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Zhang X, Ding H, Ji X, Chen L, Huang P, Lin Z, Zhu J, Zhou S, Liu Z, Zhang M, Xu Q. Predicting Vulnerable Carotid Plaques by Detecting Wall Shear Stress Based on Ultrasonic Vector Flow Imaging. J Vasc Surg 2024:S0741-5214(24)01341-7. [PMID: 38925348 DOI: 10.1016/j.jvs.2024.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 06/17/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE Carotid plaque vulnerability is a significant factor in the risk of cardio-cerebrovascular events, with intraplaque neovascularization (IPN) being a crucial characteristic of plaque vulnerability. This study investigates the value of ultrasound vector flow imaging (V-Flow) for measuring carotid plaque wall shear stress (WSS) in predicting the extent of IPN. METHODS We enrolled 140 patients into three groups: 53 in the plaque group (72 plaques), 23 in the stenosis group (27 plaques), and 64 in the control group. V-Flow was employed to measure WSS parameters, including the average WSS (WSS Mean) and the maximum WSS (WSS Max), across three plaque locations: mid-upstream, maximum thickness, and mid-downstream. Contrast-enhanced ultrasound (CEUS) was utilized in 76 patients to analyze IPN and its correlation with WSS parameters. RESULTS 1. WSS Max in the stenosis group was significantly higher than that in the control and plaque groups at the maximum thickness part (p < 0.05); WSS Mean in the stenosis group was significantly lower than that in the control group at the mid-upstream and mid-downstream segments (p < 0.05); and WSS Mean in the plaque group was significantly lower than that of the control group at all three locations (p < 0.05). 2. CEUS revealed that plaques with neovascularization enhancement exhibited significantly higher WSS values (p < 0.05), with a positive correlation between WSS parameters and IPN enhancement grades, particularly WSS Max at the thickest part (r = 0.508). 3. ROC curve analysis of WSS parameters for evaluating IPN showed that the efficacy of WSS Max in evaluating IPN was better than that of WSS Mean (p < 0.05), with an AUC of 0.7762, 0.6973; 95% CI of 0.725 - 0.822, 0.642 - 0.749, respectively; Cut-off was 4.57 Pa, 1.12 Pa; sensitivity was 74.03%, 63.64%; specificity was 75.00%, 68.18%. CONCLUSIONS V-Flow effectively measures WSS in carotid plaques. WSS Max provides a promising metric for assessing IPN, offering potential insights into plaque characteristics and showing some potential in predicting plaque vulnerability.
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Affiliation(s)
- Xiang Zhang
- Department of Ultrasonography, The Third Affiliated Hospital of Shanghai University, Wenzhou People's Hospital, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Huanhuan Ding
- Department of Ultrasonography, The Third Affiliated Hospital of Shanghai University, Wenzhou People's Hospital, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaoli Ji
- Department of Ultrasonography, The Third Affiliated Hospital of Shanghai University, Wenzhou People's Hospital, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ling Chen
- Department of Ultrasonography, The Third Affiliated Hospital of Shanghai University, Wenzhou People's Hospital, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Peipei Huang
- Department of Ultrasonography, The Third Affiliated Hospital of Shanghai University, Wenzhou People's Hospital, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zengqiao Lin
- Department of Ultrasonography, The Third Affiliated Hospital of Shanghai University, Wenzhou People's Hospital, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jianbi Zhu
- Department of Ultrasonography, The Third Affiliated Hospital of Shanghai University, Wenzhou People's Hospital, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shujing Zhou
- Department of Ultrasonography, The Third Affiliated Hospital of Shanghai University, Wenzhou People's Hospital, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zezheng Liu
- Department of Ultrasonography, The Third Affiliated Hospital of Shanghai University, Wenzhou People's Hospital, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Miaomiao Zhang
- Department of Ultrasonography, Lingkun Street Community Health Service Center of Dongtou District, Wenzhou, Zhejiang, China
| | - Qi Xu
- Department of Ultrasonography, The Third Affiliated Hospital of Shanghai University, Wenzhou People's Hospital, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Chen J, Zhang L, Gu S, Jia C, Wu R. Quantitative evaluation using carotid Ultrasonography-Based High-Frame-Rate vector flow imaging in patients with low carotid stenosis. Br J Radiol 2024:tqae115. [PMID: 38885374 DOI: 10.1093/bjr/tqae115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 01/09/2024] [Accepted: 06/05/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVE To explore the role of quantitative evaluation using carotid ultrasonography (US)-based high-frame-rate vector flow (V Flow) imaging in patients with low carotid stenosis. METHODS This single-center cross-sectional study consecutively recruited volunteers without carotid plaque and patients with low carotid stenosis from August 2022 to May 2023. Patients were divided into symptomatic and asymptomatic groups according to their head CT or MRI results within eight weeks. All V Flow imaging examinations were performed using a Mindray Resona R9 US system. The wall shear stress (WSS) values, oscillatory shear index (OSI) values and turbulence (Tur) indexes in the normal common carotid artery (CCA), normal carotid bifurcation (CB), and on the upstream and downstream surface of carotid plaque were measured. Pearson Chi-square test and Fisher exact test were used for counting data according to their type. For measurement data, independent sample t test and non-parametric rank sum test were used. RESULTS The results proved that patients have higher WSS values and Tur indexes of CB than volunteers, and higher WSS values were detected on the surface of the plaques in symptomatic patients. What's more, the downstream side of the plaque was more vulnerable to plaque rupture than the upstream side due to more dynamic blood flow. CONCLUSION Therefore, carotid US-based high-frame-rate V Flow imaging provides reliable mechanical biomarkers for assessing the hemodynamic change in patients with low stenosis. Our study may provide a new imaging tool for monitoring the progression of atherosclerosis and aiding the management of early atherosclerotic patients.
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Affiliation(s)
- Jing Chen
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Luni Zhang
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Shiyao Gu
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Caixia Jia
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Rong Wu
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
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Xiaoyong T, Yuping C, Wei H, Juan C, Feng Q, Zhuo L. Evaluafion of the efficacy of wall shear stress in carotid artery stenting. Heliyon 2024; 10:e31383. [PMID: 38828314 PMCID: PMC11140617 DOI: 10.1016/j.heliyon.2024.e31383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 06/05/2024] Open
Abstract
Objective To characterize the value of carotid wall shear stress (WSS) following carotid artery stenting (CAS) in patients with carotid stenosis. Methods Twenty-eight patients with carotid stenosis treated with CAS between March 2021 to May 2022 in the eighth medical center of the PLA General Hospital were selected for our study. Carotid ultrasound was performed before the operation, one week post-operation, and six months post-operation. Carotid artery WSS was detected by blood flow vector imaging, and the changes in WSS before and after the operation were collected. Genetic testing of drugs was detected for patients with restenosis. Results Pre-operative WSS of the proximal, narrowest region, and distal carotid arteries in patients with ischemic carotid artery stenosis was 7.88 ± 3.18Pa, 14.36 ± 6.66Pa, and 1.55 ± 1.15Pa, respectively. Comparatively, pre-operative WSS of the proximal, narrowest region and distal carotid arteries in patients without ischemic symptoms was 5.02 ± 1.99Pa, 9.68 ± 4.23Pa, and 1.10 ± 0.68Pa, respectively, with a significant difference between the two groups (p < 0.001). Overall WSS of the proximal, narrowest region, and distal carotid arteries in patients before CAS was 6.68 ± 3.0Pa, 12.47 ± 5.98Pa, and 1.39 ± 0. 96Pa. WSS of the proximal, narrowest region, and distal carotid was 4.15 ± 1.42Pa, 6.71 ± 2.64Pa, and1.86 ± 1.13Pa one week after CAS, compared to 4.44 ± 1.91Pa, 7.90 ± 4.38Pa, and 2. 36 ± 1.09Pa six months after CAS. WSS of the proximal and narrowest region of the carotid artery was reduced after carotid stenting, and the difference was statistically significant (p < 0.001). There was no statistically significant difference in WSS between one week and six months after stenting (P > 0.05). Conclusion We employed early carotid WSS as a means of evaluating the efficacy of carotid artery stenting. Changes in carotid WSS are closely associated with carotid artery stenosis, providing valuable hemodynamic information for CAS treatment. This technique holds great application value in pre-operative evaluation and long-term follow-up.
