In vivo comparison of three ultrasound vector velocity techniques to MR phase contrast angiography

Quantitative Blood Flow Measurements in the Common Carotid Artery: A Comparative Study of High-Frame-Rate Ultrasound Vector Flow Imaging, Pulsed Wave Doppler, and Phase Contrast Magnetic Resonance Imaging

V Flow is commercially developed by high-frame-rate ultrasound vector flow imaging. Compared to conventional color Doppler, V Flow is angle-independent and is capable of measuring both the magnitude and the direction of blood flow velocities. This paper aims to investigate the differences between V Flow and pulsed wave Doppler (PW) relative to phase contrast magnetic resonance imaging (PC-MRI), for the quantitative measurements of blood flow in common carotid arteries (CCA) and, consequently, to evaluate the accuracy of the new technique, V Flow. Sixty-four CCAs were measured using V Flow, PW, and PC-MRI. The maximum velocities, time-averaged mean (TAMEAN) velocities, and volume flow were measured using different imaging technologies. The mean error with standard deviation (Std), the median of absolute errors, and the r-values between V Flow and PC-MRI results for the maximum velocity, the TAMEAN velocity, and the volume flow measurements are {9.40% ± 14.91%; 11.84%; 0.84}, {21.52% ± 14.46%; 19.28%; 0.86}, and {−2.80% ± 14.01%; 10.38%; 0.7}, respectively, and are {53.44% ± 29.68%; 49.79%; 0.74}, {27.83% ± 31.60%; 23.83; 0.71}, and {21.01% ± 29.64%; 25.48%; 0.34}, respectively, for those between PW and PC-MRI. The boxplot, linear regression and Bland–Altman plots were performed for each comparison, which illustrated that the results measured via V Flow rather than via PW agreed more closely with those measured via PC-MRI.

On the Depth-Dependent Accuracy of Plane-Wave-Based Vector Velocity Measurements With Linear Arrays

High-frame-rate vector Doppler methods are used to measure blood velocities over large 2-D regions, but their accuracy is often estimated over a short range of depths. This article thoroughly examines the dependence of velocity measurement accuracy on the target position. Simulations were carried out on flat and parabolic flow profiles, for different Doppler angles, and considering a 2-D vector flow imaging (2-D VFI) method based on plane wave transmission and speckle tracking. The results were also compared with those obtained by the reference spectral Doppler (SD) method. Although, as expected, the bias and standard deviation generally tend to worsen at increasing depths, the measurements also show the following. First, the errors are much lower for the flat profile (from ≈ -4 ± 3% at 20 mm to ≈ -17 ± 4% at 100 mm) than for the parabolic profile (from ≈ -4 ± 3% to ≈ -38 ±%). Second, only part of the relative estimation error is related to the inherent low resolution of the 2-D VFI method. For example, even for SD, the error bias increases (on average) from -0.7% (20 mm) to -17% (60 mm) up to -26% (100 mm). Third, conversely, the beam divergence associated with the linear array acoustic lens was found to have a great impact on the velocity measurements. By simply removing such lens, the average bias for 2-D VFI at 60 and 100 mm dropped down to -9.4% and -19.4%, respectively. In conclusion, the results indicate that the transmission beam broadening on the elevation plane, which is not limited by reception dynamic focusing, is the main cause of velocity underestimation in the presence of high spatial gradients.

Common Carotid Artery Volume Flow: A Comparison Study between Ultrasound Vector Flow Imaging and Phase Contrast Magnetic Resonance Imaging

Volume flow estimation in the common carotid artery (CCA) can assess the absolute hemodynamic effect of a carotid stenosis. The aim of this study was to compare a commercial vector flow imaging (VFI) setup against the reference method magnetic resonance phase contrast angiography (MRA) for volume flow estimation in the CCA. Ten healthy volunteers were scanned with VFI and MRA over the CCA. VFI had an improved precision of 19.2% compared to MRA of 31.9% (p = 0.061). VFI estimated significantly lower volume flow than MRA (mean difference: 63.2 mL/min, p = 0.017), whilst the correlation between VFI and MRA was strong (R² = 0.81, p < 0.0001). A Bland–Altman plot indicated a systematic bias. After bias correction, the percentage error was reduced from 41.0% to 25.2%. This study indicated that a VFI setup for volume flow estimation is precise and strongly correlated to MRA volume flow estimation, and after correcting for the systematic bias, VFI and MRA become interchangeable.

