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Zhang L, Li X, Lyu Q, Shi G. Imaging diagnosis and research progress of carotid plaque vulnerability. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:905-912. [PMID: 35801515 DOI: 10.1002/jcu.23266] [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: 07/25/2021] [Revised: 05/26/2022] [Accepted: 06/16/2022] [Indexed: 06/15/2023]
Abstract
Ischemic stroke (IS) exhibits a high disability rate, mortality, and recurrence rate, imposing a serious threat to human survival and health. Its occurrence is affected by various factors. Although the previous research has demonstrated that the occurrence of IS is mainly associated with lumen stenosis caused by carotid atherosclerotic plaque (AP), recent studies have revealed that many patients will still suffer from IS even with mild carotid artery lumen stenosis. Blood supply disturbance causes 10% of IS to the corresponding cerebral blood supply area caused by carotid vulnerable plaque. Thrombus blockage of distal branch vessels caused by rupture of vulnerable carotid plaque is the main cause of ischemic stroke. Therefore, how to accurately evaluate vulnerable plaque and intervene as soon as possible is a problem that needs to be solved in clinic. The vulnerability of plaque is determined by its internal components, including thin and incomplete fibrous cap, necrotic lipid core, intra-plaque hemorrhage, intra-plaque neovascularization, and ulcerative plaque formation. The development of imaging technology enables the routine detection of AP vulnerability. By analyzing the pathological changes, characteristics, and formation mechanism of carotid plaque vulnerability, this article aims to explore the modern imaging methods which can be used to identify plaque composition and plaque vulnerability to provide a reference basis for disease diagnosis and differential diagnosis.
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Affiliation(s)
- Lianlian Zhang
- Yancheng Clinical College of Xuzhou Medical University, The First peolie's Hospital of Yancheng, Yancheng, Jiangsu, China
| | - Xia Li
- Affiliated Hospital of Jiangsu medical vocational college, The Third People's Hospital of Yancheng, Yancheng, Jiangsu, China
| | - Qi Lyu
- Taizhou People's Hospital, Taizhou, China
| | - Guofu Shi
- Affiliated Hospital of Jiangsu medical vocational college, The Third People's Hospital of Yancheng, Yancheng, Jiangsu, China
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New 3-Dimensional Volumetric Ultrasound Method for Accurate Quantification of Atherosclerotic Plaque Volume. JACC Cardiovasc Imaging 2022; 15:1124-1135. [PMID: 35680220 DOI: 10.1016/j.jcmg.2022.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 01/01/2022] [Accepted: 01/06/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Carotid and femoral plaque burden is a recognized biomarker of cardiovascular disease risk. A new electronic-sweep 3-dimensional (3D)-matrix transducer method can improve the functionality and image quality of vascular ultrasound atherosclerosis imaging. OBJECTIVES This study aimed to validate this method for plaque volume measurement in early and intermediate-advanced plaques in the carotid and femoral territories. METHODS Plaque volumes were measured ex vivo in pig carotid and femoral artery specimens by 3-dimensional vascular ultrasound (3DVUS) using a 3D-matrix (electronic-sweep) transducer and its associated 3D plaque quantification software, and were compared with gold-standard histology. To test the clinical feasibility and accuracy of the 3D-matrix transducer, an experiment was conducted in intermediate-high risk individuals with carotid and femoral atherosclerosis. The results were compared with those obtained using the previously validated mechanical-sweep 3D transducer and established 2-dimensional (2D)-based plaque quantification software. RESULTS In the ex vivo study, the authors assessed 19 atherosclerotic plaques (plaque volume, 0.76 µL-56.30 μL), finding strong agreement between measurements with the 3D-matrix transducer and the histological gold-standard (intraclass correlation coefficient [ICC]: 0.992; [95% CI: 0.978-0.997]). In the clinical analysis of 20 patients (mean age 74.6 ± 4.45 years; 40% men), the authors found 64 (36 carotid and 28 femoral) of 80 scanned territories with atherosclerosis (measured atherosclerotic volume, 10 μL-859 μL). There was strong agreement between measurements made from electronic-sweep and mechanical-sweep 3DVUS transducers (ICC: 0.997 [95% CI: 0.995-0.998]). Agreement was also high between plaque volumes estimated by the 2D and 3D plaque quantification software applications (ICC: 0.999 [95% CI: 0.998-0.999]). Analysis time was significantly shorter with the 3D plaque quantification software than with the 2D multislice approach with a mean time reduction of 46%. CONCLUSIONS 3DVUS using new matrix transducer technology, together with improved 3D plaque quantification software, simplifies the accurate volume measurement of early (small) and intermediate-advanced plaques located in carotid and femoral arteries.
