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Arnold L, Haas NA, Jakob A, Fischer J, Massberg S, Deseive S, Oberhoffer FS. Short-Term Changes in Arterial Stiffness Measured by 2D Speckle Tracking in Patients Undergoing Transcatheter Aortic Valve Implantation. J Clin Med 2023; 13:222. [PMID: 38202229 PMCID: PMC10779940 DOI: 10.3390/jcm13010222] [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: 11/04/2023] [Revised: 12/07/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
Arterial stiffness has received increasing interest as a cardiovascular marker in patients with aortic valve stenosis (AS). So far, studies on the impact of aortic valve replacement (AVR) on arterial stiffness have been equivocal. Two-dimensional speckle tracking (2DST) is a novel, non-invasive method to measure the motion of the vessel wall. In this prospective observational study, we aimed to assess the change in arterial stiffness of the common carotid artery (CCA) measured by 2DST in patients undergoing transcatheter aortic valve implantation (TAVI). A total of 47 patients were included in the study (age 80.04 ± 6.065 years). Peak circumferential strain (CS) was significantly improved after TAVI (4.50 ± 2.292 vs. 5.12 ± 2.958, p = 0.012), as was the peak strain rate (CSR) (0.85 ± 0.567 vs. 1.35 ± 0.710, p = 0.002). Body mass index (BMI), mean arterial pressure (MAP) and hemodynamic parameters were associated with this change. 2DST results did not correlate with aortic pulse wave velocity (aPWV) or augmentation index normalized to heart rate (AIx@75), suggesting a distinct difference between arterial stiffness of the CCA and other stiffness parameters. 2DST seems to be a promising new tool to assess arterial stiffness in TAVI patients.
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Affiliation(s)
- Leonie Arnold
- Division of Pediatric Cardiology and Intensive Care, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Nikolaus Alexander Haas
- Division of Pediatric Cardiology and Intensive Care, University Hospital, LMU Munich, 81377 Munich, Germany
| | - André Jakob
- Division of Pediatric Cardiology and Intensive Care, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Julius Fischer
- Department of Medicine I, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Steffen Massberg
- Department of Medicine I, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Simon Deseive
- Department of Medicine I, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Felix Sebastian Oberhoffer
- Division of Pediatric Cardiology and Intensive Care, University Hospital, LMU Munich, 81377 Munich, Germany
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2
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Rohlén R, Jiang B, Nyman E, Wester P, Näslund U, Grönlund C. Interframe Echo Intensity Variation of Subregions and Whole Plaque in Two-Dimensional Carotid Ultrasonography: Simulations and In Vivo Observations. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1033-1046. [PMID: 36264181 DOI: 10.1002/jum.16114] [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: 04/19/2022] [Revised: 09/26/2022] [Accepted: 10/02/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES The risk of cardiovascular disease is associated with the echo intensity of carotid plaques in ultrasound images and their cardiac cycle-induced intensity variations. In this study, we aimed to 1) explore the underlying origin of echo intensity variations by using simulations and 2) evaluate the association between the two-dimensional (2D) spatial distribution of these echo intensity variations and plaque vulnerability. METHODS First, we analyzed how out-of-plane motion and compression of simulated scattering spheres of different sizes affect the ultrasound echo intensity. Next, we propose a method to analyze the features of the 2D spatial distribution of interframe plaque echo intensity in carotid ultrasound image sequences and explore their associations with plaque vulnerability in experimental data. RESULTS The simulations showed that the magnitude of echo intensity changes was similar for both the out-of-plane motion and compression, but for scattering objects smaller than 1 mm radius, the out-of-plane motion dominated. In experimental data, maps of the 2D spatial distribution of the echo intensity variations had a low correlation with standard B-mode echo intensity distribution, indicating complementary information on plaque tissue composition. In addition, we found the existence of ∼1 mm diameter subregions with pronounced echo intensity variations associated with plaque vulnerability. CONCLUSIONS The results indicate that out-of-plane motion contributes to intra-plaque regions of high echo intensity variation. The 2D echo intensity variation maps may provide complementary information for assessing plaque composition and vulnerability. Further studies are needed to verify this method's role in identifying vulnerable plaques and predicting cardiovascular disease risk.
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Affiliation(s)
- Robin Rohlén
- Department of Radiation Sciences, Radiation Physics, Biomedical Engineering, Umeå University, Umeå, Sweden
| | - Biao Jiang
- Department of Radiation Sciences, Radiation Physics, Biomedical Engineering, Umeå University, Umeå, Sweden
| | - Emma Nyman
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Per Wester
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Ulf Näslund
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Christer Grönlund
- Department of Radiation Sciences, Radiation Physics, Biomedical Engineering, Umeå University, Umeå, Sweden
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Willems L, Vermeulen J, Wiegerinck A, Fekkes S, Reijnen M, Warlé M, De Korte C, Thijssen D. Construct Validity and Reproducibility of Handheld Ultrasound Devices in Carotid Artery Diameter Measurement. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:866-874. [PMID: 36567191 DOI: 10.1016/j.ultrasmedbio.2022.11.013] [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: 07/29/2022] [Revised: 11/18/2022] [Accepted: 11/19/2022] [Indexed: 06/17/2023]
Abstract
The construct validity and reproducibility of three commonly used handheld ultrasound (US) devices in measuring carotid arterial diameter was evaluated: Telemed MicrUs EXT-1H (Telemed, Vilnius, Lithuania), Butterfly iQ (Butterfly Network, Inc., Guilford, CT, USA) and Philips Lumify (Philips Healthcare, Best, The Netherlands). An in vitro setup was built to evaluate construct validity, compared with high-end US, and intra-observer variability of handheld US devices. Handheld devices showed a mean difference of 0.023 ± 0.030 cm, 0.012 ± 0.037 cm and 0.009 ± 0.046 cm for, respectively, Telemed, Butterfly and Lumify in comparison with high-end US devices. Intraclass agreement with the high-end system as well as intra-observer variability for handheld US devices was classified as excellent, with all values greater than 0.95. Subsequently, inter-observer variability of handheld US devices was investigated in an in vivo setup with 20 healthy volunteers. Inter-observer variability was classified as excellent for Telemed (0.901), good for Lumify (0.827) and moderate for Butterfly (0.684) with a difference of, respectively, 0.005 ± 0.031 cm, 0.020 ± 0.050 cm and -0.003 ± 0.033 cm. In conclusion, handheld US devices demonstrated an excellent construct validity and intra-observer variability. Additionally, excellent-to-good inter-observer variability for Telemed and Lumify was observed, and Butterfly demonstrated a moderate inter-observer agreement. These results indicate that handheld US devices are effective for measuring carotid arterial diameter.
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Affiliation(s)
- Loes Willems
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Jenske Vermeulen
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - Anouk Wiegerinck
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Stein Fekkes
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Michel Reijnen
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands; Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Michiel Warlé
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Chris De Korte
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Dick Thijssen
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands; Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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4
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Rocchi M, Ingram M, Claus P, D'hooge J, Meyns B, Fresiello L. Use of 3D anatomical models in mock circulatory loops for cardiac medical device testing. Artif Organs 2023; 47:260-272. [PMID: 36370033 DOI: 10.1111/aor.14433] [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: 02/08/2022] [Revised: 08/16/2022] [Accepted: 10/11/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Mock circulatory loops (MCLs) are mechanical representations of the cardiovascular system largely used to test the hemodynamic performance of cardiovascular medical devices (MD). Thanks to 3 dimensional (3D) printing technologies, MCLs can nowadays also incorporate anatomical models so to offer enhanced testing capabilities. The aim of this review is to provide an overview on MCLs and to discuss the recent developments of 3D anatomical models for cardiovascular MD testing. METHODS The review first analyses the different techniques to develop 3D anatomical models, in both rigid and compliant materials. In the second section, the state of the art of MCLs with 3D models is discussed, along with the testing of different MDs: implantable blood pumps, heart valves, and imaging techniques. For each class of MD, the MCL is analyzed in terms of: the cardiovascular model embedded, the 3D model implemented (the anatomy represented, the material used, and the activation method), and the testing applications. DISCUSSIONS AND CONCLUSIONS MCLs serve the purpose of testing cardiovascular MDs in different (patho-)physiological scenarios. The addition of 3D anatomical models enables more realistic connections of the MD with the implantation site and enhances the testing capabilities of the MCL. Current attempts focus on the development of personalized MCLs to test MDs in patient-specific hemodynamic and anatomical scenarios. The main limitation of MCLs is the impossibility to assess the impact of a MD in the long-term and at a biological level, for which animal experiments are still needed.
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Affiliation(s)
- Maria Rocchi
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Marcus Ingram
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Jan D'hooge
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Bart Meyns
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Libera Fresiello
- Cardiovasuclar and Respiratory Physiology, University of Twente, Enschede, The Netherlands
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Dong Z, Zhao Y, Chen Y, Liu Z, Song H, Li H, Shi D, Zhou C, Zhou J, Liu R. Evaluating Atherosclerosis of the Abdominal Aorta in Rabbits Using 2-D Strain Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:2199-2206. [PMID: 35953348 DOI: 10.1016/j.ultrasmedbio.2022.05.029] [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: 02/02/2022] [Revised: 05/05/2022] [Accepted: 05/22/2022] [Indexed: 06/15/2023]
Abstract
After establishment of an animal model of atherosclerosis, speckle tracking imaging was performed to analyze the correlation between ultrasound characteristics and pathological manifestations. Rabbits were divided into the normal control (NC) and atherosclerosis (AS) groups. Rabbits in the AS group were subjected to ultrasound-guided balloon injury of the abdominal aorta and fed a high-fat diet for 16 wk. Rabbits in the NC group were fed a normal diet for the same period. After 16 wk, all animals underwent serological tests, ultrasound and speckle tracking circumferential strain analysis. In the AS group, 28 hypo-echoic plaques had formed. The circumferential strain of six segments at the short axis of plaques in the AS group was lower than that in the NC group (p < 0.001), and global circumferential strain (GCS) in the AS group was significantly reduced compared with the NC group (p < 0.001). In the AS group, the area ratio of type I to type III collagen fibers was smaller than that in the NC group. The GCS of atherosclerotic plaques was positively correlated with the area ratio of type I to type III collagen fibers in plaques (r = 0.7181, p < 0.001). In conclusion, there is a significant positive correlation between the decreased circumferential strain and the decreased area ratio of type I to type III collagen fibers in hypo-echoic plaques.