Translation of Simultaneous Vessel Wall Motion and Vectorial Blood Flow Imaging in Healthy and Diseased Carotids to the Clinic: A Pilot Study

This study aims to investigate the clinical feasibility of simultaneous extraction of vessel wall motion and vectorial blood flow at high frame rates for both extraction of clinical markers and visual inspection. If available in the clinic, such a technique would allow a better estimation of plaque vulnerability and improved evaluation of the overall arterial health of patients. In this study, both healthy volunteers and patients were recruited and scanned using a planewave acquisition scheme that provided a data set of 43 carotid recordings in total. The vessel wall motion was extracted based on the complex autocorrelation of the signals received, while the vector flow was extracted using the transverse oscillation technique. Wall motion and vector flow were extracted at high frame rates, which allowed for a visual appreciation of tissue movement and blood flow simultaneously. Several clinical markers were extracted, and visual inspections of the wall motion and flow were conducted. From all the potential markers, young healthy volunteers had smaller artery diameter (7.72 mm) compared with diseased patients (9.56 mm) ( p -value ≤ 0.001), 66% of diseased patients had backflow compared with less than 10% for the other patients ( p -value ≤ 0.05), a carotid with a pulse wave velocity extracted from the wall velocity greater than 7 m/s was always a diseased vessel, and the peak wall shear rate decreased as the risk increases. Based on both the pathological markers and the visual inspection of tissue motion and vector flow, we conclude that the clinical feasibility of this approach is demonstrated. Larger and more disease-specific studies using such an approach will lead to better understanding and evaluation of vessels, which can translate to future use in the clinic.

Innovations in Vascular Ultrasound

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.

A Comparison Study of Vector Velocity, Spectral Doppler and Magnetic Resonance of Blood Flow in the Common Carotid Artery

Magnetic resonance phase contrast angiography (MRA) is the gold standard for blood flow evaluation. Spectral Doppler ultrasound (SDU) is the first clinical choice, although the method is angle dependent. Vector flow imaging (VFI) is an angle-independent ultrasound method. The aim of the study was to compare VFI- and SDU-estimated peak systolic velocities (PSV) of the common carotid artery (CCA) with PSV obtained by MRA. Furthermore, intra- and inter-observer agreement was determined. MRA estimates were significantly different from SDU estimates (left CCA: p < 0.001, right CCA: p < 0.001), but not from VFI estimates (left CCA: p = 0.28, right CCA: p = 0.18). VFI measured lower PSV in both CCAs compared with SDU (p < 0.001) with improved precision (VFI: left: 24%, right: 18%; SDU: left 38%, right: 23%). Intra- and inter-observer agreement was almost perfect for VFI and SDU (inter-observer correlation coefficient: VFI 0.88, SDU 0.91; intra-observer correlation coefficient: VFI 0.96, SDU 0.97). VFI is more accurate than SDU in evaluating PSV compared with MRA.

Accuracy and Precision of a Plane Wave Vector Flow Imaging Method in the Healthy Carotid Artery

The objective of the study described here was to investigate the accuracy and precision of a plane wave 2-D vector flow imaging (VFI) method in laminar and complex blood flow conditions in the healthy carotid artery. The approach was to study (i) the accuracy for complex flow by comparing the velocity field from a computational fluid dynamics (CFD) simulation to VFI estimates obtained from the scan of an anthropomorphic flow phantom and from an in vivo scan; (ii) the accuracy for laminar unidirectional flow in vivo by comparing peak systolic velocities from VFI with magnetic resonance angiography (MRA); (iii) the precision of VFI estimation in vivo at several evaluation points in the vessels. The carotid artery at the bifurcation was scanned using both fast plane wave ultrasound and MRA in 10 healthy volunteers. The MRA geometry acquired from one of the volunteers was used to fabricate an anthropomorphic flow phantom, which was also scanned using the fast plane wave sequence. The same geometry was used in a CFD simulation to calculate the velocity field. Results indicated that similar flow patterns and vortices were estimated with CFD and VFI in the phantom for the carotid bifurcation. The root-mean-square difference between CFD and VFI was within 0.12 m/s for velocity estimates in the common carotid artery and the internal branch. The root-mean-square difference was 0.17 m/s in the external branch. For the 10 volunteers, the mean difference between VFI and MRA was -0.17 m/s for peak systolic velocities of laminar flow in vivo. The precision in vivo was calculated as the mean standard deviation (SD) of estimates aligned to the heart cycle and was highest in the center of the common carotid artery (SD = 3.6% for velocity magnitudes and 4.5° for angles) and lowest in the external branch and for vortices (SD = 10.2% for velocity magnitudes and 39° for angles). The results indicate that plane wave VFI measures flow precisely and that estimates are in good agreement with a CFD simulation and MRA.

