Angle-independent estimation of maximum velocity through stenoses using vector Doppler ultrasound

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.

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.

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.

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

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

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

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

Innovations in Vascular Ultrasound

There are several vascular ultrasound technologies that are useful in challenging diagnostic situations. New vascular ultrasound applications include directional power Doppler ultrasound, contrast-enhanced ultrasound, B-flow imaging, microvascular imaging, 3-dimensional vascular ultrasound, intravascular ultrasound, photoacoustic imaging, and vascular elastography. All these techniques are complementary to Doppler ultrasound and provide greater ability to visualize small vessels, have higher sensitivity to detect slow flow, and better assess vascular wall and lumen while overcoming limitations color Doppler. The ultimate goal of these technologies is to make ultrasound competitive with computed tomography and magnetic resonance imaging for vascular imaging.

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

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

Real-Time 2-D Phased Array Vector Flow Imaging

Echocardiography examination of the blood flow is currently either restricted to 1-D techniques in real-time or experimental offline 2-D methods. This paper presents an implementation of transverse oscillation for real-time 2-D vector flow imaging (VFI) on a commercial BK Ultrasound scanner. A large field-of-view (FOV) sequence for studying flow dynamics at 11 frames per second (fps) and a sequence for studying peak systolic velocities (PSVs) with a narrow FOV at 36 fps were validated. The VFI sequences were validated in a flow rig with continuous laminar parabolic flow and in a pulsating flow pump system before being tested in vivo, where measurements were obtained on two healthy volunteers. Mean PSV from 11 cycles was 155 cms^-1 with a precision of ±9.0% for the pulsating flow pump. In vivo, PSV estimated in the ascending aorta was 135 cms^-1 ± 16.9% for eight cardiac cycles. Furthermore, in vivo flow dynamics of the left ventricle and in the ascending aorta were visualized. In conclusion, angle independent 2-D VFI on a phased array has been implemented in real time, and it is capable of providing quantitative and qualitative flow evaluations of both the complex and fully transverse flow.

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

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

Ultrasound Vector Flow Imaging-Part I: Sequential Systems

This paper gives a review of the most important methods for blood velocity vector flow imaging (VFI) for conventional sequential data acquisition. This includes multibeam methods, speckle tracking, transverse oscillation, color flow mapping derived VFI, directional beamforming, and variants of these. The review covers both 2-D and 3-D velocity estimation and gives a historical perspective on the development along with a summary of various vector flow visualization algorithms. The current state of the art is explained along with an overview of clinical studies conducted and methods for presenting and using VFI. A number of examples of VFI images are presented, and the current limitations and potential solutions are discussed.

Investigation of Crossbeam Multi-receiver Configurations for Accurate 3-D Vector Doppler Velocity Estimation

An accurate estimation of low blood velocities whose Doppler shifts span the wall filter cutoff, such as near the wall in recirculation or disturbed flow regions, is important for accurate mapping of velocities to achieve improved estimations of wall shear stress and turbulence, which are known risk factors for atherosclerosis and stroke. This paper presents the comparative benefit of increasing the number of receiver beams above three for an improved estimation of low 3-D velocities. The 3-D crossbeam vector Doppler ultrasound configurations were studied in terms of the number of receiver beams, interbeam angle, and beam selection method (criterion for discriminating between tissue and blood Doppler signals) for a range of velocity orientations, which may prove useful in the design of a future 2-D array for vascular imaging. For maximum velocity resolution, a shallow gradient of low flow velocities up to 5 cm/s was generated across a large-diameter (2.46 cm) straight vessel. Data were acquired using a linear array rotated around the central transmit beam axis to generate three- to eight-receiver (3R-8R) configurations;the rotation of each configuration relative to the flow axis was used to mimic a broad range of velocity vector orientations. Accuracy and precision for ≥5 receivers were consistently better over all velocity orientations and for all selection methods. For a velocity magnitude of 2 cm/s, the best accuracy and precision in both magnitude and direction (~21% ± 13%, <1° ± 9°, respectively) were seen with a 5R configuration using a weighted least-squares selection method. Asymmetry in the 5R configuration led to an improved accuracy and precision compared with that in symmetrical 6R and 8R configurations. The results demonstrated relatively little to no benefit from more than five receiver beams.

Flow Velocity Mapping Using Contrast Enhanced High-Frame-Rate Plane Wave Ultrasound and Image Tracking: Methods and Initial in Vitro and in Vivo Evaluation

Ultrasound imaging is the most widely used method for visualising and quantifying blood flow in medical practice, but existing techniques have various limitations in terms of imaging sensitivity, field of view, flow angle dependence, and imaging depth. In this study, we developed an ultrasound imaging velocimetry approach capable of visualising and quantifying dynamic flow, by combining high-frame-rate plane wave ultrasound imaging, microbubble contrast agents, pulse inversion contrast imaging and speckle image tracking algorithms. The system was initially evaluated in vitro on both straight and carotid-mimicking vessels with steady and pulsatile flows and in vivo in the rabbit aorta. Colour and spectral Doppler measurements were also made. Initial flow mapping results were compared with theoretical prediction and reference Doppler measurements and indicate the potential of the new system as a highly sensitive, accurate, angle-independent and full field-of-view velocity mapping tool capable of tracking and quantifying fast and dynamic flows.