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Affiliation(s)
- Zhizhi Dong
- Department of Ultrasound, First College of Clinical Medical Sciences, China Three Gorges University & Yichang Central People's Hospital, Yichang, China; Central Laboratory, First College of Clinical Medical Science, China Three Gorges University & Yichang Central People's Hospital, Yichang, China
| | - Yun Zhao
- Medical College of China Three Gorges University, Yichang, China
| | - Yue Chen
- Department of Ultrasound, First College of Clinical Medical Sciences, China Three Gorges University & Yichang Central People's Hospital, Yichang, China; Central Laboratory, First College of Clinical Medical Science, China Three Gorges University & Yichang Central People's Hospital, Yichang, China
| | - Zulin Liu
- Department of Ultrasound, First College of Clinical Medical Sciences, China Three Gorges University & Yichang Central People's Hospital, Yichang, China
| | - Haiying Song
- Department of Ultrasound, First College of Clinical Medical Sciences, China Three Gorges University & Yichang Central People's Hospital, Yichang, China
| | - Hao Li
- Department of Gastrointestinal Surgery, First College of Clinical Medical Sciences, China Three Gorges University & Yichang Central People's Hospital, Yichang, China
| | - Douzi Shi
- Department of Ultrasound, First College of Clinical Medical Sciences, China Three Gorges University & Yichang Central People's Hospital, Yichang, China; Central Laboratory, First College of Clinical Medical Science, China Three Gorges University & Yichang Central People's Hospital, Yichang, China
| | - Chang Zhou
- Department of Ultrasound, First College of Clinical Medical Sciences, China Three Gorges University & Yichang Central People's Hospital, Yichang, China
| | - Jun Zhou
- Department of Ultrasound, First College of Clinical Medical Sciences, China Three Gorges University & Yichang Central People's Hospital, Yichang, China
| | - Rong Liu
- Department of Ultrasound, First College of Clinical Medical Sciences, China Three Gorges University & Yichang Central People's Hospital, Yichang, China.
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Gök M, Akdam H, Gürlek Akol Z, Tuzcu G, Yeniçerioğlu Y. Assessment of Arterial Stiffness in Hemodialysis Patients, Using Speckle Tracking Carotid Strain Ultrasonography. MEANDROS MEDICAL AND DENTAL JOURNAL 2022. [DOI: 10.4274/meandros.galenos.2022.92053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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7
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Wang Y, Xie X, He Q, Liao H, Zhang H, Luo J. Hadamard-Encoded Synthetic Transmit Aperture Imaging for Improved Lateral Motion Estimation in Ultrasound Elastography. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:1204-1218. [PMID: 35100113 DOI: 10.1109/tuffc.2022.3148332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Lateral motion estimation has been a challenge in ultrasound elastography mainly due to the low resolution, low sampling frequency, and lack of phase information in the lateral direction. Synthetic transmit aperture (STA) can achieve high resolution due to two-way focusing and can beamform high-density image lines for improved lateral motion estimation with the disadvantages of low signal-to-noise ratio (SNR) and limited penetration depth. In this study, Hadamard-encoded STA (Hadamard-STA) is proposed for the improvement of lateral motion estimation in elastography, and it is compared with STA and conventional focused wave (CFW) imaging. Simulations, phantom, and in vivo experiments were conducted to make the comparison. The normalized root mean square error (NRMSE) and the contrast-to-noise ratio (CNR) were calculated as the evaluation criteria in the simulations. The results show that, at a noise level of -10 dB and an applied strain of -1% (compression), Hadamard-STA decreases the NRMSEs of lateral displacements by 46.92% and 35.35%, decreases the NRMSEs of lateral strains by 52.34% and 39.75%, and increases the CNRs by 9.70 and 9.75 dB compared with STA and CFW, respectively. In the phantom experiments performed on a heterogeneous tissue-mimicking phantom, the sum of squared differences (SSD) between the reference and the motion-compensated RF data, and the CNR were calculated as the evaluation criteria. At an applied strain of -1.80%, Hadamard-STA is found to decrease the SSDs by 20.91% and 30.99% and increase the CNRs by 14.15 and 24.66 dB compared with STA and CFW, respectively. In the experiments performed on a breast phantom, Hadamard-STA achieves better visualization of the breast inclusion with a clearer boundary between the inclusion and the background than STA and CFW. The in vivo experiments were performed on a patient with a breast tumor, and the tumor could also be better visualized with a more homogeneous background in the strain image obtained by Hadamard-STA than by STA and CFW. These results demonstrate that Hadamard-STA achieves a substantial improvement in lateral motion estimation and maybe a competitive method for quasi-static elastography.
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8
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Zheng Y, Thelen BJ, Rajaram N, Krishnamurthy VN, Hamilton J, Funes-Lora MA, Morgan T, Yessayan L, Bishop B, Osborne N, Henke P, Shih AJ, Weitzel WF. Angioplasty Induced Changes in Dialysis Vascular Access Compliance. Ann Biomed Eng 2021; 49:2635-2645. [PMID: 34382112 DOI: 10.1007/s10439-021-02844-6] [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: 04/30/2021] [Accepted: 07/29/2021] [Indexed: 11/24/2022]
Abstract
Dialysis vascular access remains vitally important to maintain life and functional capacity with end stage renal disease. Angioplasty is an integral part of maintaining dialysis access function and patency. To understand the effect of angioplasty balloon dilation on vascular wall mechanics, we conducted a clinical study to evaluate the elastic modulus of the anastomosis in five subjects with anastomosis stenoses, before and after six angioplasty procedures, using B-mode ultrasound DICOM data. A novel and open source vascular ultrasound high-resolution speckle tracking software tool was used. The median lumen diameter increased from 3.4 to 5.5 mm after angioplasty. Meanwhile, the median elastic modulus of the 18 measurements at the anastomosis increased by 52.2%, from 2.24 × 103 to 3.41 × 103 mmHg. The results support our hypothesis that the structural changes induced in the vessel wall by balloon dilation lead to reduced vascular compliance and a higher elastic modulus of the vessel wall.
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Affiliation(s)
- Yihao Zheng
- Department of Mechanical Engineering, Worcester Polytechnic Institute, 100 Institute Rd, Worcester, MA, 01609, USA. .,VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
| | - Brian J Thelen
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Statistics, University of Michigan, Ann Arbor, MI, USA.,Michigan Tech Research Institute, Michigan Technological University, Ann Arbor, MI, USA
| | - Nirmala Rajaram
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Venkataramu N Krishnamurthy
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Departments of Radiology and Surgery, University of Michigan, Ann Arbor, MI, USA
| | - James Hamilton
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Emerge Now Inc., Los Angeles, CA, USA
| | | | | | - Lenar Yessayan
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Nickolas Osborne
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Peter Henke
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Albert J Shih
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - William F Weitzel
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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9
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Effect of the internal carotid artery degree of stenosis on wall and plaque distensibility. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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10
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Gao J, Lee J, Phan A, Fowlkes JB. Velocity Vector Imaging to Assess Longitudinal Wall Motion of Adult Carotid Arteries. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1195-1207. [PMID: 32914417 DOI: 10.1002/jum.15501] [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: 02/22/2020] [Revised: 08/08/2020] [Accepted: 08/15/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE We aimed to assess longitudinal wall motion of the common carotid artery (CCA) using velocity vector imaging (VVI). METHODS From October 2018 to July 2019, we prospectively performed VVI of 204 CCAs (102 adult volunteers, 57 men, 45 women) in young (n = 40, 20-44 y), mid-age (n = 30, 45-64 y), and senior (n = 32, ≥65 y) groups. VVI parameters of CCA included longitudinal motion pattern, motion parameters (strain, strain rate, displacement), and time-to-peak motion parameters (time-to-peak strain, time-to-peak strain rate, time-to-peak displacement). Statistical analyses included one-way ANOVA post-hoc testing to examine the difference in VVI parameters among the 3 age groups and in paired groups; unpaired t tests to examine the difference in VVI parameters between CCAs with and without atherosclerotic plaque, between hypertensive and normotensive subjects without atherosclerotic plaque; linear regression to analyze correlations of VVI parameters to age, carotid intima-media thickness; and intraclass correlation coefficient to test inter- and intra-observer reliability in performing VVI of the CCA. RESULTS Differences in VVI parameters and patterns among the 3 age groups, between hypertensive and normotensive, and CCAs with and without plaque were significant (p < .01). CCA motion- and time-to-peak motion parameters were correlated to age (R2 = 0.63-0.56) and carotid intima-media thickness (R2 = 0.29-0.22). CCA wall motion dyssynchrony was remarkable in seniors. The repeatability and reproducibility for performing carotid artery VVI were good (intraclass correlation coefficient > 0.85). CONCLUSIONS VVI is feasible to assess changes in longitudinal CCA wall mechanical properties and synchrony with aging, atherosclerosis, and hypertension.