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Wang X, Luo P, Du H, Li S, Wang Y, Guo X, Wan L, Zhao B, Ren J. Ultrasound Radiomics Nomogram Integrating Three-Dimensional Features Based on Carotid Plaques to Evaluate Coronary Artery Disease. Diagnostics (Basel) 2022; 12:diagnostics12020256. [PMID: 35204347 PMCID: PMC8871132 DOI: 10.3390/diagnostics12020256] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 02/01/2023] Open
Abstract
This study aimed to explore the feasibility of ultrasound radiomics analysis before invasive coronary angiography (ICA) for evaluating the severity of coronary artery disease (CAD) quantified by the SYNTAX score (SS). This study included 105 carotid plaques from 105 patients (64 low-SS patients, 41 intermediate-high-SS patients). The clinical characteristics and three-dimensional ultrasound (3D-US) features before ICA were assessed. Ultrasound images of carotid plaques were used for radiomics analysis. Least absolute shrinkage and selection operator (LASSO) regression, which generated several nonzero coefficients, was used to select features that could predict intermediate-high SS. Based on those coefficients, the radiomics score (Rad-score) was calculated. The selected clinical characteristics, 3D-US features, and Rad-score were finally integrated into a radiomics nomogram. Among the clinical characteristics and 3D-US features, high-density lipoprotein (HDL), apolipoprotein B (Apo B), and plaque volume were identified as predictors for distinguishing between low SS and intermediate-high SS. During the radiomics process, 8 optimal radiomics features most capable of identifying intermediate-high SS were selected from 851 candidate radiomics features. The differences in Rad-score between the training and the validation set were significant (p = 0.016 and 0.006). The radiomics nomogram integrating HDL, Apo B, plaque volume, and Rad-score showed excellent results in the training set (AUC, 0.741 (95% confidence interval (CI): 0.646–0.835)) and validation set (AUC, 0.939 (95% CI: 0.860–1.000)), with good calibration (mean absolute errors of 0.028 and 0.059 in training and validation sets, respectively). Decision curve analysis showed that the radiomics nomogram could identify patients who could obtain the most benefit. We concluded that the radiomics nomogram based on carotid plaque ultrasound has favorable value for the noninvasive prediction of intermediate-high SS. This radiomics nomogram has potential value for the risk stratification of CAD before ICA and provides clinicians with a noninvasive diagnostic tool.
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Affiliation(s)
- Xiaoting Wang
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (X.W.); (P.L.); (S.L.); (Y.W.); (X.G.); (L.W.)
| | - Peng Luo
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (X.W.); (P.L.); (S.L.); (Y.W.); (X.G.); (L.W.)
| | - Huaan Du
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (H.D.); (B.Z.)
| | - Shiyu Li
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (X.W.); (P.L.); (S.L.); (Y.W.); (X.G.); (L.W.)
| | - Yi Wang
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (X.W.); (P.L.); (S.L.); (Y.W.); (X.G.); (L.W.)
| | - Xun Guo
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (X.W.); (P.L.); (S.L.); (Y.W.); (X.G.); (L.W.)
| | - Li Wan
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (X.W.); (P.L.); (S.L.); (Y.W.); (X.G.); (L.W.)
| | - Binyi Zhao
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (H.D.); (B.Z.)
| | - Jianli Ren
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (X.W.); (P.L.); (S.L.); (Y.W.); (X.G.); (L.W.)
- Correspondence:
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Lin SK, Chen YA, Chen PY. Three-dimensional ultrasound for carotid vessel wall volume measurement. Tzu Chi Med J 2022; 34:88-94. [PMID: 35233362 PMCID: PMC8830545 DOI: 10.4103/tcmj.tcmj_283_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/21/2020] [Accepted: 12/23/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives: The intima–media thickness (IMT) of the carotid artery can now be detected on a three-dimensional (3D) plane. The 3D vessel wall volume (VWV) more accurately represents vascular conditions. Through 3D ultrasound, we established a standardized method for carotid VWV measurement. Materials and Methods: A total of thirty patients without stroke or cardiovascular disease who received carotid duplex sonography were retrospectively reviewed. Gray-scale 3D images from the distal common carotid artery (CCA) to internal carotid artery on both sides were acquired using a single-sweep 3D transducer and analyzed offline by using the vascular plaque quantification function of the Philips QLAB software. Then, the 3D IMT(QLAB intima–media thickness [QIMT]), total plaque volume (TPV), and VWV were measured by a neurologist and a technician, and the interobserver variability was assessed. Results: The mean two-dimensional (2D) carotid IMT was 0.65 ± 0.12 mm. The mean QIMT, TPV, and VWV measured by observer 1 were 0.68 ± 0.18 mm, 26 ± 12 mm3, and 94 ± 10 mm3, respectively. The Bland–Altman plot of the mean differences between the QIMT, TPV, and VWV values measured by observers 1 and 2 showed that those of observer 2 were within two standard deviations of those of observer 1. Intraclass correlation coefficients (ICCs) indicated strong correlations in QIMT (ICC = 0.76), TPV (ICC = 0.85), and VWV (ICC = 0.90; P < 0.001) between observers 1 and 2. Both 2D IMT and 3D QIMT exhibited a positive linear correlation with age. Conclusion: This study established a standardized VWV measurement through 3D ultrasound. Reasonable interobserver differences were obtained within a 95% limit of agreement and high reliability (ICC = 0.90). The VWV 1 cm from the CCA bifurcation was quantified with a mean value of 94.2 mm3. Further studies on the 3D ultrasound quantification of carotid arteries are warranted.