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Affiliation(s)
- Tao Xiaoyong
- Senior Department of Neurology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Chen Yuping
- Senior Department of Neurology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Huang Wei
- Senior Department of Neurology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Chen Juan
- Senior Department of Neurology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Qiu Feng
- Senior Department of Neurology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Li Zhuo
- Department of Ultrasonography, The Eighth Medical Center of PLA General Hospital, Beijing, China
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Zhao M, Zhang L, Chen J, Gu S, Wu R, Jia C. Associations between carotid plaque shape, biomechanical parameters, and ischemic stroke in mild carotid stenosis with a single plaque. Ultrasonography 2024; 43:209-219. [PMID: 38644636 PMCID: PMC11079503 DOI: 10.14366/usg.24019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/17/2024] [Accepted: 04/02/2024] [Indexed: 04/23/2024] Open
Abstract
PURPOSE This cross-sectional cohort-comparison observational study investigated the value of high-frame-rate vector flow (V Flow) imaging for evaluating differences in carotid plaque shape and biomechanical parameters in patients with mild stenosis according to a recent history of ipsilateral ischemic stroke. METHODS The present study included 352 patients from February 2023 to October 2023, who were categorized as symptomatic or asymptomatic based on a history of recent ischemic stroke and ipsilateral ischemic lesions detected on head computed tomography or magnetic resonance imaging. A Mindray Resona R9 system was used for B-mode ultrasonography and V Flow imaging. The upstream and downstream surfaces of the plaques were examined at the carotid bifurcation for wall shear stress (WSS), oscillatory shear index (OSI), and turbulence index, which performed peri-plaque biomechanical condition. Multivariable logistic regression models were used to determine associations between plaque shape, V Flow parameters, and ischemic stroke. RESULTS Symptomatic patients exhibited higher WSS values for the upstream and downstream surfaces of carotid plaque, as well as higher OSI and turbulence index values for the downstream surface. Type Ⅲ plaques and higher WSS and OSI values for the downstream surface of the plaque were significantly associated with ischemic stroke. Type Ⅲ plaques were more prevalent in symptomatic patients and demonstrated much higher WSS and OSI values for the downstream plaque surface in both groups. CONCLUSION High-frame-rate V Flow imaging could assess peri-plaque biomechanical forces and may provide effective imaging biomarkers for early prediction of ischemic stroke in patients with mild stenosis.
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Affiliation(s)
- Man Zhao
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Luni Zhang
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Ultrasound, Shanghai General Hospital of Nanjing Medical University, Shanghai, China
| | - Jing Chen
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shiyao Gu
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong Wu
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Caixia Jia
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Franchin M, Goddi A, Muscato P, Cervarolo MC, Piffaretti G, Tozzi M. Implanted blood vessel external support device for the treatment of distal hypoperfusion ischemic syndrome in arteriovenous fistulas and high-frame-rate Vector Flow quality assessment. J Vasc Access 2024; 25:642-650. [PMID: 36708038 DOI: 10.1177/11297298231151715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Distal hypoperfusion ischemic syndrome (DHIS) is a complication occurring after arteriovenous fistula (AVF) creation. Different surgical alternatives haves been proposed in case of severe DHIS. Aim of the present paper is to present a new technique for DHIS treatment. MATERIAL AND METHODS Between the 1st of January 2021 and the 31st December 2021 all the patients referred to our center for DHIS grade 2-4 were treated with a new surgical technique. It consists of AVF remodeling using an external nitinol support (VasQ®) to reduce the risk of outflow vein enlargement and DHIS recurrence. To better appreciate the hemodynamic effects of the surgery, a new ultrasound technique called high-frame-rate Vector Flow (HiFR-VF) was used. RESULTS Seven patients (M:F 1:3; mean age 43 ± 12 years, range 29-65) were included in this study. Central line was never necessary, and technical success was 100% at 12 months. The comparison with historical data demonstrated lower recurrence of symptoms in comparison to simple artery-to-vein redo (p 0.50). The HiFR-VF showed flow with limited turbulent characteristics at the anastomosis site. DISCUSSION AND CONCLUSION The new technique proposed demonstrated to be safe and effective for treatment of DHIS, preventing symptoms recurrence. Ultrasound examination and HiFR-VF can be considered a valuable method to evaluate complex flows at the levels of vascular anastomosis.
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Affiliation(s)
- Marco Franchin
- Vascular Surgery, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Alfredo Goddi
- Centro Medico SME - Diagnostica per Immagini, Varese, Italy
| | - Paola Muscato
- Vascular Surgery, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Maria Cristina Cervarolo
- Vascular Surgery, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Gabriele Piffaretti
- Vascular Surgery, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Matteo Tozzi
- Vascular Surgery, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
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Nahas H, Ishii T, Yiu BYS, Yu ACH. A GPU-Based, Real-Time Dealiasing Framework for High-Frame-Rate Vector Doppler Imaging. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2023; 70:1384-1400. [PMID: 37549086 DOI: 10.1109/tuffc.2023.3303349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Vector Doppler is well regarded as a potential way of deriving flow vectors to intuitively visualize complex flow profiles, especially when it is implemented at high frame rates. However, this technique's performance is known to suffer from aliasing artifacts. There is a dire need to devise real-time dealiasing solutions for vector Doppler. In this article, we present a new methodological framework for achieving aliasing-resistant flow vector estimation at real-time throughput from precalculated Doppler frequencies. Our framework comprises a series of compute kernels that have synergized: 1) an extended least squares vector Doppler (ELS-VD) algorithm; 2) single-instruction, multiple-thread (SIMT) processing principles; and 3) implementation on a graphical processing unit (GPU). Results show that this new framework, when executed on an RTX-2080 GPU, can effectively generate aliasing-free flow vector maps using high-frame-rate imaging datasets acquired from multiple transmit-receive angle pairs in a carotid phantom imaging scenario. Over the entire cardiac cycle, the frame processing time for aliasing-resistant vector estimation was measured to be less than 16 ms, which corresponds to a minimum processing throughput of 62.5 frames/s. In a human femoral bifurcation imaging trial with fast flow (150 cm/s), our framework was found to be effective in resolving two-cycle aliasing artifacts at a minimum throughput of 53 frames/s. The framework's processing throughput was generally in the real-time range for practical combinations of ELS-VD algorithmic parameters. Overall, this work represents the first demonstration of real-time, GPU-based aliasing-resistant vector flow imaging using vector Doppler estimation principles.
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Gunabushanam G, Kent RH, Scoutt LM. Pitfalls in Carotid Doppler Interpretation and How to Avoid Them. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1907-1921. [PMID: 36896465 DOI: 10.1002/jum.16218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/18/2023] [Indexed: 06/18/2023]
Abstract
Imaging pitfalls commonly occur in carotid Doppler ultrasound and may lead to false positive diagnosis of stenosis, missed diagnosis of stenosis, and errors in grading stenosis severity. These pitfalls may result from suboptimal technique and/or patient-specific factors including coexisting cardiovascular pathology, contralateral high-grade stenosis/occlusion, tortuous vessels, tandem lesions, long-segment stenosis, nearly occlusive stenosis, and heavily calcified plaque. Awareness of these pitfalls and careful assessment of the extent of plaque on grayscale and color Doppler as well as analysis of the spectral Doppler waveforms can help avoid misinterpretation of the carotid Doppler examination.
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Affiliation(s)
- Gowthaman Gunabushanam
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Risa H Kent
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Leslie M Scoutt
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
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Nahas H, Yiu BYS, Chee AJY, Au JS, Yu ACH. Deep-learning-assisted and GPU-accelerated vector Doppler imaging with aliasing-resistant velocity estimation. ULTRASONICS 2023; 134:107050. [PMID: 37300906 DOI: 10.1016/j.ultras.2023.107050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/30/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023]
Abstract
Vector flow imaging is a diagnostic ultrasound modality that is suited for the visualization of complex blood flow dynamics. One popular way of realizing vector flow imaging at high frame rates over 1000 fps is to apply multi-angle vector Doppler estimation principles in conjunction with plane wave pulse-echo sensing. However, this approach is susceptible to flow vector estimation errors attributed to Doppler aliasing, which is prone to arise when a low pulse repetition frequency (PRF) is inevitably used due to the need for finer velocity resolution or because of hardware constraints. Existing dealiasing solutions tailored for vector Doppler may have high computational demand that makes them unfeasible for practical applications. In this paper, we present the use of deep learning and graphical processing unit (GPU) computing principles to devise a fast vector Doppler estimation framework that is resilient against aliasing artifacts. Our new framework works by using a convolutional neural network (CNN) to detect aliased regions in vector Doppler images and subsequently applying an aliasing correction algorithm only at these affected regions. The framework's CNN was trained using 15,000 in vivo vector Doppler frames acquired from the femoral and carotid arteries, including healthy and diseased conditions. Results show that our framework can perform aliasing segmentation with an average precision of 90 % and can render aliasing-free vector flow maps with real-time processing throughputs (25-100 fps). Overall, our new framework can improve the visualization quality of vector Doppler imaging in real-time.
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Affiliation(s)
- Hassan Nahas
- Schlegel Research Institute for Aging and Department of Electrical & Computer Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Billy Y S Yiu
- Schlegel Research Institute for Aging and Department of Electrical & Computer Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Adrian J Y Chee
- Schlegel Research Institute for Aging and Department of Electrical & Computer Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Jason S Au
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Alfred C H Yu
- Schlegel Research Institute for Aging and Department of Electrical & Computer Engineering, University of Waterloo, Waterloo, ON, Canada.