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Affiliation(s)
- Jing Gao
- Rocky Vista University, Ivins, Utah
- Weill Cornell Medicine, Cornell University, New York, New York
| | | | | | - J Brian Fowlkes
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
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11
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Song XT, Fan L, Yan ZN, Rui YF. Echocardiographic evaluation of the elasticity of the ascending aorta in patients with essential hypertension. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:351-357. [PMID: 32949012 DOI: 10.1002/jcu.22925] [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: 06/01/2020] [Revised: 07/25/2020] [Accepted: 09/10/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Hypertension is the most common chronic disease and the most important risk factor for cardiovascular and cerebrovascular diseases. Atheroma and arteriosclerosis plays a key role in the occurrence and development of hypertension. The purpose of this study was to evaluate the elasticity of ascending aorta wall in patients with essential hypertension (EH) using M-mode echocardiography. MATERIALS AND METHODS We prospectively enrolled 54 EH patients and 51 healthy subjects (HS). They all underwent transthoracic echocardiography to measure ascending aorta inner diameters and brachial blood pressure measurement to calculate aortic elastic variables: compliance, distensibility, strain, stiffness index, and Peterson's elastic modulus. All participants also underwent bilateral carotid ultrasonographic examination. RESULTS There were no significant differences in age, sex, body mass index, blood lipids, blood glucose, and ascending aorta inner diameters between the two groups. We found neither intimal thickening nor plaque formation in the left or right carotid arteries in both groups. The aortic elastic properties were significantly impaired in EH patients compared with HS. CONCLUSIONS Echocardiography can be used for the noninvasive evaluation of ascending aorta wall elasticity as an early screening technique. Subclinical arteriosclerosis appeared to occur in the ascending aorta of patients with essential hypertension even though carotid ultrasonography was normal.
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Affiliation(s)
- Xiang-Ting Song
- Department of Echocardiography, Changzhou No. 2 People's Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Li Fan
- Department of Echocardiography, Changzhou No. 2 People's Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Zi-Ning Yan
- Department of Echocardiography, Changzhou No. 2 People's Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Yi-Fei Rui
- Department of Echocardiography, Changzhou No. 2 People's Hospital Affiliated to Nanjing Medical University, Changzhou, China
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12
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Kim JH, Chhai P, Rhee K. Development and characterization of viscoelastic polydimethylsiloxane phantoms for simulating arterial wall motion. Med Eng Phys 2021; 91:12-18. [PMID: 34074461 DOI: 10.1016/j.medengphy.2021.03.004] [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: 04/17/2020] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 11/17/2022]
Abstract
Arterial wall viscoelasticity is likely to be a good diagnostic indicator of vascular disease, but only a few studies on the assessment of wall viscosity have been performed. Artery phantoms are manufactured using polydimethylsiloxane (PDMS) to simulate the viscoelastic characteristics of the artery wall, which depends on the wall tissue composition and progression of atherosclerosis. The viscoelastic property of PDMS is controlled by adjusting the mixture ratio of resin, curing agent, and pure silicone oil. The pressure and diameter waveforms of the artery phantom were measured to estimate the wall viscoelasticity. Elasticity is assessed using the diameter distention over the pulse pressure, and the viscosity is evaluated using the energy dissipation ratio of the pressure-diameter curve and the phase lag between the first harmonics of pressure and diameter waveforms (DP1). PDMS phantoms with resin-to-curing-agent ratios of 20:1 and 25:1 show viscoelastic characteristics similar to those of young and old human carotid arteries, respectively. Adding pure silicone oil further softens the silicone elastomer while decreasing its viscosity. The phantoms with 10:1:5 and 10:1:8 mixture ratios (resin: curing agent: silicone oil) show elasticity similar to that of the 20:1:0 and 25:1:0 ratios, respectively, albeit with a noticeable decrease in viscosity. An abrupt decrease in the phase lag (DP1) was found near the interface of the arterial phantom with different mixture ratios (20:1:0 and 10:1:5), while the change in diameter distension was negligible. DP1 may be a new index to differentiate wall tissues with similar elastic properties but different viscous behavior. The pressure diameter curve and DP1 of the phantom simulating the atherosclerosis wall can be compared with patient data and applied to clinical evaluation of plaque viscoelasticity. Computational analysis of arterial wall motion was performed using a standard linear viscoelastic model. The model parameters were determined from the measured pressure-diameter relationship, and the arterial wall motions of phantoms with different viscoelastic properties were successfully simulated. The computational model may provide a useful insight into the changes of arterial viscoelasticity caused by pathogenic wall degeneration.
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Affiliation(s)
- Je Hyun Kim
- Department of Mechanical Engineering, Myongji University, 116 Myongji-ro, Cheoin-gu, Yongin-si, Gyeonggi-do 17058, South Korea
| | - Pengsrorn Chhai
- Department of Mechanical Engineering, Myongji University, 116 Myongji-ro, Cheoin-gu, Yongin-si, Gyeonggi-do 17058, South Korea
| | - Kyehan Rhee
- Department of Mechanical Engineering, Myongji University, 116 Myongji-ro, Cheoin-gu, Yongin-si, Gyeonggi-do 17058, South Korea.
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Cerit MN, Sendur HN, Bolayır B, Cerit ET, Cindil E, Yaşım Aktürk M, Baloş Törüner F, Özhan Oktar S. Evaluation of common carotid artery in type 1 diabetes mellitus patients through speckle tracking carotid strain ultrasonography. Diagn Interv Radiol 2021; 27:195-205. [PMID: 33599210 DOI: 10.5152/dir.2021.20025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE We aimed to evaluate the effectiveness of speckle tracking carotid strain (STCS) technique, which enables measurement of arterial stiffness and strain parameters, in the detection of early atherosclerotic findings in type 1 diabetes mellitus (T1DM). METHODS We prospectively enrolled 30 T1DM patients and 30 age- and sex-matched control participants with no history of cardiovascular disease. All study population underwent carotid ultrasonography. Radial and circumferential movement of the common carotid artery (CCA) in the transverse plane as the well as the radial movement of the CCA in the longitudinal plane were calculated automatically by using the STCS method. In addition, the strain (%), strain rate (per second), and peak circumferential and radial displacements (mm) were calculated. Arterial stiffness parameters, such as elastic modulus, distensibility, arterial compliance, and β-stiffness index, were calculated using the radial measurements. The mean value of the carotid intima media thickness (CIMT) was calculated semi-automatically for each CCA, in the longitudinal plane. We also analyzed the patients' overall body composition. RESULTS T1DM and control groups were compared in terms of strain and stiffness parameters and no statistically significant difference was found (p > 0.05). CIMT was higher in diabetic patients than in the control group (p = 0.039). In both groups, age was correlated with all arterial stiffness and strain parameters (p < 0.05). The duration of diabetes was also correlated with β-stiffness index, distensibility, and elastic modulus in the longitudinal plane (p < 0.05). In the diabetic group, abdominal fat ratio, whole body fat ratio, and fat mass were correlated with radial and circumferential displacement and strain parameters in transverse plane, and radial displacement in longitudinal plane (p < 0.05, for each). Diabetic patients were divided into subgroups according to the presence of nephropathy and dyslipidemia. Although no significant difference was found between the groups in terms of CIMT, patients with nephropathy had higher values for transverse and longitudinal elastic modulus, pulse-wave velocity, and longitudinal β-stiffness index, as well as lower values for longitudinal arterial compliance and distensibility, compared with patients without nephropathy (p < 0.05). Also, patients with dyslipidemia had higher longitudinal β-stiffness and elastic modulus values compared with patients without dyslipidemia (p < 0.05). CONCLUSION STCS ultrasonography is an effective, easy, and noninvasive method for evaluating the arterial elasticity. It may provide an early assessment of atherosclerosis in patients with T1DM, especially in the presence of nephropathy and dyslipidemia; thus, together with CIMT measurement, it may be used more frequently to detect subclinical damage and stratify atherosclerosis.
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Affiliation(s)
- Mahi Nur Cerit
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Halit Nahit Sendur
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Başak Bolayır
- Department of Endocrinology, Gazi University Faculty of Medicine, Ankara, Turkey
| | | | - Emetullah Cindil
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Müjde Yaşım Aktürk
- Department of Endocrinology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Füsun Baloş Törüner
- Department of Endocrinology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Suna Özhan Oktar
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
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Author Correction: Impact of imaging cross-section on visualization of thyroid microvessels using ultrasound: Pilot study. Sci Rep 2020; 10:11965. [PMID: 32665701 PMCID: PMC7360610 DOI: 10.1038/s41598-020-69042-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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15
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Li H, Poree J, Chayer B, Cardinal MHR, Cloutier G. Parameterized Strain Estimation for Vascular Ultrasound Elastography With Sparse Representation. IEEE TRANSACTIONS ON MEDICAL IMAGING 2020; 39:3788-3800. [PMID: 32746123 DOI: 10.1109/tmi.2020.3005017] [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
Ultrasound vascular strain imaging has shown its potential to interrogate the motion of the vessel wall induced by the cardiac pulsation for predicting plaque instability. In this study, a sparse model strain estimator (SMSE) is proposed to reconstruct a dense strain field at a high resolution, with no spatial derivatives, and a high computation efficiency. This sparse model utilizes the highly-compacted property of discrete cosine transform (DCT) coefficients, thereby allowing to parameterize displacement and strain fields with truncated DCT coefficients. The derivation of affine strain components (axial and lateral strains and shears) was reformulated into solving truncated DCT coefficients and then reconstructed with them. Moreover, an analytical solution was derived to reduce estimation time. With simulations, the SMSE reduced estimation errors by up to 50% compared with the state-of-the-art window-based Lagrangian speckle model estimator (LSME). The SMSE was also proven to be more robust than the LSME against global and local noise. For in vitro and in vivo tests, residual strains assessing cumulated errors with the SMSE were 2 to 3 times lower than with the LSME. Regarding computation efficiency, the processing time of the SMSE was reduced by 4 to 25 times compared with the LSME, according to simulations, in vitro and in vivo results. Finally, phantom studies demonstrated the enhanced spatial resolution of the proposed SMSE algorithm against LSME.