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Chen Y, Xing H, Wen J, Peng Q, Liu R, Sun W, Jin H, Xu K, Huang Y. Three-dimensional ultrasound imaging: An effective method to detect the effect of moderate intensity statin treatment in slowing carotid plaque progression. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:731-740. [PMID: 33884633 DOI: 10.1002/jcu.23013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 03/12/2021] [Accepted: 03/17/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE We aimed to evaluate the feasibility of three-dimensional ultrasound imaging (3DUS) in assessing the therapeutic effect of moderate-intensity statin therapy on carotid atherosclerotic plaques. METHODS Patients with carotid plaques were recruited to the study from January 2016 to September 2018, and were divided into two groups based on whether or not they were taking statins. All participants underwent 3DUS of their carotid plaques at baseline, then 3 months and 2 years after initial examination. The changes of the carotid plaques were compared between the two groups. RESULTS Were included 97 patients (57 males and 40 females), 65.26 ± 9.53 year-old with 67 into the statin group and 30 in the control group. The baseline levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) were lower in the statin group than in the control group (3.79 ± 0.78 mmol/L vs 4.50 ± 1.12 mmol/L; 2.01 ± 0.62 mmol/L vs 2.58 ± 0.91 mmol/L, P < .05). There was no significant difference in the change of total plaque volume (TPV) detected by 3D-US between the statin (median [interquartile range]: 0 [-30-20] mm3 ) and the control group (0 [-22.5-25] mm3 ) at 3 months. Over 2 years, the TPV increased faster in the control group (+70 [25-150] mm3 ), than in the statin group (15 [-57.5-90) mm3 , P < .05). CONCLUSIONS 3DUS can be an effective tool to observe the development of carotid plaques and the effect of statin treatment.
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Affiliation(s)
- Yuhui Chen
- Department of Neurology, Peking University First Hospital, Beijing, China
- Department of Neurology, Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Haiying Xing
- Department of Neurology, Peking University First Hospital, Beijing, China
- Department of Neurology, Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Jiexi Wen
- Department of Neurology, Peking University First Hospital, Beijing, China
- Department of Neurology, Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Qing Peng
- Department of Neurology, Peking University First Hospital, Beijing, China
- Department of Neurology, Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Ran Liu
- Department of Neurology, Peking University First Hospital, Beijing, China
- Department of Neurology, Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Wei Sun
- Department of Neurology, Peking University First Hospital, Beijing, China
- Department of Neurology, Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Haiqiang Jin
- Department of Neurology, Peking University First Hospital, Beijing, China
- Department of Neurology, Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Ke Xu
- Department of Neurology, Peking University First Hospital, Beijing, China
- Department of Neurology, Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Yining Huang
- Department of Neurology, Peking University First Hospital, Beijing, China
- Department of Neurology, Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
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Lee DH, Chun EJ, Moon JH, Yun HM, Lim S. Effect of cilostazol on carotid plaque volume measured by three-dimensional ultrasonography in patients with type 2 diabetes: The FANCY study. Diabetes Obes Metab 2020; 22:2257-2266. [PMID: 32700396 DOI: 10.1111/dom.14147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/07/2020] [Accepted: 07/21/2020] [Indexed: 12/11/2022]
Abstract
AIMS To conduct a prospective randomized study to evaluate cilostazol, a phosphodiesterase 3 inhibitor, and compare it with aspirin for the prevention of the progression of atherosclerosis in patients with type 2 diabetes (T2D). MATERIALS AND METHODS Fifty patients with T2D and carotid atherosclerotic plaques were randomly assigned to either a 200 mg/d cilostazol (CTZ) group or a 100 mg/d aspirin (ASA) group for 6 months. The primary endpoint was change in plaque volume measured by carotid three-dimensional ultrasonography. The secondary endpoints were changes in carotid intima-media thickness (IMT) and endothelial function, assessed by laser Doppler. RESULTS Twenty-four patients in the CTZ group and 23 in the ASA group were included in the final analysis. The mean ± SD age of male (n = 20) and female (n = 16) patients was 62.2 and 59.1 years, respectively. The total plaque volume was slightly decreased in the CTZ group (from 183.8 ± 52.5 to 181.5 ± 54.0 mm3 ; P = .567), but significantly increased in the ASA group (from 112.9 ± 21.2 to 128.5 ± 23.3 mm3 ; P = .043). A significant regression in the maximum IMT was observed only in the CTZ group (right: from 2.19 ± 0.17 to 1.96 ± 0.12 mm; left: from 2.02 ± 0.20 to 1.72 ± 0.19 mm). The CTZ group exhibited an increase in HDL cholesterol and a decrease in triglycerides and liver enzymes. CONCLUSIONS Cilostazol treatment for 6 months significantly attenuated the progression of carotid plaque compared with aspirin in patients with T2D (NCT03248401).
