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

Ultrasound vector flow imaging during veno-arterial extracorporeal membrane oxygenation in a thoracic aorta model

In veno-arterial extracorporeal membrane oxygenation (VA-ECMO) treatment, the mixing zone is a key hemodynamic factor that determines the efficacy of the treatment. This study aimed to evaluate the applicability of a novel ultrasound technique called vector flow imaging (VFI) for visualizing complex flow patterns in an aorta phantom under VA-ECMO settings. VFI experiments were performed to image aortic hemodynamics under VA-ECMO treatment simulated in an anthropomorphic thoracic aorta phantom using a pulsatile pump (cardiac output: 2.7 L/min) and an ECMO pump with two different flow rates, 0.35 L/min and 1.0 L/min. The cardiac cycle of hemodynamics in the ascending aorta, aortic arch, and descending aorta was visualized, and the spatio-temporal dynamics of flow vectors were analyzed. VFI successfully visualized dynamic flow patterns in the aorta phantom. When the flow rate of the ECMO pump increased, ECMO flow was more dominant than cardiac output in the diastole phase, and the speed of cardiac output was suppressed in the systole phase. Vortex flow patterns were also detected in the ascending aorta and the arch under both ECMO flow rate conditions. The VFI technique may provide new insights into aortic hemodynamics and facilitates effective and safe VA-ECMO treatment.

The impact of V-flow on preoperative diagnosis of thyroid tumors: individually and as part of multimodal sonographic imaging

V-flow is a dynamic ultrasound technique that visualizes perfusion patterns by displaying dynamic arrows that change in response to the flow of erythrocytes. Furthermore, it provides quantitative values for the maximum and mean velocity of blood flow as well as a percentage value for turbulence. The aim was to enhance the preoperative diagnostic accuracy of thyroid lesions by combining V-flow with established ultrasound modes.B-mode, CCDS, elastography, CEUS, and V-flow were performed on 101 patients. After the ultrasound examination, every nodule was confirmed as benign or malignant via histopathology. The Kruskal-Wallis test, ROC curve, and binary logistic regression were used for the statistical analysis.93 benign regressive thyroid nodules and 8 carcinomas were included in this study. The average mean velocity value for benign lesions was measured at 19.5 cm/s and at 10.7 cm/s for malignant lesions (p = 0.039). The average turbulence percentage was 26.1% for benign nodules and 46.7% for carcinomas (p = 0.016). Carcinomas exhibited a slower and more turbulent perfusion pattern compared to benign tumors. A V-flow-centered system achieves a sensitivity of 100.0% and a specificity of 84.9% in predicting malignancy. This system could have reduced the number of unnecessary thyroid surgeries for benign lesions in our patient group by 70%.The capillary perfusion of thyroid nodules represents a significant indicator of its status. By analyzing the velocity and turbulence level of microvascular blood flow, V-flow offers promising prospects for accurately distinguishing between benign and malignant thyroid lesions. When integrated into a comprehensive multimodal sonographic imaging approach, V-flow further enhances diagnostic accuracy. · V-flow allows for qualitative and quantitative analysis of microvascular perfusion. · Malignant tumors are associated with slower and more turbulent microvascular hemodynamics. · Combining V-flow with other ultrasound modes eases the diagnosis of thyroid carcinomas. · Brandenstein MK, Zhang L, Scharf G et al. The impact of V-flow on preoperative diagnosis of thyroid tumors: individually and as part of multimodal sonographic imaging. Fortschr Röntgenstr 2024; DOI 10.1055/a-2350-0107.

Characterization of internal jugular vein region-specific distension and flow patterns during progressive volume shifting

Blood volume shifts during postural adjustment lead to irregular distension of the internal jugular vein (IJV). In microgravity, distension may contribute to flow stasis and thromboembolism, though the regional implications and associated risk remain unexplored. We characterized regional differences in IJV volume distension and flow complexity during progressive head-down tilt (HDT) (0°, -6°, -15°, -30°) using conventional ultrasound and vector flow imaging. We also evaluated low-pressure thigh cuffs (40 mmHg) as a fluid shifting countermeasure during -6° HDT. Total IJV volume expanded 139 ± 95% from supine position (4.6 ± 2.7 mL) to -30° HDT (10.3 ± 5.0 mL). Blood flow profiles had greater vector uniformity at the cranial IJV region (P < 0.01) and became more dispersed with increasing tilt (P < 0.01). Qualitatively, flow was more uniform throughout the IJV during its early flow cycle phase and more disorganized during late flow phase. This disorganized flow was accentuated closer to the vessel wall, near the caudal region, and during greater HDT. Low-pressure thigh cuffs during -6° HDT decreased IJV volume at the cranial region (-12 ± 15%; P < 0.01) but not the caudal region (P = 0.20), although flow uniformity was unchanged (both regions, P > 0.25). We describe a distensible IJV accommodating large volume shifts along its length. Prominent flow dispersion was primarily found at the caudal region, suggesting multidirectional blood flow. Thigh cuffs appear effective for decreasing IJV volume but effects on flow complexity are minor. Flow complexity along the vessel length is likely related to IJV distension during chronic volume shifting and may be a precipitating factor for flow stasis and future thromboembolism risk.NEW & NOTEWORTHY The internal jugular vein (IJV) facilitates cerebral outflow and is sensitive to volume shifts. Concerns about IJV expansion and fluid flow behavior in astronauts have surfaced following thromboembolism reports. Our study explored regional volume distension and blood flow complexity in the IJV during progressive volume shifting. We observed stepwise volume distension and increasing flow dispersion with head-down tilting across all regions. Flow dispersion may pose a risk of future thromboembolism during prolonged volume shifts.

Photoacoustic vector tomography for deep haemodynamic imaging

Imaging deep haemodynamics non-invasively remains a quest. Although optical imaging techniques can be used to measure blood flow, they are generally limited to imaging within ∼1 mm below the skin's surface. Here we show that such optical diffusion limit can be broken through by leveraging the spatial heterogeneity of blood and its photoacoustic contrast. Specifically, successive single-shot wide-field photoacoustic images of blood vessels can be used to visualize the frame-to-frame propagation of blood and to estimate blood flow speed and direction pixel-wise. The method, which we named photoacoustic vector tomography (PAVT), allows for the quantification of haemodynamics in veins more than 5 mm deep, as we show for regions in the hands and arms of healthy volunteers. PAVT may offer advantages for the diagnosis and monitoring of vascular diseases and for the mapping of the function of the circulatory system.

Evaluation of Turbulence Index and Flow Pattern for Atherosclerotic Carotid Stenosis: A High-Frame-Rate Vector Flow Imaging Study

OBJECTIVE

The emerging high-frame-rate vector flow imaging provides a new way of hemodynamic evaluation for complex blood flow. This study was aimed at exploring quantitatively the characteristics of complex flow with turbulence (Tur) index and analyzing flow patterns in atherosclerotic internal carotid artery stenosis (ICAS) using high-frame-rate vector flow imaging.

METHODS

This study prospectively included 60 patients with ICAS. Tur values in different segments of stenosis and cardiac phases were compared. Spearman correlation analysis was performed between clinical plaque characteristics with turbulence grading by ln(Tur). Three complex flow patterns were qualitatively drawn on vector flow mode, and the rates of detection of flow patterns in different stenosis groups and ulceration groups were compared.

RESULTS

Highly disordered blood flow was observed in the stenotic (Tur [M, QR] = 12.5%, 21.5%) and distal segment (15.4%, 27.2%), particularly during systole (21.0%, 30.7%, 33.3%, 38.7%, p < 0.05). Spearman correlation analysis revealed that stenosis rate was correlated with turbulence grading in the stenotic (ρ = 0.65, p < 0.05) and distal segment (ρ = 0.79, p < 0.05), and ulcer formation was correlated with turbulence grading in the stenotic segment (ρ = 0.58, p < 0.05). The overall rate of detection of three flow patterns was higher in the severe stenosis group (22/22) versus the mild to moderate stenosis group (21/38) (p < 0.001) and in the ulcer group (21/23) versus the non-ulcer group (23/37) (p < 0.001).

CONCLUSION

High-frame-rate vector flow imaging was helpful in assessing the severity and characteristics of flow turbulence. Lumen geometric factors could affect flow turbulence and blood flow patterns around the plaque. This would provide important hemodynamic information for the detection of high-risk plaque.

Feasibility study of combining wall shear stress and elastography to assess the vascular status of carotid artery

INTRODUCTION

At present, early detection of the potential risk of atherosclerosis and prevention is of great significance to reduce the occurrence of stroke.

AIM

This study aims to explore the value of combining the wall shear stress measured by ultrasound vector flow imaging technique and sound touch elastography of common carotid artery in normal adults using the Mindray Resona 7 ultrasound system.

METHODS

Forty volunteers (mean age 39.5 y, 23 females, 17 males) were divided into four groups according to their age. All volunteers underwent ultrasound carotid artery examination, and the values of wall shear stress and elasticity on the posterior wall of the common carotid artery were measured using advanced imaging functions, vector flow imaging technique, and sound touch elastography.

RESULTS

Different cut-off values of wall shear stress were used to investigate the significance between two groups with corresponding sound touch elastography values. It can be seen that the statistical difference could be found when the mean wall shear stress was larger than 1.5 Pa approximately (statistical significance was defined when P < 0.05), and the sound touch elastography value was positively correlated with the wall shear stress value.

