring intracranial pressure |
US5117835A (en) | 1990-07-31 | 1992-06-02 | Mick Edwin C | Method and apparatus for the measurement of intracranial pressure |
US5617873A (en) | 1994-08-25 | 1997-04-08 | The United States Of America As Represented By The Administrator, Of The National Aeronautics And Space Administration | Non-invasive method and apparatus for monitoring intracranial pressure and pressure volume index in humans |
US5840018A (en) | 1996-11-15 | 1998-11-24 | Inta Medics Ltd. | Non-invasive real time diagnosis of migraine |
WO1999063890A1 (en) | 1998-06-12 | 1999-12-16 | Children's Medical Center Corporation | Non-invasive in vivo pressure measurement |
Non-Patent Citations (1)
Title |
---|
See also references of EP1289408A4 |
Cited By (4)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US6875176B2 (en) | 2000-11-28 | 2005-04-05 | Aller Physionix Limited | Systems and methods for making noninvasive physiological assessments |
US7547283B2 (en) | 2000-11-28 | 2009-06-16 | Physiosonics, Inc. | Methods for determining intracranial pressure non-invasively |
JP2006230504A (en) * | 2005-02-22 | 2006-09-07 | Micro-Star Internatl Co Ltd | Method for measuring intracranial pressure and system |
US7682310B2 (en) | 2005-03-03 | 2010-03-23 | Micro-Star Int'l Co., Ltd. | Method and related system for measuring intracranial pressure |
Also Published As
Publication number | Publication date |
---|---|
AU5869901A (en) | 2001-12-03 |
IL152982A0 (en) | 2003-06-24 |
WO2001089358A3 (en) | 2002-04-04 |
EP1289408A4 (en) | 2005-09-21 |
US6328694B1 (en) | 2001-12-11 |
MXPA02011496A (en) | 2003-04-25 |
US20030013956A1 (en) | 2003-01-16 |
CA2409850A1 (en) | 2001-11-29 |
EP1289408A2 (en) | 2003-03-12 |
JP2004519259A (en) | 2004-07-02 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
US6328694B1 (en) | Ultrasound apparatus and method for tissue resonance analysis | |
US6702743B2 (en) | Ultrasound apparatus and method for tissue resonance analysis | |
CA2428872C (en) | Systems and methods for making non-invasive physiological assessments | |
Bode | Pediatric applications of transcranial Doppler sonography | |
EP3154424B1 (en) | Apparatus for detecting increase in intracranial pressure | |
Raksin et al. | Noninvasive intracranial compliance and pressure based on dynamic magnetic resonance imaging of blood flow and cerebrospinal fluid flow: review of principles, implementation, and other noninvasive approaches | |
US20060079773A1 (en) | Systems and methods for making non-invasive physiological assessments by detecting induced acoustic emissions | |
Moraes et al. | Noninvasive intracranial pressure monitoring methods: a critical review | |
Michaeli et al. | Tissue resonance analysis: a novel method for noninvasive monitoring of intracranial pressure | |
US11672439B2 (en) | Method and apparatus for noninvasive absolute (mean) intracranial pressure (A-ICP) measurement and/or monitoring | |
Kasapas et al. | Invasive and ultrasound based monitoring of the intracranial pressure in an experimental model of epidural hematoma progressing towards brain tamponade on rabbits | |
Penson et al. | Intracranial hypertension: condition monitoring, simulation and time-domain analysis | |
Ragauskas et al. | Non-invasive assessment of intracranial biomechanics of the human brain | |
Xie et al. | Techniques in Measuring Intraocular and Intracranial Pressure Gradients | |
Hernandez | An investigation of systemic haemodynamic correlates of intracranial pressure | |
