High-definition imaging of carotid artery wall dynamics

Simplified single neuron model for robust local pulse wave velocity sensing using a tetherless bioimpedance device

Pulse arrival time (PAT), Pulse transit time (PTT), and Pulse Wave Velocity (PWV) have all been used as metrics for assessing a number of cardiovascular applications, including arterial stiffness and cuffless blood pressure monitoring. These have been measured using various sensing methods, including electrocardiogram (ECG) with photoplethysmogram (PPG), two PPG sensors, or two Bioimpedance (BioZ) sensors. Our study addresses the mathematical inaccuracies of previous bioimpedance approaches and incorporates PTT weights for the peak-peak (PTTpp), middle-middle (PTTmm), and foot-foot (PTTff) segments of the sensing signal into a single neuron model to determine a more accurate and stable PWV. In addition, we developed a tetherless bioimpedance device and compared our PTT estimation approaches, which yielded PWV across six subjects and two different arteries. Specifically, using our model, we found that the most reliable combination of weights corresponding to PTTpp, PTTmm, and PTTff was (0.260, 0.704, 0.036) for the brachial artery and (0.104, 0.858, 0.038) for radial artery. This model consistently yielded stable values across repetitions, with PWV values of 5.2 m/s, 5.3 m/s, and 5.9 m/s for the brachial artery and values of 5.8 m/s, 6.6 m/s, and 6.5 m/s for the radial artery. This system and model offer the possibility of obtaining higher reliability PTT and PWV values yielding better monitoring of cardiovascular health measures such as blood pressure and arterial stiffness.

Fetal Aortic Blood Flow Velocity and Power Doppler Profiles in the First Trimester: A Comprehensive Study Using High-Definition Flow Imaging

OBJECTIVES

This study aimed to establish reference values for fetal aortic isthmus blood flow velocity and associated indices during the first trimester, utilizing a novel ultrasonographic technique known as high-definition flow imaging (HDFI). Additionally, the correlation between Doppler profiles of aortic blood flow and key fetal parameters, including nuchal thickness (NT), crown-rump length (CRL), and fetal heartbeat (FHB), was investigated.

METHODS

A total of 262 fetuses were included in the analysis between December 2022 and December 2023. Utilizing 2D power Doppler ultrasound images, aortic blood flow parameters were assessed, including aortic peak systolic velocity (PS), aortic end-diastolic velocity (ED), aortic time average maximal velocity (TAMV), and various indices such as aortic systolic velocity/diastolic velocity (S/D), aortic pulsatile index (PI), aortic resistance index (RI), aortic isthmus flow velocity index (IFI), and aortic isthmic systolic index (ISI). Concurrently, fetal FHB, NT, and CRL were evaluated during early trimester Down syndrome screening.

RESULTS

Significant findings include a positive correlation between gestational age (GA) and PS (PS = 3.75 × (GA) - 15.4, r2 = 0.13, p < 0.01), ED (ED = 0.42 × (GA) - 0.61, r2 = 0.04, p < 0.01), PI (PI = 0.07 × (GA) + 1.03, r2 = 0.04, p < 0.01), and TAMV (TAMV = 1.23 × (GA) - 1.66, r2 = 0.08, p < 0.01). In contrast, aortic ISI demonstrated a significant decrease (ISI = -0.03 × (GA) + 0.57, r2 = 0.05, p < 0.05) with gestational age. No significant correlation was observed for aortic RI (p = 0.33), S/D (p = 0.39), and IFI (p = 0.29) with gestational age. Aortic PS exhibited positive correlations with NT (0.217, p = 0.001) and CRL (0.360, p = 0.000) but a negative correlation with FHB (-0.214, p = 0.001). Aortic PI demonstrated positive correlations with CRL (0.208, p = 0.001) and negative correlations with FHB (-0.176, p = 0.005). Aortic TAMV showed positive correlations with NT (0.233, p = 0.000) and CRL (0.290, p = 0.000) while exhibiting a negative correlation with FHB (-0.141, p = 0.026). Aortic ISI demonstrated negative correlations with NT (-0.128, p = 0.045) and CRL (-0.218, p = 0.001) but a positive correlation with FHB (0.163, p = 0.010).

