Intra-observer variability of longitudinal displacement and intramural shear strain measurements of the arterial wall using ultrasound noninvasively in vivo

Interframe Echo Intensity Variation of Subregions and Whole Plaque in Two-Dimensional Carotid Ultrasonography: Simulations and In Vivo Observations

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.

The influence of respiration, neck flexion, and arterial segment on carotid artery longitudinal wall motion

Although carotid artery longitudinal wall motion (CALM) has been highly detailed in cross-sectional studies, there is little evidence to explain population interindividual variability. This study was conducted to investigate how common external factors impact CALM. Twenty-one young healthy adults (11 females, aged 22 ± 2 yr) underwent three within-subject protocols. To evaluate probe positioning, vascular ultrasound was performed at a proximal and distal location along the common carotid artery. To evaluate neck angle, scans were acquired with the neck positioned at 70°, 90°, maximum extension (112 ± 9°), and maximum flexion (51 ± 7°). For the respiratory cycle condition, scans were taken during 7 s of inhalation, 7 s of exhalation, and 7 s of breath hold. CALM was evaluated for anterograde, retrograde, and maximum displacements, as well as radial-axial displacement. CALM was greater at proximal versus distal locations (retrograde = 1.14 ± 0.62 vs. 0.63 ± 0.24 mm, maximal = 1.32 ± 0.59 vs. 0.73 ± 0.24 mm; all P < 0.05). Minimum neck angles had greater motion than maximum angles (maximum displacement = 1.03 ± 0.43 vs. 0.77 ± 0.23 mm, P < 0.05). Without correcting breathing bias, retrograde displacement was greater during inspiration versus expiration (1.06 ± 0.34 vs. 0.58 ± 0.24 mm) and breath hold (1.06 ± 0.34 vs. 0.58 ± 0.24 mm), diastolic CALM was greater during expiration versus breath hold (1.10 ± 0.44 vs. 0.76 ± 0.33 mm), and maximum CALM was smaller during breath hold versus expiration (0.89 ± 0.31 vs. 1.21 ± 0.39 mm) and inspiration (0.89 ± 0.31 vs. 1.41 ± 0.70 mm). We recommend scanning 1-2 cm proximal to the carotid bifurcation, maintaining a neutral neck angle (70°-90°) for optimal CALM data collection in humans.NEW & NOTEWORTHY Carotid artery longitudinal wall motion (CALM) provides unique cardiovascular health information, yet a standardized approach to measurement is nonexistent. We tested CALM during manipulation of common external factors including probe position, neck angle, and breathing. All three conditions were found to alter CALM with drift in the breathing condition correctable by use of a linear bias correction. Consistent techniques should be used in CALM acquisition to reduce variability between individuals and population groups.

Response of the carotid artery longitudinal motion to submaximal physical activity in healthy humans-Marked changes already at low workload

The longitudinal motion of the arterial wall, that is, the displacement of the arterial wall along the artery, parallel to blood flow, is still largely unexplored. The magnitude and nature of putative changes in longitudinal motion of the arterial wall in response to physical activity in humans remain unknown. The aim of this study was therefore to study the longitudinal motion of the carotid artery wall during physical activity in healthy humans. Using in-house developed non-invasive ultrasonic methods, the longitudinal motion of the intima-media complex and the diameter changes of the right common carotid artery (CCA) in 40 healthy volunteers (20 volunteers aged 22-35 years; 20 volunteers aged 55-68 years) were assessed at rest and during submaximal supine bicycle exercise. In a subset of the subjects (n = 18) also intramural shear strain were analyzed. The longitudinal motion of the intima-media complex underwent marked changes in response to physical activity, already at low workload; with most evident a marked increase of the first antegrade displacement (p < 0.001) in early systole. Likewise, the corresponding shear strain also increased significantly (p = 0.004). The increase in longitudinal motion showed significant correlation to increase in blood pressure, but not to blood flow velocity or wall shear stress. In conclusion, physical activity markedly influences the longitudinal motion of the carotid artery wall in healthy humans already at low load. A possible "cushioning" function as well as possible implications for the function of the vasa vasorum, endothelium, and smooth muscle cells and extracellular matrix of the media, are discussed.