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Affiliation(s)
- Dong-Hwa Lee
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Eun Ju Chun
- Department of Radiology, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ji Hye Moon
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Han Mi Yun
- Physiologic Diagnostic Laboratory, Vascular Laboratory, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Soo Lim
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, South Korea
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Johri AM, Nambi V, Naqvi TZ, Feinstein SB, Kim ESH, Park MM, Becher H, Sillesen H. Recommendations for the Assessment of Carotid Arterial Plaque by Ultrasound for the Characterization of Atherosclerosis and Evaluation of Cardiovascular Risk: From the American Society of Echocardiography. J Am Soc Echocardiogr 2020; 33:917-933. [PMID: 32600741 DOI: 10.1016/j.echo.2020.04.021] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Atherosclerotic plaque detection by carotid ultrasound provides cardiovascular disease risk stratification. The advantages and disadvantages of two-dimensional (2D) and three-dimensional (3D) ultrasound methods for carotid arterial plaque quantification are reviewed. Advanced and emerging methods of carotid arterial plaque activity and composition analysis by ultrasound are considered. Recommendations for the standardization of focused 2D and 3D carotid arterial plaque ultrasound image acquisition and measurement for the purpose of cardiovascular disease stratification are formulated. Potential clinical application towards cardiovascular risk stratification of recommended focused carotid arterial plaque quantification approaches are summarized.
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Affiliation(s)
| | | | | | | | - Esther S H Kim
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Margaret M Park
- Cleveland Clinic Heart and Vascular Institute, Cleveland, Ohio
| | - Harald Becher
- University of Alberta Hospital, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Henrik Sillesen
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Murgia A, Balestrieri A, Francone M, Lucatelli P, Scapin E, Buckler A, Micheletti G, Faa G, Conti M, Suri JS, Guglielmi G, Carriero A, Saba L. Plaque imaging volume analysis: technique and application. Cardiovasc Diagn Ther 2020; 10:1032-1047. [PMID: 32968659 PMCID: PMC7487381 DOI: 10.21037/cdt.2020.03.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/15/2020] [Indexed: 12/12/2022]
Abstract
The prevention and management of atherosclerosis poses a tough challenge to public health organizations worldwide. Together with myocardial infarction, stroke represents its main manifestation, with up to 25% of all ischemic strokes being caused by thromboembolism arising from the carotid arteries. Therefore, a vast number of publications have focused on the characterization of the culprit lesion, the atherosclerotic plaque. A paradigm shift appears to be taking place at the current state of research, as the attention is gradually moving from the classically defined degree of stenosis to the identification of features of plaque vulnerability, which appear to be more reliable predictors of recurrent cerebrovascular events. The present review will offer a perspective on the present state of research in the field of carotid atherosclerotic disease, focusing on the imaging modalities currently used in the study of the carotid plaque and the impact that such diagnostic means are having in the clinical setting.
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Affiliation(s)
- Alessandro Murgia
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Polo di Monserrato, s.s. 554 Monserrato (Cagliari) 09045, Italy
| | - Antonella Balestrieri
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Polo di Monserrato, s.s. 554 Monserrato (Cagliari) 09045, Italy
| | - Marco Francone
- Department of Radiological, Oncological and Anatomopathological Sciences-Radiology, ‘Sapienza’ University of Rome, Rome, Italy
| | - Pierleone Lucatelli
- Department of Radiological, Oncological and Anatomopathological Sciences-Radiology, ‘Sapienza’ University of Rome, Rome, Italy
| | - Elisa Scapin
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Polo di Monserrato, s.s. 554 Monserrato (Cagliari) 09045, Italy
| | | | - Giulio Micheletti
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Polo di Monserrato, s.s. 554 Monserrato (Cagliari) 09045, Italy
| | - Gavino Faa
- Department of Pathology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Polo San Giovanni di Dio, Cagliari (Cagliari) 09045, Italy
| | - Maurizio Conti
- Diagnostic and Monitoring Division, AtheroPoint™ LLC, Roseville, CA, USA
- Department of Electrical Engineering, U of Idaho (Affl.), Idaho, USA
| | - Jasjit S. Suri
- Diagnostic and Monitoring Division, AtheroPoint™ LLC, Roseville, CA, USA
- Department of Electrical Engineering, U of Idaho (Affl.), Idaho, USA
| | | | - Alessandro Carriero
- Department of Radiology, Maggiore della Carità Hospital, Università del Piemonte Orientale, Novara, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Polo di Monserrato, s.s. 554 Monserrato (Cagliari) 09045, Italy
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Abstract
There are several vascular ultrasound technologies that are useful in challenging diagnostic situations. New vascular ultrasound applications include directional power Doppler ultrasound, contrast-enhanced ultrasound, B-flow imaging, microvascular imaging, 3-dimensional vascular ultrasound, intravascular ultrasound, photoacoustic imaging, and vascular elastography. All these techniques are complementary to Doppler ultrasound and provide greater ability to visualize small vessels, have higher sensitivity to detect slow flow, and better assess vascular wall and lumen while overcoming limitations color Doppler. The ultimate goal of these technologies is to make ultrasound competitive with computed tomography and magnetic resonance imaging for vascular imaging.