CONCLUSIONS

Power Doppler angiography with Doppler ultrasound demonstrates the ability to establish accurate reference values for fetal aortic blood flow during the first trimester of pregnancy. Notably, aortic PS, TAMV, and ISI exhibit significant correlations with NT, CRL, and FHB, with ISI appearing more relevant than IFI, PS, TAMV, and FHB. The utilization of HDFI technology proves advantageous in efficiently detecting the site of the aortic isthmus compared to traditional color Doppler mode in early second trimesters.

In Vivo Comparison of Pulse Wave Velocity Estimation Based on Ultrafast Plane Wave Imaging and High-Frame-Rate Focused Transmissions

Ultrasound-based local pulse wave velocity (PWV) estimation, as a measure of arterial stiffness, can be based on fast focused imaging (FFI) or plane wave imaging (PWI). This study was aimed at comparing the accuracy of in vivo PWV estimation using FFI and PWI. Ultrasound radiofrequency data of carotid arteries were acquired in 14 healthy volunteers (25-57 y) by executing the FFI (12 lines, 7200 Hz) and PWI (128 lines, 2000 Hz) methods consecutively. PWV was derived at two time-reference points, dicrotic notch (DN) and systolic foot (SF), for multiple pressure cycles by fitting a linear function through the positions of the peaks of low-pass filtered wall acceleration curves as a function of time. The accuracy of PWV estimation was determined for various cutoff frequencies (10-200 Hz). No statistically significant difference was observed between PWVs estimated by both approaches. The PWV and R² at DN were higher, on average, than those at SF (PWV/R²: FFI SF 5.5/0.92, FFI DN 6.1/0.92; PWI SF 5.4/0.89, PWI DN 6.3/0.95). The use of cutoff frequencies between 40 and 80 Hz provided the most accurate PWVs. Both methods seemed equally suitable for use in clinical practice, although we have a preference for the PWV at DN given the higher R² values.

Design of an Ultrasound Transceiver ASIC with a Switching-Artifact Reduction Technique for 3D Carotid Artery Imaging

This paper presents an ultrasound transceiver application-specific integrated circuit (ASIC) directly integrated with an array of 12 × 80 piezoelectric transducer elements to enable next-generation ultrasound probes for 3D carotid artery imaging. The ASIC, implemented in a 0.18 µm high-voltage Bipolar-CMOS-DMOS (HV BCD) process, adopted a programmable switch matrix that allowed selected transducer elements in each row to be connected to a transmit and receive channel of an imaging system. This made the probe operate like an electronically translatable linear array, allowing large-aperture matrix arrays to be interfaced with a manageable number of system channels. This paper presents a second-generation ASIC that employed an improved switch design to minimize clock feedthrough and charge-injection effects of high-voltage metal-oxide-semiconductor field-effect transistors (HV MOSFETs), which in the first-generation ASIC caused parasitic transmissions and associated imaging artifacts. The proposed switch controller, implemented with cascaded non-overlapping clock generators, generated control signals with improved timing to mitigate the effects of these non-idealities. Both simulation results and electrical measurements showed a 20 dB reduction of the switching artifacts. In addition, an acoustic pulse-echo measurement successfully demonstrated a 20 dB reduction of imaging artifacts.

Regional Upstroke Tracking for Transit Time Detection to Improve the Ultrasound-Based Local PWV Estimation in Carotid Arteries

Pulse wave velocity (PWV) is the most important index for quantifying the elasticity of an artery. The accurate estimation of the local PWV is of great relevance to the early diagnosis and effective prevention of arterial stiffness. In ultrasonic transit time-based local PWV estimation, the locations of time fiduciary point (TFP) in the upstrokes of the propagating pulse waves (PWs) are inconsistent because of the reflected waves and ultrasonic noise. In this study, a regional upstroke tracking (RUT) approach that involved identifying the most similar TFP-centered region in the upstrokes is proposed to detect the time delay for improving the local PWV estimation. Five RUT algorithms with different tracking points are assessed via simulation and clinical experiments. To quantitatively evaluate the RUT algorithms, the normalized root-mean-squared errors and standard deviations of the estimated PWVs are calculated using an ultrasound simulation model. The reproducibility of the five RUT algorithms based on 30 human subjects is also evaluated using the Bland-Altman analysis and coefficient of variation (CV). The obtained results show that the RUT algorithms with only three tracking points provide greater accuracy, precision, and reproducibility for the local PWV estimation than the TFP methods. Compared with the TFP methods, the RUT algorithms reduce the mean errors from 12.23% ± 3.10% to 7.13% ± 2.31%, as well as the CVs from 21.76% to 13.39%. In conclusion, the proposed RUT algorithms are superior to the TFP methods for local carotid PWV estimation.