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Haniel J, Yiu BYS, Chee AJY, Huebner R, Yu ACH. Efficacy of ultrasound vector flow imaging in tracking omnidirectional pulsatile flow. Med Phys 2023; 50:1699-1714. [PMID: 36546560 DOI: 10.1002/mp.16168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Ultrasound vector flow imaging (VFI) shows potential as an emerging non-invasive modality for time-resolved flow mapping. However, its efficacy in tracking multidirectional pulsatile flow with temporal resolvability has not yet been systematically evaluated because of the lack of an appropriate test protocol. PURPOSE We present the first systematic performance investigation of VFI in tracking pulsatile flow in a meticulously designed scenario with time-varying, omnidirectional flow fields (with flow angles from 0° to 360°). METHODS Ultrasound VFI was performed on a three-loop spiral flow phantom (4 mm diameter; 5 mm pitch) that was configured to operate under pulsatile flow conditions (10 ml/s peak flow rate; 1 Hz pulse rate; carotid pulse shape). The spiral lumen geometry was designed to simulate recirculatory flow dynamics observed in the heart and in curvy blood vessel segments such as the carotid bulb. The imaging sequence was based on steered plane wave pulsing (-10°, 0°, +10° steering angles; 5 MHz imaging frequency; 3.3 kHz interleaved pulse repetition frequency). VFI's pulsatile flow estimation performance and its ability to detect secondary flow were comparatively assessed against flow fields derived from computational fluid dynamics (CFD) simulations that included consideration of fluid-structure interactions (FSI). The mean percentage error (MPE) and the coefficient of determination (R2 ) were computed to assess the correspondence of the velocity estimates derived from VFI and CFD-FSI simulations. In addition, VFI's efficacy in tracking pulse waves was analyzed with respect to pressure transducer measurements made at the phantom's inlet and outlet. RESULTS Pulsatile flow patterns rendered by VFI agreed with the flow profiles computed from CFD-FSI simulations (average MPE: -5.3%). The shape of the VFI-measured velocity magnitude profile generally matched the inlet flow profile. High correlation exists between VFI measurements and simulated flow vectors (lateral velocity: R2 = 0.8; axial velocity R2 = 0.89; beam-flow angle: R2 = 0.98; p < 0.0001 for all three quantities). VFI was found to be capable of consistently tracking secondary flow. It also yielded pulse wave velocity (PWV) estimates (5.72 ± 1.02 m/s) that, on average, are within 6.4% of those obtained from pressure transducer measurements (6.11 ± 1.15 m/s). CONCLUSION VFI can consistently track omnidirectional pulsatile flow on a time-resolved basis. This systematic investigation serves well as a quality assurance test of VFI.
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Affiliation(s)
- Jonathas Haniel
- Schlegel Research Institute for Aging and Department of Electrical & Computer Engineering, University of Waterloo, Waterloo, Ontario, Canada
- Department of Mechanical Engineering, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Billy Y S Yiu
- Schlegel Research Institute for Aging and Department of Electrical & Computer Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Adrian J Y Chee
- Schlegel Research Institute for Aging and Department of Electrical & Computer Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Rudolf Huebner
- Department of Mechanical Engineering, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Alfred C H Yu
- Schlegel Research Institute for Aging and Department of Electrical & Computer Engineering, University of Waterloo, Waterloo, Ontario, Canada
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Dong Y, Hong S, Song D, Liu M, Gao W, Du Y, Xu J, Dong F. Blood Flow Turbulence Quantification of Carotid Artery With a High-Frame Rate Vector Flow Imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:427-436. [PMID: 35716339 DOI: 10.1002/jum.16039] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/17/2022] [Accepted: 05/27/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To assess the feasibility and performance of Turbulence (Tur) index as a quantitative tool for carotid artery flow turbulence; to detect and compare the blood flow patterns of common carotid artery (CCA) and carotid bulb (CB) at different ages and cardiac phases in healthy adults, and thus interpret the evolvement of etiology difference between CCA and CB. METHODS Carotid flow characteristics of 40 healthy volunteers were evaluated quantitatively by a high-frame rate vector flow imaging. Three types of flow patterns were defined depending on the distributive range of complex flow during systole in CB. Comparison of mean Tur value in CCA and CB at different age groups and cardiac phases was performed. And the correlation between Tur value and the diameter ratio of proximal internal carotid artery to common carotid artery (DRpro-ica/cca) was tested. RESULTS Mean Tur values in CB were remarkably higher than that in CCA, whether during systole or diastole (P < .001). Meanwhile Tur values in CB during systole were significantly higher than that during diastole (P < .001). Flow complexity of CB showed variations among 40 participants especially in systole, whereas the flow pattern of CCA was relatively consistent. Mean Tur values were positively correlated with DRpro-ica/cca in CB (ρ = 0.69, P < .05). CONCLUSIONS V Flow imaging provided a reliable method-Tur, for quantitative analysis of carotid blood flow. It had potential to be further applied in distinguishing complex hemodynamic characteristics in high-risk people of carotid diseases for the risk stratification of cardiovascular events.
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Affiliation(s)
- Yinghui Dong
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Shaofu Hong
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Di Song
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Mengmeng Liu
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Wenjing Gao
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Yigang Du
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China
| | - Jinfeng Xu
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Fajin Dong
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
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Poloni S, Bozzetto M, Du Y, Aiani L, Goddi A, Fiorina I, Remuzzi A. Velocity vector comparison between vector flow imaging and computational fluid dynamics in the carotid bifurcation. ULTRASONICS 2023; 128:106860. [PMID: 36244088 DOI: 10.1016/j.ultras.2022.106860] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/27/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
It has been largely documented that local hemodynamic conditions, characterized by low and oscillating wall shear stresses, play a key role in the initiation and progression of vascular atherosclerotic lesions. Thus, investigation of the flow field in the carotid bifurcation can lead to early identification of vulnerable plaques. In this scenario, the development of novel non-invasive imaging tools that can be used in routine clinical practice to identify disturbed and recirculating blood flow becomes crucial. In this context, Vector Flow Imaging is becoming a relevant tool as it provides an angle independent assessment of blood flow velocity and multidimensional flow vector visualization. The purpose of the present study was to validate, in several locations of the carotid bifurcation, the high-frame rate vector flow imaging (HiFR-VFI) technique by comparing with computational fluid dynamic simulations (CFD). In all eight carotid bifurcations, HiFR-VFI accurately detected regions of laminar flow as well as recirculation and unsteady flow areas. An accurate and statistically significant agreement was observed between velocity vectors obtained by HiFR-VFI and those computed by CFD, both for vector magnitude (R = 0.85) and direction (R = 0.74). Our study demonstrated that HiFR-VFI is a valid technique for rapid and advanced visual representation of velocity field in large arteries. Thus, it has a great potential in research-based clinical practice for the identification of flow recirculation, low and oscillating velocity gradients near vessel wall. The use of HiFR-VFI may provide a great improvement in the investigation of the role of local hemodynamics in vascular pathologies, as well in the assessment of the effect of pharmacological treatments.
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Affiliation(s)
- Sofia Poloni
- Department of Biomedical Engineering, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Michela Bozzetto
- Department of Biomedical Engineering, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Yigang Du
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen 518057, China
| | - Luca Aiani
- Centro Medico SME - Diagnostica per Immagini, Varese, Italy
| | - Alfredo Goddi
- Centro Medico SME - Diagnostica per Immagini, Varese, Italy
| | - Ilaria Fiorina
- Institute of Radiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Remuzzi
- Department of Management, Information and Production Engineering, University of Bergamo, Italy.