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Affiliation(s)
- Lori Mankowski Gettle
- University of Wisconsin - Madison, 600 Highland Avenue, E3/380, Madison, WI 53792, USA.
| | - Margarita V Revzin
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale New Haven Hospital, 330 Cedar Street, TE 2-214, New Haven, CT 06520, USA. https://twitter.com/MargaritaRevzin
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Stenudd I, Sjödin E, Nyman E, Wester P, Johansson E, Grönlund C. Ultrasound risk marker variability in symptomatic carotid plaque: impact on risk reclassification and association with temporal variation pattern. Int J Cardiovasc Imaging 2020; 36:1061-1068. [PMID: 32144637 PMCID: PMC7228988 DOI: 10.1007/s10554-020-01801-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 02/18/2020] [Indexed: 12/27/2022]
Abstract
Purpose Ultrasound examinations of atherosclerotic carotid plaques can be used to calculate risk markers associated with plaque vulnerability. Recent studies demonstrate significant inter-frame variability in risk markers. Here, we investigate risk marker variability in symptomatic plaques and its impact on reclassification of plaque vulnerability, as well as its association with the shape of the temporal variation over the cardiac cycle. Methods 56 patients with symptomatic carotid stenosis were included in this study. 88 plaques were identified and the plaque risk markers size (area), echogenicity (gray scale median, GSM) and heterogeneity (coarseness) were measured in all frames of ultrasound B-mode image sequences. Inter-frame variability was quantified using the coefficient of variation (CV). Results Inter-frame variabilities of the risk markers were area CV 5–8%; GSM CV 4–7%; coarseness CV 8–15% and was in general significantly lower in large as compared to smaller plaques. The variability in GSM risk marker caused a reclassification of vulnerability in 30 to 38% of the plaques. Temporal variations in GSM with a heart rate periodic or drift/trending pattern were found in smaller plaques (< 26 mm2), whereas random pattern was found in larger plaques. In addition, hypoechoic plaques (GSM < 25) were associated with cyclic variation pattern, independent of their size. Conclusions Risk marker variability causes substantial reclassification of plaque vulnerability in symptomatic patients. Inter-frame variation and its temporal pattern should be considered in the design of future studies related to risk markers.
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Affiliation(s)
- Isak Stenudd
- Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden.
| | | | - Emma Nyman
- Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Per Wester
- Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Elias Johansson
- Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden.,Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden.,Wallenberg Center for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Christer Grönlund
- Department of Radiation Sciences, Biomedical Engineering R&D, Umeå University, Umeå, Sweden
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11
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Nyman E, Lindqvist P, Näslund U, Grönlund C. Risk Marker Variability in Subclinical Carotid Plaques Based on Ultrasound is Influenced by Cardiac Phase, Echogenicity and Size. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:1742-1750. [PMID: 29735317 DOI: 10.1016/j.ultrasmedbio.2018.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/14/2018] [Accepted: 03/16/2018] [Indexed: 06/08/2023]
Abstract
Identification of risk markers based on quantitative ultrasound texture analysis of carotid plaques has the ability to define vulnerable components that correlate with increased cardiovascular risk. However, data describing factors with the potential to influence the measurement variability of risk markers are limited. The aim of this study was to evaluate the influence of electrocardiogram-guided image selection, plaque echogenicity and area on carotid plaque risk markers and their variability in asymptomatic carotid plaques. Plaque risk markers were measured in 57 plaques during three consecutive heartbeats at two cardiac cycle time instants corresponding to the electrocardiogram R-wave (end diastole) and end of T-wave (end systole), resulting in six measurements for each plaque. Risk marker variability was quantified by computing the coefficient of variation (CV) across the three heartbeats. The CV was significantly higher for small plaques (area <15 mm2, 10%) than for large plaques (area >15 mm2, 6%) (p < 0.001) in measurements of area, and the CV for measurements of gray-scale median were higher for echolucent plaques (<40, 15%) than for echogenic plaques (>40, 9%) (p < 0.001). No significant differences were found between systole and diastole for the mean of any risk marker or the corresponding CV value. However, in a sub-analysis, the echolucent plaques were found to have a higher CV during systole compared with diastole. The variability also caused plaque type reclassification in 16% to 25% of the plaques depending on cutoff value. The results of this study indicate that echolucent and small plaques each contribute to increased risk marker variability. Based on these results, we recommend that measurements in diastole are preferred to reduce variation, although we found that it may not be possible to characterize small plaques accurately using contemporary applied risk markers.