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Zhou KN, Sung KT, Yen CH, Su CH, Lee PY, Hung TC, Huang WH, Chien SC, Tsai JP, Yun CH, Chang SC, Yeh HI, Hung CL. Carotid arterial mechanics as useful biomarker of extracellular matrix turnover and preserved ejection fraction heart failure. ESC Heart Fail 2020; 7:1615-1625. [PMID: 32449609 PMCID: PMC7373904 DOI: 10.1002/ehf2.12714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 02/10/2020] [Accepted: 03/31/2020] [Indexed: 11/12/2022] Open
Abstract
Aims We aimed to investigate the functional alterations, diagnostic utilization, and prognostic implication of carotid arterial deformations in subjects with cardiovascular risk factors and heart failure (HF) with preserved ejection fraction (HFpEF). Methods and results Among 251 prospectively participants (mean age 66.0 ± 9.8 years, 65.7% female) in a single centre between December 2011 and September 2014, carotid artery deformations including circumferential strain (CCS)/strain rate and radial strain were analysed by two‐dimensional speckle tracking. We further related these carotid artery deformation indices to HF biomarkers and cardiac structure and function by echocardiography and explored their prognostic values. Significant reductions of CCS, circumferential strain rate, and circumferential radial strain were observed across control (n = 52), high risk (n = 147), and HFpEF (n = 52) (trend P ≤ 0.001). Aging, hypertension, HFpEF, and higher pulse rate showed independent associations with reduced CCS by stepwise multivariate regressions (all P < 0.05). Higher CCS was inversely associated with better cardiac remodelling and functional indices, and lower multiple HF biomarkers (all P ≤ 0.005). After adjustment, higher CCS was independently associated with better global ventricular longitudinal strain/early diastolic strain rate, lower matrix metalloproteinase‐2, and N‐terminal propeptide of procollagen type III levels (adjusted coef: −0.08 and −19.9, all P < 0.05). During a median follow‐up of 1406 days (interquartile range: 1342‑1720 days), CCS less than 3.28% as a cut‐off had markedly higher HF events [Harrell's C: 0.72, adjusted HR: 2.20 (95% confidence interval: 1.24, 3.16), P = 0.008]. CCS also showed significantly improved risk prediction for HF over global ventricular longitudinal strain (net reclassification index: 48%, P = 0.001; integrated discrimination improvement: 1.8%, P < 0.001). Conclusions Carotid artery deformations using two‐dimensional speckle‐tracking imaging showed novel mechanistic insights on functional arterial alterations reflecting coupled arterial‐ventricular pathophysiology. Utilization of such measure may further provide additive prognostic value to advanced myocardial functional assessment.
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Affiliation(s)
- Kevin Ning Zhou
- Williams College Department of Biology, Williams College, 59 Lab Campus Drive, Williamstown, MA, 01267, USA
| | - Kuo-Tzu Sung
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.,Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Zhongshan North Road, Taipei, 104, Taiwan
| | - Chih-Hsuan Yen
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.,Institute of Preventive Medicine, School of Public Health, National Taiwan University, Taipei, Taiwan.,Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Zhongshan North Road, Taipei, 104, Taiwan
| | - Cheng-Huang Su
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.,Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Zhongshan North Road, Taipei, 104, Taiwan
| | - Ping-Ying Lee
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.,Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Zhongshan North Road, Taipei, 104, Taiwan
| | - Ta-Chuan Hung
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.,Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Zhongshan North Road, Taipei, 104, Taiwan
| | - Wen-Hung Huang
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.,Institute of Preventive Medicine, School of Public Health, National Taiwan University, Taipei, Taiwan.,Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Zhongshan North Road, Taipei, 104, Taiwan
| | - Shih-Chieh Chien
- Department of Critical Care Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Jui-Peng Tsai
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.,Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Zhongshan North Road, Taipei, 104, Taiwan.,Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei, Taiwan
| | - Chun-Ho Yun
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei, Taiwan.,Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Shun-Chuan Chang
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Hung-I Yeh
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Institute of Preventive Medicine, School of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chung-Lieh Hung
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.,Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Zhongshan North Road, Taipei, 104, Taiwan.,Institute of biomedical sciences, Mackay Medical College, New Taipei City, Taiwan
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Hjertaas JJ, Matre K. A left ventricular phantom for 3D echocardiographic twist measurements. BIOMED ENG-BIOMED TE 2020; 65:209-218. [DOI: 10.1515/bmt-2019-0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/08/2019] [Indexed: 11/15/2022]
Abstract
AbstractTraditional two-dimensional (2D) ultrasound speckle tracking echocardiography (STE) studies have shown a wide range of twist values, also for normal hearts, which is due to the limitations of short-axis 2D ultrasound. The same limitations do not apply to three-dimensional (3D) ultrasound, and several studies have shown 3D ultrasound to be superior to 2D ultrasound, which is unreliable for measuring twist. The aim of this study was to develop a left ventricular twisting phantom and to evaluate the accuracy of 3D STE twist measurements using different acquisition methods and volume rates (VR). This phantom was not intended to simulate a heart, but to function as a medium for ultrasound deformation measurement. The phantom was made of polyvinyl alcohol (PVA) and casted using 3D printed molds. Twist was obtained by making the phantom consist of two PVA layers with different elastic properties in a spiral pattern. This gave increased apical rotation with increased stroke volume in a mock circulation. To test the accuracy of 3D STE twist, both single-beat, as well as two, four and six multi-beat acquisitions, were recorded and compared against twist from implanted sonomicrometry crystals. A custom-made software was developed to calculate twist from sonomicrometry. The phantom gave sonomicrometer twist values from 2.0° to 13.8° depending on the stroke volume. STE software tracked the phantom wall well at several combinations of temporal and spatial resolution. Agreement between the two twist methods was best for multi-beat acquisitions in the range of 14.4–30.4 volumes per second (VPS), while poorer for single-beat and higher multi-beat VRs. Smallest offset was obtained at six-beat multi-beat at 17.1 VPS and 30.4 VPS. The phantom proved to be a useful tool for simulating cardiac twist and gave different twist at different stroke volumes. Best agreement with the sonomicrometer reference method was obtained at good spatial resolution (high beam density) and a relatively low VR. 3D STE twist values showed better agreement with sonomicrometry for most multi-beat recordings compared with single-beat recordings.
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Affiliation(s)
- Johannes Just Hjertaas
- Department of Clinical Science, University of Bergen, Haukeland University Hospital, 5021 Bergen, Norway
| | - Knut Matre
- Department of Clinical Science, University of Bergen, Haukeland University Hospital, 5021 Bergen, Norway
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19
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Alshareef A, Giudice JS, Forman J, Shedd DF, Wu T, Reynier KA, Panzer MB. Application of trilateration and Kalman filtering algorithms to track dynamic brain deformation using sonomicrometry. Biomed Signal Process Control 2020. [DOI: 10.1016/j.bspc.2019.101691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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20
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Kim K, Choi D, Im S. Understanding the effect of methane gas sensitivity using ultrasonic sensors and multi-matching layers inside a natural gas vehicle tank. ULTRASONICS 2019; 99:105970. [PMID: 31394480 DOI: 10.1016/j.ultras.2019.105970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/24/2019] [Accepted: 07/26/2019] [Indexed: 06/10/2023]
Abstract
This research paper is the experimental study to investigate the effect of ultrasound sensitivity in the pure methane gas space as the pressure and sensor distance increases. We offer the solution to overcome the low sensitivity characteristics of ultrasonic sensors in the methane gas space. This proposal shows the physical characteristics analyzed with self-induced vibration, beam pattern, amplitude, attenuation, and Gaussian distribution validation in CH4 gas space. An ultrasonic sensor is designed with PbTio3 material of an MS-50 PTZ. The signal processing analysis system (APAS) is composed of the mechanical and controlling sections including three mass flow controllers, an air cylinder, safety valves, three pressure regulators, a CVC, ultrasound sensors, and two gas tanks (air and CH4). The experiment is performed in a wide range of the initial conditions, i.e., supplying voltage of 25 V, current of 0.2 A, pulse rate of 7 Hz, measuring distance of 0.32 to 1.02 m, resonance frequency of 57.3 Hz, ambient temperature of 296 K, and pressure increases of 1, 2, 3 and 4 bar. The ultrasonic sensitivity of a sensor (T: EVA and R: EVA) significantly enhanced the acoustic impedance in a methane gas space as pressure increases. It is verified that the sensitivity effect of an ultrasonic sensor used with ethylene vinyl acetate (EVA) matching layer is higher in the methane gas space than a chemical wood (CW) matching layer. Consequently, the effect of gas sensitivity computed by a GDA including the width (W), area (A), and height (H) is enhanced by an EVA sensor in comparison to other Models.
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Affiliation(s)
- Kwonse Kim
- Mechanical Engineering Department, Mississippi State University, Starkville, MS 39762, USA
| | - Dooseuk Choi
- Mechanical & Automotive Engineering Division, Kongju National University, 1223-24, Cheonan-daero, Seobuk-gu, Cheonan-si, Chungnam 31080, Republic of Korea
| | - Seokyeon Im
- Automotive Engineering Department, Tongmyong University, 428, Sinseon-ro, Nam-gu, Busan 48520, Republic of Korea.