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12
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Qiu YJ, Cheng J, Zhang Q, Yang DH, Zuo D, Mao F, Liu LX, Dong Y, Cao SQ, Wang WP. Clinical Application of High-Frame-Rate Vector Flow Imaging in Evaluation of Carotid Atherosclerotic Stenosis. Diagnostics (Basel) 2023; 13:diagnostics13030519. [PMID: 36766624 PMCID: PMC9914914 DOI: 10.3390/diagnostics13030519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/16/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE This study seeks to evaluate the value of the high-frame-rate vector flow imaging technique in assessing the hemodynamic changes of carotid atherosclerotic stenosis in aging people (>60 years old). METHODS Aging patients diagnosed with carotid atherosclerotic stenosis who underwent carotid high-frame-rate vector flow imaging examination were prospectively enrolled. A Mindray Resona7s ultrasound machine equipped with high-frame-rate vector flow function was used for ultrasound evaluation. First, B mode ultrasound and color Doppler flow imaging were used to evaluate carotid stenosis. Then, the vector arrows and flow streamline detected by V Flow were analyzed and the wall shear stress values (Pa) at the carotid stenosis site were measured. All patients were divided into symptomatic and asymptomatic groups according to whether they had acute/subacute stroke or other clinical symptoms within 2 weeks before ultrasound examination. The results of digital subtraction angiography or computed tomography angiography were used as the gold standard. The stenosis rate was calcified, according to North American Symptomatic Carotid Endarterectomy Trial criteria. The diagnostic values of wall shear stress, conventional ultrasound, and the combined diagnosis in carotid atherosclerotic stenosis were compared. RESULTS Finally, 88 patients with carotid atherosclerotic plaque were enrolled (71 males (80.7%), mean age 67.6 ± 5.4 years). The success rate of high-frame-rate vector flow imaging was 96.7% (88/91). The WSS value of symptomatic carotid stenosis (1.4 ± 0.15 Pa) was significantly higher than that of asymptomatic carotid stenosis (0.80 ± 0.08 Pa) (p < 0.05). Taking the wall shear stress value > 0.78 Pa as the diagnostic criteria for symptomatic carotid atherosclerotic plaque, the area under receiver operating characteristic curves was 0.79 with 87.1% sensitivity and 69.6% specificity. The area under receiver operating characteristic curves of the combined diagnosis (0.966) for differentiating severe carotid atherosclerotic stenosis was significantly higher than that of conventional ultrasound and WSS value, with 89.7% sensitivity and 93.2% specificity (p < 0.05). CONCLUSION As a non-invasive imaging method, the high-frame-rate vector flow imaging technique showed potential value in the preoperative assessment of the symptomatic carotid atherosclerotic stenosis and diagnosing carotid atherosclerotic stenosis in aging patients.
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Affiliation(s)
- Yi-Jie Qiu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Juan Cheng
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Qi Zhang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Dao-Hui Yang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Dan Zuo
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Feng Mao
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Ling-Xiao Liu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Correspondence: (L.-X.L.); (Y.D.); Tel.: +86-(0)21-6404-1990 (ext. 2474) (L.-X.L.); +86-(0)21-2507-6104 (Y.D.); Fax: +86-(0)21-6422-0319 (L.-X.L.); +86-(0)21-2507-7258 (Y.D.)
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
- Correspondence: (L.-X.L.); (Y.D.); Tel.: +86-(0)21-6404-1990 (ext. 2474) (L.-X.L.); +86-(0)21-2507-6104 (Y.D.); Fax: +86-(0)21-6422-0319 (L.-X.L.); +86-(0)21-2507-7258 (Y.D.)
| | - Si-Qi Cao
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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13
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Riemer K, Rowland EM, Broughton-Venner J, Leow CH, Tang M, Weinberg PD. Contrast Agent-Free Assessment of Blood Flow and Wall Shear Stress in the Rabbit Aorta using Ultrasound Image Velocimetry. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:437-449. [PMID: 34876322 PMCID: PMC8843088 DOI: 10.1016/j.ultrasmedbio.2021.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 10/07/2021] [Accepted: 10/10/2021] [Indexed: 06/13/2023]
Abstract
Blood flow velocity and wall shear stress (WSS) influence and are influenced by vascular disease. Their measurement is consequently useful in the laboratory and clinic. Contrast-enhanced ultrasound image velocimetry (UIV) can estimate them accurately but the need to inject contrast agents limits utility. Singular value decomposition and high-frame-rate imaging may render contrast agents dispensable. Here we determined whether contrast agent-free UIV can measure flow and WSS. In simulation, accurate measurements were achieved with a signal-to-noise ratio of 13.5 dB or higher. Signal intensity in the rabbit aorta increased monotonically with mechanical index; it was lowest during stagnant flow and uneven across the vessel. In vivo measurements with contrast-free and contrast-enhanced UIV differed by 4.4% and 1.9% for velocity magnitude and angle and by 9.47% for WSS. Bland-Altman analysis of waveforms revealed good agreement between contrast-free and contrast-enhanced UIV. In five rabbits, the root-mean-square errors were as low as 0.022 m/s (0.81%) and 0.11 Pa (1.7%). This study indicates that with an optimised protocol, UIV can assess flow and WSS without contrast agents. Unlike contrast-enhanced UIV, contrast-free UIV could be routinely employed.
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Affiliation(s)
- Kai Riemer
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Ethan M Rowland
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | | | - Chee Hau Leow
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Mengxing Tang
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - P D Weinberg
- Department of Bioengineering, Imperial College London, London, United Kingdom.
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14
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Zhao R, Zheng H, Wang W, Du Y, Tong Y, Wen C. Quantitative Evaluation of Post-stenotic Blood Flow Disturbance in Canine Femoral Artery Stenosis Model: An Early Experience With Vector Flow Imaging. Front Cardiovasc Med 2022; 9:829825. [PMID: 35282375 PMCID: PMC8907590 DOI: 10.3389/fcvm.2022.829825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/02/2022] [Indexed: 12/15/2022] Open
Abstract
Objective To investigate the value of Vector Flow Imaging (V Flow) in the assessment of post-stenotic turbulence in the canine arterial stenosis model. Materials and Methods Canine femoral artery stenosis models were established using ameroid constrictors in 12 beagle dogs. 50% and then 70% femoral artery stenoses were confirmed by selective femoral artery angiography. V Flow was used to measure femoral artery flow turbulence index (Tur) preoperatively as a baseline. After establishing of a 50% and then 70% stenoses, the Tur indices were recorded in the femoral artery at 1, 3, 5, 7, 9, 11, 13, 15, 17, and 19 mm distal to the stenosis. Results Baseline Tur indices of normal canine femoral arteries were <1% in 11 of 12 cases (91.7%). Distal to a 50% stenosis, the Tur index (>1%) was recorded in 83.3–100% cases between 1 and 9 mm, 41.7–58.3% between 11 and 17 mm, and 16.7% at 19 mm. For a 70% stenosis, the Tur index (>1%) occurred in 81.8–100% cases between 1 and 17 mm distal to the stenosis, and 63.6% at 19 mm. The Tur index peaked around 7 mm or 2.3 times of the initial vessel diameter (3 mm) downstream for a 50% stenosis and 11 mm or 3.7 times of vessel diameter downstream for a 70% stenosis. Conclusion V Flow with Tur index measurement adds quantitative information of post-stenotic turbulence when assessing an arterial stenosis with ultrasound. Tur index of 1% seems a useful threshold for assessment of flow turbulence in this small sample study. Further studies with larger sample size are needed to evaluate the value of V Flow in clinical applications.
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Affiliation(s)
- Rui Zhao
- Department of Ultrasound, Peking University International Hospital, Beijing, China
| | - Haining Zheng
- Department of Ultrasound, Peking University International Hospital, Beijing, China
| | - Wei Wang
- Department of Ultrasound, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Yigang Du
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China
| | - Yisha Tong
- Department of Vascular Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia
- Yisha Tong
| | - Chaoyang Wen
- Department of Ultrasound, Peking University International Hospital, Beijing, China
- *Correspondence: Chaoyang Wen
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15
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Ilaria P, Mario M, Ilaria F. Advances in vascular anatomy and pathophysiology using high resolution and multiparametric sonography. J Vasc Access 2021; 22:1-8. [PMID: 34338066 PMCID: PMC8606621 DOI: 10.1177/11297298211020150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
B-mode and Color Doppler are the first-line imaging modalities in cardiovascular diseases. However, conventional ultrasound (US) provides a lower spatial and temporal resolution (70-100 frames per second) compared to ultrafast technology which acquires several thousand frames per second. Consequently, the multiparametric ultrafast platforms manage new imaging algorithms as high-frequency ultrasound, contrast-enhanced ultrasound, shear wave elastography, vector flow, and local pulse wave imaging. These advances allow better ultrasound performances, more detailed blood flow visualization and vessel walls' characterization, and many future applications for vascular viscoelastic properties evaluation.In this paper, we provide an overview of each new technique's principles and concepts and the real or potential applications of these modalities on the study of the artery and venous anatomy and pathophysiology of the upper limb before and after creating a native or prosthetic arterio-venous fistula. In particular, we focus on high-frequency ultrasound that could predict cannulation readiness and its potential role in the venous valvular status evaluation before vascular access creation; on contrast-enhanced ultrasound that could improve the peri-operative imaging evaluation during US-guided angioplasty; on shear wave elastography and local pulse wave imaging that could evaluate preoperative vessels stiffness and their potential predictive role in vascular access failure; on vector flow imaging that could better characterize the different components of the vascular access complex flow.