Ultrasound Open Platforms for Next-Generation Imaging Technique Development

Open platform (OP) ultrasound systems are aimed primarily at the research community. They have been at the forefront of the development of synthetic aperture, plane wave, shear wave elastography, and vector flow imaging. Such platforms are driven by a need for broad flexibility of parameters that are normally preset or fixed within clinical scanners. OP ultrasound scanners are defined to have three key features including customization of the transmit waveform, access to the prebeamformed receive data, and the ability to implement real-time imaging. In this paper, a formative discussion is given on the development of OPs from both the research community and the commercial sector. Both software- and hardware-based architectures are considered, and their specifications are compared in terms of resources and programmability. Software-based platforms capable of real-time beamforming generally make use of scalable graphics processing unit architectures, whereas a common feature of hardware-based platforms is the use of field-programmable gate array and digital signal processor devices to provide additional on-board processing capacity. OPs with extended number of channels (>256) are also discussed in relation to their role in supporting 3-D imaging technique development. With the increasing maturity of OP ultrasound scanners, the pace of advancement in ultrasound imaging algorithms is poised to be accelerated.

Vector Flow Imaging Compared with Pulse Wave Doppler for Estimation of Peak Velocity in the Portal Vein

The study described here investigated whether angle-independent vector flow imaging (VFI) technique estimates peak velocities in the portal vein comparably to pulsed wave Doppler (PWD). Furthermore, intra- and inter-observer agreement was assessed in a substudy. VFI and PWD peak velocities were estimated with from intercostal and subcostal views for 32 healthy volunteers, and precision analyses were conducted. Blinded to estimates, three physicians rescanned 10 volunteers for intra- and inter-observer agreement analyses. The precision of VFI and PWD was 18% and 28% from an intercostal view and 23% and 77% from a subcostal view, respectively. Bias between VFI and PWD was 0.57 cm/s (p = 0.38) with an intercostal view and 9.89 cm/s (p <0.001) with a subcostal view. Intra- and inter-observer agreement was highest for VFI (inter-observer intra-class correlation coefficient: VFI 0.80, PWD 0.3; intra-observer intra-class correlation coefficient: VFI 0.90, PWD 0.69). Regardless of scan view, VFI was more precise than PWD.

Spiral Flow Phantom for Ultrasound Flow Imaging Experimentation

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.

Common Carotid Artery Flow Measured by 3-D Ultrasonic Vector Flow Imaging and Validated with Magnetic Resonance Imaging

Ultrasound (US) examination of the common carotid artery was compared with a through-plane magnetic resonance imaging (MRI) sequence to validate a recently proposed technique for 3-D US vector flow imaging. Data from the first volunteer examined were used as the training set, before volume flow and peak velocities were calculated for the remaining eight volunteers. Peak systolic velocities (PSVs) and volume flow obtained with 3-D US were, on average, 34% higher and 24% lower than those obtained with MRI, respectively. A high correlation was observed for PSV (r = 0.79), whereas a lower correlation was observed for volume flow (r = 0.43). The overall standard deviations were ±5.7% and ±5.7% for volume flow and PSV with 3-D US, compared with ±2.7% and ±3.2% for MRI. Finally, the data were re-processed with a change in the parameter settings for the echo-canceling filter to investigate its influence on overall performance. PSV was less affected by the re-processing, whereas the difference in volume flow between 3-D vector flow imaging and MRI was reduced to -9%, and with an improved overall standard deviation of ±4.7%. The results illustrate the feasibility of using 3-D US for precise and angle-independent volume flow and PSV estimation in vivo.

Vector velocity estimation of blood flow - A new application in medical ultrasound

Vector flow techniques in the field of ultrasound encompass different pulse emission and estimation strategies. Numerous techniques have been introduced over the years, and recently commercial implementations usable in the clinic have been made. A number of clinical papers using different vector velocity approaches have been published. This review will give an overview of the most significant in vivo results achieved with ultrasound vector flow techniques, and will outline some of the possible clinical applications for vector velocity estimation in the future.