Arterial wall mechanical inhomogeneity detection and atherosclerotic plaque characterization using high frame rate pulse wave imaging in carotid artery disease patients in vivo

Pulse wave imaging (PWI) is a non-invasive, ultrasound-based technique, which provides information on arterial wall stiffness by estimating the pulse wave velocity (PWV) along an imaged arterial wall segment. The aims of the present study were to: (1) utilize the PWI information to automatically and optimally divide the artery into the segments with most homogeneous properties and (2) assess the feasibility of this method to provide arterial wall mechanical characterization in normal and atherosclerotic carotid arteries in vivo. A silicone phantom consisting of a soft and stiff segment along its longitudinal axis was scanned at the stiffness transition, and the PWV in each segment was estimated through static testing. The proposed algorithm detected the stiffness interface with an average error of 0.98  ±  0.49 mm and 1.04  ±  0.27 mm in the soft-to-stiff and stiff-to-soft pulse wave transmission direction, respectively. Mean PWVs estimated in the case of the soft-to-stiff pulse wave transmission direction were 2.47 [Formula: see text] 0.04 m s^-1 and 3.43 [Formula: see text] 0.08 m s^-1 for the soft and stiff phantom segments, respectively, while in the case of stiff-to-soft transmission direction PWVs were 2.60 [Formula: see text] 0.18 m s^-1 and 3.72 [Formula: see text] 0.08 m s^-1 for the soft and stiff phantom segments, respectively, which were in good agreement with the PWVs obtained through static testing (soft segment: 2.41 m s^-1, stiff segment: 3.52 m s^-1). Furthermore, the carotid arteries of N  =  9 young subjects (22-32 y.o.) and N  =  9 elderly subjects (60-73 y.o.) with no prior history of carotid artery disease were scanned, in vivo, as well as the atherosclerotic carotid arteries of N  =  12 (59-85 y.o.) carotid artery disease patients. One-way ANOVA with Holm-Sidak correction showed that the number of most homogeneous segments in which the artery was divided was significantly higher in the case of carotid artery disease patients compared to young (3.25 [Formula: see text] 0.86 segments versus 1.00 [Formula: see text] 0.00 segments, p -value  <  0.0001) and elderly non-atherosclerotic subjects (3.25 [Formula: see text] 0.86 segments versus 1.44 [Formula: see text] 0.51 segments p -value  <  0.0001), indicating increased wall inhomogeneity in atherosclerotic arteries. The compliance provided by the proposed algorithm was significantly higher in non-calcified/high-lipid plaques as compared with calcified plaques (3.35 [Formula: see text] 2.45 *[Formula: see text] versus 0.22 [Formula: see text] 0.18 * [Formula: see text], p -value  <  0.01) and the compliance estimated in elderly subjects (3.35 [Formula: see text] 2.45 * [Formula: see text] versus 0.79 [Formula: see text] 0.30 * [Formula: see text], p -value  <  0.01). Moreover, lower compliance was estimated in cases where vulnerable plaque characteristics were present (i.e. necrotic lipid core, thrombus), compared to stable plaque components (calcification), as evaluated through plaque histological examination. The proposed algorithm was thus capable of evaluating arterial wall inhomogeneity and characterize wall mechanical properties, showing promise in vascular disease diagnosis and monitoring.