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Nayak R, Kumar V, Webb J, Fatemi M, Alizad A. Non-invasive Small Vessel Imaging of Human Thyroid Using Motion-Corrected Spatiotemporal Clutter Filtering. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1010-1018. [PMID: 30718145 PMCID: PMC6391182 DOI: 10.1016/j.ultrasmedbio.2018.10.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 09/13/2018] [Accepted: 10/22/2018] [Indexed: 05/08/2023]
Abstract
Reliable assessment of small vessel blood flow in the thyroid, without using any contrast agents, can be challenging because of increased physiological motion resulting from its proximity to the pulsating carotid artery. In this study, we hypothesized that correction of tissue motion prior to singular value decomposition (SVD)-based clutter filtering can improve the coherency of the tissue components and, thus, may allow better clutter suppression and visualization of small vessels in the thyroid. We corroborated this hypothesis by conducting phantom and in vivo studies using a clinical ultrasound scanner implemented with compounded plane wave imaging. The phantom studies were conducted using a homogeneous tissue-mimicking phantom to study the impact of motion on the covariance of the spatiotemporal Doppler data, in the absence of blood activity. The non-invasive in vivo study was conducted on a 74-y-old woman with a thyroid nodule suspicious of malignancy. A rigid body-based motion correction was performed using tissue displacements obtained from 2-D normalized cross-correlation-based speckle tracking. Subsequently, the power Doppler images were computed using SVD-based spatiotemporal clutter filtering. The results from the phantom study revealed that motion can considerably reduce the covariance of the spatiotemporal data and, thus, increase the rank of the tissue components. When the phantom was subjected to a total translation displacement of 6 pixels over the entire ensemble, in each direction (axial and lateral), the covariance dropped by more than 25%. The results obtained from the non-invasive in vivo study indicated that visualization of small vessel blood flow improved with motion correction of the power Doppler ensemble. The contrast-to-noise ratio of the blood signal in motion-corrected power Doppler images was considerably higher (8.17 and 8.32 dB), compared with that obtained using the standard SVD approach at an optimal threshold (0.87 and 4.33 dB) and a lower singular value threshold (1.92 and 3.05 dB). Further, the covariance of the in vivo thyroid spatiotemporal data increased by approximately 10% with motion correction. These preliminary results indicate that motion correction can be used to improve the visualization of small vessel blood flow in the thyroid, without using any contrast agents. The results of this feasibility study were encouraging, and warrant further development and more in vivo validation in moving tissues and organs.
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Affiliation(s)
- Rohit Nayak
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, 55902, United States
- Corresponding Author: Azra Alizad ()
| | - Viksit Kumar
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, 55902, United States
| | - Jeremy Webb
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, 55902, United States
| | - Mostafa Fatemi
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, 55902, United States
| | - Azra Alizad
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, 55902, United States
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Liu Z, Bai Z, Huang C, Huang M, Huang L, Xu D, Zhang H, Yuan C, Luo J. Interoperator Reproducibility of Carotid Elastography for Identification of Vulnerable Atherosclerotic Plaques. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2019; 66:505-516. [PMID: 30575532 DOI: 10.1109/tuffc.2018.2888479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Ultrasound-based carotid elastography has been developed to evaluate the vulnerability of carotid atherosclerotic plaques. The aim of this study was to investigate the in vivo interoperator reproducibility of carotid elastography for the identification of vulnerable plaques, with high-resolution magnetic resonance imaging (MRI) as reference. Ultrasound radio-frequency data of 45 carotid arteries (including 53 plaques) from 32 volunteers were acquired separately by two experienced operators in the longitudinal view and then were used to estimate the interframe axial strain rate (ASR) with a two-step optical flow method. The maximum 99th percentile of absolute ASR of all plaques in a carotid artery was used as the elastographic index. MRI scanning was also performed on each volunteer to identify the vulnerable plaque. The results showed no systematic bias in the Bland-Altman plot and an intraclass correlation coefficient of 0.66 between the two operators. In addition, no statistical significance was found between the receiver operating characteristic (ROC) curves from the two operators ( ), and their areas under the ROC curves were 0.83 and 0.77, respectively. Using the mean measurements of the two operators as the classification criterion, a sensitivity of 71.4%, a specificity of 87.1%, and an accuracy of 82.2% were obtained with a cutoff value of 1.37 [Formula: see text]. This study validates the interoperator reproducibility of ultrasound-based carotid elastography for identifying vulnerable carotid plaques.
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Li H, Porée J, Roy Cardinal MH, Cloutier G. Two-dimensional affine model-based estimators for principal strain vascular ultrasound elastography with compound plane wave and transverse oscillation beamforming. ULTRASONICS 2019; 91:77-91. [PMID: 30081331 DOI: 10.1016/j.ultras.2018.07.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 04/26/2018] [Accepted: 07/20/2018] [Indexed: 06/08/2023]
Abstract
Polar strain (radial and circumferential) estimations can suffer from artifacts because the center of a nonsymmetrical carotid atherosclerotic artery, defining the coordinate system in cross-sectional view, can be misregistered. Principal strains are able to remove coordinate dependency to visualize vascular strain components (i.e., axial and lateral strains and shears). This paper presents two affine model-based estimators, the affine phase-based estimator (APBE) developed in the framework of transverse oscillation (TO) beamforming, and the Lagrangian speckle model estimator (LSME). These estimators solve simultaneously the translation (axial and lateral displacements) and deformation (axial and lateral strains and shears) components that were then used to compute principal strains. To improve performance, the implemented APBE was also tested by introducing a time-ensemble estimation approach. Both APBE and LSME were tested with and without the plane strain incompressibility assumption. These algorithms were evaluated on coherent plane wave compounded (CPWC) images considering TO. LSME without TO but implemented with the time-ensemble and incompressibility constraint (Porée et al., 2015) served as benchmark comparisons. The APBE provided better principal strain estimations with the time-ensemble and incompressibility constraint, for both simulations and in vitro experiments. With a few exceptions, TO did not improve principal strain estimates for the LSME. With simulations, the smallest errors compared with ground true measures were obtained with the LSME considering time-ensemble and the incompressibility constraint. This latter estimator also provided the highest elastogram signal-to-noise ratios (SNRs) for in vitro experiments on a homogeneous vascular phantom without any inclusion, for applied strains varying from 0.07% to 4.5%. It also allowed the highest contrast-to-noise ratios (CNRs) for a heterogeneous vascular phantom with a soft inclusion, at applied strains from 0.07% to 3.6%. In summary, the LSME outperformed the implemented APBE, and the incompressibility constraint improved performances of both estimators.
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Affiliation(s)
- Hongliang Li
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center (CRCHUM), Montréal, QC, Canada; Institute of Biomedical Engineering, University of Montreal, Montréal, QC, Canada
| | - Jonathan Porée
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center (CRCHUM), Montréal, QC, Canada; Institute of Biomedical Engineering, University of Montreal, Montréal, QC, Canada
| | - Marie-Hélène Roy Cardinal
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center (CRCHUM), Montréal, QC, Canada
| | - Guy Cloutier
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center (CRCHUM), Montréal, QC, Canada; Institute of Biomedical Engineering, University of Montreal, Montréal, QC, Canada; Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, Montréal, QC, Canada.
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Non-contrast agent based small vessel imaging of human thyroid using motion corrected power Doppler imaging. Sci Rep 2018; 8:15318. [PMID: 30333509 PMCID: PMC6193022 DOI: 10.1038/s41598-018-33602-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 10/02/2018] [Indexed: 01/15/2023] Open
Abstract
Singular value based spatiotemporal clutter filtering (SVD-STF) can significantly improve the sensitivity of blood flow imaging in small vessels without using contrast agents. However, despite effective clutter filtering, large physiological motion in thyroid imaging can impact coherent integration of the Doppler signal and degrade the visualization of the underlying vasculature. In this study, we hypothesize that motion correction of the clutter filtered Doppler ensemble, prior to the power Doppler estimation, can considerably improve the visualization of smalls vessels in suspicious thyroid nodules. We corroborated this hypothesis by conducting in vivo experiments on 10 female patients in the age group 44-82 yrs, with at least one thyroid nodule suspicious of malignancy, with recommendation for fine needle aspiration biopsy. Ultrasound images were acquired using a clinical ultrasound scanner, implemented with compounded plane wave imaging. Axial and lateral displacements associated with the thyroid nodules were estimated using 2D normalized cross-correlation. Subsequently, the tissue clutter associated with the Doppler ensemble was suppressed using SVD-STF. Motion correction of the clutter-filtered Doppler ensemble was achieved using a spline based sub-pixel interpolation. The results demonstrated that power Doppler images of thyroid nodules were noticeably degraded due to large physiological motion of the pulsating carotid artery in the proximity. The resultant power Doppler images were corrupted with signal distortion, motion blurring and occurrence of artificial shadow vessels and displayed visibly low signal-to-background contrast. In contrast, the power Doppler images obtained from the motion corrected ultrasound data addressed the issue and considerabley improved the visualization of blood flow. The signal-to-noise ratio and the contrast-to-noise ratio increased by up to 15.2 dB and 12.1 dB, respectively. Across the ten subjects, the highest improvement was observed for the nodule with the largest motion. These preliminary results show the ability of using motion correction to improve the visualization of small vessel blood flow in thyroid, without using any contrast agents. The results of this feasibility study were encouraging, and warrant further development and more in vivo validation in moving tissues and organs.
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Nayak R, Schifitto G, Doyley MM. Visualizing Angle-Independent Principal Strains in the Longitudinal View of the Carotid Artery: Phantom and In Vivo Evaluation. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:1379-1391. [PMID: 29685590 PMCID: PMC5960628 DOI: 10.1016/j.ultrasmedbio.2018.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 02/08/2018] [Accepted: 03/16/2018] [Indexed: 05/03/2023]
Abstract
Non-invasive vascular elastography can evaluate the stiffness of the carotid artery by visualizing the vascular strain distribution. Axial strain estimates of the longitudinal cross section of the carotid artery are sensitive to the angle between the artery and the transducer. Anatomical variations in branching and arching of the carotid artery can affect the assessment of arterial stiffness. In this study, we hypothesized that principal strain elastograms computed using compounded plane wave imaging can reliably visualize the strain distribution in the carotid artery, independent of the transducer angle. We corroborated this hypothesis by conducting phantom and in vivo studies using a commercial ultrasound scanner (Sonix RP, Ultrasonix Medical Corp., Richmond, BC, Canada). The phantom studies were conducted using a homogeneous cryogel vessel phantom. The goal of the phantom study was to assess the feasibility of visualizing the radial deformation in the longitudinal plane of the vessel phantom, independent of the transducer angle (±30°, ±20°, ±10° and 0°). The in vivo studies were conducted on 20 healthy human volunteers in the age group 50-60 y. All echo imaging was performed at a transmit frequency of 5 MHz and sampling frequency of 40 MHz. The elastograms obtained from the phantom study revealed that for straight vessels, which had their lumen parallel to the transducer, principal strains were similar to axial strains. At non-parallel configurations (angles ±30°, ±20° and ±10°), the magnitudes of the mean principal strains were within 2.5% of the parallel configuration (0° angle) estimates and, thus, were observed to be relatively unaffected by change in angle. However, in comparison, the magnitude of the axial strain decreased with increase in angle because of coordinate dependency. Further, the pilot in vivo study indicated that the principal and axial strain elastograms were similar for subjects with relatively straight arteries. However, for arteries with arched geometry, axial strains were significantly lower (p <0.01) than the corresponding principal vascular strains, which was consistent with the results obtained from the phantom study. In conclusion, the results of the phantom and in vivo studies revealed that principal strain elastograms computed using CPW imaging could reliably visualize angle-independent vascular strains in the longitudinal plane of the carotid artery.