Physiological basis for longitudinal motion of the arterial wall

As opposed to arterial distension in the radial plane, longitudinal wall motion (LWM) is a multiphasic and bidirectional displacement of the arterial wall in the anterograde (i.e., in the direction of blood flow) and retrograde (i.e., opposing direction of blood flow) directions. While initially disregarded as imaging artifact, LWM has been consistently reported in ultrasound investigations in the last decade and is reproducible beat-to-beat, albeit with large inter-individual variability across healthy and diseased populations. Emerging literature has sought to examine the mechanistic control of LWM to explain the shape and variability of the motion pattern but lacks considerations for key foundational vascular principles at the level of the arterial wall ultrastructure. The purpose of this review is to summarize the potential factors that underpin the causes and control of arterial LWM, spanning considerations from the arterial extracellular matrix to systems-level integrative theories. First, an overview of LWM and relevant aspects wall composition will be discussed, including major features of the multiphasic pattern, arterial wall extracellular components, tunica fiber orientations, and arterial longitudinal pre-stretch. Second, current theories on the systems-level physiological mechanisms driving LWM will be discussed in the context of available evidence including experimental human research, porcine studies, and mathematical models. Throughout, we discuss implications of these observations with suggestions for future priority research areas.

Carotid Artery Longitudinal Wall Motion Is Unaffected by 12 Weeks of Endurance, Sprint Interval or Resistance Exercise Training

Carotid artery longitudinal wall motion (CALM) exhibits reduced magnitude in older adults and in individuals with chronic diseases, although longitudinal data are lacking to indicate how changes in CALM might develop over time. Therefore, the aim of this study was to investigate the effect of exercise training in healthy men on CALM using a retrospective design. Carotid ultrasound data were analysed from two previous studies in which men performed 12 wk of moderate-intensity continuous exercise training (n = 9), sprint-interval training (n = 7), higher-repetition resistance exercise training (n = 15) or lower-repetition resistance exercise training (n = 15). The CALM pattern was unaltered after 12 wk of exercise training, regardless of exercise mode, with no differences in systolic or diastolic CALM magnitudes (p > 0.05), similar to carotid intima-media thickness (p > 0.05). Our findings suggest that CALM is resistant to transient changes in lifestyle factors, similar to wall thickness in otherwise healthy populations.

A dynamic ultrasound simulation of a pulsating three-layered CCA for validation of two-dimensional wall motion and blood velocity estimation algorithms

PURPOSE

A dynamic ultrasound simulation model for the common carotid artery (CCA) with three arterial layers for validation of two-dimensional wall motion and blood velocity estimation algorithms is proposed in the present study. This model describes layers with not only characteristics of echo distributions conforming to clinical ones but also varying thicknesses, axial, and radial displacements with pulsatile blood pressure during a cardiac cycle.

METHODS

The modeling process is as follows: first, a geometrical model according with the clinical structure size of a CCA is built based on the preset layer thicknesses and the diameter of lumen. Second, a three-dimensional scatterer model is constructed by a mapping with a Hilbert space-filling curve from the one-dimensional scatterer distribution with the position and amplitude following Gamma and Gaussian distributions, respectively. The characteristics of three layers and blood are depicted by smoothly adjusting the scatterer density, the scale, and shape parameters of the Gamma distribution as well as the mean and standard deviation of the Gaussian distribution. To obtain the values of parameters of scatterer distributions, including the shape parameter, density, and intensity, for arterial layers and blood, the envelope signals simulated from different configurations of scatterer distribution are compared with those from different kinds of tissue of CCAs in vivo through a statistic analysis. Finally, the dynamic scatterer model is realized based on the blood pressure, elasticity modulus of intima-media (IM) and adventitia, varying IM thickness, axial displacement of IM as well as blood flow velocity at central axis during a cardiac cycle. Then, the corresponding radiofrequency (RF) signals, envelope signals, and B-mode images of the pulsatile CCA are generated in a dynamic scanning mode using Field II platform.