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Affiliation(s)
- Emma Nyman
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
| | - Per Lindqvist
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Ulf Näslund
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Christer Grönlund
- Department of Radiation Sciences, Biomedical Engineering R&D, Umeå University, Umeå, Sweden
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12
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3-Dimensional Ultrasound in Carotid Stenosis Quantitation and Beyond. JACC Cardiovasc Imaging 2018; 11:397-399. [DOI: 10.1016/j.jcmg.2017.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 03/09/2017] [Indexed: 11/20/2022]
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13
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Subclinical Atherosclerosis Burden by 3D Ultrasound in Mid-Life. J Am Coll Cardiol 2017; 70:301-313. [DOI: 10.1016/j.jacc.2017.05.033] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/05/2017] [Accepted: 05/12/2017] [Indexed: 11/21/2022]
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14
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Three-Dimensional and Conventional Carotid Ultrasound for Assessment of Carotid Plaque in a Stroke Patient: A Simple Way to Validate Findings. Can J Cardiol 2017; 33:412.e1-412.e3. [DOI: 10.1016/j.cjca.2016.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 11/06/2016] [Accepted: 11/08/2016] [Indexed: 11/21/2022] Open
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15
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Lee DH, Park JH. Diagnostic and Therapeutic Approach of Carotid and Cerebrovascular Plaque on the Basis of Vessel Imaging. J Lipid Atheroscler 2017. [DOI: 10.12997/jla.2017.6.1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Dong Hyun Lee
- Department of Stroke Neurology, Seonam University Myongji Hospital, Goyang-si, Korea
| | - Jong-Ho Park
- Department of Stroke Neurology, Seonam University Myongji Hospital, Goyang-si, Korea
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16
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Chiu B, Chen W, Cheng J. Concise biomarker for spatial-temporal change in three-dimensional ultrasound measurement of carotid vessel wall and plaque thickness based on a graph-based random walk framework: Towards sensitive evaluation of response to therapy. Comput Biol Med 2016; 79:149-162. [PMID: 27810621 DOI: 10.1016/j.compbiomed.2016.10.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 10/14/2016] [Accepted: 10/15/2016] [Indexed: 11/17/2022]
Abstract
Rapid progression in total plaque area and volume measured from ultrasound images has been shown to be associated with an elevated risk of cardiovascular events. Since atherosclerosis is focal and predominantly occurring at the bifurcation, biomarkers that are able to quantify the spatial distribution of vessel-wall-plus-plaque thickness (VWT) change may allow for more sensitive detection of treatment effect. The goal of this paper is to develop simple and sensitive biomarkers to quantify the responsiveness to therapies based on the spatial distribution of VWT-Change on the entire 2D carotid standardized map previously described. Point-wise VWT-Changes computed for each patient were reordered lexicographically to a high-dimensional data node in a graph. A graph-based random walk framework was applied with the novel Weighted Cosine (WCos) similarity function introduced, which was tailored for quantification of responsiveness to therapy. The converging probability of each data node to the VWT regression template in the random walk process served as a scalar descriptor for VWT responsiveness to treatment. The WCos-based biomarker was 14 times more sensitive than the mean VWT-Change in discriminating responsive and unresponsive subjects based on the p-values obtained in T-tests. The proposed framework was extended to quantify where VWT-Change occurred by including multiple VWT-Change distribution templates representing focal changes at different regions. Experimental results show that the framework was effective in classifying carotid arteries with focal VWT-Change at different locations and may facilitate future investigations to correlate risk of cardiovascular events with the location where focal VWT-Change occurs.
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Affiliation(s)
- Bernard Chiu
- Department of Electronic Engineering, City University of Hong Kong, Kowloon, Hong Kong, China.
| | - Weifu Chen
- Department of Electronic Engineering, City University of Hong Kong, Kowloon, Hong Kong, China; School of Mathematics, Sun Yat-sen University, Guangzhou, China
| | - Jieyu Cheng
- Department of Electronic Engineering, City University of Hong Kong, Kowloon, Hong Kong, China
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17
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Imam YZ, D'Souza A, Malik RA, Shuaib A. Secondary Stroke Prevention: Improving Diagnosis and Management with Newer Technologies. Transl Stroke Res 2016; 7:458-477. [PMID: 27586681 DOI: 10.1007/s12975-016-0494-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 08/08/2016] [Accepted: 08/15/2016] [Indexed: 12/22/2022]
Abstract
Treatment of hypertension, diabetes, high cholesterol, smoking cessation, and healthy lifestyle have all contributed to the decline in the incidence of vascular disease over the last several decades. Patients who suffer an acute stroke are at a high risk for recurrence. Introduction of newer technologies and their wider use allows for better identification of patients in whom the risk of recurrence following an acute stroke may be very high. Traditionally, the major focus for diagnosis and management has focused on patient history, examination, imaging for carotid stenosis/occlusion, and detection of AF and paroxysmal AF (PAF) with 24-48 h cardiac monitoring. This review focuses on the usefulness of three newer investigative tools that are becoming widely available and lead to better prevention. Continuous ambulatory blood pressure measurements for 24 h or longer and 3D Doppler measures of the carotid arteries provide key useful information on the state of vascular health and enhance our ability to monitor the response to preventive therapies. Furthermore, the detection of PAF can be significantly improved with prolonged cardiac monitoring for 3 weeks or longer, enabling the initiation of appropriate prevention therapy. This review will focus on the potential impact and importance of these emerging technologies on the prevention of recurrent stroke in high-risk patients.
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Affiliation(s)
- Yahia Z Imam
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine in Qatar, Doha, Qatar
| | | | - Rayaz A Malik
- University of Manchester, Manchester, UK.,Weill Cornell Medicine in Qatar, Doha, Qatar
| | - Ashfaq Shuaib
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar. .,Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada.