CONCLUSION

This study reveals that the combination of wall shear stress and sound touch elastography is an effective and feasible method for assessing carotid artery health. When the mean wall shear stress value is over 1.5 Pa, the corresponding sound touch elastography value increases significantly. The risk of atherosclerosis increases with the stiffness of blood vessel walls.

First assessment of flow phenomena of acute and chronic thrombosis in the jugular veins using new ultrasound vector-flow imaging

AIM

First assessment of flow changes in the jugular veins using high resolution ultrasound vector flow.

MATERIAL UND METHODS

15 patients (8 males, 7 females) with an age range of 35 to 82 years (mean age 58.53±12.26 years) were examined by an experienced examiner using high power ultrasound equipment (Resona R9, Mindray) with probe technology (Mindray L9-3U Linear Array transducer, 2.5 to 9.0 MHz). This group was compared with five healthy subjects (mean age 35.4±13.79 years) as a reference. To assess flow changes, the color-coded duplex sonography and the novel vector flow technique were used. The evaluation was performed of vector morphology changes, turbulence, and wall resistance measurements.

RESULTS

There were changes after acute and chronic thrombosis in 9 cases, and venous compression in 7 cases. Turbulence was measurable from 0.01 % to 64.44 %, the average turbulence was 19.73±22.06 %. Wall resistance measurement showed values from 0.01 Pa to 3.14 Pa, depending on the age of the thrombosis or compression. The reference veins showed turbulence of 0.94±1.5 % and a mean wall resistance of 0.05±0.05 Pa. There are statistically significant differences between normal and thrombotic or compressed veins in terms of maximum wall stress (p = 0.006) and mean degree of turbulence (p = 0.012), while the difference in mean wall stress is not statistically significant (p = 0.058).

CONCLUSION

Despite still existing technical limitations, the combination of V-flow and wall stress measurements in jugular vein changes suggests a high diagnostic potential.

Transrectal ultrasound vector projectile imaging for time-resolved visualization of flow dynamics in the male urethra: A clinical pilot study

BACKGROUND

Quantitative and comprehensive visualization of urinary flow dynamics in the urethra is crucial for investigating patient-specific mechanisms of lower urinary tract symptoms (LUTS). Although some methods can evaluate the global properties of the urethra, it is critical to assess the local information, such as the location of the responsible lesion and its interactions with urinary flow in relation to LUTS. This approach is vital for enhancing personalized and focal treatments. However, there is a lack of such diagnostic tools that can directly observe how the urethral shape and motion impact urinary flow in the urethra.

PURPOSE

This study aimed to develop a novel transrectal ultrasound imaging modality based on the contrast-enhanced urodynamic vector projectile imaging (CE-UroVPI) framework and validate its clinical applicability for visualizing time-resolved flow dynamics in the urethra.

METHODS

A new CE-UroVPI system was developed using a research-purpose ultrasound platform and a custom transrectal linear probe, and an imaging protocol for acquiring urodynamic echo data in male patients was designed. Thirty-four male patients with LUTS participated in this study. CE-UroVPI was performed to acquire ultrasound echo signals from the participant's urethra and urinary flow at various voiding phases (initiation, maintenance, and terminal). The ultrasound datasets were processed with custom software to visualize urinary flow dynamics and urethra tissue deformation.

RESULTS

The transrectal CE-UroVPI system successfully visualized the time-resolved multidirectional urinary flow dynamics in the prostatic urethra during the initiation, maintenance, and terminal phases of voiding in 17 patients at a frame rate of 1250 fps. The maximum flow speed measured in this study was 2.5 m/s. In addition, when the urethra had an obstruction or an irregular partial deformation, the devised imaging modality visualized complex flow patterns, such as vortices and flow jets around the lesion.

CONCLUSIONS

Our study findings demonstrate that the transrectal CE-UroVPI system developed in this study can effectively image fluid-structural interactions in the urethra. This new diagnostic technology has the potential to facilitate quantitative and precise assessments of urethral voiding functions and aid in the improvement of focal and effective treatments for patients with LUTS.

High-Spatiotemporal-Resolution Ultrasound Flow Imaging to Determine Cerebrovascular Hemodynamics in Alzheimer's Disease Mice Model

Although the relationships of cerebrovascular hemodynamic dysfunction with neurodegenerative diseases remain unclear, many studies have indicated that poor cerebral perfusion accelerates the progression of neurodegenerative diseases, such as Alzheimer's disease (AD). Small animal models are widely used in AD research. However, providing an imaging modality with a high spatiotemporal resolution and sufficiently large field of view to assess cerebrovascular hemodynamics in vivo remains a challenge. The present study proposes a novel technique for high-spatiotemporal-resolution vector micro-Doppler imaging (HVμDI) based on contrast-free ultrafast high frequency ultrasound imaging to visualize the cerebrovascular hemodynamics of the mouse, with a data acquisition time of 0.4 s, a minimal detectable vessel size of 38 µm, and a temporal resolution of 500 Hz. In vivo experiments are conducted on wild-type and AD mice. Cerebrovascular hemodynamics are quantified using the cerebral vascular density, diameter, velocity, tortuosity, cortical flow pulsatility, and instant flow direction variations. Results reveal that AD significantly change the cerebrovascular hemodynamics. HVμDI offers new opportunities for in vivo analysis of cerebrovascular hemodynamics in neurodegenerative pathologies in preclinical animal research.

A GPU-Based, Real-Time Dealiasing Framework for High-Frame-Rate Vector Doppler Imaging

Vector Doppler is well regarded as a potential way of deriving flow vectors to intuitively visualize complex flow profiles, especially when it is implemented at high frame rates. However, this technique's performance is known to suffer from aliasing artifacts. There is a dire need to devise real-time dealiasing solutions for vector Doppler. In this article, we present a new methodological framework for achieving aliasing-resistant flow vector estimation at real-time throughput from precalculated Doppler frequencies. Our framework comprises a series of compute kernels that have synergized: 1) an extended least squares vector Doppler (ELS-VD) algorithm; 2) single-instruction, multiple-thread (SIMT) processing principles; and 3) implementation on a graphical processing unit (GPU). Results show that this new framework, when executed on an RTX-2080 GPU, can effectively generate aliasing-free flow vector maps using high-frame-rate imaging datasets acquired from multiple transmit-receive angle pairs in a carotid phantom imaging scenario. Over the entire cardiac cycle, the frame processing time for aliasing-resistant vector estimation was measured to be less than 16 ms, which corresponds to a minimum processing throughput of 62.5 frames/s. In a human femoral bifurcation imaging trial with fast flow (150 cm/s), our framework was found to be effective in resolving two-cycle aliasing artifacts at a minimum throughput of 53 frames/s. The framework's processing throughput was generally in the real-time range for practical combinations of ELS-VD algorithmic parameters. Overall, this work represents the first demonstration of real-time, GPU-based aliasing-resistant vector flow imaging using vector Doppler estimation principles.

First experiences of ultrasound vector flow imaging at the femoropopliteal artery in peripheral arterial disease

Background: The femoropopliteal artery (FPA) plays a central role in diagnosing and treating peripheral arterial disease (PAD). FPA lesions are the most frequent cause of intermittent claudication, and no other artery of the lower extremities is recanalised more frequently. Generally, ultrasound is the primary imaging tool in PAD, particularly FPA. With the development of high-frame-rate ultrasound technology in addition to traditional ultrasound modes, vector flow imaging (VFI) has provided deeper haemodynamic insights when used in the carotid artery. Here, we report the use of VFI at the FPA level in routine PAD examinations. Patients and methods: In this single-centre prospective study, we evaluated consecutive patients with PAD using B-mode imaging, colour Doppler, pulsed wave Doppler (PW) and vector flow. Hemodynamic parameters at predefined locations at the carotid artery and FPA were compared. Results: Qualitatively adequate VFI at all sites was possible in 76% of the patients with PAD. With decreasing volume flow from the common carotid artery to the internal carotid artery and from the common femoral artery via the superficial femoral artery to the popliteal artery, the correlation between VFI- and PW-derived-volume flow was high at every site. Based on different techniques, the VFI-derived values were significantly lower than the PW-derived values. The mean wall shear stress was significantly lower at all femoropopliteal sites than at the carotid sites, whereas the oscillatory shear index at the femoral site was higher than that at the carotid sites rather than at the popliteal location. Conclusions: Our findings suggest that vector flow data acquisition in the FPA is feasible in most patients with PAD. Therefore, with knowledge of the method and its limitations, VFI provides haemodynamic information beyond traditional ultrasound techniques and is a promising new tool for flow analysis in PAD.