RESULTS

The three arterial layers, blood, and surrounding tissue in simulated B-mode ultrasound images are clearly legible. The results based on a statistical analysis for the envelope signals from 30 simulations indicate that the echo characteristics of blood, intima, media, and adventitia are in accordant with clinical ones. The maximum relative errors between the preset geometrical sizes and the measured ones from the simulated images for the diameter of the lumen and the thicknesses of the intima, media, and adventitia are 0.13%, 3.89%, 1.35%, and 0.06%, respectively. For the dynamic parameters, the variation in IM thickness, the radial displacements of lumen and adventitia as well as the axial displacement of IM and blood flow velocity are measured with the mean relative errors of 68.03%, 9.27%, 2.10%, 4.93%, and 17.34%, respectively.

CONCLUSION

The simulated results present static sizes and dynamical variations according with preset values; echo distributions conforming to clinical versions. Therefore, the presented simulation model could be useful as a data source to evaluate the performance of studies on measurements of ultrasound-based tissue structures and dynamic parameters for the CCA layers.

Repeated Loading Behavior of Pediatric Porcine Common Carotid Arteries

Rapid flexion and extension of the neck may occur during scenarios associated with traumatic brain injury (TBI), and understanding the mechanical response of the common carotid artery (CCA) to longitudinal stretch may enhance understanding of contributing factors that may influence CCA vasospasm and exacerbate ischemic injury associated with TBI. Immature (4-week-old) porcine CCAs were tested under subcatastrophic (1.5 peak stretch ratio) cyclic loading at 3 Hz for 30 s. Under subcatastrophic cyclic longitudinal extension, the immature porcine CCA displays softening behavior. This softening can be represented by decreasing peak stress and increasing corner stretch values with an increasing number of loading cycles. This investigation is an important first step in the exploration of fatiguelike behavior in arterial tissue that may be subjected to repeated longitudinal loads.

A combination of parabolic and grid slope interpolation for 2D tissue displacement estimations

Parabolic sub-sample interpolation for 2D block-matching motion estimation is computationally efficient. However, it is well known that the parabolic interpolation gives a biased motion estimate for displacements greater than |y.2| samples (y = 0, 1, …). Grid slope sub-sample interpolation is less biased, but it shows large variability for displacements close to y.0. We therefore propose to combine these sub-sample methods into one method (GS15PI) using a threshold to determine when to use which method. The proposed method was evaluated on simulated, phantom, and in vivo ultrasound cine loops and was compared to three sub-sample interpolation methods. On average, GS15PI reduced the absolute sub-sample estimation errors in the simulated and phantom cine loops by 14, 8, and 24% compared to sub-sample interpolation of the image, parabolic sub-sample interpolation, and grid slope sub-sample interpolation, respectively. The limited in vivo evaluation of estimations of the longitudinal movement of the common carotid artery using parabolic and grid slope sub-sample interpolation and GS15PI resulted in coefficient of variation (CV) values of 6.9, 7.5, and 6.8%, respectively. The proposed method is computationally efficient and has low bias and variance. The method is another step toward a fast and reliable method for clinical investigations of longitudinal movement of the arterial wall.

Carotid artery longitudinal wall motion is associated with local blood velocity and left ventricular rotational, but not longitudinal, mechanics

Recent studies have identified a predictable movement pattern of the common carotid artery wall in the longitudinal direction. While there is evidence that the magnitude of this carotid artery longitudinal wall motion (CALM) is sensitive to cardiovascular health status, little is known about the determinants of CALM. The purpose of this integrative study was to evaluate the contribution of left ventricular (LV) cardiac motion and local blood velocity to CALM. Simultaneous ultrasound measurements of CALM, common carotid artery mean blood velocity (MBV), and left ventricular motion were performed in ten young, healthy individuals (6 males; 22 ± 1 years). Peak anterograde CALM occurred at a similar time as peak MBV (18.57 ± 3.98% vs. 18.53 ± 2.81% cardiac cycle; t‐test: P = 0.94; ICC: 0.79, P < 0.01). The timing of maximum retrograde CALM displacement was different, but related, to both peak apical (41.00 ± 7.81% vs. 35.33 ± 5.79% cardiac cycle; t‐test: P < 0.01; ICC: 0.79, P < 0.01) and basal rotation (41.80 ± 6.12% vs. 37.30 ± 5.66% cardiac cycle; t‐test: P < 0.01; ICC: 0.74, P < 0.01) with peak cardiac displacements preceding peak CALM displacements in both cases. The association between basal rotation and retrograde CALM was further supported by strong correlations between their peak magnitudes (r = −0.70, P = 0.02), whereas the magnitude of septal longitudinal displacement was not associated with peak CALM (r = 0.11, P = 0.77). These results suggest that the rotational mechanical movement of the LV base may be closely associated with longitudinal mechanics in the carotid artery. This finding may have important implications for interpreting the complex relationship between ventricular and vascular function.

