Doppler ultrasound is one of the oldest modalities for measuring and visualizing blood flow. This review paper explores the principles of Doppler ultrasound and blood flow imaging. Following a brief history of Doppler ultrasound, all Doppler modes, including B-Flow imaging, are discussed, with emphasis on spectral broadening and Doppler spectrum amplitude in relation to clinical implications. The paper also outlines sources of uncertainty in Doppler flow measurement. Emerging technologies in blood flow imaging are introduced, including microvascular flow imaging without contrast agents and four-dimensional vascular imaging from a two-dimensional transducer, which have been commercialized within the past decade, as well as row-column array transducer systems, high-frame-rate imaging, and photoacoustic imaging, which remain in preclinical and research stages.

This observational study investigated the changes in choroidal thickness (ChT) in different patterns of diabetic macular edema (DME) based on image processing using enhanced-depth imaging spectral-domain optical coherence tomography (EDI-SD-OCT). Participants with ocular conditions affecting the fundus view, including retinal diseases, were excluded. After observing the patient’s medical record, multicolor fundus photos, thickness maps, and subtypes of DME were diagnosed according to the criteria reported by the Early Treatment Diabetic Retinopathy Study (ETDRS). Edema was classified as focal or diffuse and was subdivided into cystic macular edema (CME), CME with subretinal fluid (CME+), and spongy macular edema (SME). Image processing was performed on the B-scan images from SD-OCT to segment the choroid layer and obtain the choroid thickness. A total of 159 eyes of 81 patients (46 males and 35 females; 57.53 ± 9.78 years of age), and 57 eyes of 30 healthy individuals (age 57.34 ± 8.76 years) were enrolled in this study. Out of 159 eyes, 76 had focal macular edema (FME), 13 exhibited SME, and 51 presented CME. Among those with cystic macular edema, 19 eyes showed subretinal fluid (CME+). The average choroidal thickness in FME, diffuse SME, CME, and CME+ was 216.95 ± 52.94 µm, 243.00 ± 46.34 µm, 221.38 ± 60.78 µm, and 249.63 ± 53.90 µm, respectively. The average choroidal thickness in age-matched controls was 213.88 ± 45.60 µm. Choroidal thickness increases with the severity of edema; choroidal thickness was higher in diffuse macular edema than in FME. However, choroidal thickness increased in cystic macular edema with subretinal fluid (CME+).

Erythrocyte aggregation (EA) is a highly dynamic, vital phenomenon to interpreting human hemorheology, which would be helpful for the diagnosis and prediction of circulatory anomalies. Previous studies of EA on erythrocyte migration and the Fåhraeus Effect are based on the microvasculature. They have not considered the natural pulsatility of the blood flow or large vessels and mainly focused on shear rate along radial direction under steady flow to comprehend the dynamic properties of EA. To our knowledge, the rheological characteristics of non-Newtonian fluids under Womersley flow have not reflected the spatiotemporal behaviors of EA or the distribution of erythrocyte dynamics (ED). Hence, it needs to interpret the ED affected by temporal and spatial flow variation to understand the effect of EA under Womersley flow. Here, we demonstrated the numerically simulated ED to decipher EA's rheological role in axial shear rate under Womersley flow. In the present study, the temporal and spatial variations of the local EA were found to mainly depend on the axial shear rate under Womersley flow in an elastic vessel, while mean EA decreased with radial shear rate. The localized distribution of parabolic or M-shape clustered EA was found in a range of the axial shear rate profile (-15 to 15s^-1) at low radial shear rates during a pulsatile cycle. However, the linear formation of rouleaux was realized without local clusters in a rigid wall where the axial shear rate is zero. In vivo, the axial shear rate is usually considered insignificant, especially in straight arteries, but it has a great impact on the disturbed blood flow due to the geometrical properties, such as bifurcations, stenosis, aneurysm, and the cyclic variation of pressure. Our findings regarding axial shear rate provide new insight into the local dynamic distribution of EA, which is a critical player in blood viscosity. These will provide a basis for the computer-aided diagnosis of hemodynamic-based cardiovascular diseases by decreasing the uncertainty in the pulsatile flow calculation.

Blood viscosity is inversely proportionate with shear rate mainly due to red blood cell (RBC) aggregation under steady flow. However, this inverse relation cannot explain the spatiotemporal variation of RBC dynamics under pulsatile flow. This study aimed to clarify the relationship between hemodynamics and hemorheology based on a novel computational model that couples RBC dynamics with blood viscosity under pulsatile flow. By integrating both whole-blood experiments with ultrasound imaging and numerical simulations, the spatiotemporal variations of local hematocrit were shown to drive local variations of blood viscosity under pulsatile flow. The results suggest that the local parabolic distribution of high hematocrit is influenced by RBC aggregation and pulsatile flow characteristics, which in turn affect blood viscosity. Computational analysis supports that local blood viscosity increased in regions with elevated hematocrit during the acceleration phase of pulsatile flow. Local hematocrit and RBC dynamics play critical roles in influencing blood viscosity under pulsatile flow, highlighting the importance of incorporating hemorheological and hemodynamic factors. These are crucial for understanding large arterial flow and potentially enhancing diagnostic and therapeutic approaches for cardiovascular diseases.

Multibeam echosounder (MBES) backscatter data are influenced by underwater sound absorption, which is dependent on environmental parameters such as temperature, salinity, and depth. This study leverages CTD datasets from the Korea Oceanographic Data Center (KODC) to analyze and visualize the spatiotemporal variations in absorption parameters in the East Sea of Korea, which are subject to pronounced variability over time and space. The legacy MBES backscatter data, originally processed using generalized absorption parameters that neglected spatiotemporal variations, were compared with the calibrated data. The calibration process included inverse calculation of water temperature with depth-specific average salinity values from the nearest KODC stations. This calibration revealed discrepancies of up to 2.1 dB in backscatter intensity across survey lines, highlighting the potential misrepresentation of legacy MBES backscatter data due to site-specific absorption variability having been overlooked. By addressing these discrepancies, this study underscores the importance of incorporating spatiotemporal absorption variability into MBES calibration workflows. This integrated approach not only enhances the reliability of legacy MBES data but also provides valuable insights for marine resource management, seafloor mapping, and environmental monitoring in highly dynamic marine environments such as the East Sea of Korea.

We are pleased to see that Marino et al. have written a Comment: “Choroidal Thickness Measurements in the Case of Diabetic Macular Edema”