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Affiliation(s)
- Petrucci Ilaria
- Institute of Life Sciences, S. Anna School of Advanced Studies, Pisa, Italy
| | - Meola Mario
- Institute of Life Sciences, S. Anna School of Advanced Studies, Department of Internal Medicine, University of Pisa, Pisa, Italy
| | - Fiorina Ilaria
- Radiodiagnostic and Interventional Radiology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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16
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Iskander A, Bilgi C, Naftalovich R, Hacihaliloglu I, Berkman T, Naftalovich D, Pahlevan N. The Rheology of the Carotid Sinus: A Path Toward Bioinspired Intervention. Front Bioeng Biotechnol 2021; 9:678048. [PMID: 34178967 PMCID: PMC8222608 DOI: 10.3389/fbioe.2021.678048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/05/2021] [Indexed: 11/30/2022] Open
Abstract
The association between blood viscosity and pathological conditions involving a number of organ systems is well known. However, how the body measures and maintains appropriate blood viscosity is not well-described. The literature endorsing the function of the carotid sinus as a site of baroreception can be traced back to some of the earliest descriptions of digital pressure on the neck producing a drop in blood delivery to the brain. For the last 30 years, improved computational fluid dynamic (CFD) simulations of blood flow within the carotid sinus have demonstrated a more nuanced understanding of the changes in the region as it relates to changes in conventional metrics of cardiovascular function, including blood pressure. We suggest that the unique flow patterns within the carotid sinus may make it an ideal site to transduce flow data that can, in turn, enable real-time measurement of blood viscosity. The recent characterization of the PIEZO receptor family in the sinus vessel wall may provide a biological basis for this characterization. When coupled with other biomarkers of cardiovascular performance and descriptions of the blood rheology unique to the sinus region, this represents a novel venue for bioinspired design that may enable end-users to manipulate and optimize blood flow.
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Affiliation(s)
- Andrew Iskander
- Department of Anesthesiology, Westchester Medical Center, New York Medical College, Valhalla, NY, United States
| | - Coskun Bilgi
- Department of Aerospace and Mechanical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Rotem Naftalovich
- Department of Anesthesiology, New Jersey Medical School, University Hospital, Rutgers University, Newark, NJ, United States.,Medical Corps of the U.S. Army, U.S. Army Medical Department, Fort Sam Houston, San Antonio, TX, United States
| | - Ilker Hacihaliloglu
- Department of Biomedical Engineering, Rutgers School of Engineering, Rutgers University, Piscataway, NJ, United States
| | - Tolga Berkman
- Department of Anesthesiology, New Jersey Medical School, University Hospital, Rutgers University, Newark, NJ, United States
| | - Daniel Naftalovich
- Department of Computational and Mathematical Sciences, California Institute of Technology, Pasadena, CA, United States.,Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Niema Pahlevan
- Department of Aerospace and Mechanical Engineering, University of Southern California, Los Angeles, CA, United States.,Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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17
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Qiu Y, Dong Y, Mao F, Zhang Q, Yang D, Chen K, Shi S, Zuo D, Tian X, Yu L, Wang WP. High-Frame Rate Vector Flow Imaging Technique: Initial Application in Evaluating the Hemodynamic Changes of Carotid Stenosis Caused by Atherosclerosis. Front Cardiovasc Med 2021; 8:617391. [PMID: 33763457 PMCID: PMC7982422 DOI: 10.3389/fcvm.2021.617391] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/08/2021] [Indexed: 01/22/2023] Open
Abstract
Objective: To investigate the value of high-frame rate vector flow imaging technique (V flow) in evaluating the hemodynamic changes of carotid stenosis caused by atherosclerotic plaques. Methods and Materials: In this prospective study, patients with stenosis rate (diameter) ≥30% caused by carotid atherosclerotic plaques were included. Degrees of carotid stenosis were graded according to North American Symptomatic Carotid Endarterectomy Trial criteria: moderate (30–69%) or severe (70–99%). Mindray Resona 7s ultrasound machine with a linear array transducer (3–11 MHz) was used for ultrasound examinations. The mean WSS value of carotid arteries was measured at the proximal, narrowest region and distal of carotid stenosis. The mean WSS values were correlated with peak systolic velocity (PSV) measured by color Doppler flow imaging and stenosis degree detected by digital subtraction angiography (DSA). The vector arrows and flow streamline detected by V flow dynamic imaging were analyzed. Imaging findings of DSA in carotid arteries were used as the gold standard. Results: Finally, 51 patients were included. V flow measurements were performed successfully in 17 patients (100%) with moderate-grade stenosis and in 30 patients (88.2%) with severe-grade stenosis. Dynamic V flow imaging showed yellow or red vectors at the stenotic segment, indicating fast speed blood flow (up to 260.92 cm/s). Changes of streamlines were detected in the stenotic segment. The mean WSS value measured at the narrowest region of the carotid artery had a moderately positive correlation with stenosis degree (r = 0.58, P < 0.05) and PSV value (r = 0.54, P < 0.05), respectively. Significant difference was detected in mean WSS value at the narrowest region of the carotid artery between severe carotid stenosis (1.47 ± 0.97 Pa) and moderate carotid stenosis (0.96 ± 0.44 Pa) (P < 0.05). Conclusion: The hemodynamic changes detected by V flow of the carotid stenosis might be a potential non-invasive imaging tool for assessing the degree of carotid stenosis.
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Affiliation(s)
- Yijie Qiu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Feng Mao
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qi Zhang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Daohui Yang
- Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kailing Chen
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shuainan Shi
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Dan Zuo
- Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaofan Tian
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lingyun Yu
- Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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18
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Nahas H, Au JS, Ishii T, Yiu BYS, Chee AJY, Yu ACH. A Deep Learning Approach to Resolve Aliasing Artifacts in Ultrasound Color Flow Imaging. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2020; 67:2615-2628. [PMID: 32746180 DOI: 10.1109/tuffc.2020.3001523] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Despite being used clinically as a noninvasive flow visualization tool, color flow imaging (CFI) is known to be prone to aliasing artifacts that arise due to fast blood flow beyond the detectable limit. From a visualization standpoint, these aliasing artifacts obscure proper interpretation of flow patterns in the image view. Current solutions for resolving aliasing artifacts are typically not robust against issues such as double aliasing. In this article, we present a new dealiasing technique based on deep learning principles to resolve CFI aliasing artifacts that arise from single- and double-aliasing scenarios. It works by first using two convolutional neural networks (CNNs) to identify and segment CFI pixel positions with aliasing artifacts, and then it performs phase unwrapping at these aliased pixel positions. The CNN for aliasing identification was devised as a U-net architecture, and it was trained with in vivo CFI frames acquired from the femoral bifurcation that had known presence of single- and double-aliasing artifacts. Results show that the segmentation of aliased CFI pixels was achieved successfully with intersection over union approaching 90%. After resolving these artifacts, the dealiased CFI frames consistently rendered the femoral bifurcation's triphasic flow dynamics over a cardiac cycle. For dealiased CFI pixels, their root-mean-squared difference was 2.51% or less compared with manual dealiasing. Overall, the proposed dealiasing framework can extend the maximum flow detection limit by fivefold, thereby improving CFI's flow visualization performance.
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19
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Richter C, Weinreich A, Mucha S, Saur D, Pelz JO. Evaluation of the interrater and intermethod agreement of the German multiparametric ultrasound criteria for the grading of internal carotid artery stenosis. Neuroradiology 2020; 63:519-528. [PMID: 32945912 PMCID: PMC7966642 DOI: 10.1007/s00234-020-02546-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/31/2020] [Indexed: 10/26/2022]
Abstract
PURPOSE The interdisciplinary German guidelines for the diagnosis and treatment of internal carotid artery stenosis (ICAS) recommend a multiparametric approach for the sonographic grading of extracranial ICAS. The aim of this study is to evaluate the interrater and intermethod agreement of this elaborated sonographic approach with different angiographic modalities. METHODS Patients with extracranial ICAS were examined twice with colour-coded duplex sonography (CDS) by two experienced vascular neurologists. Each of the ten criteria and the resulting stenotic value were assessed. Grading of ICAS based on the multiparametric ultrasound criteria was compared with different angiography modalities (magnetic resonance angiography (MRA), computed tomography angiography (CTA), digital subtraction angiography (DSA)). RESULTS Seventy-four consecutive patients with 91 extracranial ICAS were recruited from our stroke unit and neurovascular outpatient clinic. Interrater agreement for each single ultrasound criterion ranged from moderate to excellent (for the peak systolic velocity). Concerning the absolute stenotic value of ICAS, an excellent agreement between both ultrasound examiners with an ICC of 0.91 (range 0.87-0.94; p < 0.001) was found. In 96% of ICAS, the difference between the stenotic values was ≤ 10%. Intermethod agreements between CDS and DSA, CTA, and MRA were also good for both sonographers. CONCLUSION Strictly adhering to the multiparametric "DEGUM ultrasound criteria", we found an excellent interrater agreement and a good intermethod agreement compared with angiography for the sonographic grading of extracranial ICAS. Thus, multiparametric CDS is in particular suitable for the follow up of extracranial ICAS even when examinations are done by different sonographers.