Reduced common carotid artery longitudinal wall motion and intramural shear strain in individuals with elevated cardiovascular disease risk using speckle tracking

Longitudinal motion of the intima-media and adventitia layers of the common carotid artery (CCA) wall were assessed with ultrasound speckle tracking in seven individuals with spinal cord injury (SCI), who are considered at increased risk of cardiovascular disease, and in seven able-bodied participants. CCA longitudinal wall displacement and intramural shear strain were compared to traditional markers of arterial health, including CCA stiffness and intima-media thickness (IMT). For each cardiac cycle, longitudinal CCA wall motion was characterized by bidirectional movement patterns containing motion retrograde to blood flow during systole, followed by antegrade motion during diastole. Relative displacement of the intima-media versus the adventitia was used to calculate longitudinal intramural shear strain and provided insight to local arterial wall properties. The retrograde intramural shear strain was smaller in individuals with SCI by 60·2% (P<0·05) compared to able-bodied participants, showing smaller peak displacements in both the intima-media (P<0·05) and adventitia (P<0·05). In the antegrade direction, there were no group differences in either longitudinal displacements or shear strain. The group differences observed in the retrograde wall motion phase were greater than those observed for CCA stiffness or IMT and were found to be independent of both indices, indicating indices of the retrograde phase intramural shear strain may be a novel and sensitive marker of vascular health. Our findings demonstrate that assessment of longitudinal arterial wall shear strain may provide valuable insight into vascular structure and function and may hold potential for the early detection of cardiovascular disease.

A novel non-invasive ultrasonic method to assess total axial stress of the common carotid artery wall in healthy and atherosclerotic men

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.

Continuous assessment of carotid intima-media thickness applied to estimate a volumetric compliance using B-mode ultrasound sequences

Recent reports have shown that the carotid artery wall had significant movements not only in the radial but also in the longitudinal direction during the cardiac cycle. Accordingly, the idea that longitudinal elongations could be systematically neglected for compliance estimations became controversial. Assuming a dynamic change in vessel length, the standard measurement of cross-sectional compliance can be revised. In this work, we propose to estimate a volumetric compliance based on continuous measurements of carotid diameter and intima-media thickness (IMT) from B-mode ultrasound sequences. Assuming the principle of conservation of the mass of wall volume (compressibility equals zero), a temporal longitudinal elongation can be calculated to estimate a volumetric compliance. Moreover, elongations can also be estimated allowing small compressibility factors to model some wall leakage. The cross-sectional and the volumetric compliance were estimated in 45 healthy volunteers and 19 asymptomatic patients. The standard measurement underestimated the volumetric compliance by 25% for young volunteers (p < 0.01) and 17% for patients (p < 0.05). When compressibility factors different from zero were allowed, volunteers and patients reached values of 9% and 4%, respectively. We conclude that a simultaneous assessment of carotid diameter and IMT can be employed to estimate a volumetric compliance incorporating a longitudinal elongation. The cross-sectional compliance, that neglects the change in vessel length, underestimates the volumetric compliance.