A Methodology for Anatomic Ultrasound Image Diagnostic Quality Assessment

This paper discusses the methods for the assessment of ultrasound image quality based on our experiences with evaluating new methods for anatomic imaging. It presents a methodology to ensure a fair assessment between competing imaging methods using clinically relevant evaluations. The methodology is valuable in the continuing process of method optimization and guided development of new imaging methods. It includes a three phased study plan covering from initial prototype development to clinical assessment. Recommendations to the clinical assessment protocol, software, and statistical analysis are presented. Earlier uses of the methodology has shown that it ensures validity of the assessment, as it separates the influences between developer, investigator, and assessor once a research protocol has been established. This separation reduces confounding influences on the result from the developer to properly reveal the clinical value. This paper exemplifies the methodology using recent studies of synthetic aperture sequential beamforming tissue harmonic imaging.

Vector Flow Imaging Compared with Conventional Doppler Ultrasound and Thermodilution for Estimation of Blood Flow in the Ascending Aorta

Transverse oscillation (TO) is a real-time ultrasound vector flow method implemented on a commercial scanner. The TO setup was examined on a flowrig with constant and pulsatile flow. Subsequently, 25 patients undergoing cardiac bypass surgery were scanned intraoperatively with TO on the ascending aorta and compared to transesophageal echocardiography (TEE) and pulmonary artery catheter thermodilution (PACTD). On the flowrig, TO had a precision of 5.5%, 9.4% and 14.7%, a percentage error of 18.2%, 14.6% and 40.7%, and a mean bias of 0.4 cm/s, 36.8 ml/min and 32.4 ml/min for velocity and flow rate (constant and pulsatile) estimation. The correlation coefficients for all flowrig evaluations were 0.99 indicating systematic bias. After bias correction, the percentage error was reduced to 11.5%, 12.6% and 15.9% for velocity and flow rate (constant and pulsatile) estimation. In the in vivo setup, TO, TEE, and PACTD had a precision of 21.9%, 13.7%, and 12.0%. TO compared with TEE and PACTD had a mean bias of 12.6 cm/s and -0.08 l/min, and a percentage error of 23.4%, and 36.7%, respectively. The percentage error was reduced to 22.9% for the TEE comparison, but increased to 43.8% for the PACTD comparison, after correction for the systematic bias found in the flowrig. TO is a reliable and precise method for velocity and flow rate estimation on a flowrig. However, TO with the present setup, is not interchangeable with PACTD for cardiac volume flow estimation, but is a reliable and precise angle-independent ultrasound alternative for velocity estimation of cardiac flow.

Ultrasound Vector Flow Imaging-Part II: Parallel Systems

This paper gives a review of the current state-of-the-art in ultrasound parallel acquisition systems for flow imaging using spherical and plane waves emissions. The imaging methods are explained along with the advantages of using these very fast and sensitive velocity estimators. These experimental systems are capable of acquiring thousands of images per second for fast moving flow as well as yielding the estimates of low velocity flow. These emerging techniques allow the vector flow systems to assess highly complex flow with transitory vortices and moving tissue, and they can also be used in functional ultrasound imaging for studying brain function in animals. This paper explains the underlying acquisition and estimation methods for fast 2-D and 3-D velocity imaging and gives a number of examples. Future challenges and the potentials of parallel acquisition systems for flow imaging are also discussed.

Accurate Angle Estimator for High-Frame-Rate 2-D Vector Flow Imaging

This paper presents a novel approach for estimating 2-D flow angles using a high-frame-rate ultrasound method. The angle estimator features high accuracy and low standard deviation (SD) over the full 360° range. The method is validated on Field II simulations and phantom measurements using the experimental ultrasound scanner SARUS and a flow rig before being tested in vivo. An 8-MHz linear array transducer is used with defocused beam emissions. In the simulations of a spinning disk phantom, a 360° uniform behavior on the angle estimation is observed with a median angle bias of 1.01° and a median angle SD of 1.8°. Similar results are obtained on a straight vessel for both simulations and measurements, where the obtained angle biases are below 1.5° with SDs around 1°. Estimated velocity magnitudes are also kept under 10% bias and 5% relative SD in both simulations and measurements. An in vivo measurement is performed on a carotid bifurcation of a healthy individual. A 3-s acquisition during three heart cycles is captured. A consistent and repetitive vortex is observed in the carotid bulb during systoles.