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Affiliation(s)
- Rohit Nayak
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, New York, USA.
| | - Giovanni Schifitto
- Department of Neurology, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York, USA
| | - Marvin M Doyley
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, New York, USA; Department of Biomedical Engineering, University of Rochester, Rochester, New York, USA
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Impairment of vascular strain in patients with obstructive sleep apnea. PLoS One 2018; 13:e0193397. [PMID: 29489881 PMCID: PMC5831412 DOI: 10.1371/journal.pone.0193397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 02/10/2018] [Indexed: 11/18/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) is an independent risk factor for the development of cardiovascular diseases. Aim of this present study was to evaluate and extend recent research on the influence of obstructive sleep apnea on vascular strain. Methods A total number of 98 patients were integrated in the study. Patients were grouped according to the Apnea-Hypopnea-Index (AHI) in patients with mild-to-moderate OSA (5/h ≤ AHI < 30/h), severe OSA (AHI ≥ 30/h) and controls (AHI < 5/h). Groups were matched in age, body-mass-index and cardiovascular risks. Vascular strain of common carotid arteries was assessed by ultrasound speckle-tracking. A minor group of 30 patients and controls further underwent assessment of vascular strain of brachial and femoral arteries. Additionally, all patients underwent blood testing to reveal potential influences of inflammatory markers on arterial stiffness. In additional analysis we examined the effect of statin therapy on vascular strain. Results Patients with OSA showed significantly reduced values of vascular strain of common carotid arteries. Radial and circumferential strains were significantly lower in both patients with mild-to-moderate (p = .05) and patients with severe OSA (p = .001) compared to control. Vascular strain parameters of brachial and femoral arteries showed no consistent results. There were no significant correlations of inflammatory markers with vascular strain parameters. No significant differences in vascular strain were detected between statin and non-statin groups. Conclusion Patients with OSA show significantly reduced vascular strain assessed by ultrasound-based speckle-tracking. Vascular stiffness increases with the severity of the disease. Target vessels to assess vascular strain in patients with OSA are common carotid arteries, whereas other sites of the arterial tree are not reliable. No significant impact of current statin therapy on vascular strain was found. Further studies are needed to evaluate potential benefit of statins in secondary prevention of atherosclerosis in OSA.
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Tuleta I, Skowasch D, Aurich F, Eckstein N, Schueler R, Pizarro C, Schahab N, Nickenig G, Schaefer C, Pingel S. Asthma is associated with atherosclerotic artery changes. PLoS One 2017; 12:e0186820. [PMID: 29073174 PMCID: PMC5658104 DOI: 10.1371/journal.pone.0186820] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 10/09/2017] [Indexed: 12/18/2022] Open
Abstract
Asthma is a chronic airway inflammation with a potential systemic impact. Atherosclerosis is a chronic inflammatory artery disease. The aim of our study was to prove if there is a correlation between the occurrence of asthma and increased atherosclerotic vessel disorders. Vessel status was compared between mild-to-moderate, severe allergic asthma and matched controls. Measurements of artery stiffness were calculated by central pulse wave velocity, ultrasonographic strain imaging and ankle-brachial index. Atherosclerotic plaque burden was assessed by colour-coded duplex sonography. Additionally, analysis of cardiovascular and asthma blood markers was conducted. Arterial stiffness expressed as an increased central pulse wave velocity and decreased circumferential and radial strains as well as the prevalence of media sclerosis were significantly higher among asthma patients compared to controls. Atherosclerotic plaque burden was relevantly increased in asthma groups vs. controls (severe asthma: 43.1%, mild-to-moderate asthma: 25.0%, control: 14.3% of study participants). Except for the elevated IgE and fibrinogen concentrations as well as leukocyte number there were no relevant differences in the blood parameters between the groups. Allergic asthma is associated with distinct atherosclerotic artery changes compared to the respectively matched control collective. The severity of asthma correlates with more pronounced pathological vessel alternations.
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Affiliation(s)
- Izabela Tuleta
- Department of Internal Medicine II–Cardiology, Pulmonology and Angiology, University of Bonn, Bonn, Germany
- * E-mail:
| | - Dirk Skowasch
- Department of Internal Medicine II–Cardiology, Pulmonology and Angiology, University of Bonn, Bonn, Germany
| | - Florian Aurich
- Department of Internal Medicine II–Cardiology, Pulmonology and Angiology, University of Bonn, Bonn, Germany
| | - Nicolas Eckstein
- Department of Internal Medicine II–Cardiology, Pulmonology and Angiology, University of Bonn, Bonn, Germany
| | - Robert Schueler
- Department of Internal Medicine II–Cardiology, Pulmonology and Angiology, University of Bonn, Bonn, Germany
| | - Carmen Pizarro
- Department of Internal Medicine II–Cardiology, Pulmonology and Angiology, University of Bonn, Bonn, Germany
| | - Nadjib Schahab
- Department of Internal Medicine II–Cardiology, Pulmonology and Angiology, University of Bonn, Bonn, Germany
| | - Georg Nickenig
- Department of Internal Medicine II–Cardiology, Pulmonology and Angiology, University of Bonn, Bonn, Germany
| | - Christian Schaefer
- Department of Internal Medicine II–Cardiology, Pulmonology and Angiology, University of Bonn, Bonn, Germany
| | - Simon Pingel
- Department of Internal Medicine II–Cardiology, Pulmonology and Angiology, University of Bonn, Bonn, Germany
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Black JM, Stöhr EJ, Stone K, Pugh CJA, Stembridge M, Shave R, Esformes JI. The effect of an acute bout of resistance exercise on carotid artery strain and strain rate. Physiol Rep 2017; 4:4/17/e12959. [PMID: 27624687 PMCID: PMC5027362 DOI: 10.14814/phy2.12959] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 08/06/2016] [Indexed: 01/10/2023] Open
Abstract
Arterial wall mechanics likely play an integral role in arterial responses to acute physiological stress. Therefore, this study aimed to determine the impact of low and moderate intensity double‐leg press exercise on common carotid artery (CCA) wall mechanics using 2D vascular strain imaging. Short‐axis CCA ultrasound images were collected in 15 healthy men (age: 21 ± 3 years; stature: 176.5 ± 6.2 cm; body mass; 80.6 ± 15.3 kg) before, during, and immediately after short‐duration isometric double‐leg press exercise at 30% and 60% of participants' one‐repetition maximum (1RM: 317 ± 72 kg). Images were analyzed for peak circumferential strain (PCS), peak systolic and diastolic strain rate (S‐SR and D‐SR), and arterial diameter. Heart rate (HR), systolic and diastolic blood pressure (SBP and DBP) were simultaneously assessed and arterial stiffness indices were calculated post hoc. A two‐way repeated measures ANOVA revealed that during isometric contraction, PCS and S‐SR decreased significantly (P < 0.01) before increasing significantly above resting levels post exercise (P < 0.05 and P < 0.01, respectively). Conversely, D‐SR was unaltered throughout the protocol (P = 0.25). No significant differences were observed between the 30% and 60% 1RM trials. Multiple regression analysis highlighted that HR, BP, and arterial diameter did not fully explain the total variance in PCS, S‐SR, and D‐SR. Acute double‐leg press exercise is therefore associated with similar transient changes in CCA wall mechanics at low and moderate intensities. CCA wall mechanics likely provide additional insight into localized intrinsic vascular wall properties beyond current measures of arterial stiffness.
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Affiliation(s)
- Jane M Black
- Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom Cardiff Centre for Exercise and Health, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Eric J Stöhr
- Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Keeron Stone
- Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Christopher J A Pugh
- Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom Cardiff Centre for Exercise and Health, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Mike Stembridge
- Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom Cardiff Centre for Exercise and Health, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Rob Shave
- Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom Cardiff Centre for Exercise and Health, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Joseph I Esformes
- Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom Cardiff Centre for Exercise and Health, Cardiff Metropolitan University, Cardiff, United Kingdom
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Liu Z, Huang C, Luo J. A Systematic Investigation of Lateral Estimation Using Various Interpolation Approaches in Conventional Ultrasound Imaging. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2017; 64:1149-1160. [PMID: 28534769 DOI: 10.1109/tuffc.2017.2705186] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Accurate lateral displacement and strain estimation is critical for some applications of elasticity imaging. Typically, motion estimation in the lateral direction is challenging because of low sampling frequency and lack of phase information in conventional ultrasound imaging. Several approaches have been proposed to improve the performance of lateral estimation, such as lateral interpolation on the radio frequency (RF) signals (Interp_RF), lateral interpolation on the cross-correlation function (Interp_CCF), and lateral interpolation on both the RF signals and cross-correlation function (Interp_Both). In this paper, the estimation performances of the above-mentioned three approaches are compared systematically in simulations and phantom experiments. In the simulations, the root-mean-square error (RMSE) of axial/lateral displacement and strain is utilized to assess the accuracy of motion estimation. In the phantom experiments, the displacement quality metric (DQM), defined as the normalized cross-correlation between the motion-compensated reference frame and the comparison frame, and the contrast-to-noise ratio (CNR) of axial/lateral strain are used as the evaluation criteria. The results show that the three approaches have similar performance in axial estimation. For lateral estimation, if the line density of ultrasound imaging is relatively high (i.e., >4.2 lines/mm), Interp_CCF is comparable to Interp_Both, and Interp_RF performs the worst. However, if the line density is relatively low (i.e., <2.8 lines/mm), Interp_Both performs the best as indicated by the lowest RMSEs or highest DQMs and CNRs in lateral estimation. The trend is consistent at different window sizes, applied strains, and sonographic signal-to-noise ratios (>20 dB). Besides, Interp_Both with a small interpolation factor (e.g., 3-5) is found to obtain the best tradeoff between the estimation accuracy and the computational cost, and thus is suggested for lateral motion estimation in the case of a low line density (i.e., <2.8 lines/mm).