Changes in cerebral connectivity and brain tissue pulsations with the antidepressant response to an equimolar mixture of oxygen and nitrous oxide: an MRI and ultrasound study

Nitrous oxide (N2O) has recently emerged as a potential fast-acting antidepressant but the cerebral mechanisms involved in this effect remain speculative. We hypothesized that the antidepressant response to an Equimolar Mixture of Oxygen and Nitrous Oxide (EMONO) would be associated with changes in cerebral connectivity and brain tissue pulsations (BTP). Thirty participants (20 with a major depressive episode resistant to at least one antidepressant and 10 healthy controls-HC, aged 25-50, only females) were exposed to a 1-h single session of EMONO and followed for 1 week. We defined response as a reduction of at least 50% in the MADRS score 1 week after exposure. Cerebral connectivity of the Anterior Cingulate Cortex (ACC), using ROI-based resting state fMRI, and BTP, using ultrasound Tissue Pulsatility Imaging, were compared before and rapidly after exposure (as well as during exposure for BTP) among HC, non-responders and responders. We conducted analyses to compare group × time, group, and time effects. Nine (45%) depressed participants were considered responders and eleven (55%) non-responders. In responders, we observed a significant reduction in the connectivity of the subgenual ACC with the precuneus. Connectivity of the supracallosal ACC with the mid-cingulate also significantly decreased after exposure in HC and in non-responders. BTP significantly increased in the three groups between baseline and gas exposure, but the increase in BTP within the first 10 min was only significant in responders. We found that a single session of EMONO can rapidly modify the functional connectivity in the subgenual ACC-precuneus, nodes within the default mode network, in depressed participants responders to EMONO. In addition, larger increases in BTP, associated with a significant rise in cerebral blood flow, appear to promote the antidepressant response, possibly by facilitating optimal drug delivery to the brain. Our study identified potential cerebral mechanisms related to the antidepressant response of N2O, as well as potential markers for treatment response with this fast-acting antidepressant.

Detection of Abnormal Wall Shear Stress and Oscillatory Shear Index via Ultrasound Vector Flow Imaging as Possible Indicators for Arteriovenous Fistula Stenosis in Hemodialysis

OBJECTIVE

The arteriovenous fistula (AVF) is an essential vascular access for hemodialysis patients. AVF stenosis may occur at sites with abnormal wall shear stress (WSS) and oscillatory shear index (OSI), which are caused by the complex flow in the AVF. At present, an effective method for rapid determination of the WSS and OSI of the AVF is lacking. The objective of this study was to apply an ultrasound-based method for determination of the WSS and OSI to explore the risk sites of the AVF.

METHODS

In this study, the ultrasound vector flow imaging technique V Flow was applied to measure the WSS and OSI at four different regions of the AVF to detect and analyze the risk sites: (i) anastomosis region, (ii) curved region, (iii) proximal vein and (iv) distal vein. Twenty-one patients were included in this study. The relative residence time was calculated based on the measured WSS and OSI.

RESULTS

The curved region had the lowest WSS; the anastomosis region had a significantly higher OSI (p < 0.05) compared with the venous regions, and the curved region had a significantly higher RRT (p < 0.05) compared with the proximal vein region.

CONCLUSION

V Flow is a feasible tool for studying WSS variations in AVF. The possible risk site in the AVF may be located in the anastomosis and curved regions, where the latter could present a higher risk for AVF stenosis.

Transverse oscillation tensor velocity imaging using a row-column addressed array: Experimental validation

Tensor velocity imaging (TVI) performance with a row-column probe was assessed for constant flow in a straight vessel phantom and pulsatile flow in a carotid artery phantom. TVI, i.e., estimating the 3-D velocity vector as a function of time and spatial position, was performed using the transverse oscillation cross-correlation estimator, and the flow was acquired with a Vermon 128+128 row-column array probe connected to a Verasonics 256 research scanner. The emission sequence used 16 emissions per image, and a TVI volume rate of 234 Hz was obtained for a pulse repetition frequency (f_prf) of 15 kHz. The TVI was validated by comparing estimates of the flow rate through several cross-sections with the flow rate set by the pump. For the constant 8 mL/s flow in the straight vessel phantom with relative estimator bias (RB) and standards deviation (RSD) was found in the range of -2.18% to 0.55% and 4.58% to 2.48% in measurements performed with an f_prf of 15, 10, 8, and 5 kHz. The pulsatile flow in the carotid artery phantom the was set to an average flow rate of 2.44 mL/s, and the flow was acquired with an f_prf of 15, 10, and 8 kHz. The pulsatile flow was estimated from two measurement sites: one at a straight section of the artery and one at the bifurcation. In the straight section, the estimator predicted the average flow rate with an RB value ranging from -7.99% to 0.10% and an RSD value ranging from 10.76% to 6.97%. At the bifurcation, RB and RSD values were between -7.47% to 2.02% and 14.46% to 8.89%. This demonstrates that an RCA with 128 receive elements can accurately capture the flow rate through any cross-section at a high sampling rate.

Novel ultrasound techniques in the identification of vulnerable plaques-an updated review of the literature

Atherosclerosis is an inflammatory disease partly mediated by lipoproteins. The rupture of vulnerable atherosclerotic plaques and thrombosis are major contributors to the development of acute cardiovascular events. Despite various advances in the treatment of atherosclerosis, there has been no satisfaction in the prevention and assessment of atherosclerotic vascular disease. The identification and classification of vulnerable plaques at an early stage as well as research of new treatments remain a challenge and the ultimate goal in the management of atherosclerosis and cardiovascular disease. The specific morphological features of vulnerable plaques, including intraplaque hemorrhage, large lipid necrotic cores, thin fibrous caps, inflammation, and neovascularisation, make it possible to identify and characterize plaques with a variety of invasive and non-invasive imaging techniques. Notably, the development of novel ultrasound techniques has introduced the traditional assessment of plaque echogenicity and luminal stenosis to a deeper assessment of plaque composition and the molecular field. This review will discuss the advantages and limitations of five currently available ultrasound imaging modalities for assessing plaque vulnerability, based on the biological characteristics of the vulnerable plaque, and their value in terms of clinical diagnosis, prognosis, and treatment efficacy assessment.

Deep-learning-assisted and GPU-accelerated vector Doppler imaging with aliasing-resistant velocity estimation

Vector flow imaging is a diagnostic ultrasound modality that is suited for the visualization of complex blood flow dynamics. One popular way of realizing vector flow imaging at high frame rates over 1000 fps is to apply multi-angle vector Doppler estimation principles in conjunction with plane wave pulse-echo sensing. However, this approach is susceptible to flow vector estimation errors attributed to Doppler aliasing, which is prone to arise when a low pulse repetition frequency (PRF) is inevitably used due to the need for finer velocity resolution or because of hardware constraints. Existing dealiasing solutions tailored for vector Doppler may have high computational demand that makes them unfeasible for practical applications. In this paper, we present the use of deep learning and graphical processing unit (GPU) computing principles to devise a fast vector Doppler estimation framework that is resilient against aliasing artifacts. Our new framework works by using a convolutional neural network (CNN) to detect aliased regions in vector Doppler images and subsequently applying an aliasing correction algorithm only at these affected regions. The framework's CNN was trained using 15,000 in vivo vector Doppler frames acquired from the femoral and carotid arteries, including healthy and diseased conditions. Results show that our framework can perform aliasing segmentation with an average precision of 90 % and can render aliasing-free vector flow maps with real-time processing throughputs (25-100 fps). Overall, our new framework can improve the visualization quality of vector Doppler imaging in real-time.

FLUST: A fast, open source framework for ultrasound blood flow simulations

BACKGROUND AND OBJECTIVE

Ultrasound based blood velocity estimation is a continuously developing frontier, where the vast number of possible acquisition setups and velocity estimators makes it challenging to assess which combination is better suited for a given imaging application. FLUST, the Flow-Line based Ultrasound Simulation Tool, may be used to address this challenge, providing a common platform for evaluation of velocity estimation schemes on in silico data. However, the FLUST approach had some limitations in its original form, including reduced robustness for phase sensitive setups and the need for manual selection of integrity parameters. In addition, implementation of the technique and therefore also documentation of signal integrity was left to potential users of the approach.

METHODS

In this work, several improvements to the FLUST technique are proposed and investigated, and a robust, open source simulation framework developed. The software supports several transducer types and acquisition setups, in addition to a range of different flow phantoms. The main goal of this work is to offer a robust, computationally cheap and user-friendly framework to simulate ultrasound data from stationary blood velocity fields and thereby facilitate design and evaluation of estimation schemes, including acquisition design, velocity estimation and other post-processing steps.

RESULTS

The technical improvements proposed in this work resulted in reduced interpolation errors, reduced variability in signal power, and also automatic selection of spatial and temporal discretization parameters. Results are presented illustrating the challenges and the effectiveness of the solutions. The integrity of the improved simulation framework is validated in an extensive study, with results indicating that speckle statistics, spatial and temporal correlation and frequency content all correspond well with theoretical predictions. Finally, an illustrative example shows how FLUST may be used throughout the design and optimization process of a velocity estimator.

CONCLUSIONS

The FLUST framework is available as a part of the UltraSound ToolBox (USTB), and the results in this paper demonstrate that it can be used as an efficient and reliable tool for the development and validation of ultrasound-based velocity estimation schemes.

New Technologies in the Assessment of Carotid Stenosis: Beyond the Color-Doppler Ultrasound-High Frame Rate Vector-Flow and 3D Arterial Analysis Ultrasound

Atherosclerotic plaque in the carotid artery is the main cause of ischemic stroke, with a high incidence rate among people over 65 years. A timely and precise diagnosis can help to prevent the ischemic event and decide patient management, such as follow up, medical, or surgical treatment. Presently, diagnostic imaging techniques available include color-Doppler ultrasound, as a first evaluation technique, computed tomography angiography, which, however, uses ionizing radiation, magnetic resonance angiography, still not in widespread use, and cerebral angiography, which is an invasively procedure reserved for therapeutically purposes. Contrast-enhanced ultrasound is carving out an important and emerging role which can significantly improve the diagnostic accuracy of an ultrasound. Modern ultrasound technologies, still not universally utilized, are opening new horizons in the arterial pathologies research field. In this paper, the technical development of various carotid artery stenosis diagnostic imaging modalities and their impact on clinical efficacy is thoroughly reviewed.