Analysis of Systolic Backflow and Secondary Helical Blood Flow in the Ascending Aorta Using Vector Flow Imaging

Secondary rotational flow and systolic backflow are seen in the ascending aorta and, in this study, were analyzed with the vector velocity method transverse oscillation. Twenty-five patients were scanned intra-operatively, and the vector velocities were related to estimates of transesophageal echocardiography and pulmonary artery catheter thermodilution, and associated with gender, age, aortic diameter, atherosclerotic plaques, left ventricular ejection fraction and previous myocardial infarctions. Secondary flow was present for all patients. The duration and rotational frequency (p < 0.001) and the duration and flow direction of the secondary flow (p < 0.002) were associated. Systolic backflow was present in 40% of the patients and associated with systolic velocities (p < 0.002) and the presence of atherosclerotic plaques (p < 0.001). No other significant associations were observed. The study indicates that backflow is injurious and that secondary flow is a normal flow phenomenon. The study also shows that transverse oscillation can provide new information on blood flow in the ascending aorta.

Surveillance for Hemodialysis Access Stenosis: Usefulness of Ultrasound Vector Volume Flow

Purpose

To investigate if ultrasound vector-flow imaging (VFI) is equal to the reference method ultrasound dilution technique (UDT) in estimating volume flow and changes over time in arteriovenous fistulas (AVFs) for hemodialysis.

Materials and methods

From January 2014 to January 2015, patients with end-stage renal disease and matured functional AVFs were consecutively solicited to participate in this prospective study. All patients were included after written informed consent and approval by the National Committee on Biomedical Research Ethics and the local Ethics Committee (journal no. H-4-2014-FSP). VFI and UDT measurements were performed monthly over a six-month period. Nineteen patients were included in the study. VFI measurements were performed before dialysis, and UDT measurements after. Statistical analyses were performed with Bland-Altman plot, Student's t-test, four-quadrant plot, and regression analysis. Repeated measurements and precision analysis were used for reproducibility determination.

Results

Precision measurements for UDT and VFI were 32% and 20%, respectively (p = 0.33). Average volume flow measured with UDT and VFI were 1161 mL/min (±778 mL/min) and 1213 mL/min (±980 mL/(min), respectively (p = 0.3). The mean difference was -51 mL/min (CI: -150 mL/min to 46 mL/min) with limits of agreement from -35% to 54%, with a strong correlation (r2 = 0.87). A large change in volume flow between dialysis sessions detected by UDT was confirmed by VFI (p = 0.0001), but the concordance rate was poor (0.72).

Conclusions

VFI is an acceptable method for volume flow estimation and volume flow changes over time in AVFs.

Convex array vector velocity imaging using transverse oscillation and its optimization

A method for obtaining vector flow images using the transverse oscillation (TO) approach on a convex array is presented. The paper presents optimization schemes for TO fields and evaluates their performance using simulations and measurements with an experimental scanner. A 3-MHz 192-element convex array probe (pitch 0.33 mm) is used in both simulations and measurements. A parabolic velocity profile is simulated at a beam-to-flow angle of 90°. The optimization routine changes the lateral oscillation period λ࠭ as a function of depth to yield the best possible estimates based on the energy ratio between positive and negative spatial frequencies in the ultrasound field. The energy ratio is reduced from -17.1 dB to -22.1 dB. Parabolic profiles are estimated on simulated data using 16 emissions. The optimization gives a reduction in standard deviation from 8.81% to 7.4% for 16 emissions, with a reduction in lateral velocity bias from -15.93% to 0.78% at 90° (transverse flow) at a depth of 40 mm. Measurements have been performed using the experimental ultrasound scanner and a convex array transducer. A bias of -0.93% was obtained at 87° for a parabolic velocity profile along with a standard deviation of 6.37%. The livers of two healthy volunteers were scanned using the experimental setup. The in vivo images demonstrate that the method yields realistic estimates with a consistent angle and mean velocity across three heart cycles.