Fearon et al. | Transcranial Doppler: Advanced Technology for Assessing Cerebral Hem dynamics | |
Padayachy | Ultrasound as a non-invasive diagnostic tool in paediatric neurosurgery: relationship between the optic nerve sheath diameter (ONSD) and intracranial pressure (ICP) | |
Whitehouse | Methods to assess CSF dynamics and the mechanical properties of the cerebral mantel in hydrocephalus | |
Penson et al. | Intracranial pressure monitoring by time domain analysis | |
RU2428925C1 (en) | Method of diagnosing intracranial hypertension | |
Scott et al. | The impact of chiropractic adjustments on intracranial blood flow: A pilot study | |
Hargens | Noninvasive Intracranial Volume and Pressure Measurements Using Ultrasound (Head and Spinal) | |
Bakker | Cerebral hemodynamic indices measured by means of transcranial Doppler |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
AK | Designated states |
Kind code of ref document: A2 Designated state(s): AE AG AL AM AT AU AZ BA BB BG BR BY BZ CA CH CN CR CU CZ DE DK DM DZ EE ES FI GB GD GE GH GM HR HU ID IL IN IS JP KE KG KP KR KZ LC LK LR LS LT LU LV MA MD MG MK MN MW MX MZ NO NZ PL PT RO RU SD SE SG SI SK SL TJ TM TR TT TZ UA UG US UZ VN YU ZA ZW |
|
AL | Designated countries for regional patents |
Kind code of ref document: A2 Designated state(s): GH GM KE LS MW MZ SD SL SZ TZ UG ZW AM AZ BY KG KZ MD RU TJ TM AT BE CH CY DE DK ES FI FR GB GR IE IT LU MC NL PT SE TR BF BJ CF CG CI CM GA GN GW ML MR NE SN TD TG |
|
121 | Ep: the epo has been informed by wipo that ep was designated in this application | ||
AK | Designated states |
Kind code of ref document: A3 Designated state(s): AE AG AL AM AT AU AZ BA BB BG BR BY BZ CA CH CN CR CU CZ DE DK DM DZ EE ES FI GB GD GE GH GM HR HU ID IL IN IS JP KE KG KP KR KZ LC LK LR LS LT LU LV MA MD MG MK MN MW MX MZ NO NZ PL PT RO RU SD SE SG SI SK SL TJ TM TR TT TZ UA UG US UZ VN YU ZA ZW |
|
AL | Designated countries for regional patents |
Kind code of ref document: A3 Designated state(s): GH GM KE LS MW MZ SD SL SZ TZ UG ZW AM AZ BY KG KZ MD RU TJ TM AT BE CH CY DE DK ES FI FR GB GR IE IT LU MC NL PT SE TR BF BJ CF CG CI CM GA GN GW ML MR NE SN TD TG |
|
REG | Reference to national code |
Ref country code: DE Ref legal event code: 8642 |
|
WWE | Wipo information: entry into national phase |
Ref document number: 2409850 Country of ref document: CA |
|
WWE | Wipo information: entry into national phase |
Ref document number: 152982 Country of ref document: IL |
|
WWE | Wipo information: entry into national phase |
Ref document number: PA/a/2002/011496 Country of ref document: MX |
|
WWE | Wipo information: entry into national phase |
Ref document number: 2001932025 Country of ref document: EP |
|
WWP | Wipo information: published in national office |
Ref document number: 2001932025 Country of ref document: EP |
|
DFPE | Request for preliminary examination filed prior to expiration of 19th month from priority date (pct application filed before 20040101) | ||
WWW | Wipo information: withdrawn in national office |
Ref document number: 2001932025 Country of ref document: EP |
|
ENPW | Started to enter national phase and was withdrawn or failed for other reasons |
Ref document number: PI0111342 Country of ref document: BR Free format text: PEDIDO RETIRADO FACE A IMPOSSIBILIDADE DE ACEITACAO DA ENTRADA NA FASE NACIONAL POR TER SIDO INTEMPESTIVA. O PRAZO LIMITE PARA ENTRADA NA FASE NACIONAL EXPIRAVA EM 26.01.2002(20 MESES - BR DESIGNADO APENAS) , E A PRETENSA ENTRADA NA FASE NACIONAL SO OCORREU EM 22.11.2002. |