Advanced Fourier migration for Plane-Wave vector flow imaging

Ultrafast ultrasound imaging modalities have been studied extensively in the ultrasound community. It breaks the compromise between the frame rate and the region of interest by imaging the whole medium with wide unfocused waves. Continuously available data allow monitoring fast transient dynamics at hundreds to thousands of frames per second. This feature enables a more accurate and robust velocity estimation in vector flow imaging (VFI). On the other hand, the huge amount of data and real-time processing demands are still challenging in VFI. A solution is to provide a more efficient beamforming approach with smaller computation complexity than the conventional time-domain beamformer like delay-and-sum (DAS). Fourier-domain beamformers are shown to be more computationally efficient and can provide equally good image quality as DAS. However, previous studies generally focus on B-mode imaging. In this study, we propose a new framework for VFI which is based on two advanced Fourier migration methods, namely, slant stack migration (SSM) and ultrasound Fourier slice beamform (UFSB). By carefully modifying the beamforming parameters, we successfully apply the cross-beam technique within the Fourier beamformers. The proposed Fourier-based VFI is validated in simulation studies, in vitro, and in vivo experiments. The velocity estimation is evaluated via bias and standard deviation and the results are compared with conventional time-domain VFI using the DAS beamformer. In the simulation, the bias is 6.4%, -6.2%, and 5.7%, and the standard deviation is 4.3%, 2.4%, and 3.9% for DAS, UFSB, and SSM, respectively. In vitro studies reveal a bias of 4.5%, -5.3%, and 4.3% and a standard deviation of 3.5%, 1.3%, and 1.6% from DAS, UFSB, and SSM, respectively. The in vivo imaging of the basilic vein and femoral bifurcation also generate similar results using all three methods. With the proposed Fourier beamformers, the computation time can be shortened by up to 9 times and 14 times using UFSB and SSM.

Recent Advances in Ultrasound of Soft Tissue Lesions

The superficial soft tissue lesions are commonly discovered during routine clinical practice. However, their diagnosis can be challenging. Non-invasive imaging can differentiate the features of various superficial soft tissue lesions. Moreover, imaging-based evaluations can help guide treatment and surgical planning, evaluate tumor extension, and perform staging and follow-up. Novel imaging modalities and techniques have been developed to improve diagnostic performance and differentiate between benign and malignant lesions in vivo. The authors reviewed the literature to determine how ultrasound has been utilized to diagnose and treat superficial soft tissue lesions.

Efficacy of ultrasound vector flow imaging in tracking omnidirectional pulsatile flow

BACKGROUND

Ultrasound vector flow imaging (VFI) shows potential as an emerging non-invasive modality for time-resolved flow mapping. However, its efficacy in tracking multidirectional pulsatile flow with temporal resolvability has not yet been systematically evaluated because of the lack of an appropriate test protocol.

PURPOSE

We present the first systematic performance investigation of VFI in tracking pulsatile flow in a meticulously designed scenario with time-varying, omnidirectional flow fields (with flow angles from 0° to 360°).

METHODS

Ultrasound VFI was performed on a three-loop spiral flow phantom (4 mm diameter; 5 mm pitch) that was configured to operate under pulsatile flow conditions (10 ml/s peak flow rate; 1 Hz pulse rate; carotid pulse shape). The spiral lumen geometry was designed to simulate recirculatory flow dynamics observed in the heart and in curvy blood vessel segments such as the carotid bulb. The imaging sequence was based on steered plane wave pulsing (-10°, 0°, +10° steering angles; 5 MHz imaging frequency; 3.3 kHz interleaved pulse repetition frequency). VFI's pulsatile flow estimation performance and its ability to detect secondary flow were comparatively assessed against flow fields derived from computational fluid dynamics (CFD) simulations that included consideration of fluid-structure interactions (FSI). The mean percentage error (MPE) and the coefficient of determination (R² ) were computed to assess the correspondence of the velocity estimates derived from VFI and CFD-FSI simulations. In addition, VFI's efficacy in tracking pulse waves was analyzed with respect to pressure transducer measurements made at the phantom's inlet and outlet.

RESULTS

Pulsatile flow patterns rendered by VFI agreed with the flow profiles computed from CFD-FSI simulations (average MPE: -5.3%). The shape of the VFI-measured velocity magnitude profile generally matched the inlet flow profile. High correlation exists between VFI measurements and simulated flow vectors (lateral velocity: R²  = 0.8; axial velocity R²  = 0.89; beam-flow angle: R²  = 0.98; p < 0.0001 for all three quantities). VFI was found to be capable of consistently tracking secondary flow. It also yielded pulse wave velocity (PWV) estimates (5.72 ± 1.02 m/s) that, on average, are within 6.4% of those obtained from pressure transducer measurements (6.11 ± 1.15 m/s).

CONCLUSION

VFI can consistently track omnidirectional pulsatile flow on a time-resolved basis. This systematic investigation serves well as a quality assurance test of VFI.

Blood Flow Turbulence Quantification of Carotid Artery With a High-Frame Rate Vector Flow Imaging

OBJECTIVES

To assess the feasibility and performance of Turbulence (Tur) index as a quantitative tool for carotid artery flow turbulence; to detect and compare the blood flow patterns of common carotid artery (CCA) and carotid bulb (CB) at different ages and cardiac phases in healthy adults, and thus interpret the evolvement of etiology difference between CCA and CB.

METHODS

Carotid flow characteristics of 40 healthy volunteers were evaluated quantitatively by a high-frame rate vector flow imaging. Three types of flow patterns were defined depending on the distributive range of complex flow during systole in CB. Comparison of mean Tur value in CCA and CB at different age groups and cardiac phases was performed. And the correlation between Tur value and the diameter ratio of proximal internal carotid artery to common carotid artery (DRpro-ica/cca) was tested.

RESULTS

Mean Tur values in CB were remarkably higher than that in CCA, whether during systole or diastole (P < .001). Meanwhile Tur values in CB during systole were significantly higher than that during diastole (P < .001). Flow complexity of CB showed variations among 40 participants especially in systole, whereas the flow pattern of CCA was relatively consistent. Mean Tur values were positively correlated with DRpro-ica/cca in CB (ρ = 0.69, P < .05).

CONCLUSIONS

V Flow imaging provided a reliable method-Tur, for quantitative analysis of carotid blood flow. It had potential to be further applied in distinguishing complex hemodynamic characteristics in high-risk people of carotid diseases for the risk stratification of cardiovascular events.

Velocity vector comparison between vector flow imaging and computational fluid dynamics in the carotid bifurcation

It has been largely documented that local hemodynamic conditions, characterized by low and oscillating wall shear stresses, play a key role in the initiation and progression of vascular atherosclerotic lesions. Thus, investigation of the flow field in the carotid bifurcation can lead to early identification of vulnerable plaques. In this scenario, the development of novel non-invasive imaging tools that can be used in routine clinical practice to identify disturbed and recirculating blood flow becomes crucial. In this context, Vector Flow Imaging is becoming a relevant tool as it provides an angle independent assessment of blood flow velocity and multidimensional flow vector visualization. The purpose of the present study was to validate, in several locations of the carotid bifurcation, the high-frame rate vector flow imaging (HiFR-VFI) technique by comparing with computational fluid dynamic simulations (CFD). In all eight carotid bifurcations, HiFR-VFI accurately detected regions of laminar flow as well as recirculation and unsteady flow areas. An accurate and statistically significant agreement was observed between velocity vectors obtained by HiFR-VFI and those computed by CFD, both for vector magnitude (R = 0.85) and direction (R = 0.74). Our study demonstrated that HiFR-VFI is a valid technique for rapid and advanced visual representation of velocity field in large arteries. Thus, it has a great potential in research-based clinical practice for the identification of flow recirculation, low and oscillating velocity gradients near vessel wall. The use of HiFR-VFI may provide a great improvement in the investigation of the role of local hemodynamics in vascular pathologies, as well in the assessment of the effect of pharmacological treatments.

Two-Dimensional Wavenumber Analysis Implemented in Ultrasonic Vector Doppler Method with Focused Transmit Beams

The multi-angle Doppler method was introduced for the estimation of velocity vectors by measuring axial velocities from multiple directions. We have recently reported that the autocorrelation-based velocity vector estimation could be ameliorated significantly by estimating the wavenumbers in two dimensions. Since two-dimensional wavenumber estimation requires a snapshot of an ultrasonic field, the method was first implemented in plane wave imaging. Although plane wave imaging is predominantly useful for examining blood flows at an extremely high temporal resolution, it was reported that the contrast in a B-mode image obtained with a few plane wave emissions was lower than that obtained with focused beams. In this study, the two-dimensional wavenumber analysis was first implemented in a framework with focused transmit beams. The simulations showed that the proposed method achieved an accuracy in velocity estimation comparable to that of the method with plane wave imaging. Furthermore, the performances of the methods implemented in focused beam and plane wave imaging were compared by measuring human common carotid arteries in vivo. Image contrasts were analyzed in normal and clutter-filtered B-mode images. The method with focused beam imaging achieved a better contrast in normal B-mode imaging, and similar velocity magnitudes and angles were obtained by both the methods with focused beam and plane wave imaging. In contrast, the method with plane wave imaging gave a better contrast in a clutter-filtered B-mode image and smaller variances in velocity magnitudes than those with focused beams.