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18
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Raj JR, Rahman SMK, Anand S. An insight into elasticity analysis of common carotid artery using ultrasonography. Proc Inst Mech Eng H 2016; 230:750-60. [DOI: 10.1177/0954411916650220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 04/25/2016] [Indexed: 12/14/2022]
Abstract
Elastance is a distinguished marker in diagnosing various arterial diseases as studies have reported carotid artery–related diseases linked with stiffness index (β) values greater than 5. This study was to estimate elasticity of common carotid artery by measuring the diameter during systolic and diastolic phases using pixel tracing of successive frames and blood pressure. The B-mode ultrasonography video containing arterial wall motion was captured and fragmented into image frames. Each pixel on the greyscale image was converted into RGB intensity values. The diameter of the artery as well as the thickness of the wall was measured by tracing the pixel displacements from successive frames during arterial pulsation. The study was conducted on 19 subjects aged 25–40 years. The systolic and diastolic carotid artery lumen diameters and carotid intima-media thickness were calculated as 7.1 ± 0.7, 6.3 ± 0.6 and 0.5 ± 0.05 mm (mean ± standard deviation), respectively. The mean stiffness index (β), Peterson’s modulus and Young’s modulus of elasticity were 5.2 ± 1.1, 69 ± 15 kPa and 453 ± 99 kPa, respectively. The pixel displacements in tunica intima, tunica media and tunica adventitia were not homogeneous, due to varied macro-constituents such as endothelial tissues, smooth muscle cells, elastin lamina, fibrous tissue and micro-constituents such as collagen, fibroblast and elastin. We found that women have smaller arteries, and the stiffness increased during the systolic phase.
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Affiliation(s)
- Jean Rossario Raj
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India
| | - SMK Rahman
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India
- Biomedical Engineering Unit, All India Institute of Medical Sciences – New Delhi, New Delhi, India
| | - Sneh Anand
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India
- Biomedical Engineering Unit, All India Institute of Medical Sciences – New Delhi, New Delhi, India
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19
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Accurate quantification of atherosclerotic plaque volume by 3D vascular ultrasound using the volumetric linear array method. Atherosclerosis 2016; 248:230-7. [DOI: 10.1016/j.atherosclerosis.2016.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 01/20/2016] [Accepted: 03/02/2016] [Indexed: 11/22/2022]
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20
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Reproducibility of the SPI-US protocol for ultrasound diameter measurements of the Posterior Circumflex Humeral Artery and Deep Brachial Artery: an inter-rater reliability study. Eur Radiol 2015; 26:2455-61. [PMID: 26662028 PMCID: PMC4927614 DOI: 10.1007/s00330-015-4110-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 09/30/2015] [Accepted: 11/10/2015] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Elite overhead athletes are at risk of posterior circumflex humeral artery (PCHA) degeneration, aneurysm formation and thrombosis. Identification of the proximal PCHA and the nearby originating deep brachial artery (DBA) can be a challenge, even among experienced sonographers. The aim of this study was to assess the accuracy and precision of a newly designed standardized ultrasound (US) protocol (SPI-US) for assessment of the PCHA and DBA. METHODS Two experienced sonographers determined diameters of the PCHA and DBA using the SPI-US protocol. Inter-observer agreement was evaluated using intra-class correlation coefficient (ICC), standard error of measurement (SEM), minimal detectable change (MDC), Bland-Altman (BA) analysis, and variance component (VARCOMP) analysis. RESULTS Thirty-three healthy volunteers participated. The ICC for diameter measurement of the PCHA and DBA were 0.70 (95 %CI 0.50-0.83) and 0.60 (95 %CI 0.30-0.80), respectively. The SEM for the PCHA and DBA was 0.32 mm and 0.29 mm and MDC was 0.90 mm and 0.80 mm, respectively. The BA and VARCOMP analyses showed no systematic and only marginal sonographer bias. CONCLUSIONS The SPI-US protocol is accurate and precise for PCHA and DBA diameter assessment in cases where they originate from the axillary artery. PCHA and DBA diameter measurements are sonographer-independent using the SPI-US-protocol. KEY POINTS • PCHA & DBA diameter assessment is accurate and reliable using the SPI-US protocol • PCHA & DBA diameter measurements are sonographer-independent using the SPI-US protocol • The SPI-US protocol minimal detectable change is 0.90 mm for PCHA diameter measurement • This minimal detectable change enables detection of PCHA aneurysms • First step towards international periodic surveillance of athletes at risk of PCHA-injury.
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Vlachopoulos C, Xaplanteris P, Aboyans V, Brodmann M, Cífková R, Cosentino F, De Carlo M, Gallino A, Landmesser U, Laurent S, Lekakis J, Mikhailidis DP, Naka KK, Protogerou AD, Rizzoni D, Schmidt-Trucksäss A, Van Bortel L, Weber T, Yamashina A, Zimlichman R, Boutouyrie P, Cockcroft J, O'Rourke M, Park JB, Schillaci G, Sillesen H, Townsend RR. The role of vascular biomarkers for primary and secondary prevention. A position paper from the European Society of Cardiology Working Group on peripheral circulation. Atherosclerosis 2015; 241:507-32. [DOI: 10.1016/j.atherosclerosis.2015.05.007] [Citation(s) in RCA: 476] [Impact Index Per Article: 52.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 04/29/2015] [Accepted: 05/14/2015] [Indexed: 02/07/2023]
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22
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Hoskins PR, Kenwright DA. Recent developments in vascular ultrasound technology. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2015; 23:158-65. [PMID: 27433252 DOI: 10.1177/1742271x15578778] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This article describes four technologies relevant to vascular ultrasound which are available commercially in 2015, and traces their origin back through the research literature. The technologies are 3D ultrasound and its use in plaque volume estimation (first described in 1994), colour vector Doppler for flow visualisation (1994), wall motion for estimation of arterial stiffness (1968), and shear wave elastography imaging of the arterial wall (2010). Overall these technologies have contributed to the understanding of vascular disease but have had little impact on clinical practice. The basic toolkit for vascular ultrasound has for the last 25 years been real-time B-mode, colour flow and spectral Doppler. What has changed over this time is improvement in image quality. Looking ahead it is noted that 2D array transducers and high frame rate imaging continue to spread through the commercial vascular ultrasound sector and both have the potential to impact on clinical practice.