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Podgórski M, Grzelak P, Kaczmarska M, Polguj M, Łukaszewski M, Stefańczyk L. Feasibility of two-dimensional speckle tracking in evaluation of arterial stiffness: Comparison with pulse wave velocity and conventional sonographic markers of atherosclerosis. Vascular 2017; 26:63-69. [PMID: 28728481 DOI: 10.1177/1708538117720047] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Arterial stiffening is an early marker of atherosclerosis that has a prognostic value for cardiovascular morbidity and mortality. Although many markers of arterial hardening have been proposed, the search is on for newer, more user-friendly and reliable surrogates. One such potential candidate has emerged from cardiology, the speckle-tracking technique. The aim of this study was to evaluate the feasibility of the two-dimensional speckle tracking for the evaluation of arterial wall stiffness in comparison with standard stiffness parameters. Methods Carotid ultrasound and applanation tonometry were performed in 188 patients with no cardiovascular risk factors. The following parameters were then evaluated: the intima-media complex thickness, distensibility coefficient, β-stiffness index, circumferential strain/strain rate, and pulse wave velocity and augmentation index. These variables were compared with each other and with patient age, and their reliability was assessed with Bland-Altman plots. Results Strain parameters derived from two-dimensional speckle tracking and intima-media complex thickness correlated better with age and pulse wave velocity than standard makers of arterial stiffness. Moreover, the reliability of these measurements was significantly higher than conventional surrogates. Conclusions Two-dimensional speckle tracing is a reliable method for the evaluation of arterial stiffness. Therefore, together with intima-media complex thickness measurement, it offers great potential in clinical practice as an early marker of atherosclerosis.
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Affiliation(s)
- Michał Podgórski
- 1 Department of Radiology and Diagnostic Imaging, Medical University of Lodz, Poland
| | - Piotr Grzelak
- 1 Department of Radiology and Diagnostic Imaging, Medical University of Lodz, Poland
| | - Magdalena Kaczmarska
- 1 Department of Radiology and Diagnostic Imaging, Medical University of Lodz, Poland
| | - Michał Polguj
- 2 Department of Angiology, Chair of Anatomy, Medical University of Lodz, Poland
| | - Maciej Łukaszewski
- 3 Department of Diagnostic Imaging, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Ludomir Stefańczyk
- 1 Department of Radiology and Diagnostic Imaging, Medical University of Lodz, Poland
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Teixeira R, Monteiro R, Baptista R, Pereira T, Ribeiro MA, Gonçalves A, Cardim N, Gonçalves L. Aortic arch mechanics measured with two-dimensional speckle tracking echocardiography. J Hypertens 2017; 35:1402-1410. [DOI: 10.1097/hjh.0000000000001336] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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32
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Petrini J, Eriksson MJ, Caidahl K, Larsson M. Circumferential strain by velocity vector imaging and speckle-tracking echocardiography: validation against sonomicrometry in an aortic phantom. Clin Physiol Funct Imaging 2017; 38:269-277. [DOI: 10.1111/cpf.12410] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 11/22/2016] [Indexed: 12/29/2022]
Affiliation(s)
- Johan Petrini
- Department of Molecular Medicine and Surgery; Karolinska Institutet; Stockholm Sweden
- Department of Clinical Physiology; Södersjukhuset; Stockholm Sweden
| | - Maria J. Eriksson
- Department of Molecular Medicine and Surgery; Karolinska Institutet; Stockholm Sweden
- Department of Clinical Physiology; Karolinska University Hospital; Stockholm Sweden
| | - Kenneth Caidahl
- Department of Molecular Medicine and Surgery; Karolinska Institutet; Stockholm Sweden
- Department of Clinical Physiology; Karolinska University Hospital; Stockholm Sweden
| | - Matilda Larsson
- Department of Molecular Medicine and Surgery; Karolinska Institutet; Stockholm Sweden
- Department of Medical Engineering; School of Technology and Health; KTH Royal Institute of Technology; Stockholm Sweden
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Ho CK, Chee AJY, Yiu BYS, Tsang ACO, Chow KW, Yu ACH. Wall-Less Flow Phantoms With Tortuous Vascular Geometries: Design Principles and a Patient-Specific Model Fabrication Example. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2017; 64:25-38. [PMID: 27959808 DOI: 10.1109/tuffc.2016.2636129] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Flow phantoms with anatomically realistic geometry and high acoustic compatibility are valuable investigative tools in vascular ultrasound studies. Here, we present a new framework to fabricate ultrasound-compatible flow phantoms to replicate human vasculature that is tortuous, nonplanar, and branching in nature. This framework is based upon the integration of rapid prototyping and investment casting principles. A pedagogical walkthrough of our engineering protocol is presented in this paper using a patient-specific cerebral aneurysm model as an exemplar demonstration. The procedure for constructing the flow circuit component of the phantoms is also presented, including the design of a programmable flow pump system, the fabrication of blood mimicking fluid, and flow rate calibration. Using polyvinyl alcohol cryogel as the tissue mimicking material, phantoms developed with the presented protocol exhibited physiologically relevant acoustic properties [attenuation coefficient: 0.229±0.032 dB/( [Formula: see text]) and acoustic speed: 1535±2.4 m/s], and their pulsatile flow dynamics closely resembled the flow profile input. As a first application of our developed phantoms, the flow pattern of the patient-specific aneurysm model was visualized by performing high-frame-rate color-encoded speckle imaging over multiple time-synchronized scan planes. Persistent recirculation was observed, and the vortex center was found to shift in position over a cardiac cycle, indicating the 3-D nature of flow recirculation inside an aneurysm. These findings suggest that phantoms produced from our reported protocol can serve well as acoustically compatible test beds for vascular ultrasound studies, including 3-D flow imaging.
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Descending aortic mechanics and atrial fibrillation: a two-dimensional speckle tracking transesophageal echocardiography study. Int J Cardiovasc Imaging 2016; 33:509-519. [DOI: 10.1007/s10554-016-1028-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 11/21/2016] [Indexed: 12/20/2022]
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35
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Leite L, Teixeira R, Oliveira-Santos M, Barbosa A, Martins R, Castro G, Gonçalves L, Pego M. Aortic Valve Disease and Vascular Mechanics: Two-Dimensional Speckle Tracking Echocardiographic Analysis. Echocardiography 2016; 33:1121-30. [PMID: 27083146 DOI: 10.1111/echo.13236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Degenerative aortic valve disease (AVD) is a complex disorder that goes beyond valve itself, also undermining aortic wall. We aimed to assess the ascending aortic mechanics with two-dimensional speckle tracking echocardiography (2DSTE) in patients with aortic regurgitation (AR) and hypothesized a relationship with degree of AR. Aortic mechanics were then compared with those of similarly studied healthy controls and patients with aortic stenosis (AS); finally, we aimed to assess the prognostic significance of vascular mechanics in AVD. METHODS Overall, 73 patients with moderate-to-severe AR and 22 healthy subjects were enrolled, alongside a previously examined cohort (N = 45) with moderate-to-severe AS. Global circumferential ascending aortic strain (CAAS) and strain rate (CAASR) served as indices of aortic deformation; corrected CAAS was calculated as CAAS/pulse pressure (PP). Median clinical follow-up was 438 days. RESULTS In patients with severe (vs. moderate) AR, CAASR (1.53 ± 0.29/sec vs. 1.90 ± 0.62/sec, P < 0.05) and corrected CAAS (0.14 ± 0.06%/mmHg vs. 0.19 ± 0.08%/mmHg, P < 0.05) were significantly lower, whereas CAAS did not differ significantly. Measurers of aortic mechanics (CAAS, corrected CAAS, CAASR) differed significantly (all P < 0.01) in patients with AS and AR and in healthy subjects, with lower values seen in patients with AS. In follow-up, survival rate of AVD patients with baseline CAASR >0.88/sec was significantly higher (log rank, 97.4% vs. 73.0%; P = 0.03). CONCLUSIONS Quantitative measures of aortic mechanics were lower for AS patients, suggesting a more significant derangement of aortic elastic properties. In the context of AVD, vascular mechanics assessment proved useful in gauging clinical prognosis.