Adaptive Pulse Wave Imaging: Automated Spatial Vessel Wall Inhomogeneity Detection in Phantoms and in-Vivo

Imaging arterial mechanical properties may improve vascular disease diagnosis. Pulse wave velocity (PWV) is a marker of arterial stiffness linked to cardio-vascular mortality. Pulse wave imaging (PWI) is a technique for imaging the pulse wave propagation at high spatial and temporal resolution. In this paper, we introduce adaptive PWI, a technique for the automated partition of heterogeneous arteries into individual segments characterized by most homogeneous pulse wave propagation, allowing for more robust PWV estimation. This technique was validated in a silicone phantom with a soft-stiff interface. The mean detection error of the interface was 4.67 ± 0.73 mm and 3.64 ± 0.14 mm in the stiff-to-soft and soft-to-stiff pulse wave transmission direction, respectively. This technique was tested in monitoring the progression of atherosclerosis in mouse aortas in vivo ( n = 11 ). The PWV was found to already increase at the early stage of 10 weeks of high-fat diet (3.17 ± 0.67 m/sec compared to baseline 2.55 ± 0.47 m/sec, ) and further increase after 20 weeks of high-fat diet (3.76±1.20 m/sec). The number of detected segments of the imaged aortas monotonically increased with the duration of high-fat diet indicating an increase in arterial wall property inhomogeneity. The performance of adaptive PWI was also tested in aneurysmal mouse aortas in vivo. Aneurysmal boundaries were detected with a mean error of 0.68±0.44 mm. Finally, initial feasibility was shown in the carotid arteries of healthy and atherosclerotic human subjects in vivo ( n = 3 each). Consequently, adaptive PWI was successful in detecting stiffness inhomogeneity at its early onset and monitoring atherosclerosis progression in vivo.

Vascular Smooth Muscle Cells and Arterial Stiffening: Relevance in Development, Aging, and Disease

The cushioning function of large arteries encompasses distension during systole and recoil during diastole which transforms pulsatile flow into a steady flow in the microcirculation. Arterial stiffness, the inverse of distensibility, has been implicated in various etiologies of chronic common and monogenic cardiovascular diseases and is a major cause of morbidity and mortality globally. The first components that contribute to arterial stiffening are extracellular matrix (ECM) proteins that support the mechanical load, while the second important components are vascular smooth muscle cells (VSMCs), which not only regulate actomyosin interactions for contraction but mediate also mechanotransduction in cell-ECM homeostasis. Eventually, VSMC plasticity and signaling in both conductance and resistance arteries are highly relevant to the physiology of normal and early vascular aging. This review summarizes current concepts of central pressure and tensile pulsatile circumferential stress as key mechanical determinants of arterial wall remodeling, cell-ECM interactions depending mainly on the architecture of cytoskeletal proteins and focal adhesion, the large/small arteries cross-talk that gives rise to target organ damage, and inflammatory pathways leading to calcification or atherosclerosis. We further speculate on the contribution of cellular stiffness along the arterial tree to vascular wall stiffness. In addition, this review provides the latest advances in the identification of gene variants affecting arterial stiffening. Now that important hemodynamic and molecular mechanisms of arterial stiffness have been elucidated, and the complex interplay between ECM, cells, and sensors identified, further research should study their potential to halt or to reverse the development of arterial stiffness.

Feasibility and Validation of 4-D Pulse Wave Imaging in Phantoms and In Vivo

Pulse wave imaging (PWI) is a noninvasive technique for tracking the propagation of the pulse wave along the arterial wall. The 3-D ultrasound imaging would aid in objectively estimating the pulse wave velocity (PWV) vector. This paper aims to introduce a novel PWV estimation method along the propagation direction, validate it in phantoms, and test its feasibility in vivo. A silicone vessel phantom consisting of a stiff and a soft segment along the longitudinal axis and a silicone vessel with a plaque were constructed. A 2-D array with a center frequency of 2.5 MHz was used. Propagation was successfully visualized in 3-D in each phantom and in vivo in six healthy subjects. In three of the healthy subjects, results were compared against conventional PWI using a linear array. PWVs were estimated in the stiff (3.42 ± 0.23 m [Formula: see text]) and soft (2.41 ± 0.07 m [Formula: see text]) phantom segments. Good agreement was found with the corresponding static testing values (stiff: 3.41 m [Formula: see text] and soft: 2.48 m [Formula: see text]). PWI-derived vessel compliance values were validated with dynamic testing. Comprehensive views of pulse propagation in the plaque phantom were generated and compared against conventional PWI acquisitions. Good agreement was found in vivo between the results of 4-D PWI (4.80 ± 1.32 m [Formula: see text]) and conventional PWI (4.28±1.20 m [Formula: see text]) ( n=3 ). PWVs derived for all of the healthy subjects ( n = 6 ) were within the physiological range. Thus, the 4-D PWI was successfully validated in phantoms and used to image the pulse wave propagation in normal human subjects in vivo.