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Affiliation(s)
- Cindy Richter
- Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | | | - Simone Mucha
- Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | - Dorothee Saur
- Department of Neurology, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Johann Otto Pelz
- Department of Neurology, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
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20
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Du Y, Goddi A, Bortolotto C, Shen Y, Dell'Era A, Calliada F, Zhu L. Wall Shear Stress Measurements Based on Ultrasound Vector Flow Imaging: Theoretical Studies and Clinical Examples. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1649-1664. [PMID: 32124997 PMCID: PMC7497026 DOI: 10.1002/jum.15253] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/02/2020] [Accepted: 02/04/2020] [Indexed: 05/15/2023]
Abstract
Wall shear stress (WSS) is considered as a key factor for atherosclerosis development. Previous WSS research based on pulsed wave Doppler (PWD) showed limitations in complex flows. To improve accuracy for nonlaminar flow, a commercial ultrasound vector flow imaging (UVFI)-based WSS calculation is proposed. Errors for PWD are presented theoretically when flow is not laminar. Based on this, simulations of WSS calculations between PWD and UVFI were set up for different turbulent flows. Our simulations show that UVFI has obviously better performance than PWD in WSS calculations. Wall shear stress results in different flow conditions at carotid bifurcations are described.
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Affiliation(s)
- Yigang Du
- Shenzhen Mindray Bio‐Medical Electronics Co., Ltd.ShenzhenChina
| | | | - Chandra Bortolotto
- Radiology DepartmentFondazione Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San MatteoPaviaItaly
| | - Yingying Shen
- Shenzhen Mindray Bio‐Medical Electronics Co., Ltd.ShenzhenChina
| | - Alex Dell'Era
- Shenzhen Mindray Bio‐Medical Electronics Co., Ltd.ShenzhenChina
| | - Fabrizio Calliada
- Radiology DepartmentFondazione Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San MatteoPaviaItaly
| | - Lei Zhu
- Shenzhen Mindray Bio‐Medical Electronics Co., Ltd.ShenzhenChina
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21
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Qiu Y, Yang D, Zhang Q, Chen K, Dong Y, Wang WP. V Flow technology in measurement of wall shear stress of common carotid arteries in healthy adults: Feasibility and normal values. Clin Hemorheol Microcirc 2020; 74:453-462. [PMID: 31683473 DOI: 10.3233/ch-190719] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the feasibility of vector flow imaging technique (V Flow) in measurement of wall shear stress (WSS) of common carotid arteries (CCA) in healthy adults and to provide the normal WSS values assessed by V Flow. METHODS & MATERIALS This prospective study was approved by the Ethics Committee of our University. Eighty healthy adult volunteers were included (mean age 43.3 y, 47 females, 33 males). The volunteers were classified into three groups according to their age: group I (age 20 - 39 y), group II (age 40 - 59 y) and group III (age 60 - 80 y). Mindray Resona 8 ultrasound machine and a linear array transducer (3-9 MHz) was used, equipped with the updated V Flow function. Common carotid arteries of both sides were evaluated in three segments (initial segment, middle segment and near bifurcation segment). The WSS values of CCA were measured by two independent radiologists. The intraclass correlation coefficient (ICC) of observer reliability in WSS measurement was calculated. Inter-observer reproducibility was also evaluated with the 95% Bland-Altman limits of agreement (LOA). RESULTS V Flow measurements were performed successfully in 79 volunteers (98.8 %, 79/80). The mean value of WSS in right CCA was (0.66±0.24) Pa, in left CCA was (0.66±0.18) Pa (P > 0.05). Mean WSS value had a moderately negative correlation with age group (P < 0.05). The mean WSS value of group I(mean±SD, 0.75±0.25 Pa) is larger than group II (mean±SD, 0.62±0.13 Pa) and group III (mean±SD, 0.49±0.11 Pa) (P < 0.05). The ICC of observer reliability of group I, II and III was 0.96 (95% confidence interval (95% CI) 0.92-0.98), 0.94 (95% CI 0.88-0.97), 0.93 (95% CI 0.76-0.98) respectively. The Bland-Altman plots showed that the 95% LOA were -0.17-0.12 (Pa) for group I, -0.09-0.13 (Pa) for group II and -0.08-0.10 (Pa) for group III. CONCLUSION V Flow measurement is a simple, rapid and feasible imaging method for the WSS assessment of CCA in healthy volunteers, which will probably be an important tool for assessing CCA function.
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Affiliation(s)
- Yijie Qiu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Daohui Yang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qi Zhang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kailing Chen
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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22
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Au JS, Yiu BYS, So H, Chee AJY, Greaves DK, Hughson RL, Yu ACH. Ultrasound vector projectile imaging for detection of altered carotid bifurcation hemodynamics during reductions in cardiac output. Med Phys 2019; 47:431-440. [PMID: 31693196 DOI: 10.1002/mp.13905] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 09/13/2019] [Accepted: 10/30/2019] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Complex blood flow is commonly observed in the carotid bifurcation, although the factors that regulate these patterns beyond arterial geometry are unknown. The emergence of high-frame-rate ultrasound vector flow imaging allows for noninvasive, time-resolved analysis of complex hemodynamic behavior in humans, and it can potentially help researchers understand which physiological stressors can alter carotid bifurcation hemodynamics in vivo. Here, we seek to pursue the first use of vector projectile imaging (VPI), a dynamic form of vector flow imaging, to analyze the regulation of carotid bifurcation hemodynamics during experimental reductions in cardiac output induced via a physiological stressor called lower body negative pressure (LBNP). METHODS Seven healthy adults (age: 27 ± 4 yr, 4 men) underwent LBNP at -45 mmHg to simulate a postural hemodynamic response in a controlled environment. Using a research-grade, high-frame-rate ultrasound platform, vector flow estimation in each subject's right carotid bifurcation was performed through a multi-angle plane wave imaging (two transmission angles of 10° and -10°) formulation, and VPI cineloops were generated at a frame rate of 750 fps. Vector concentration was quantified by the resultant blood velocity vector angles within a region of interest; lower concentration indicated greater flow dispersion. Discrete concentration values during peak and late systole were compared across different segments of the carotid artery bifurcation before, and during, LBNP. RESULTS Vector projectile imaging revealed that external and internal carotid arteries exhibited regional hemodynamic changes during LBNP, which acted to reduce both the subject's cardiac output (Δ - 1.2 ± 0.5 L/min, -19%; P < 0.01) and peak carotid blood velocity (Δ - 6.30 ± 8.27 cm/s, -7%; P = 0.05). In these carotid artery branches, the vector concentration time trace before and during LBNP were observed to be different. The impact of LBNP on flow complexity in the two carotid artery branches showed variations between subjects. CONCLUSIONS Using VPI, intuitive visualization of complex hemodynamic changes can be obtained in healthy humans subjected to LBNP. This imaging tool has potential for further applications in vascular physiology to identify and quantify complex hemodynamic features in humans during different physiological stressor tests that regulate hemodynamics.
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Affiliation(s)
- Jason S Au
- Schlegel-University of Waterloo Research Institute for Aging, 250 Laurelwood Dr., Waterloo, N2J0E2, Canada.,Department of Electrical and Computer Engineering, University of Waterloo, 200 University Ave West, Waterloo, N2L3G1, Canada
| | - Billy Y S Yiu
- Schlegel-University of Waterloo Research Institute for Aging, 250 Laurelwood Dr., Waterloo, N2J0E2, Canada.,Department of Electrical and Computer Engineering, University of Waterloo, 200 University Ave West, Waterloo, N2L3G1, Canada
| | - Hélène So
- Faculty of Science and Engineering, Sorbonne Université, 75005, Paris, France
| | - Adrian J Y Chee
- Schlegel-University of Waterloo Research Institute for Aging, 250 Laurelwood Dr., Waterloo, N2J0E2, Canada.,Department of Electrical and Computer Engineering, University of Waterloo, 200 University Ave West, Waterloo, N2L3G1, Canada
| | - Danielle K Greaves
- Schlegel-University of Waterloo Research Institute for Aging, 250 Laurelwood Dr., Waterloo, N2J0E2, Canada.,University of Caen Normandy, Espl. De la Paix, 14032, Caen, France
| | - Richard L Hughson
- Schlegel-University of Waterloo Research Institute for Aging, 250 Laurelwood Dr., Waterloo, N2J0E2, Canada
| | - Alfred C H Yu
- Schlegel-University of Waterloo Research Institute for Aging, 250 Laurelwood Dr., Waterloo, N2J0E2, Canada.,Department of Electrical and Computer Engineering, University of Waterloo, 200 University Ave West, Waterloo, N2L3G1, Canada
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Saris AECM, Hansen HHG, Fekkes S, Menssen J, Nillesen MM, de Korte CL. In Vivo Blood Velocity Vector Imaging Using Adaptive Velocity Compounding in the Carotid Artery Bifurcation. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1691-1707. [PMID: 31079874 DOI: 10.1016/j.ultrasmedbio.2019.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/06/2019] [Accepted: 03/10/2019] [Indexed: 06/09/2023]
Abstract
Visualization and quantification of blood flow are considered important for early detection of atherosclerosis and patient-specific diagnosis and intervention. As conventional Doppler imaging is limited to 1-D velocity estimates, 2-D and 3-D techniques are being developed. We introduce an adaptive velocity compounding technique that estimates the 2-D velocity vector field using predominantly axial displacements estimated by speckle tracking from dual-angle plane wave acquisitions. Straight-vessel experiments with a 7.8-MHz linear array transducer connected to a Verasonics Vantage ultrasound system revealed that the technique performed with a maximum velocity magnitude bias and angle bias of -3.7% (2.8% standard deviation) and -0.16° (0.41° standard deviation), respectively. In vivo, complex flow patterns were visualized in two healthy and three diseased carotid arteries and quantified using a vector complexity measure that increased with increasing wall irregularity. This measure could potentially be a relevant clinical parameter which might aid in early detection of atherosclerosis.