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Affiliation(s)
- Luís Leite
- Department of Cardiology, University Unit, Coimbra Hospital and University Center, Coimbra, Portugal
| | - Rogério Teixeira
- Department of Cardiology, General Unit, Coimbra Hospital and University Center, Coimbra, Portugal.,Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
| | - Manuel Oliveira-Santos
- Department of Cardiology, University Unit, Coimbra Hospital and University Center, Coimbra, Portugal
| | - António Barbosa
- Department of Cardiology, University Unit, Coimbra Hospital and University Center, Coimbra, Portugal
| | - Rui Martins
- Department of Cardiology, University Unit, Coimbra Hospital and University Center, Coimbra, Portugal
| | - Graça Castro
- Department of Cardiology, University Unit, Coimbra Hospital and University Center, Coimbra, Portugal
| | - Lino Gonçalves
- Department of Cardiology, General Unit, Coimbra Hospital and University Center, Coimbra, Portugal.,Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
| | - Mariano Pego
- Department of Cardiology, University Unit, Coimbra Hospital and University Center, Coimbra, Portugal
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Boekhoven RW, Peters MFJ, Rutten MCM, van Sambeek MR, van de Vosse FN, Lopata RGP. Inflation and Bi-Axial Tensile Testing of Healthy Porcine Carotid Arteries. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:574-585. [PMID: 26598396 DOI: 10.1016/j.ultrasmedbio.2015.09.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 09/16/2015] [Accepted: 09/16/2015] [Indexed: 06/05/2023]
Abstract
Knowledge of the intrinsic material properties of healthy and diseased arterial tissue components is of great importance in diagnostics. This study describes an in vitro comparison of 13 porcine carotid arteries using inflation testing combined with functional ultrasound and bi-axial tensile testing. The measured tissue behavior was described using both a linear, but geometrically non-linear, one-parameter (neo-Hookean) model and a two-parameter non-linear (Demiray) model. The shear modulus estimated using the linear model resulted in good agreement between the ultrasound and tensile testing methods, GUS = 25 ± 5.7 kPa and GTT = 23 ± 5.4 kPa. No significant correspondence was observed for the non-linear model aUS = 1.0 ± 2.7 kPa vs. aTT = 17 ± 8.8 kPa, p ∼ 0); however, the exponential parameters were in correspondence (bUS = 12 ± 4.2 vs. bTT = 10 ± 1.7, p > 0.05). Estimation of more complex models in vivo is cumbersome considering the sensitivity of the model parameters to small changes in measurement data and the absence of intraluminal pressure data, endorsing the use of a simple, linear model in vivo.
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Affiliation(s)
- Renate W Boekhoven
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Mathijs F J Peters
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Marcel C M Rutten
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Marc R van Sambeek
- Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Frans N van de Vosse
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Richard G P Lopata
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
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Obstructive Sleep Apnea Is Related to Increased Arterial Stiffness in Ultrasound Speckle-Tracking Analysis. RESPIRATORY MEDICINE AND SCIENCE 2016; 910:9-14. [DOI: 10.1007/5584_2016_215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Maksuti E, Widman E, Larsson D, Urban MW, Larsson M, Bjällmark A. Arterial Stiffness Estimation by Shear Wave Elastography: Validation in Phantoms with Mechanical Testing. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:308-21. [PMID: 26454623 DOI: 10.1016/j.ultrasmedbio.2015.08.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 07/07/2015] [Accepted: 08/17/2015] [Indexed: 05/26/2023]
Abstract
Arterial stiffness is an independent risk factor found to correlate with a wide range of cardiovascular diseases. It has been suggested that shear wave elastography (SWE) can be used to quantitatively measure local arterial shear modulus, but an accuracy assessment of the technique for arterial applications has not yet been performed. In this study, the influence of confined geometry on shear modulus estimation, by both group and phase velocity analysis, was assessed, and the accuracy of SWE in comparison with mechanical testing was measured in nine pressurized arterial phantoms. The results indicated that group velocity with an infinite medium assumption estimated shear modulus values incorrectly in comparison with mechanical testing in arterial phantoms (6.7 ± 0.0 kPa from group velocity and 30.5 ± 0.4 kPa from mechanical testing). To the contrary, SWE measurements based on phase velocity analysis (30.6 ± 3.2 kPa) were in good agreement with mechanical testing, with a relative error between the two techniques of 8.8 ± 6.0% in the shear modulus range evaluated (40-100 kPa). SWE by phase velocity analysis was validated to accurately measure stiffness in arterial phantoms.
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Affiliation(s)
- Elira Maksuti
- Department of Medical Engineering, School of Technology and Health, KTH Royal Institute of Technology, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden.
| | - Erik Widman
- Department of Medical Engineering, School of Technology and Health, KTH Royal Institute of Technology, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden
| | - David Larsson
- Department of Medical Engineering, School of Technology and Health, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Matthew W Urban
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Matilda Larsson
- Department of Medical Engineering, School of Technology and Health, KTH Royal Institute of Technology, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden
| | - Anna Bjällmark
- Department of Medical Engineering, School of Technology and Health, KTH Royal Institute of Technology, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden
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Teixeira R, Vieira MJ, Gonçalves A, Cardim N, Gonçalves L. Ultrasonographic vascular mechanics to assess arterial stiffness: a review. Eur Heart J Cardiovasc Imaging 2015; 17:233-46. [DOI: 10.1093/ehjci/jev287] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 10/04/2015] [Indexed: 12/21/2022] Open
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40
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Zhang Q, Li C, Zhou M, Liao Y, Huang C, Shi J, Wang Y, Wang W. Quantification of carotid plaque elasticity and intraplaque neovascularization using contrast-enhanced ultrasound and image registration-based elastography. ULTRASONICS 2015; 62:253-262. [PMID: 26074459 DOI: 10.1016/j.ultras.2015.05.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 05/18/2015] [Accepted: 05/29/2015] [Indexed: 06/04/2023]
Abstract
It is valuable for evaluation of carotid plaque vulnerability to investigate the relation between intraplaque neovascularization (IPN) and plaque elasticity. The contrast-enhanced ultrasound (CEUS) has been used in IPN measurement, but it cannot assess plaque elasticity. The aim of this study was to develop an ultrasound elastography technique based on registration of CEUS sequential images and to use this technique for direct comparison between IPN and plaque elasticity. We employed a nonrigid image registration method using the free-form deformation model to register a pair of clinical CEUS images at systole and diastole. The 2D displacement field of the plaque was estimated and then utilized to calculate the axial and lateral strain distributions within the plaque, from which quantitative strain parameters were obtained. The IPN was measured semiquantitatively with visual assessment and quantitatively with the time-intensity curve analysis and the analysis of contrast agent spatial distributions. Histopathology with CD34 staining for quantification of microvessel density (MVD) was performed on plaques excised by carotid endarterectomy. Simulation experiments showed that the mean absolute error and the root mean squared error of the displacement estimation were 0.325±0.180 pixel (7.2%±3.8%) and 0.556±0.284 pixel (12.3%±6.1%), respectively, demonstrating high accuracy of the elastography technique. Thirty-eight plaques in 29 patients met the inclusion criteria for the elastography and image analysis, where ten plaques underwent endarterectomy. The 95th percentile (A95) and standard deviation (Asd) of the axial strains exhibited significant differences between the low and high grades of IPN visually assessed (p<0.01). A95 (R=0.579; p<0.001) and Asd (R=0.609; p<0.001) were correlated with the enhanced intensity of plaque, and also correlated with the MVD (R=0.793 and 0.817, respectively; p<0.01), suggesting that plaque became softer and more elastically heterogeneous as IPN increased. These findings provide direct and quantitative evidence for the associations between plaque strains and IPN and might be helpful for evaluation of carotid plaque vulnerability and for plaque risk stratification.
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Affiliation(s)
- Qi Zhang
- School of Communication and Information Engineering, Shanghai University, 200444 Shanghai, China.
| | - Chaolun Li
- Department of Ultrasound, Zhongshan Hospital, Fudan University, 200032 Shanghai, China.
| | - Moli Zhou
- School of Communication and Information Engineering, Shanghai University, 200444 Shanghai, China
| | - Yu Liao
- School of Communication and Information Engineering, Shanghai University, 200444 Shanghai, China
| | - Chunchun Huang
- School of Communication and Information Engineering, Shanghai University, 200444 Shanghai, China
| | - Jun Shi
- School of Communication and Information Engineering, Shanghai University, 200444 Shanghai, China.
| | - Yuanyuan Wang
- Department of Electronic Engineering, Fudan University, 200433 Shanghai, China.
| | - Wenping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, 200032 Shanghai, China.
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41
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Soleimani E, Mokhtari-Dizaji M, Saberi H. A novel non-invasive ultrasonic method to assess total axial stress of the common carotid artery wall in healthy and atherosclerotic men. J Biomech 2015; 48:1860-7. [PMID: 25981101 DOI: 10.1016/j.jbiomech.2015.04.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 02/09/2015] [Accepted: 04/23/2015] [Indexed: 11/17/2022]
Abstract
In the present study, developing a new non-invasive method independent from blood flow, we estimated and compared the total axial stress of the common carotid artery wall in healthy and atherosclerotic subjects. Consecutive ultrasonic images of the common carotid artery of 48 male subjects including healthy, with less and more than 50% stenosis in carotid artery were recorded. Longitudinal displacement and acceleration was extracted from ultrasonic image processing using a block matching algorithm. Furthermore, images were examined using a maximum gradient algorithm and time rate changes of the internal diameter and intima-media thickness were extracted. Finally, axial stress was estimated using an appropriate constitutive equation. Statistical analysis results showed that with stenosis initiation and its progression, axial acceleration and stress increase significantly. According to the results of the present study, maximum axial stress of the arterial wall is 1.713±0.546, 1.993±0.731 and 2.610±0.603 (kPa) in normal, with less and more than 50% stenosis in carotid artery respectively. Whereas minimum axial stress is -1.714±0.676, -1.982±0.663 and -2.593±0.661 (kPa) in normal, with less and more than 50% stenosis in carotid artery respectively. Moreover, internal diameter and intima-media thickness of the artery also increase significantly with stenosis initiation and its progression. In this study, the feasibility of axial wall stress computation for human common carotid arteries based on non-invasive in vivo clinical data is concluded. We found a strong and graded association between axial stress and severity of carotid stenosis, which might be used to discriminate healthy from atherosclerotic arteries.
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Affiliation(s)
- Effat Soleimani
- Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, P.O. Box: 14115-133, Tehran, Iran
| | - Manijhe Mokhtari-Dizaji
- Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, P.O. Box: 14115-133, Tehran, Iran.
| | - Hajir Saberi
- Department of Radiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Larsson M, Verbrugghe P, Smoljkić M, Verhoeven J, Heyde B, Famaey N, Herijgers P, D’hooge J. Strain assessment in the carotid artery wall using ultrasound speckle tracking: validation in a sheep model. Phys Med Biol 2015; 60:1107-23. [DOI: 10.1088/0031-9155/60/3/1107] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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