3D reconstruction of a carotid bifurcation from 2D transversal ultrasound images

Visualizing and analyzing the morphological structure of carotid bifurcations are important for understanding the etiology of carotid atherosclerosis, which is a major cause of stroke and transient ischemic attack. For delineation of vasculatures in the carotid artery, ultrasound examinations have been widely employed because of a noninvasive procedure without ionizing radiation. However, conventional 2D ultrasound imaging has technical limitations in observing the complicated 3D shapes and asymmetric vasodilation of bifurcations. This study aims to propose image-processing techniques for better 3D reconstruction of a carotid bifurcation in a rat by using 2D cross-sectional ultrasound images. A high-resolution ultrasound imaging system with a probe centered at 40MHz was employed to obtain 2D transversal images. The lumen boundaries in each transverse ultrasound image were detected by using three different techniques; an ellipse-fitting, a correlation mapping to visualize the decorrelation of blood flow, and the ellipse-fitting on the correlation map. When the results are compared, the third technique provides relatively good boundary extraction. The incomplete boundaries of arterial lumen caused by acoustic artifacts are somewhat resolved by adopting the correlation mapping and the distortion in the boundary detection near the bifurcation apex was largely reduced by using the ellipse-fitting technique. The 3D lumen geometry of a carotid artery was obtained by volumetric rendering of several 2D slices. For the 3D vasodilatation of the carotid bifurcation, lumen geometries at the contraction and expansion states were simultaneously depicted at various view angles. The present 3D reconstruction methods would be useful for efficient extraction and construction of the 3D lumen geometries of carotid bifurcations from 2D ultrasound images.

Improved tracking performance of Lagrangian block-matching methodologies using block expansion in the time domain: in silico, phantom and in vivo evaluations

The aim of this study was to evaluate tracking performance when an extra reference block is added to a basic block-matching method, where the two reference blocks originate from two consecutive ultrasound frames. The use of an extra reference block was evaluated for two putative benefits: (i) an increase in tracking performance while maintaining the size of the reference blocks, evaluated using in silico and phantom cine loops; (ii) a reduction in the size of the reference blocks while maintaining the tracking performance, evaluated using in vivo cine loops of the common carotid artery where the longitudinal movement of the wall was estimated. The results indicated that tracking accuracy improved (mean = 48%, p < 0.005 [in silico]; mean = 43%, p < 0.01 [phantom]), and there was a reduction in size of the reference blocks while maintaining tracking performance (mean = 19%, p < 0.01 [in vivo]). This novel method will facilitate further exploration of the longitudinal movement of the arterial wall.

Asymmetric radial expansion and contraction of rat carotid artery observed using a high-resolution ultrasound imaging system

The geometry of carotid artery bifurcation is of high clinical interest because it determines the characteristics of blood flow that is closely related to the formation and development of atherosclerotic plaque. However, information on the dynamic changes in the vessel wall of carotid artery bifurcation during a pulsatile cycle is limited. This pilot study investigated the cyclic changes in carotid artery geometry caused by blood flow pulsation in rats. A high-resolution ultrasound imaging system with a broadband scanhead centered at 40 MHz was used to obtain longitudinal images of the rat carotid artery. A high frame rate retrospective B-scan imaging technique based on the use of electrocardiogram to trigger signal acquisition was used to examine precisely the fast arterial wall motion. Two-dimensional geometry data obtained from nine rats showed that the rat carotid artery asymmetrically contracts and dilates during each cardiac cycle. Systolic/diastolic vessel diameters near the upstream and downstream regions from the bifurcation were 0.976 ± 0.011/0.825 ± 0.015 mm and 0.766 ± 0.015/0.650 ± 0.016 mm, respectively. Their posterior/anterior wall displacement ratios in the radial direction were 41.0 ± 14.9% and 2.9 ± 1.6%, respectively. These results indicate that in the vicinity of bifurcation, the carotid artery favorably expands to the anterior side during the systolic phase. This phenomenon was observed to be more prominent in the downstream region near the bifurcation. The cyclic variation pattern in wall movement varies depending on the measurement site, which shows different patterns at far upstream and downstream of the bifurcation. The asymmetric radial expansion and contraction of the rat carotid artery observed in this study may be useful in studying the hemodynamic etiology of cardiovascular diseases because the pulsatile changes in vessel geometry may affect the local hemodynamics that determines the spatial distribution of wall shear stress, one of important cardiovascular risk factors. Further systematic study is needed to clarify the effects of wall elasticity, branch angle and vessel diameter ratio on the asymmetric wall motion of carotid artery bifurcation.

