Ultrasound backscattering from non-aggregating and aggregating erythrocytes--a review.

The objective of the present paper is to provide a detailed review of theoretical, experimental and clinical works aimed at understanding the scattering of ultrasound by red blood cells (RBC). The paper focuses on the role of biofluid mechanics and blood biorheology on the scattering mechanisms. The influence of RBC aggregation on the ultrasound backscattered power is specifically addressed. After a short introduction, the paper presents the theory of Rayleigh scattering and summarizes theoretical models on ultrasound backscattering by RBC. The particle, continuum and hybrid models are presented along with reported packing factors used to consider the orderliness in the spatial arrangement of RBC. Computer models of ultrasound backscattering by RBC are also presented in this section. In the second section, experimental factors affecting the ultrasound backscattered power from blood are presented. The influence of the volume of the scatterers, ultrasound frequency, hematocrit, orientation of the scatterers, flow turbulence, flow pulsatility, and concentration of fibrinogen and dextran is discussed. The third section focuses on the use of ultrasound to characterize RBC aggregation. Three aspects are reported: the shear rate dependence of the backscattered power, the "black hole" phenomenon, and the kinetics of RBC rouleau formation. The fourth section reports in vivo observations of the "smoke like" echo in mitral valve disease, and blood echogenicity and backscattered power in veins and arteries. In the last section, new areas of research, clinical applications of ultrasound backscattering, and areas of potential future developments are presented.