Quantitative Magnetic Resonance Angiography in Internal Carotid Artery Occlusion with Primary Collateral Pathway

Background and Purpose

Quantitative magnetic resonance angiography (Q-MRA) enables direct measurement of volume flow rate (VFR) of intracranial arteries. We aimed to evaluate the collateral flows in internal carotid artery (ICA) occlusion with primary collateral pathway via circle of Willis using Q-MRA, and to compare them between patients who recently developed ipsilateral symptomatic ischemia and those who did not.

Methods

Between 2012 and 2014, 505 patients underwent Q-MRA in our institution. Among these, 33 patients who had unilateral ICA occlusion with primary collateral pathway were identified, and grouped into asymptomatic patients, stable patients with chronic infarction, and symptomatic patients with acute/subacute infarction. Mean VFR (mVFR) in intracranial arteries was measured and compared between the patients’ groups. Kruskal-Wallis test was used for statistical analysis.

Results

Six patients were asymptomatic, fifteen with chronic infarction were stable, and twelve with acute/subacute infarction were symptomatic. The mVFR of ipsilateral middle cerebral artery in symptomatic patients was significantly lower than those in stable or asymptomatic patients (73.7±45.6 mL/min vs. 119.9±36.1 mL/min vs. 121.8±42.0 mL/min; P = 0.04). Total sum of the mVFR of ipsilateral anterior, middle, and posterior cerebral arteries was significantly lower in symptomatic patients than those in other groups (229.3 ± 51.3 mL/min vs. 282.0±68.6 mL/min vs. 314.0±44.4 mL/min; P = 0.02).

Conclusions

Q-MRA could be helpful to demonstrate the difference in the degree of primary collateral flow in ICA occlusion between the patients with recent symptomatic ischemia and those without.

Recent developments in vascular ultrasound technology

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.

First report on intraoperative vector flow imaging of the heart among patients with healthy and diseased aortic valves

The vector velocity method Transverse Oscillation (TO) implemented on a conventional ultrasound (US) scanner (ProFocus, BK Medical, Herlev, Denmark) can provide real-time, angle-independent estimates of the cardiac blood flow. During cardiac surgery, epicardial US examination using TO was performed on (A) 3 patients with healthy aortic valve and (B) 3 patients with aortic valve stenosis. In group B, the systolic flow of the ascending aorta had higher velocities, was more aliased and chaotic. The jet narrowed to 44% of the lumen compared to 75% in group A and with a vector concentration, a measure of flow complexity, of 0.41 compared to 0.87 in group A. The two groups had similar secondary flow of the ascending aorta with an average rotation frequency of 4.8 Hz. Simultaneous measurements were obtained with spectral Doppler (SD) and a thermodilution technique (TD). The mean difference in peak systolic velocity compared to SD in group A was 22% and 45% in B, while the mean difference in volume flow compared to TD in group A was 30% and 32% in B. TO can potentially reveal new information of cardiac blood flow, and may become a valuable diagnostic tool in the evaluation of patients with cardiovascular diseases.

Novel flow quantification of the carotid bulb and the common carotid artery with vector flow ultrasound

Abnormal blood flow is usually assessed using spectral Doppler estimation of the peak systolic velocity. The technique, however, only estimates the axial velocity component, and therefore the complexity of blood flow remains hidden in conventional ultrasound examinations. With the vector ultrasound technique transverse oscillation the blood velocities of both the axial and the transverse directions are obtained and the complexity of blood flow can be visualized. The aim of the study was to determine the technical performance and interpretation of vector concentration as a tool for estimation of flow complexity. A secondary aim was to establish accuracy parameters to detect flow changes/patterns in the common carotid artery (CCA) and the carotid bulb (CB). The right carotid bifurcation including the CCA and CB of eight healthy volunteers were scanned in a longitudinal plane with vector flow ultrasound (US) using a commercial vector flow ultrasound scanner (ProFocus, BK Medical, Denmark) with a linear 5 MHz transducer transverse oscillation vector flow software. CCA and CB areas were marked in one cardiac cycle from each volunteer. The complex flow was assessed by medical expert evaluation and by vector concentration calculation. A vortex with complex flow was found in all carotid bulbs, whereas the CCA had mainly laminar flow. The medical experts evaluated the flow to be mainly laminar in the CCA (0.82 ± 0.14) and mainly complex (0.23 ± 0.22) in the CB. Likewise, the estimated vector concentrations in CCA (0.96 ± 0.16) indicated mainly laminar flow and in CB (0.83 ± 0.07) indicated mainly turbulence. Both methods were thus able to clearly distinguish the flow patterns of CCA and CB in systole. Vector concentration from angle-independent vector velocity estimates is a quantitative index, which is simple to calculate and can differentiate between laminar and complex flow.