Pulse wave analysis with diffusing-wave spectroscopy

Hypertension is a major risk factor for cardiovascular disease and thus at the origin of many deaths by e.g. heart attack or stroke. Hypertension is caused by many factors including an increase in arterial stiffness which leads to changes in pulse wave velocity and wave reflections. Those often result in an increased left ventricular load which may result in heart failure as well as an increased pulsatile pressure in the microcirculation l to damage to blood vessels. In order to specifically treat the different causes of hypertension it is desirable to perform a pulse wave analysis as a complement to measurements of systolic and diastolic pressure by brachial cuff sphygmomanometry. Here we show that Diffusing Wave Spectroscopy, a novel non-invasive portable tool, is able to monitor blood flow changes with a high temporal resolution. The measured pulse travel times give detailed information of the pulse wave blood flow profile.

Pulse wave imaging using coherent compounding in a phantom and in vivo

Pulse wave velocity (PWV) is a surrogate marker of arterial stiffness linked to cardiovascular morbidity. Pulse wave imaging (PWI) is a technique developed by our group for imaging the pulse wave propagation in vivo. PWI requires high temporal and spatial resolution, which conventional ultrasonic imaging is unable to simultaneously provide. Coherent compounding is known to address this tradeoff and provides full aperture images at high frame rates. This study aims to implement PWI using coherent compounding within a GPU-accelerated framework. The results of the implemented method were validated using a silicone phantom against static mechanical testing. Reproducibility of the measured PWVs was assessed in the right common carotid of six healthy subjects (n  =  6) approximately 10-15 mm before the bifurcation during two cardiac cycles over the course of 1-3 d. Good agreement of the measured PWVs (3.97  ±  1.21 m s^-1, 4.08  ±  1.15 m s^-1, p  =  0.74) was obtained. The effects of frame rate, transmission angle and number of compounded plane waves on PWI performance were investigated in the six healthy volunteers. Performance metrics such as the reproducibility of the PWVs, the coefficient of determination (r ²), the SNR of the PWI axial wall velocities ([Formula: see text]) and the percentage of lateral positions where the pulse wave appears to arrive at the same time-point, indicating inadequacy of the temporal resolution (i.e. temporal resolution misses) were used to evaluate the effect of each parameter. Compounding plane waves transmitted at 1° increments with a linear array yielded optimal performance, generating significantly higher r ² and [Formula: see text] values (p  ⩽  0.05). Higher frame rates (⩾1667 Hz) produced improvements with significant gains in the r ² coefficient (p  ⩽  0.05) and significant increase in both r ² and [Formula: see text] from single plane wave imaging to 3-plane wave compounding (p  ⩽  0.05). Optimal performance was established at 2778 Hz with 3 plane waves and at 1667 Hz with 5 plane waves.

Walled Carotid Bifurcation Phantoms for Imaging Investigations of Vessel Wall Motion and Blood Flow Dynamics

As a major application domain of vascular ultrasound, the carotid artery has long been the subject of anthropomorphic phantom design. It is nevertheless not trivial to develop walled carotid phantoms that are compatible for use in integrative imaging of carotid wall motion and flow dynamics. In this paper, we present a novel phantom design protocol that can enable efficient fabrication of walled carotid bifurcation phantoms with: (i) high acoustic compatibility, (ii) artery-like vessel elasticity, and (iii) stenotic narrowing feature. Our protocol first involved direct fabrication of the vessel core and an outer mold using computer-aided design tools and 3-D printing technology; these built parts were then used to construct an elastic vessel tube through investment casting of a polyvinyl alcohol containing mixture, and an agar-gelatin tissue mimicking slab was formed around the vessel tube. For demonstration, we applied our protocol to develop a set of healthy and stenosed (25%, 50%, 75%) carotid bifurcation phantoms. Plane wave imaging experiments were performed on these phantoms using an ultrasound scanner with channel-level configurability. Results show that the wall motion dynamics of our phantoms agreed with pulse wave propagation in an elastic vessel (pulse wave velocity of 4.67±0.71 m/s measured at the common carotid artery), and their flow dynamics matched the expected ones in healthy and stenosed bifurcation (recirculation and flow jet formation observed). Integrative imaging of vessel wall motion and blood flow dynamics in our phantoms was also demonstrated, from which we observed fluid-structure interaction differences between healthy and diseased bifurcation phantoms. These findings show that the walled bifurcation phantoms developed with our new protocol are useful in vascular imaging studies that individually or jointly assess wall motion and flow dynamics.