Time-Resolved Wall Shear Rate Mapping Using High-Frame-Rate Ultrasound Imaging

In atherosclerosis, low wall shear stress (WSS) is known to favor plaque development, while high WSS increases plaque rupture risk. To improve plaque diagnostics, WSS monitoring is crucial. Here, we propose wall shear imaging (WASHI), a noninvasive contrast-free framework that leverages high-frame-rate ultrasound (HiFRUS) to map the wall shear rate (WSR) that relates to WSS by the blood viscosity coefficient. Our method measures WSR as the tangential flow velocity gradient along the arterial wall from the flow vector field derived using a multi-angle vector Doppler technique. To improve the WSR estimation performance, WASHI semiautomatically tracks the wall position throughout the cardiac cycle. WASHI was first evaluated with an in vitro linear WSR gradient model; the estimated WSR was consistent with theoretical values (an average error of 4.6% ± 12.4 %). The framework was then tested on healthy and diseased carotid bifurcation models. In both scenarios, key spatiotemporal dynamics of WSR were noted: 1) oscillating shear patterns were present in the carotid bulb and downstream to the internal carotid artery (ICA) where retrograde flow occurs; and 2) high WSR was observed particularly in the diseased model where the measured WSR peaked at 810 [Formula: see text] due to flow jetting. We also showed that WASHI could consistently track arterial wall motion to map its WSR. Overall, WASHI enables high temporal resolution mapping of WSR that could facilitate investigations on causal effects between WSS and atherosclerosis.

Investigation on the differences of hemodynamics in normal common carotid, subclavian, and common femoral arteries using the vector flow technique

OBJECTIVES

To investigate the feasibility of the vector flow imaging (V Flow) technique to measure peripheral arterial hemodynamic parameters, including wall shear stress (WSS) and turbulence index (Tur) in healthy adults, and compare the results in different arteries.

MATERIALS AND METHODS

Fifty-two healthy adult volunteers were recruited in this study. The maximum and mean values of WSS, and the Tur values at early-systole, mid-systole, late-systole, and early diastole for total 156 normal peripheral arteries [common carotid arteries (CCA), subclavian arteries (SCA), and common femoral arteries (CFA)] were assessed using the V Flow technique.

RESULTS

The mean WSS values for CCA, SCA, and CFA were (1.66 ± 0.68) Pa, (0.62 ± 0.30) Pa, and (0.56 ± 0.27) Pa, respectively. The mean Tur values for CCA, SCA, and CFA were (0.46 ± 1.09%), (20.7 ± 9.06%), and (24.63 ± 17.66%), respectively. The CCA and SCA, as well as the CCA and CFA, showed statistically significant differences in the mean WSS and the mean Tur (P < 0.01). The mean Tur values had a negative correlation with the mean WSS; the correlation coefficient between log(Tur) and WSS is -0.69 (P < 0.05).

CONCLUSION

V Flow technique is a simple, practical, and feasible quantitative imaging approach for assessing WSS and Tur in peripheral arteries. It has the potential to be a useful tool for evaluating atherosclerotic plaques in peripheral arteries. The results provide a new quantitative foundation for future investigations into diverse arterial hemodynamic parameters.

Accelerated 2-D Real-Time Refraction-Corrected Transcranial Ultrasound Imaging

In a recent study, we proposed a technique to correct aberration caused by the skull and reconstruct a transcranial B-mode image with a refraction-corrected synthetic aperture imaging (SAI) scheme. Given a sound speed map, the arrival times were calculated using a fast marching technique (FMT), which solves the Eikonal equation and, therefore, is computationally expensive for real-time imaging. In this article, we introduce a two-point ray tracing method, based on Fermat's principle, for fast calculation of the travel times in the presence of a layered aberrator in front of the ultrasound probe. The ray tracing method along with the reconstruction technique is implemented on a graphical processing unite (GPU). The point spread function (PSF) in a wire phantom image reconstructed with the FMT and the GPU implementation was studied with numerical synthetic data and experiments with a bone-mimicking plate and a sagittally cut human skull. The numerical analysis showed that the error on travel times is less than 10% of the ultrasound temporal period at 2.5 MHz. As a result, the lateral resolution was not significantly degraded compared with images reconstructed with FMT-calculated travel times. The results using the synthetic, bone-mimicking plate, and skull dataset showed that the GPU implementation causes a lateral/axial localization error of 0.10/0.20, 0.15/0.13, and 0.26/0.32 mm compared with a reference measurement (no aberrator in front of the ultrasound probe), respectively. For an imaging depth of 70 mm, the proposed GPU implementation allows reconstructing 19 frames/s with full synthetic aperture (96 transmission events) and 32 frames/s with multiangle plane wave imaging schemes (with 11 steering angles) for a pixel size of [Formula: see text]. Finally, refraction-corrected power Doppler imaging is demonstrated with a string phantom and a bone-mimicking plate placed between the probe and the moving string. The proposed approach achieves a suitable frame rate for clinical scanning while maintaining the image quality.

Cross-Ray Ultrasound Tomography and Photoacoustic Tomography of Cerebral Hemodynamics in Rodents

Recent advances in functional ultrasound imaging (fUS) and photoacoustic tomography (PAT) offer powerful tools for studying brain function. Complementing each other, fUS and PAT, respectively, measure the cerebral blood flow (CBF) and hemoglobin concentrations, allowing synergistic characterization of cerebral hemodynamics. Here, cross-ray ultrasound tomography (CRUST) and its combination with PAT are presented. CRUST employs a virtual point source from a spherically focused ultrasonic transducer (SFUST) to provide widefield excitation at a 4-kHz pulse repetition frequency. A full-ring-shaped ultrasonic transducer array whose imaging plane is orthogonal to the SFUST's acoustic axis receives scattered ultrasonic waves. Superior to conventional fUS, whose sensitivity to blood flow is angle-dependent and low for perpendicular flow, the crossed transmission and panoramic detection fields of CRUST provide omnidirectional sensitivity to CBF. Using CRUST-PAT, the CBF, oxygen saturation, and hemoglobin concentration changes of the mouse brain during sensory stimulation are measured, with a field of view of ≈7 mm in diameter, spatial resolution of ≈170 µm, and temporal resolution of 200 Hz. The results demonstrate CRUST-PAT as a unique tool for studying cerebral hemodynamics.

High-Spatiotemporal-Resolution Visualization of Myocardial Strains Through Vector Doppler Estimation: A Small-Animal Study

High-frequency ultrasound (HFUS) imaging is extensively used for cardiac diseases in small animals due to its high spatial resolution. However, there is a lack of a system that can provide a 2-D high-spatiotemporal dynamic visualization of mouse myocardial strains. In this article, a dynamic HFUS (40 MHz) high-resolution strain imaging was developed through the vector Doppler imaging. Following in vitro tests using a rubber balloon phantom, in vivo experiments were performed on wild-type (WT) and myocardial infarction (MI) mice. High-resolution dynamic images of myocardial strains were obtained in the longitudinal, radial, and circumferential directions at a frame rate of 1 kHz. Global peak strain values for WT mice were -19.3% ± 1.3% (longitudinal), 31.4% ± 1.7% (radial in the long axis), -19.9% ±.8% (circumferential), and 34.4% ± 1.9% (radial in the short axis); those for the MI mice were -16.1% ±.9% (longitudinal), 26.8% ± 2.9% (radial in the long axis), -15.2% ± 2.7% (circumferential), and 21.6% ± 4.8% (radial in the short axis). These results indicate that the strains for MI mice are significantly lower than those for WT mice. Regional longitudinal strain curves in the epicardial, midcardial, and endocardial layers were measured and the peak strain values for WT mice were -22.% and -16.8% in the endocardial and epicardial layers, respectively. However, no significant difference in the layer-based values was noted for the MI mice. Regional analysis results revealed obvious myocardial strain variation in the apical anterior region in the MI mice. The experimental results demonstrate that the proposed dynamic cardiac strain imaging can be useful in high-performance imaging of small-animal cardiac diseases.

Contribution of UltraFast™ Ultrasound and Shear Wave Elastography in the Imaging of Carotid Artery Disease

Carotid artery disease is one of the main global causes of disability and premature mortality in the spectrum of cardiovascular diseases. One of its main consequences, stroke, is the second biggest global contributor to disability and burden via Disability Adjusted Life Years after ischemic heart disease. In the last decades, B-mode and Doppler-based ultrasound imaging techniques have become an indispensable part of modern medical imaging of carotid artery disease. However, they have limited abilities in carotid artery plaque and wall characterization and are unable to provide simultaneous quantitative and qualitative flow information while the images are burdened by low framerates. UltraFast™ ultrasound is able to overcome these obstacles by providing simultaneous quantitative and qualitative flow analysis information in high frame rates via UltraFast™ Doppler. Another newly developed ultrasound technique, shear wave elastography, is based on the visualization of induced shear waves and the measurement of the shear wave propagation speed in the examined tissues which enables real-time carotid plaque and wall analysis. These newly developed ultrasound modalities have potential to significantly improve workflow efficiency and are able to provide a plethora of additional imaging information of carotid artery disease in comparison to conventional ultrasound techniques.

Left ventricular high frame rate echo-particle image velocimetry: clinical application and comparison with conventional imaging

Background

Echo-Particle Image Velocimetry (echoPIV) tracks speckle patterns from ultrasound contrast agent(UCA), being less angle-sensitive than colour Doppler. High frame rate (HFR) echoPIV enables tracking of high velocity flow in the left ventricle (LV). We aimed to demonstrate the potential clinical use of HFR echoPIV and investigate the feasibility and accuracy in patients.