Axial and radial waveforms in common carotid artery: an advanced method for studying arterial elastic properties in ultrasound imaging

Our objective was to develop a method for studying the biomechanics of the common carotid artery (CCA) by evaluating both radial and less known axial distension of the arterial wall. We developed software capable of tracking the movements of different arterial wall layers from ultrasound recordings of CCA, and we then calculated several indices of arterial stiffness. The wide spectrum of arterial stiffness indices defined from one measurement is a unique feature of our method. The motion-tracking algorithm is based on 2-D cross-correlation enhanced with luminance optimizations. The repeatability and reproducibility of the motion tracking were evaluated by performing 10-s ultrasound recordings of left CCA twice to 19 healthy volunteers (11 women, 8 men, age 41.3 ± 14.3 y). The method revealed a biphasic axial movement of the CCA and demonstrated that the indices of arterial stiffness defined from radial movement of carotid artery are reproducible (Cronbach's α, 0.59-0.97) as well as the indices from axial movement are reproducible (Cronbach's α, -0.68 to 0.93). The good reproducibility of the motion tracking is evidence that this method of studying arterial elastic properties is adequate for in vivo studies.

Longitudinal displacement of the carotid wall and cardiovascular risk factors: associations with aging, adiposity, blood pressure and periodontal disease independent of cross-sectional distensibility and intima-media thickness

The recently discovered longitudinal displacement of the common carotid arterial wall (i.e., the motion along the same plane as the blood flow), may be associated with incident cardiovascular events and represents a novel and relevant clinical information. At present, there have only been a few studies that have been conducted to investigate this longitudinal movement. We propose here a method to assess noninvasively the wall bi-dimensional (two-dimensional [2-D], cross-sectional and longitudinal) motion and present an original approach that combines a robust speckle tracking scheme to guidance by minimal path contours segmentation. Our method is well suited to large clinical population studies as it does not necessitate strong imaging prerequisites. The aim of this study is to describe the association between the longitudinal displacement of the carotid arterial wall and cardiovascular risk factors, among which periodontal disease. Some 126 Indigenous Australians with periodontal disease, an emerging risk factor, and 27 healthy age- and sex-matched non-indigenous control subjects had high-resolution ultrasound scans of the common carotid artery. Carotid intima-media thickness and arterial wall 2-D motion were then assessed using our method in ultrasound B-mode sequences. Carotid longitudinal displacement was markedly lower in the periodontal disease group than the control group (geometric mean (IQR): 0.15 mm (0.13) vs. 0.42 mm (0.30), respectively; p < 0.0001), independent of cardiovascular risk factors, cross-sectional distensibility and carotid intima-media thickness (p < 0.0001). A multivariable model indicated that the strongest correlates of carotid longitudinal displacement in adults with periodontal disease were age (β-coefficient = -.235, p = .03), waist (β-coefficient = -.357, p = 0.001), and pulse pressure (β-coefficient = .175, p = 0.07), independent of other cardiovascular risk factors, cross-sectional distensibility and pulse wave velocity. Carotid longitudinal displacement, estimated with our approach, is impaired in the periodontal disease group, independent of established cardiovascular risk factors and other noninvasive measures of arterial stiffness, and may represent an important marker of cardiovascular risk.

Different patterns of longitudinal displacement of the common carotid artery wall in healthy humans are stable over a four-month period

Using an in-house developed ultrasonic method, we have shown that there is distinct longitudinal multiphasic displacement of the human common carotid artery (CCA) wall during the cardiac cycle. Different subjects showed markedly different patterns of displacement. At present, it is not known if the pattern of displacement in an individual is stable over time. Therefore, in this study, we measured the longitudinal displacement of the right CCA in 10 healthy humans at two different occasions 4 months apart. The basic pattern of longitudinal displacement for an individual was highly stable, including intraclass correlation coefficient (ICC) of 0.88 for the ratio between the first antegrade and the retrograde displacement, and ICC of 0.76 for the magnitude of the first antegrade displacement. The stable basic pattern of displacement showed marked differences among subjects, also of the same age and gender. Further studies are needed to elucidate the underlying mechanisms, the physiologic, pathophysiologic and clinical implications of this phenomenon.