Volume flow in arteriovenous fistulas using vector velocity ultrasound

Volume flow in arteriovenous fistulas for hemodialysis was measured using the angle-independent ultrasound technique Vector Flow Imaging and compared with flow measurements using the ultrasound dilution technique during dialysis. Using an UltraView 800 ultrasound scanner (BK Medical, Herlev, Denmark) with a linear transducer, 20 arteriovenous fistulas were scanned directly on the most superficial part of the fistula just before dialysis. Vector Flow Imaging volume flow was estimated with two different approaches, using the maximum and the average flow velocities detected in the fistula. Flow was estimated to be 242 mL/min and 404 mL/min lower than the ultrasound dilution technique estimate, depending on the approach. The standard deviations of the two Vector Flow Imaging approaches were 175.9 mL/min and 164.8 mL/min compared with a standard deviation of 136.9 mL/min using the ultrasound dilution technique. The study supports that Vector Flow Imaging is applicable for volume flow measurements.

Vector projectile imaging: time-resolved dynamic visualization of complex flow patterns

Achieving non-invasive, accurate and time-resolved imaging of vascular flow with spatiotemporal fluctuations is well acknowledged to be an ongoing challenge. In this article, we present a new ultrasound-based framework called vector projectile imaging (VPI) that can dynamically render complex flow patterns over an imaging view at millisecond time resolution. VPI is founded on three principles: (i) high-frame-rate broad-view data acquisition (based on steered plane wave firings); (ii) flow vector estimation derived from multi-angle Doppler analysis (coupled with data regularization and least-squares fitting); (iii) dynamic visualization of color-encoded vector projectiles (with flow speckles displayed as adjunct). Calibration results indicated that by using three transmit angles and three receive angles (-10°, 0°, +10° for both), VPI can consistently compute flow vectors in a multi-vessel phantom with three tubes positioned at different depths (1.5, 4, 6 cm), oriented at different angles (-10°, 0°, +10°) and of different sizes (dilated diameter: 2.2, 4.4 and 6.3 mm; steady flow rate: 2.5 mL/s). The practical merit of VPI was further illustrated through an anthropomorphic flow phantom investigation that considered both healthy and stenosed carotid bifurcation geometries. For the healthy bifurcation with 1.2-Hz carotid flow pulses, VPI was able to render multi-directional and spatiotemporally varying flow patterns (using a nominal frame rate of 416 fps or 2.4-ms time resolution). In the case of stenosed bifurcations (50% eccentric narrowing), VPI enabled dynamic visualization of flow jet and recirculation zones. These findings suggest that VPI holds promise as a new tool for complex flow analysis.

Intraoperative cardiac ultrasound examination using vector flow imaging

Conventional ultrasound (US) methods for blood velocity estimation only provide one-dimensional and angle-dependent velocity estimates; thus, the complexity of cardiac flow has been difficult to measure. To circumvent these limitations, the Transverse Oscillation (TO) vector flow method has been proposed. The vector flow method implemented on a commercial scanner provided real-time, angle-independent estimates of cardiac blood flow. Epicardiac and epiaortic, intraoperative US examinations were performed on three patients with stenosed coronary arteries scheduled for bypass surgery. Repeating cyclic beat-to-beat flow patterns were seen in the ascending aorta and pulmonary artery of each patient, but these patterns varied between patients. Early systolic retrograde flow filling the aortic sinuses was seen in the ascending aorta as well as early systolic retrograde flow in the pulmonary artery. In diastole, stable vortices in aortic sinuses of the ascending aorta created central antegrade flow. A stable vortex in the right atrium was seen during the entire heart cycle. The measurements were compared with estimates obtained intraoperatively with conventional spectral Doppler US using a transesophageal and an epiaortic approach. Mean differences in peak systole velocity of 11% and 26% were observed when TO was compared with transesophageal echocardiography and epiaortic US, respectively. In one patient, the cardiac output derived from vector velocities was compared with pulmonary artery catheter thermodilution technique and showed a difference of 16%. Vector flow provides real-time, angle-independent vector velocities of cardiac blood flow. The technique can potentially reveal new information of cardiovascular physiology and give insight into blood flow dynamics.