Review: Mechanical Characterization of Carotid Arteries and Atherosclerotic Plaques

Cardiovascular disease (CVD) is a leading cause of death and is in the majority of cases due to the formation of atherosclerotic plaques in arteries. Initially, thickening of the inner layer of the arterial wall occurs. Continuation of this process leads to plaque formation. The risk of a plaque to rupture and thus to induce an ischemic event is directly related to its composition. Consequently, characterization of the plaque composition and its proneness to rupture are of crucial importance for risk assessment and treatment strategies. The carotid is an excellent artery to be imaged with ultrasound because of its superficial position. In this review, ultrasound-based methods for characterizing the mechanical properties of the carotid wall and atherosclerotic plaque are discussed. Using conventional echography, the intima media thickness (IMT) can be quantified. There is a wealth of studies describing the relation between IMT and the risk for myocardial infarction and stroke. Also the carotid distensibility can be quantified with ultrasound, providing a surrogate marker for the cross-sectional mechanical properties. Although all these parameters are associated with CVD, they do not easily translate to individual patient risk. Another technique is pulse wave velocity (PWV) assessment, which measures the propagation of the pressure pulse over the arterial bed. PWV has proven to be a marker for global arterial stiffness. Recently, an ultrasound-based method to estimate the local PWV has been introduced, but the clinical effectiveness still needs to be established. Other techniques focus on characterization of plaques. With ultrasound elastography, the strain in the plaque due to the pulsatile pressure can be quantified. This technique was initially developed using intravascular catheters to image coronaries, but recently noninvasive methods were successfully developed. A high correlation between the measured strain and the risk for rupture was established. Acoustic radiation force impulse (ARFI) imaging also provides characterization of local plaque components based on mechanical properties. However, both elastography and ARFI provide an indirect measure of the elastic modulus of tissue. With shear wave imaging, the elastic modulus can be quantified, although the carotid artery is one of the most challenging tissues for this technique due to its size and geometry. Prospective studies still have to establish the predictive value of these techniques for the individual patient. Validation of ultrasound-based mechanical characterization of arteries and plaques remains challenging. Magnetic resonance imaging is often used as the "gold" standard for plaque characterization, but its limited resolution renders only global characterization of the plaque. CT provides information on the vascular tree, the degree of stenosis, and the presence of calcified plaque, while soft plaque characterization remains limited. Histology still is the gold standard, but is available only if tissue is excised. In conclusion, elastographic ultrasound techniques are well suited to characterize the different stages of vascular disease.

Photonic sensing of arterial distension

Most cardiovascular diseases, such as arteriosclerosis and hypertension, are directly linked to pathological changes in hemodynamics, i.e. the complex coupling of blood pressure, blood flow and arterial distension. To improve the current understanding of cardiovascular diseases and pave the way for novel cardiovascular diagnostics, innovative tools are required that measure pressure, flow, and distension waveforms with yet unattained spatiotemporal resolution. In this context, miniaturized implantable solutions for continuously measuring these parameters over the long-term are of particular interest. We present here an implantable photonic sensor system capable of sensing arterial wall movements of a few hundred microns in vivo with sub-micron resolution, a precision in the micrometer range and a temporal resolution of 10 kHz. The photonic measurement principle is based on transmission photoplethysmography with stretchable optoelectronic sensors applied directly to large systemic arteries. The presented photonic sensor system expands the toolbox of cardiovascular measurement techniques and makes these key vital parameters continuously accessible over the long-term. In the near term, this new approach offers a tool for clinical research, and as a perspective, a continuous long-term monitoring system that enables novel diagnostic methods in arteriosclerosis and hypertension research that follow the trend in quantifying cardiovascular diseases by measuring arterial stiffness and more generally analyzing pulse contours.