Methods

Nineteen patients admitted for heart failure were included. HFR contrast images were acquired from an apical long axis view (ALAX), using a fully-programmable ultrasound system. A clinical UCA was continuously infused with a dedicated pump. Additionally, echocardiographic images were obtained using a clinical system, including LV contrast-enhanced images and pulsed-wave (PW) Doppler of the LV inflow and outflow in ALAX. 11 patients underwent CMR and 4 cardiac CT as clinically indicated. These CMR and CT images were used as reference. In 10 patients with good echoPIV tracking and reference imaging, the intracavitary flow was compared between echoPIV, conventional and UCA echocardiography.

Results

EchoPIV tracking quality was good in 12/19 (63%), moderate in 2/19 (10%) and poor in 5/19 (26%) subjects. EchoPIV could determine inflow velocity in 17/19 (89%), and outflow in 14/19 (74%) patients. The correlation of echoPIV and PW Doppler was good for the inflow (R² = 0.77 to PW peak; R² = 0.80 PW mean velocity) and moderate for the outflow (R² = 0.54 to PW peak; R² = 0.44 to PW mean velocity), with a tendency for echoPIV to underestimate PW velocities. In selected patients, echoPIV was able in a single acquisition to demonstrate flow patterns which required multiple interrogations with classical echocardiography. Those flow patterns could also be linked to anatomical abnormalities as seen in CMR or CT.

Conclusion

HFR echoPIV tracks multidirectional and complex flow patterns which are unapparent with conventional echocardiography, while having comparable feasibility. EchoPIV tends to underestimate flow velocities as compared to PW Doppler. It has the potential to provide in one acquisition all the functional information obtained by conventional imaging, overcoming the angle dependency of Doppler and low frame rate of classical contrast imaging.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12947-022-00283-4.

On the Investigation of Autocorrelation-Based Vector Doppler Method With Plane Wave Imaging

Although color flow imaging is one of the representative applications of the Doppler method, it can estimate only the velocity component in the direction of ultrasonic propagation, that is, the axial velocity component. The vector Doppler method with high-frame-rate plane wave imaging overcomes such a limitation by estimating the blood flow velocity vectors using the axial velocities obtained by emitting plane waves in multiple directions. The autocorrelation technique can be used for the estimation of the axial velocity using the phase shift of an ultrasonic echo signal between two transmit-receive events. The technique also requires the frequency of the received echo signal. Although the center frequency of the emitted ultrasonic signal is commonly used in the estimation of axial velocities, the center frequency should be estimated from the received signals. In this study, a method for the estimation of the center frequency designed particularly for the high-frame-rate plane wave imaging was developed. The proposed method estimates the wavenumbers of the received signal in lateral and vertical directions to estimate the wavenumber in the axial direction, from which the center frequency was estimated. The beam steering angle was also estimated from the wavenumbers in the two directions. The effect of the proposed method was validated in simulations. The absolute bias error (ABE) and root-mean squared error in estimated velocity vectors obtained by plane wave imaging with three beam steering angles (-15°, 0°, and 15°) were reduced from 9.27% and 14.80% to 1.15% and 8.75%, respectively, by the proposed method. The applicability of the proposed method to in vivo measurements was also demonstrated using the in vivo recordings of human common carotid arteries. Physiologically consistent blood flow velocity distributions were obtained with respect to three subjects using the proposed method.

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

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

Contrast Agent-Free Assessment of Blood Flow and Wall Shear Stress in the Rabbit Aorta using Ultrasound Image Velocimetry

Blood flow velocity and wall shear stress (WSS) influence and are influenced by vascular disease. Their measurement is consequently useful in the laboratory and clinic. Contrast-enhanced ultrasound image velocimetry (UIV) can estimate them accurately but the need to inject contrast agents limits utility. Singular value decomposition and high-frame-rate imaging may render contrast agents dispensable. Here we determined whether contrast agent-free UIV can measure flow and WSS. In simulation, accurate measurements were achieved with a signal-to-noise ratio of 13.5 dB or higher. Signal intensity in the rabbit aorta increased monotonically with mechanical index; it was lowest during stagnant flow and uneven across the vessel. In vivo measurements with contrast-free and contrast-enhanced UIV differed by 4.4% and 1.9% for velocity magnitude and angle and by 9.47% for WSS. Bland-Altman analysis of waveforms revealed good agreement between contrast-free and contrast-enhanced UIV. In five rabbits, the root-mean-square errors were as low as 0.022 m/s (0.81%) and 0.11 Pa (1.7%). This study indicates that with an optimised protocol, UIV can assess flow and WSS without contrast agents. Unlike contrast-enhanced UIV, contrast-free UIV could be routinely employed.

Quantitative Evaluation of Post-stenotic Blood Flow Disturbance in Canine Femoral Artery Stenosis Model: An Early Experience With Vector Flow Imaging

Objective

To investigate the value of Vector Flow Imaging (V Flow) in the assessment of post-stenotic turbulence in the canine arterial stenosis model.

Materials and Methods

Canine femoral artery stenosis models were established using ameroid constrictors in 12 beagle dogs. 50% and then 70% femoral artery stenoses were confirmed by selective femoral artery angiography. V Flow was used to measure femoral artery flow turbulence index (Tur) preoperatively as a baseline. After establishing of a 50% and then 70% stenoses, the Tur indices were recorded in the femoral artery at 1, 3, 5, 7, 9, 11, 13, 15, 17, and 19 mm distal to the stenosis.

Results

Baseline Tur indices of normal canine femoral arteries were <1% in 11 of 12 cases (91.7%). Distal to a 50% stenosis, the Tur index (>1%) was recorded in 83.3–100% cases between 1 and 9 mm, 41.7–58.3% between 11 and 17 mm, and 16.7% at 19 mm. For a 70% stenosis, the Tur index (>1%) occurred in 81.8–100% cases between 1 and 17 mm distal to the stenosis, and 63.6% at 19 mm. The Tur index peaked around 7 mm or 2.3 times of the initial vessel diameter (3 mm) downstream for a 50% stenosis and 11 mm or 3.7 times of vessel diameter downstream for a 70% stenosis.

Conclusion

V Flow with Tur index measurement adds quantitative information of post-stenotic turbulence when assessing an arterial stenosis with ultrasound. Tur index of 1% seems a useful threshold for assessment of flow turbulence in this small sample study. Further studies with larger sample size are needed to evaluate the value of V Flow in clinical applications.

Forward-viewing estimation of 3D blood flow velocity fields by intravascular ultrasound: Influence of the catheter on velocity estimation in stenoses

Coronary artery disease is the most common type of cardiovascular disease, affecting > 18 million adults, and is responsible for > 365 k deaths per year in the U.S. alone. Wall shear stress (WSS) is an emerging indicator of likelihood of plaque rupture in coronary artery disease, however, non-invasive estimation of 3-D blood flow velocity and WSS is challenging due to the requirement for high spatial resolution at deep penetration depths in the presence of significant cardiac motion. Thus we propose minimally-invasive imaging with a catheter-based, 3-D intravascular forward-viewing ultrasound (FV US) transducer and present experiments to quantify the effect of the catheter on flow disturbance in stenotic vessel phantoms with realistic velocities and luminal diameters for both peripheral (6.33 mm) and coronary (4.74 mm) arteries. An external linear array ultrasound transducer was used to quantify 2-D velocity fields in vessel phantoms under various conditions of catheter geometry, luminal diameter, and position of the catheter relative to the stenosis at a frame rate of 5000 frames per second via a particle imaging velocimetry (PIV) approach. While a solid catheter introduced an underestimation of velocity measurement by > 20% relative to the case without a catheter, the hollow catheter introduced < 10% velocity overestimation, indicating that a hollow catheter design allowing internal blood flow reduces hemodynamic disturbance. In addition, for both peripheral and coronary arteries, the hollow catheter introduced < 3% deviation in flow velocity at the minimum luminal area compared to the control case. Finally, an initial comparison was made between velocity measurements acquired using a low frequency, catheter-based, 3-D intravascular FV US transducer and external linear array measurements, with relative error < 12% throughout the region of interest for a flow rate of 150 mL/min. While further system development is required, results suggest intravascular ultrasound characterization of blood flow velocity fields in stenotic vessels could be feasible with appropriate catheter design.

An Angle Independent Depth Aware Fusion Beamforming Approach for Ultrafast Ultrasound Flow Imaging. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021;2021:3399-3402. [PMID: 34891969 DOI: 10.1109/embc46164.2021.9630742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

In the case of vector flow imaging systems, the most employed flow estimation techniques are the directional beamforming based cross correlation and the triangulation-based autocorrelation. However, the directional beamforming-based techniques require an additional angle estimator and are not reliable if the flow angle is not constant throughout the region of interest. On the other hand, estimates with triangulation-based techniques are prone to large bias and variance at low imaging depths due to limited angle for left and right apertures. In view of this, a novel angle independent depth aware fusion beamforming approach is proposed and evaluated in this paper. The hypothesis behind the proposed approach is that the peripheral flows are transverse in nature, where directional beamforming can be employed without the need of an angle estimator and the deeper flows being non-transverse and directional, triangulation-based vector flow imaging can be employed. In the simulation study, an overall 67.62% and 74.71% reduction in magnitude bias along with a slight reduction in the standard deviation are observed with the proposed fusion beamforming approach when compared to triangulation-based beamforming and directional beamforming, respectively, when implemented individually. The efficacy of the proposed approach is demonstrated with in-vivo experiments.