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Affiliation(s)
- Anne E C M Saris
- Medical Ultrasound Imaging Centre (MUSIC), Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Hendrik H G Hansen
- Medical Ultrasound Imaging Centre (MUSIC), Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stein Fekkes
- Medical Ultrasound Imaging Centre (MUSIC), Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan Menssen
- Medical Ultrasound Imaging Centre (MUSIC), Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maartje M Nillesen
- Medical Ultrasound Imaging Centre (MUSIC), Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Chris L de Korte
- Medical Ultrasound Imaging Centre (MUSIC), Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; Physics of Fluid Group, MESA+ Institute for Nanotechnology, and MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
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24
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Meyer P, Pelz JO. Blood flow reversal from the external into the internal carotid artery-New insights into the hemodynamics at the carotid bifurcation. Brain Behav 2018; 8:e01139. [PMID: 30311746 PMCID: PMC6236250 DOI: 10.1002/brb3.1139] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 09/24/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Complex blood flow patterns are a well-known phenomenon at the carotid bifurcation. However, unlike for the descending aorta, a blood flow reversal has not been detected at the carotid bifurcation, so far. METHODS In 17 subjects, flow patterns with focus on blood flow reversal were examined at the carotid bifurcation with vector flow imaging. RESULTS We found a blood flow reversal from the external carotid artery (ECA) into the internal carotid artery (ICA) in 13 of 25 (52%) carotid bifurcations. The blood flow reversal ranged 5.3 ± 1.7 mm (range 2.6-8.3 mm) distally to the beginning of the ECA and lasted 105 ± 59 ms (range 32-225 ms). The mean peak systolic velocity within the blood flow reversal was 12.5 ± 4.6 cm/s (range 5-18 cm/s). CONCLUSION A blood flow reversal from the ECA into the ICA during the systole is a frequent finding at the carotid bifurcation. Considering ischemic stroke, retrograde embolism from plaques in the proximal ECA into the ICA might play a role.
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Affiliation(s)
- Patrick Meyer
- Department of NeurologyUniversity Hospital LeipzigLeipzigGermany
| | - Johann Otto Pelz
- Department of NeurologyUniversity Hospital LeipzigLeipzigGermany
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25
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Zhang B, Ma Y, Ding F. Evaluation of spatial distribution and characterization of wall shear stress in carotid sinus based on two-dimensional color Doppler imaging. Biomed Eng Online 2018; 17:141. [PMID: 30340641 PMCID: PMC6195704 DOI: 10.1186/s12938-018-0589-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 10/10/2018] [Indexed: 01/05/2023] Open
Abstract
Objective This study aims to use a wall shear stress (WSS) quantitative analysis software to analyze and evaluate the carotid sinus WSS spatial distribution and characteristics in intima-media thickness (IMT) normal and thickening group by using two-dimensional color doppler flow imaging (CDFI) so as to assist clinicians to predict the location and risk of plaque formation. Methods According to IMT, 50 subjects was selected as IMT thickening group and 50 subjects as IMT normal group from subjects who had a carotid ultrasound examination in Shanghai East hospital during October 2016 to October 2017. This study presents the spatial distribution of the carotid sinus WSS based on the WSS quantitative analysis software and compared the spatial distribution and characteristics of the carotid sinus WSS between IMT thickening group and IMT normal group through two- and three-dimensional WSS maps and a fused WSS image. Results The distributional regularity of WSS in both two group was: carotid sinus < common carotid artery (CCA) < internal carotid artery (ICA) and posterior-interior wall of the carotid sinus < the anterior-lateral wall of the carotid sinus. Furthermore, the WSS of CCA, ICA, the anterior-lateral proximal wall of the carotid sinus, the anterior-lateral distal wall of the carotid sinus, the posterior-interior proximal wall of the carotid sinus, and the posterior-interior distal wall of the carotid sinus in IMT thickening group was lower than the corresponding part of IMT normal group (P < 0.05). Conclusion In summary, this WSS quantitative analysis framework by two-dimensional CDFI can measure and reflect the carotid sinus WSS spatial distribution and characteristics more accurately and visually. As a convenient tool, it may be used for clinical prediction of the plaque formation in carotid sinus in the future.
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Affiliation(s)
- Bo Zhang
- Department of Ultrasound in Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China.
| | - Yuqin Ma
- Department of Ultrasound in Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Fang Ding
- Department of Ultrasound in Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
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26
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Shahriari S, Garcia D. Meshfree simulations of ultrasound vector flow imaging using smoothed particle hydrodynamics. Phys Med Biol 2018; 63:205011. [PMID: 30247153 DOI: 10.1088/1361-6560/aae3c3] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Before embarking on a series of in vivo tests, design of ultrasound-flow-imaging modalities are generally more efficient through computational models as multiple configurations can be tested methodically. To that end, simulation models must generate realistic blood flow dynamics and Doppler signals. The current in silico ultrasound simulation techniques suffer mainly from uncertainty in providing accurate trajectories of moving ultrasound scatterers. In mesh-based Eulerian methods, numerical truncation errors from the interpolated velocities, both in the time and space dimensions, can accumulate significantly and make the pathlines unreliable. These errors can distort beam-to-beam inter-correlation present in ultrasound flow imaging. It is thus a technical issue to model a correct motion of the scatterers by considering their interaction with boundaries and neighboring scatterers. We hypothesized that in silico analysis of emerging ultrasonic imaging modalities can be implemented more accurately with meshfree approaches. We developed an original fluid-ultrasound simulation environment based on a meshfree Lagrangian CFD (computational fluid dynamics) formulation, which allows analysis of ultrasound flow imaging. This simulator combines smoothed particle hydrodynamics (SPH) and Fourier-domain linear acoustics (SIMUS = simulator for ultrasound imaging). With such a particle-based computation, the fluid particles also acted as individual ultrasound scatterers, resulting in a direct and physically sound fluid-ultrasonic coupling. We used the in-house algorithms for fluid and ultrasound simulations to simulate high-frame-rate vector flow imaging. The potential of the particle-based method was tested in 2D simulations of vector Doppler for the intracarotid flow. The Doppler-based velocity fields were compared with those issued from SPH. The numerical evaluations showed that the vector flow fields obtained by vector Doppler components were in good agreement with the original SPH velocities, with relative errors less than 10% and 2% in the cross-beam and axial directions, respectively. Our results showed that SPH-SIMUS coupling enables direct and realistic simulations of ultrasound flow imaging. The proposed coupled algorithm has also the advantage to be 3D compatible and parallelizable.
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Affiliation(s)
- Shahrokh Shahriari
- Previously, Research Center of the University of Montreal Hospital, Montreal, QC H2X 0A9, Canada
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27
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Bechsgaard T, Hansen KL, Brandt A, Moshavegh R, Forman JL, Føgh P, Klitfod L, Bækgaard N, Lönn L, Jensen JA, Nielsen MB. Evaluation of Peak Reflux Velocities with Vector Flow Imaging and Spectral Doppler Ultrasound in Varicose Veins. Ultrasound Int Open 2018; 4:E91-E98. [PMID: 30276359 PMCID: PMC6162191 DOI: 10.1055/a-0643-4430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/24/2018] [Accepted: 05/17/2018] [Indexed: 10/29/2022] Open
Abstract
Purpose Spectral Doppler ultrasound (SDUS) is used for quantifying reflux in lower extremity varicose veins. The technique is angle-dependent opposed to the new angle-independent Vector Flow Imaging (VFI) method. The aim of this study was to compare peak reflux velocities obtained with VFI and SDUS in patients with chronic venous disease, i. e., pathological retrograde blood flow caused by incompetent venous valves. Materials and Methods 64 patients with chronic venous disease were scanned with VFI and SDUS in the great or the small saphenous vein, and reflux velocities were compared to three assessment tools for chronic venous disease. A flow rig was used to assess the accuracy and precision of the two methods. Results The mean peak reflux velocities differed significantly (VFI: 47.4 cm/s vs. SDUS: 62.0 cm/s, p<0.001). No difference in absolute precision (p=0.18) nor relative precision (p=0.79) was found. No correlation to disease severity, according to assessment tools, was found for peak reflux velocities obtained with either method. In vitro, VFI was more accurate but equally precise when compared to SDUS. Conclusion Both VFI and SDUS detected the pathologic retrograde flow in varicose veins but measured different reflux velocities with equal precision. VFI may play a role in evaluating venous disease in the future.