Comparison of Different Pulse Waveforms for Local Pulse Wave Velocity Measurement in Healthy and Hypertensive Common Carotid Arteries in Vivo

Pulse wave velocity (PWV), a measurement of arterial stiffness, can be estimated locally by determining the time delay of the pulse waveforms for a known distance as measured in an ultrasound image. Our aim was to compare three ultrasound-based methods for estimation of local PWV based on the measurement of diameter distension waveforms, displacement waveforms of the anterior wall and displacement waveforms of the posterior wall, respectively, in human common carotid arteries in vivo. The local PWVs at both systolic foot (PWVsf) and dicrotic notch (PWVdn) were estimated from ultrasound radiofrequency data of 25 healthy and 24 hypertensive patients for each method. PWV estimation using the distension waveform method was found to have the highest precision in both groups. Both PWVsf and PWVdn were significantly higher in the hypertensive group compared with the healthy group using the distension waveform method (PWVsf: 6.08 ± 1.70 m/s vs. 4.75 ± 0.92 m/s, p = 0.000014; PWVdn: 7.83 ± 2.26 m/s vs. 5.21 ± 0.95 m/s, p < 0.000001), whereas there was no significant difference at a significance level of 0.01 between the two groups when the anterior or posterior wall waveform method was used. Thus, the difference in arterial stiffness between the two groups could be discriminated well by the distension waveform method. The local PWV estimated using distension waveforms might be a promising index for arterial stiffness characterization and hypertension management.

High frame rate and high line density ultrasound imaging for local pulse wave velocity estimation using motion matching: A feasibility study on vessel phantoms

Pulse wave imaging (PWI) is an ultrasound-based method to visualize the propagation of pulse wave and to quantitatively estimate regional pulse wave velocity (PWV) of the arteries within the imaging field of view (FOV). To guarantee the reliability of PWV measurement, high frame rate imaging is required, which can be achieved by reducing the line density of ultrasound imaging or transmitting plane wave at the expense of spatial resolution and/or signal-to-noise ratio (SNR). In this study, a composite, full-view imaging method using motion matching was proposed with both high temporal and spatial resolution. Ultrasound radiofrequency (RF) data of 4 sub-sectors, each with 34 beams, including a common beam, were acquired successively to achieve a frame rate of ∼507 Hz at an imaging depth of 35 mm. The acceleration profiles of the vessel wall estimated from the common beam were used to reconstruct the full-view (38-mm width, 128-beam) image sequence. The feasibility of mapping local PWV variation along the artery using PWI technique was preliminarily validated on both homogeneous and inhomogeneous polyvinyl alcohol (PVA) cryogel vessel phantoms. Regional PWVs for the three homogeneous phantoms measured by the proposed method were in accordance with the sparse imaging method (38-mm width, 32-beam) and plane wave imaging method. Local PWV was estimated using the above-mentioned three methods on 3 inhomogeneous phantoms, and good agreement was obtained in both the softer (1.91±0.24 m/s, 1.97±0.27 m/s and 1.78±0.28 m/s) and the stiffer region (4.17±0.46 m/s, 3.99±0.53 m/s and 4.27±0.49 m/s) of the phantoms. In addition to the improved spatial resolution, higher precision of local PWV estimation in low SNR circumstances was also obtained by the proposed method as compared with the sparse imaging method. The proposed method might be helpful in disease detections through mapping the local PWV of the vascular wall.

Measuring submicrometer displacement vectors using high-frame-rate ultrasound imaging

Measuring the magnitude and direction of tissue displacement provides the basis for the assessment of tissue motion or tissue stiffness. Using conventional displacement tracking by ultrasound delay estimation, only one direction of tissue displacement can be estimated reliably. In this paper, we describe a new technique for estimating the complete two-dimensional displacement vector using high-frame-rate ultrasound imaging. We compute the displacement vector using phase delays that can be measured between pairs of elements within an array. By combining multiple element-pair solutions, we find a new robust estimate for the displacement vector. In this paper, we provide experimental proof that this method permits measurement of the displacement vector for isolated scatterers and diffuse scatterers with high (submicrometer) precision, without the need for beam steering. We also show that we can measure the axial and lateral distension of a carotid artery in a transverse view.