A 2D non-invasive ultrasonic method for simultaneous measurement of arterial strain and flow pattern

INTRODUCTION

Many cardiovascular diseases are closely associated with the mechanical properties of arterial wall and hemodynamic parameters. Simultaneous measurements of the arterial strain and flow pattern may aid diagnosis of cardiovascular diseases and may be useful to study fluid-structure interaction between blood and vessel. This paper proposes a 2D non-invasive ultrasonic method to simultaneously measure arterial strain and flow pattern with sub-pixel accuracy.

MATERIALS AND METHODS

The method uses a multiple iterative algorithm to estimate the geometrical transformations of arterial wall and high-velocity gradient flows simultaneously. The accuracy of the method was validated by an in vitro arterial phantom and in vivo common carotid arteries (CCAs) of 12 mice using a Sonix RP (10 MHz) and a VisualSonics Vevo 2100 (30 MHz) ultrasound imaging system, respectively.

RESULTS

For the arterial phantom, the calculated elasticity modulus from the strain profile shows good agreement with the mechanical testing value, deviating no more than 9.3%. The calculated flow velocity agrees well with the value obtained from the rotameter, deviating only 4.3%. For the CCAs of mice, good agreement is found between the calculated flow velocity and the measured value by ultrasound Doppler. The mean elasticity modulus of CCAs is 134.62 ± 54.3 kPa, which is in accordance with published data.

CONCLUSION

The proposed method is capable of measuring the arterial wall strain and flow velocity pattern. This may be clinically useful for early detecting and monitoring cardiovascular diseases and may provide an essential tool in modelling the fluid-structure interaction between the blood and blood vessel.

Longitudinal displacement and intramural shear strain of the porcine carotid artery undergo profound changes in response to catecholamines

The effects of catecholamines on longitudinal displacements and intramural shear strain of the arterial wall are unexplored. Therefore, the common carotid artery of five anaesthetized pigs was investigated using an in-house developed noninvasive ultrasonic technique. The study protocol included intravenous infusion of low-dose epinephrine (β-adrenoceptor activation), as well as intravenous boluses of norepinephrine (α-adrenoceptor activation). Further, the effects of β-blockade (metoprolol) were studied. There were significant positive correlations between pulse pressure and longitudinal displacement of the intima-media complex ( r = 0.72; P < 0.001), as well as between pulse pressure and intramural shear strain ( r = 0.48; P < 0.001). Following administration of norepinephrine, the longitudinal displacement of the intima-media complex and intramural shear strain profoundly increased (median 190%, range 102–296%, and median 141%, range 101–182%, respectively, compared with baseline), also when given during β-blockade (median 228%, range 133–266%, and median 158%, range 152–235%, respectively). During infusion of low-dose epinephrine, the longitudinal displacement of the intima-media complex and intramural shear strain decreased (median 88%, range 69–122%, and median 69%, range 47–117%, respectively, compared with baseline). In conclusion, the present study shows, for the first time, that the longitudinal displacement and intramural shear strain of the porcine carotid artery undergo profound changes in response to catecholamines. Increase in longitudinal displacements seems to be strongly related to α-adrenoceptor activation. Thus metoprolol is insufficient to counteract a profound increase in longitudinal displacement and intramural shear strain following a surge of norepinephrine.

Measurement of two-dimensional movement parameters of the carotid artery wall for early detection of arteriosclerosis: a preliminary clinical study