Wall shear stress mapping for human femoral artery based on ultrafast ultrasound vector Doppler estimations

PURPOSE

Wall shear stress (WSS), a type of friction exerted on the artery wall by flowing blood, is considered a crucial factor in atherosclerotic plaque development. Currently, achieving a reliable WSS mapping of an artery noninvasively by using existing imaging modalities is still challenging. In this study, a WSS mapping based on vector Doppler flow velocity estimation was proposed to measure the dynamic WSS on the human femoral artery.

METHODS

Because ultrafast ultrasound imaging was used here, flow-enhanced imaging was also performed to observe the moving blood flow condition. The performance of WSS mapping was verified using both straight (8 mm in diameter) and stenosis (70% of stenosis) phantoms under a pulsatile flow condition. A human study was conducted from five healthy volunteers.

RESULTS

Experimental results demonstrated that the WSS estimation was close to the standard value that was obtained from maximum velocity estimation in straight phantom experiments. In a stenosis phantom experiment, a low WSS region was observed at a site downstream of an obstruction, which is a high-risk area for plaque formation. Dynamic WSS mapping was accomplished in measurement in the femoral artery bifurcation. In measurements, the time-averaged WSS of the common femoral artery, superficial femoral artery, and deep femoral artery was 0.52± 0.19, 0.44 ± 0.21, and 0.29 ± 0.16 Pa, respectively, for the anterior wall and 0.29 ± 0.11, 0.54 ± 0.24, and 0.23 ± 0.10 Pa, respectively, for the posterior wall.

CONCLUSIONS

All results indicated that WSS mapping has the potential to be a useful tool for vessel duplex scanning in the future.

Advances in vascular anatomy and pathophysiology using high resolution and multiparametric sonography

B-mode and Color Doppler are the first-line imaging modalities in cardiovascular diseases. However, conventional ultrasound (US) provides a lower spatial and temporal resolution (70-100 frames per second) compared to ultrafast technology which acquires several thousand frames per second. Consequently, the multiparametric ultrafast platforms manage new imaging algorithms as high-frequency ultrasound, contrast-enhanced ultrasound, shear wave elastography, vector flow, and local pulse wave imaging. These advances allow better ultrasound performances, more detailed blood flow visualization and vessel walls' characterization, and many future applications for vascular viscoelastic properties evaluation.In this paper, we provide an overview of each new technique's principles and concepts and the real or potential applications of these modalities on the study of the artery and venous anatomy and pathophysiology of the upper limb before and after creating a native or prosthetic arterio-venous fistula. In particular, we focus on high-frequency ultrasound that could predict cannulation readiness and its potential role in the venous valvular status evaluation before vascular access creation; on contrast-enhanced ultrasound that could improve the peri-operative imaging evaluation during US-guided angioplasty; on shear wave elastography and local pulse wave imaging that could evaluate preoperative vessels stiffness and their potential predictive role in vascular access failure; on vector flow imaging that could better characterize the different components of the vascular access complex flow.

Optimization of Microbubble Concentration and Acoustic Pressure for Left Ventricular High-Frame-Rate EchoPIV in Patients

High-frame-rate (HFR) echo-particle image velocimetry (echoPIV) is a promising tool for measuring intracardiac blood flow dynamics. In this study, we investigate the optimal ultrasound contrast agent (UCA: SonoVue) infusion rate and acoustic output to use for HFR echoPIV (PRF = 4900 Hz) in the left ventricle (LV) of patients. Three infusion rates (0.3, 0.6, and 1.2 ml/min) and five acoustic output amplitudes (by varying transmit voltage: 5, 10, 15, 20, and 30 V-corresponding to mechanical indices of 0.01, 0.02, 0.03, 0.04, and 0.06 at 60-mm depth) were tested in 20 patients admitted for symptoms of heart failure. We assess the accuracy of HFR echoPIV against pulsed-wave Doppler acquisitions obtained for mitral inflow and aortic outflow. In terms of image quality, the 1.2-ml/min infusion rate provided the highest contrast-to-background ratio (CBR) (3-dB improvement over 0.3 ml/min). The highest acoustic output tested resulted in the lowest CBR. Increased acoustic output also resulted in increased microbubble disruption. For the echoPIV results, the 1.2-ml/min infusion rate provided the best vector quality and accuracy; mid-range acoustic outputs (corresponding to 15-20-V transmit voltages) provided the best agreement with the pulsed-wave Doppler. Overall, the highest infusion rate (1.2 ml/min) and mid-range acoustic output amplitudes provided the best image quality and echoPIV results.

Dealiasing High-Frame-Rate Color Doppler Using Dual-Wavelength Processing

Doppler ultrasound is the premier modality to analyze blood flow dynamics in clinical practice. With conventional systems, Doppler can either provide a time-resolved quantification of the flow dynamics in sample volumes (spectral Doppler) or an average Doppler velocity/power [color flow imaging (CFI)] in a wide field of view (FOV) but with a limited frame rate. The recent development of ultrafast parallel systems made it possible to evaluate simultaneously color, power, and spectral Doppler in a wide FOV and at high-frame rates but at the expense of signal-to-noise ratio (SNR). However, like conventional Doppler, ultrafast Doppler is subject to aliasing for large velocities and/or large depths. In a recent study, staggered multi-pulse repetition frequency (PRF) sequences were investigated to dealias color-Doppler images. In this work, we exploit the broadband nature of pulse-echo ultrasound and propose a dual-wavelength approach for CFI dealiasing with a constant PRF. We tested the dual-wavelength bandpass processing, in silico, in laminar flow phantom and validated it in vivo in human carotid arteries ( n = 25 ). The in silico results showed that the Nyquist velocity could be extended up to four times the theoretical limit. In vivo, dealiased CFI were highly consistent with unfolded Spectral Doppler ( r²=0.83 , y=1.1x+0.1 , N=25 ) and provided consistent vector flow images. Our results demonstrate that dual-wavelength processing is an efficient method for high-velocity CFI.

Wall Shear Stress Measurement by Ultrafast Vector Flow Imaging for Atherosclerotic Carotid Stenosis

OBJECTIVE

 Carotid plaque vulnerability assessment could guide the decision to perform endarterectomy. Ultrafast ultrasound imaging (UF) can evaluate local flow velocities over an entire 2D image, allowing measurement of the wall shear stress (WSS). We aimed at evaluating the feasibility of WSS measurement in a prospective series of patients with carotid stenosis.

METHODS

 UF acquisitions, performed with a linear probe, had an effective frame rate of 5000 Hz. The flow velocity was imaged over the entire plaque area. WSS was computed with the vector field speed using the formula: with the blood velocity and μ, the blood viscosity. The WSS measurement method was validated using a calibrated phantom. In vivo, WSS was analyzed in 5 areas of the carotid wall: common carotid artery, plaque ascent, plaque peak, plaque descent, internal carotid artery.

RESULTS

 Good correlation was found between in vitro measurement and the theoretical WSS values (R₂ = 0.95; p < 0.001). 33 patients were prospectively evaluated, with a median carotid stenosis degree of 80 % [75-85]. The maximum WSS value over the cardiac cycle follows the shape of the plaque with an increase during the ascent, reaching its maximum value of 3.25 Pa [2.26-4.38] at the peak of the plaque, and a decrease after passing of the peak (0.93 Pa [0.80-1.19]) lower than the WSS values in the non-stenotic areas (1.47 Pa [1.12-1.77] for the common carotid artery).

CONCLUSION

 UF allowed local and direct evaluation of the plaque's WSS, thus better characterizing local hemodynamics to identify areas of vulnerability.

KEY POINTS

  · Ultrafast vector Doppler allows calculation of the wall shear stress (WSS) by measuring velocity vectors over the entire 2D image.. · The setup to measure the WSS has been validated in vitro on a linear flow phantom by comparing measurements to in silico calculations.. · Applying this method to carotid plaque allows us to better describe the hemodynamic constraints that apply along the entire length of the plaque..

From Anatomy to Functional and Molecular Biomarker Imaging and Therapy: Ultrasound Is Safe, Ultrafast, Portable, and Inexpensive

Ultrasound is the most widely used medical imaging modality worldwide. It is abundant, extremely safe, portable, and inexpensive. In this review, we consider some of the current development trends for ultrasound imaging, which build upon its current strength and the popularity it experiences among medical imaging professional users.Ultrasound has rapidly expanded beyond traditional radiology departments and cardiology practices. Computing power and data processing capabilities of commonly available electronics put ultrasound systems in a lab coat pocket or on a user's mobile phone. Taking advantage of new contributions and discoveries in ultrasound physics, signal processing algorithms, and electronics, the performance of ultrasound systems and transducers have progressed in terms of them becoming smaller, with higher imaging performance, and having lower cost. Ultrasound operates in real time, now at ultrafast speeds; kilohertz frame rates are already achieved by many systems.Ultrasound has progressed beyond anatomical imaging and monitoring blood flow in large vessels. With clinical approval of ultrasound contrast agents (gas-filled microbubbles) that are administered in the bloodstream, tissue perfusion studies are now routine. Through the use of modern ultrasound pulse sequences, individual microbubbles, with subpicogram mass, can be detected and observed in real time, many centimeters deep in the body. Ultrasound imaging has broken the wavelength barrier; by tracking positions of microbubbles within the vasculature, superresolution imaging has been made possible. Ultrasound can now trace the smallest vessels and capillaries, and obtain blood velocity data in those vessels.Molecular ultrasound imaging has now moved closer to clinic; the use of microbubbles with a specific affinity to endothelial biomarkers allows selective accumulation and retention of ultrasound contrast in the areas of ischemic injury, inflammation, or neoangiogenesis. This will aid in noninvasive molecular imaging and may provide additional help with real-time guidance of biopsy, surgery, and ablation procedures.The ultrasound field can be tightly focused inside the body, many centimeters deep, with millimeter precision, and ablate lesions by energy deposition, with thermal or mechanical bioeffects. Some of such treatments are already in clinical use, with more indications progressing through the clinical trial stage. In conjunction with intravascular microbubbles, focused ultrasound can be used for tissue-specific drug delivery; localized triggered release of sequestered drugs from particles in the bloodstream may take time to get to clinic. A combination of intravascular microbubbles with circulating drug and low-power ultrasound allows transient opening of vascular endothelial barriers, including blood-brain barrier; this approach has reached clinical trial stage. Therefore, the drugs that normally would not be getting to the target tissue in the brain will now have an opportunity to produce therapeutic efficacy.Overall, medical ultrasound is developing at a brisk rate, even in an environment where other imaging modalities are also advancing rapidly and may be considered more lucrative. With all the current advances that we discuss, and many more to come, ultrasound may help solve many problems that modern medicine is facing.