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Affiliation(s)
- P R Hoskins
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4TJ
| | - D A Kenwright
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4TJ
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23
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Yeom E, Nam KH, Jin C, Paeng DG, Lee SJ. 3D reconstruction of a carotid bifurcation from 2D transversal ultrasound images. ULTRASONICS 2014; 54:2184-2192. [PMID: 24965564 DOI: 10.1016/j.ultras.2014.06.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/12/2014] [Accepted: 06/01/2014] [Indexed: 06/03/2023]
Abstract
Visualizing and analyzing the morphological structure of carotid bifurcations are important for understanding the etiology of carotid atherosclerosis, which is a major cause of stroke and transient ischemic attack. For delineation of vasculatures in the carotid artery, ultrasound examinations have been widely employed because of a noninvasive procedure without ionizing radiation. However, conventional 2D ultrasound imaging has technical limitations in observing the complicated 3D shapes and asymmetric vasodilation of bifurcations. This study aims to propose image-processing techniques for better 3D reconstruction of a carotid bifurcation in a rat by using 2D cross-sectional ultrasound images. A high-resolution ultrasound imaging system with a probe centered at 40MHz was employed to obtain 2D transversal images. The lumen boundaries in each transverse ultrasound image were detected by using three different techniques; an ellipse-fitting, a correlation mapping to visualize the decorrelation of blood flow, and the ellipse-fitting on the correlation map. When the results are compared, the third technique provides relatively good boundary extraction. The incomplete boundaries of arterial lumen caused by acoustic artifacts are somewhat resolved by adopting the correlation mapping and the distortion in the boundary detection near the bifurcation apex was largely reduced by using the ellipse-fitting technique. The 3D lumen geometry of a carotid artery was obtained by volumetric rendering of several 2D slices. For the 3D vasodilatation of the carotid bifurcation, lumen geometries at the contraction and expansion states were simultaneously depicted at various view angles. The present 3D reconstruction methods would be useful for efficient extraction and construction of the 3D lumen geometries of carotid bifurcations from 2D ultrasound images.
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Affiliation(s)
- Eunseop Yeom
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang, South Korea
| | - Kweon-Ho Nam
- Department of Ocean System Engineering, Interdisciplinary Postgraduate Program in Biomedical Engineering, Jeju National University, Jeju, South Korea
| | - Changzhu Jin
- Department of Ocean System Engineering, Interdisciplinary Postgraduate Program in Biomedical Engineering, Jeju National University, Jeju, South Korea
| | - Dong-Guk Paeng
- Department of Ocean System Engineering, Interdisciplinary Postgraduate Program in Biomedical Engineering, Jeju National University, Jeju, South Korea.
| | - Sang-Joon Lee
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang, South Korea.
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Fernández-Friera L, Ibáñez B, Fuster V. Imaging subclinical atherosclerosis: is it ready for prime time? A review. J Cardiovasc Transl Res 2014; 7:623-34. [PMID: 25119855 DOI: 10.1007/s12265-014-9582-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 07/28/2014] [Indexed: 01/02/2023]
Abstract
Imaging subclinical atherosclerosis holds the promise of individualized cardiovascular (CV) risk assessment. The large arsenal of noninvasive imaging techniques available today is playing an increasingly important role in the diagnosis and monitoring of subclinical atherosclerosis. However, there is a debate about the advisability of clinical screens for subclinical atherosclerosis and which modality is the most appropriate for monitoring risk and atherosclerosis progression. This article offers an overview of the traditional and emerging noninvasive imaging modalities used to detect early atherosclerosis, surveys population studies addressing the value of subclinical atherosclerosis detection, and also examines guideline recommendations for their clinical implementation. The clinical relevance of this manuscript lies in the potential of current imaging technology to improve CV risk prediction based on traditional risk factors and the present recommendations for subclinical atherosclerosis assessment. Noninvasive imaging will also help to identify individuals at high CV who would benefit from intensive prevention or therapeutic interventions.
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25
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Pfister K, Kasprzak P, Apfelbeck H, Schäberle W, Janotta M, Schierling W. Hochauflösende 3-D-Sonographie und Bildfusion mit der CT-Angiographie. GEFASSCHIRURGIE 2014. [DOI: 10.1007/s00772-014-1336-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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