The aim of this study was to clinically investigate the association between the risk factors of early-stage atherosclerosis and the two-dimensional (2-D) movement of the artery wall. To meet this objective, a speckle tracking approach for the estimation of the 2-D trajectory of the vessel wall was proposed and applied to B-mode ultrasound (US) sequences of the left common carotid artery (CCA). A deformable skeleton model was also introduced in the block matching scheme. Finally, the 2-D movements of both proximal and distal walls were investigated in three different local regions, with 1.5 × 0.3 mm(2) kernel blocks. A clinical study was conducted in which two different populations (26 young healthy volunteers and 26 older diabetic patients) were studied. The results show that the mean amplitude value of the diameter change ΔD, of the longitudinal displacement of the proximal wall ΔX(p) and of the longitudinal displacement of the distal wall ΔX(d) were 0.65 ± 0.17 vs. 0.41 ± 0.12 mm (p < 0.001), 0.48 ± 0.21 vs. 0.26 ± 0.18 mm (p < 0.001) and 0.48 ± 0.20 vs. 0.35 ± 0.23 mm (p = 0.006) for the young healthy volunteers and the older diabetic patients, respectively. The results of the three dynamic parameters ΔD, ΔX(p) and ΔX(d) were systematically and significantly lower for the diabetic subjects, respectively 37%, 46% and 27%. The method introduced in this feasibility study might constitute a pertinent approach to assess the presence of early-stage arteriosclerosis by the noninvasive estimation of the 2-D motion of the intima-media complex in the CCA.

Segmentation of plaques in sequences of ultrasonic B-mode images of carotid arteries based on motion estimation and a Bayesian model

The goal of this work is to perform a segmentation of atherosclerotic plaques in view of evaluating their burden and to provide boundaries for computing properties such as the plaque deformation and elasticity distribution (elastogram and modulogram). The echogenicity of a region of interest comprising the plaque, the vessel lumen, and the adventitia of the artery wall in an ultrasonic B-mode image was modeled by mixtures of three Nakagami distributions, which yielded the likelihood of a Bayesian segmentation model. The main contribution of this paper is the estimation of the motion field and its integration into the prior of the Bayesian model that included a local geometrical smoothness constraint, as well as an original spatiotemporal cohesion constraint. The Maximum A Posteriori (MAP) of the proposed model was computed with a variant of the Exploration/Selection (ES) algorithm. The starting point is a manual segmentation of the first frame. The proposed method was quantitatively compared with manual segmentations of all frames by an expert technician. Various measures were used for this evaluation, including the mean point-to-point distance and the Hausdorff distance. Results were evaluated on 94 sequences of 33 patients (for a total of 8988 images). We report a mean point-to- point distance of 0.24 ± 0.08 mm and a Hausdorff distance of 1.24 ± 0.40 mm. Our tests showed that the algorithm was not sensitive to the degree of stenosis or calcification.

Pulse wave velocity as a diagnostic index: the pitfalls of tethering versus stiffening of the arterial wall

Pulse wave velocity (PWV) is often used as a clinical index of aging, vascular disease, or age related hypertension. This practice is based on the assumption that a higher wave speed indicates vascular stiffening. This assumption is well grounded in the physics of pulsatile flow of an incompressible fluid where it is fully established that a pulse wave travels faster in a tube of stiffer wall, the wave speed becoming infinite in the mathematical limit of a rigid wall. However, in this paper we point out that the physical principal of higher pulse wave velocity in a stiffer tube is strictly valid only when the wall is free from outside constraints, which in the physiological setting is present in the form of tethering of the vessel wall. The use of PWV as an index of arterial stiffening may thus lose its validity if tethering is involved. A solution of the problem of vessel wall mechanics as they arise from the physiological pulsatile flow problem is presented for the purpose of resolving this issue. The vessel wall is considered to have finite thickness with or without tethering and with a range of mechanical properties ranging from viscoelastic to stiff. The results show that, indeed, while the wave speed becomes infinite in the mathematical limit of a rigid free wall, the opposite actually happens if the vessel wall is tethered. Here the wave speed actually diminishes as the degree of tethering increases. This dichotomy in the effects of tethering versus stiffening of the arterial wall may clearly lead to error in the interpretation of PWV as an index of vessel wall stiffness. In particular, a normal value of PWV may lead to the conclusion that vessel wall stiffening is absent while this value may in fact have been lowered by tethering. In other words, the diagnostic test may lead to a false negative diagnosis. Our results indicate that the reason for which PWV is lower in a tethered wall compared with that in a free wall of the same stiffness is that the radial movements of the wall are greatly reduced by tethering. More precisely, the results show that PWV depends strongly on the ratio of radial to axial displacements and that this ratio is much lower in a tethered wall than it is in a free wall of the same stiffness.