Tapered Vector Doppler for Improved Quantification of Low Velocity Blood Flow

A new vector velocity estimation scheme is developed, termed tapered vector Doppler (TVD), aiming to improve the accuracy of low velocity flow estimation. This is done by assessing the effects of singular value decomposition (SVD) and finite impulse response (FIR) filters and designing an estimator which accounts for signal loss due to filtering. Synthetic data created using a combination of in vivo recordings and flow simulations were used to investigate scenarios with low blood flow, in combination with true clutter motion. Using this approach, the accuracy and precision of TVD was investigated for a range of clutter-to-blood and signal-to-noise ratios. The results indicated that for the investigated carotid application and setup, the SVD filter performed as a frequency-based filter. For both SVD and FIR filters, suppression of the clutter signal resulted in large bias and variance in the estimated blood velocity magnitude and direction close to the vessel walls. Application of the proposed tapering technique yielded significant improvement in the accuracy and precision of near-wall vector velocity measurements, compared to non-TVD and weighted least squares approaches. In synthetic data, for a blood SNR of 5 dB, and in a near-wall region where the average blood velocity was 9 cm/s, the use of tapering reduced the average velocity magnitude bias from 26.3 to 1.4 cm/s. Complex flow in a carotid bifurcation was used to demonstrate the in vivo performance of TVD, and it was shown that tapering enables vector velocity estimation less affected by clutter and clutter filtering than what could be obtained by adaptive filter design only.

High-Frame Rate Vector Flow Imaging Technique: Initial Application in Evaluating the Hemodynamic Changes of Carotid Stenosis Caused by Atherosclerosis

Objective: To investigate the value of high-frame rate vector flow imaging technique (V flow) in evaluating the hemodynamic changes of carotid stenosis caused by atherosclerotic plaques.

Methods and Materials: In this prospective study, patients with stenosis rate (diameter) ≥30% caused by carotid atherosclerotic plaques were included. Degrees of carotid stenosis were graded according to North American Symptomatic Carotid Endarterectomy Trial criteria: moderate (30–69%) or severe (70–99%). Mindray Resona 7s ultrasound machine with a linear array transducer (3–11 MHz) was used for ultrasound examinations. The mean WSS value of carotid arteries was measured at the proximal, narrowest region and distal of carotid stenosis. The mean WSS values were correlated with peak systolic velocity (PSV) measured by color Doppler flow imaging and stenosis degree detected by digital subtraction angiography (DSA). The vector arrows and flow streamline detected by V flow dynamic imaging were analyzed. Imaging findings of DSA in carotid arteries were used as the gold standard.

Results: Finally, 51 patients were included. V flow measurements were performed successfully in 17 patients (100%) with moderate-grade stenosis and in 30 patients (88.2%) with severe-grade stenosis. Dynamic V flow imaging showed yellow or red vectors at the stenotic segment, indicating fast speed blood flow (up to 260.92 cm/s). Changes of streamlines were detected in the stenotic segment. The mean WSS value measured at the narrowest region of the carotid artery had a moderately positive correlation with stenosis degree (r = 0.58, P < 0.05) and PSV value (r = 0.54, P < 0.05), respectively. Significant difference was detected in mean WSS value at the narrowest region of the carotid artery between severe carotid stenosis (1.47 ± 0.97 Pa) and moderate carotid stenosis (0.96 ± 0.44 Pa) (P < 0.05).

Conclusion: The hemodynamic changes detected by V flow of the carotid stenosis might be a potential non-invasive imaging tool for assessing the degree of carotid stenosis.

Characterization of Vortex Flow in a Mouse Model of Ventricular Dyssynchrony by Plane-Wave Ultrasound Using Hexplex Processing

The rodent heart is frequently used to study human cardiovascular disease (CVD). Although advanced cardiovascular ultrasound imaging methods are available for human clinical practice, application of these techniques to small animals remains limited due to the temporal and spatial-resolution demands. Here, an ultrasound vector-flow workflow is demonstrated that enables visualization and quantification of the complex hemodynamics within the mouse heart. Wild type (WT) and fibroblast growth factor homologous factor 2 (FHF2)-deficient mice (Fhf2 ^KO/Y ), which present with hyperthermia-induced ECG abnormalities highly reminiscent of Brugada syndrome, were used as a mouse model of human CVD. An 18-MHz linear array was used to acquire high-speed (30 kHz), plane-wave data of the left ventricle (LV) while increasing core body temperature up to 41.5 °C. Hexplex (i.e., six output) processing of the raw data sets produced the output of vector-flow estimates (magnitude and phase); B-mode and color-Doppler images; Doppler spectrograms; and local time histories of vorticity and pericardium motion. Fhf2 ^WT/Y mice had repeatable beat-to-beat cardiac function, including vortex formation during diastole, at all temperatures. In contrast, Fhf2 ^KO/Y mice displayed dyssynchronous contractile motion that disrupted normal inflow vortex formation and impaired LV filling as temperature rose. The hexplex processing approach demonstrates the ability to visualize and quantify the interplay between hemodynamic and mechanical function in a mouse model of human CVD.

A Deep Learning Approach to Resolve Aliasing Artifacts in Ultrasound Color Flow Imaging

Despite being used clinically as a noninvasive flow visualization tool, color flow imaging (CFI) is known to be prone to aliasing artifacts that arise due to fast blood flow beyond the detectable limit. From a visualization standpoint, these aliasing artifacts obscure proper interpretation of flow patterns in the image view. Current solutions for resolving aliasing artifacts are typically not robust against issues such as double aliasing. In this article, we present a new dealiasing technique based on deep learning principles to resolve CFI aliasing artifacts that arise from single- and double-aliasing scenarios. It works by first using two convolutional neural networks (CNNs) to identify and segment CFI pixel positions with aliasing artifacts, and then it performs phase unwrapping at these aliased pixel positions. The CNN for aliasing identification was devised as a U-net architecture, and it was trained with in vivo CFI frames acquired from the femoral bifurcation that had known presence of single- and double-aliasing artifacts. Results show that the segmentation of aliased CFI pixels was achieved successfully with intersection over union approaching 90%. After resolving these artifacts, the dealiased CFI frames consistently rendered the femoral bifurcation's triphasic flow dynamics over a cardiac cycle. For dealiased CFI pixels, their root-mean-squared difference was 2.51% or less compared with manual dealiasing. Overall, the proposed dealiasing framework can extend the maximum flow detection limit by fivefold, thereby improving CFI's flow visualization performance.

Contrast-Enhanced High-Frame-Rate Ultrasound Imaging of Flow Patterns in Cardiac Chambers and Deep Vessels

Cardiac function and vascular function are closely related to the flow of blood within. The flow velocities in these larger cavities easily reach 1 m/s, and generally complex spatiotemporal flow patterns are involved, especially in a non-physiologic state. Visualization of such flow patterns using ultrasound can be greatly enhanced by administration of contrast agents. Tracking the high-velocity complex flows is challenging with current clinical echographic tools, mostly because of limitations in signal-to-noise ratio; estimation of lateral velocities; and/or frame rate of the contrast-enhanced imaging mode. This review addresses the state of the art in 2-D high-frame-rate contrast-enhanced echography of ventricular and deep-vessel flow, from both technological and clinical perspectives. It concludes that current advanced ultrasound equipment is technologically ready for use in human contrast-enhanced studies, thus potentially leading to identification of the most clinically relevant flow parameters for quantifying cardiac and vascular function.

Wall Shear Stress Measurements Based on Ultrasound Vector Flow Imaging: Theoretical Studies and Clinical Examples

Wall shear stress (WSS) is considered as a key factor for atherosclerosis development. Previous WSS research based on pulsed wave Doppler (PWD) showed limitations in complex flows. To improve accuracy for nonlaminar flow, a commercial ultrasound vector flow imaging (UVFI)-based WSS calculation is proposed. Errors for PWD are presented theoretically when flow is not laminar. Based on this, simulations of WSS calculations between PWD and UVFI were set up for different turbulent flows. Our simulations show that UVFI has obviously better performance than PWD in WSS calculations. Wall shear stress results in different flow conditions at carotid bifurcations are described.