Performance assessment of Pulse Wave Imaging using conventional ultrasound in canine aortas ex vivo and normal human arteries in vivo

The propagation behavior of the arterial pulse wave may provide valuable diagnostic information for cardiovascular pathology. Pulse Wave Imaging (PWI) is a noninvasive, ultrasound imaging-based technique capable of mapping multiple wall motion waveforms along a short arterial segment over a single cardiac cycle, allowing for the regional pulse wave velocity (PWV) and propagation uniformity to be evaluated. The purpose of this study was to improve the clinical utility of PWI using a conventional ultrasound system. The tradeoff between PWI spatial and temporal resolution was evaluated using an ex vivo canine aorta (n = 2) setup to assess the effects of varying image acquisition and signal processing parameters on the measurement of the PWV and the pulse wave propagation uniformity r². PWI was also performed on the carotid arteries and abdominal aortas of 10 healthy volunteers (24.8 ± 3.3 y.o.) to determine the waveform tracking feature that would yield the most precise PWV measurements and highest r² values in vivo. The ex vivo results indicated that the highest precision for measuring PWVs ~ 2.5 - 3.5 m/s was achieved using 24-48 scan lines within a 38 mm image plane width (i.e. 0.63 - 1.26 lines/mm). The in vivo results indicated that tracking the 50% upstroke of the waveform would consistently yield the most precise PWV measurements and minimize the error in the propagation uniformity measurement. Such findings may help establish the optimal image acquisition and signal processing parameters that may improve the reliability of PWI as a clinical measurement tool.

2-D arterial wall motion imaging using ultrafast ultrasound and transverse oscillations

Ultrafast ultrasound is a promising imaging modality that enabled, inter alia, the development of pulse wave imaging and the local velocity estimation of the so-called pulse wave for a quantitative evaluation of arterial stiffness. However, this technique only focuses on the propagation of the axial displacement of the artery wall, and most techniques are not specific to the intima-media complex and do not take into account the longitudinal motion of this complex. Within this perspective, this paper presents a study of two-dimensional tissue motion estimation in ultrafast imaging combining transverse oscillations, which can improve motion estimation in the transverse direction, i.e., perpendicular to the beam axis, and a phase-based motion estimation. First, the method was validated in simulation. Two-dimensional motion, inspired from a real data set acquired on a human carotid artery, was applied to a numerical phantom to produce a simulation data set. The estimated motion showed axial and lateral mean errors of 4.2 ± 3.4 μm and 9.9 ± 7.9 μm, respectively. Afterward, experimental results were obtained on three artery phantoms with different wall stiffnesses. In this study, the vessel phantoms did not contain a pure longitudinal displacement. The longitudinal displacements were induced by the axial force produced by the wall's axial dilatation. This paper shows that the approach presented is able to perform 2-D tissue motion estimation very accurately even if the displacement values are very small and even in the lateral direction, making it possible to estimate the pulse wave velocity in both the axial and longitudinal directions. This demonstrates the method's potential to estimate the velocity of purely longitudinal waves propagating in the longitudinal direction. Finally, the stiffnesses of the three vessel phantom walls investigated were estimated with an average relative error of 2.2%.

Ultrasound imaging for risk assessment in atherosclerosis

Atherosclerosis and its consequences like acute myocardial infarction or stroke are highly prevalent in western countries, and the incidence of atherosclerosis is rapidly rising in developing countries. Atherosclerosis is a disease that progresses silently over several decades before it results in the aforementioned clinical consequences. Therefore, there is a clinical need for imaging methods to detect the early stages of atherosclerosis and to better risk stratify patients. In this review, we will discuss how ultrasound imaging can contribute to the detection and risk stratification of atherosclerosis by (a) detecting advanced and early plaques; (b) evaluating the biomechanical consequences of atherosclerosis in the vessel wall;