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Affiliation(s)
| | | | - Andreas Brandt
- Copenhagen University Hospital Rigshospitalet, Department of Diagnostic Radiology, 2100 Copenhagen Oe, Denmark
| | - Ramin Moshavegh
- The Technical University of Denmark, Department of Electrical Engineering Center for Fast Ultrasound Imaging, 2800 Kgs. Lyngby, Denmark
| | - Julie Lyng Forman
- Copenhagen University, Department of Public Health Section of Biostatistics, 1014 Copenhagen K, Denmark
| | - Pia Føgh
- Copenhagen University Hospital Rigshospitalet, Department of Vascular Surgery Herlev & Gentofte Hospital, 2900 Hellerup, Denmark
| | - Lotte Klitfod
- Copenhagen University Hospital Rigshospitalet, Department of Vascular Surgery Herlev & Gentofte Hospital, 2900 Hellerup, Denmark
| | - Niels Bækgaard
- Copenhagen University Hospital Rigshospitalet, Department of Vascular Surgery Herlev & Gentofte Hospital, 2900 Hellerup, Denmark
| | - Lars Lönn
- Rigshospitalet, Copenhagen, DK, Radiology, Copenhagen, Denmark
| | - Jørgen Arendt Jensen
- Technical University of Denmark, Department of Electrical Engineering Center for Fast Ultrasound Imaging, 2800 Kgs. Lyngby, Denmark
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28
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Bechsgaard T, Hansen KL, Brandt AH, Moshavegh R, Forman JL, Føgh P, Klitfod L, Bækgaard N, Lönn L, Nielsen MB, Jensen JA. Respiratory variability of peak velocities in the common femoral vein estimated with vector flow imaging and Doppler ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:1941-1950. [PMID: 29960752 DOI: 10.1016/j.ultrasmedbio.2018.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 04/26/2018] [Accepted: 05/04/2018] [Indexed: 06/08/2023]
Abstract
Respiratory variability of peak velocities (RVPV) in the common femoral vein measured with ultrasound can reveal venous outflow obstruction. Pulse wave (PW) Doppler is the gold standard for venous velocity estimation of the lower extremities. PW Doppler measurements are angle dependent, whereas vector flow imaging (VFI) can yield angle-independent measures. The hypothesis of the present study was that VFI can provide RVPV estimations without the angle dependency of PW Doppler for an improved venous disease assessment. Sixty-seven patients with symptomatic chronic venous disease were included in the study. On average, VFI measured a lower RVPV than PW Doppler (VFI: 14.11 cm/s; PW: 17.32 cm/s, p = 0.002) with a non-significant improved precision compared with PW Doppler (VFI: 21.09%; PW: 26.49%, p = 0.08). In a flow phantom, VFI had improved accuracy (p < 0.01) and equal precision compared with PW Doppler. The study indicated that VFI can characterize the hemodynamic fluctuations in the common femoral vein.
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Affiliation(s)
- Thor Bechsgaard
- Department of Diagnostic Radiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen Ø, Denmark.
| | - Kristoffer Lindskov Hansen
- Department of Diagnostic Radiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Andreas Hjelm Brandt
- Department of Diagnostic Radiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Ramin Moshavegh
- Center for Fast Ultrasound Imaging, Department of Electrical Engineering, Technical University of Denmark, Lyngby, Denmark
| | - Julie Lyng Forman
- Section of Biostatistics, Department of Public Health, Copenhagen University, Copenhagen K, Denmark
| | - Pia Føgh
- Department of Vascular Surgery, Rigshospitalet & Gentofte Hospital - Copenhagen University Hospital, Hellerup, Denmark
| | - Lotte Klitfod
- Department of Vascular Surgery, Rigshospitalet & Gentofte Hospital - Copenhagen University Hospital, Hellerup, Denmark
| | - Niels Bækgaard
- Department of Vascular Surgery, Rigshospitalet & Gentofte Hospital - Copenhagen University Hospital, Hellerup, Denmark
| | - Lars Lönn
- Department of Diagnostic Radiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Michael Bachmann Nielsen
- Department of Diagnostic Radiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Jørgen Arendt Jensen
- Center for Fast Ultrasound Imaging, Department of Electrical Engineering, Technical University of Denmark, Lyngby, Denmark
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Riding the Plane Wave: Considerations for In Vivo Study Designs Employing High Frame Rate Ultrasound. APPLIED SCIENCES-BASEL 2018. [DOI: 10.3390/app8020286] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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30
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Yiu BYS, Yu ACH. Spiral Flow Phantom for Ultrasound Flow Imaging Experimentation. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2017; 64:1840-1848. [PMID: 29035216 DOI: 10.1109/tuffc.2017.2762860] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
As new ultrasound flow imaging methods are being developed, there is a growing need to devise appropriate flow phantoms that can holistically assess the accuracy of the derived flow estimates. In this paper, we present a novel spiral flow phantom design whose Archimedean spiral lumen naturally gives rise to multi-directional flow over all possible angles (i.e., from 0° to 360°). Developed using lost-core casting principles, the phantom geometry comprised a three-loop spiral (4-mm diameter and 5-mm pitch), and it was set to operate in steady flow mode (3 mL/s flow rate). After characterizing the flow pattern within the spiral vessel using computational fluid dynamics (CFD) simulations, the phantom was applied to evaluate the performance of color flow imaging (CFI) and high-frame-rate vector flow imaging. Significant spurious coloring artifacts were found when using CFI to visualize flow in the spiral phantom. In contrast, using vector flow imaging (least-squares multi-angle Doppler based on a three-transmit and three-receive configuration), we observed consistent depiction of flow velocity magnitude and direction within the spiral vessel lumen. The spiral flow phantom was also found to be a useful tool in facilitating demonstration of dynamic flow visualization based on vector projectile imaging. Overall, these results demonstrate the spiral flow phantom's practical value in analyzing the efficacy of ultrasound flow estimation methods.
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Goddi A, Fanizza M, Bortolotto C, Raciti MV, Fiorina I, He X, Du Y, Calliada F. Vector flow imaging techniques: An innovative ultrasonographic technique for the study of blood flow. JOURNAL OF CLINICAL ULTRASOUND : JCU 2017; 45:582-588. [PMID: 28734035 DOI: 10.1002/jcu.22519] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 06/03/2017] [Accepted: 06/09/2017] [Indexed: 06/07/2023]
Abstract
Doppler ultrasonography is routinely used to identify abnormal blood flow. Nevertheless, conventional Doppler can be used to determine only the axial component of blood flow velocity and is angle dependent. A new method of multidimensional angle-independent estimation of flow velocity, called Vector Flow Imaging (VFI), has been proposed. It quantitatively evaluates the true velocity vector's amplitude and direction at any location into a vessel and displays a more intuitive depiction of the flow movements. High frame rate VFI, based on plane wave imaging, allows a detailed dynamic visualization of complex flow by showing even transient events, otherwise undetectable. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:582-588, 2017.
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Affiliation(s)
- Alfredo Goddi
- Centro Medico SME-Diagnostica per Immagini, Varese, Italy
| | - Marianna Fanizza
- Radiology Department, Fondazione IRCCS Policlinico San Matteo, Via Oberdan 21, Pavia, 27100, Italy
| | - Chandra Bortolotto
- Radiology Department, Fondazione IRCCS Policlinico San Matteo, Via Oberdan 21, Pavia, 27100, Italy
| | - Maria Vittoria Raciti
- Radiology Department, Fondazione IRCCS Policlinico San Matteo, Via Oberdan 21, Pavia, 27100, Italy
| | - Ilaria Fiorina
- Radiology Department, Fondazione IRCCS Policlinico San Matteo, Via Oberdan 21, Pavia, 27100, Italy
| | - Xujin He
- Ultrasound R&D Department, Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China
| | - Yigang Du
- Ultrasound R&D Department, Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China
| | - Fabrizio Calliada
- Radiology Department, Fondazione IRCCS Policlinico San Matteo, Via Oberdan 21, Pavia, 27100, Italy
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