Out-of-plane Doppler imaging based on ultrafast plane wave imaging

Retrieving the out-of-plane blood flow velocity vector from two-dimensional transverse acquisitions of large vessels could improve the quantification of flow rate and maximum speed. The in-plane vector flow component can be computed easily using the Doppler frequency shift. The main problem is estimating the angle between the probe imaging plane and the vessel axis to derive the out-of-plane component from in-plane measurements. In this article, we study the case in which the velocity vector can be decomposed on two directions: the out-of-plane direction and the in-plane depth direction. We explore the combination of a technique called intrinsic spectral broadening with ultrafast plane wave imaging to retrieve the out-of-plane component of the flow velocity vector. Using a one-time probe calibration of this intrinsic spectral broadening, out-of-plane angle and flow speed can be recovered easily, thus avoiding approximations of a complex theoretical analysis. For the calibration step, ultrafast plane wave imaging permits a fast calibration procedure for the Doppler intrinsic spectral broadening. In vitro experimental validations are performed on a homogeneous flow phantom and a Poiseuille flow; the absolute speed was retrieved with 6% error. The potential of the technique is demonstrated in vivo on the human carotid artery. Combined with in-plane vector flow approaches, this out-of-plane Doppler imaging method paves the way to threedimensional vector flow imaging using only conventional onedimensional probe technology.

Recent developments in vascular ultrasound technology

This article describes four technologies relevant to vascular ultrasound which are available commercially in 2015, and traces their origin back through the research literature. The technologies are 3D ultrasound and its use in plaque volume estimation (first described in 1994), colour vector Doppler for flow visualisation (1994), wall motion for estimation of arterial stiffness (1968), and shear wave elastography imaging of the arterial wall (2010). Overall these technologies have contributed to the understanding of vascular disease but have had little impact on clinical practice. The basic toolkit for vascular ultrasound has for the last 25 years been real-time B-mode, colour flow and spectral Doppler. What has changed over this time is improvement in image quality. Looking ahead it is noted that 2D array transducers and high frame rate imaging continue to spread through the commercial vascular ultrasound sector and both have the potential to impact on clinical practice.

A transverse oscillation approach for estimation of three-dimensional velocity vectors, part I: concept and simulation study

A method for 3-D velocity vector estimation using transverse oscillations is presented. The method employs a 2-D transducer and decouples the velocity estimation into three orthogonal components, which are estimated simultaneously and from the same data. The validity of the method is investigated by conducting simulations emulating a 32 × 32 matrix transducer. The results are evaluated using two performance metrics related to precision and accuracy. The study includes several parameters including 49 flow directions, the SNR, steering angle, and apodization types. The 49 flow directions cover the positive octant of the unit sphere. In terms of accuracy, the median bias is -2%. The precision of v(x) and v(y) depends on the flow angle ß and ranges from 5% to 31% relative to the peak velocity magnitude of 1 m/s. For comparison, the range is 0.4 to 2% for v(z). The parameter study also reveals, that the velocity estimation breaks down with an SNR between -6 and -3 dB. In terms of computational load, the estimation of the three velocity components requires 0.75 billion floating point operations per second (0.75 Gflops) for a realistic setup. This is well within the capability of modern scanners.

Combined vector velocity and spectral Doppler imaging for improved imaging of complex blood flow in the carotid arteries

Color flow imaging and pulsed wave (PW) Doppler are important diagnostic tools in the examination of patients with carotid artery disease. However, measurement of the true peak systolic velocity is dependent on sample volume placement and the operator's ability to provide an educated guess of the flow direction. Using plane wave transmissions and a duplex imaging scheme, we present an all-in-one modality that provides both vector velocity and spectral Doppler imaging from one acquisition, in addition to separate B-mode images of sufficient quality. The vector Doppler information was used to provide automatically calibrated (angle-corrected) PW Doppler spectra at every image point. It was demonstrated that the combined information can be used to generate spatial maps of the peak systolic velocity, highlighting regions of high velocity and the extent of the stenotic region, which could be used to automate work flow as well as improve the accuracy of measurement of true peak systolic velocity. The modality was tested in a small group (N = 12) of patients with carotid artery disease. PW Doppler, vector velocity and B-mode images could successfully be obtained from a single recording for all patients with a body mass index ranging from 21 to 31 and a carotid depth ranging from 16 to 28 mm.

Ultrasound imaging velocimetry: effect of beam sweeping on velocity estimation

As an emerging flow-mapping tool that can penetrate deep into optically opaque media such as human tissue, ultrasound imaging velocimetry has promise in various clinical applications. Previous studies have shown that errors occur in velocity estimation, but the causes have not been well characterised. In this study, the error in velocity estimation resulting from ultrasound beam sweeping in image acquisition is quantitatively investigated. The effects on velocity estimation of the speed and direction of beam sweeping relative to those of the flow are studied through simulation and experiment. The results indicate that a relative error in velocity estimation of up to 20% can be expected. Correction methods to reduce the errors under steady flow conditions are proposed and evaluated. Errors in flow estimation under unsteady flow are discussed.

Estimation of blood velocity, volumetric flow and wall shear rate using Doppler ultrasound

Commercial ultrasound systems can make a number of measurements related to haemodynamics which are relevant to clinical practice and to clinical research. These include maximum velocity, volumetric flow and wall shear rate. Using appropriate protocols, measurements can be made averaged over the cardiac cycle, or as a function of time through the cardiac cycle. Maximum velocity underpins most of these measurements. Maximum velocity is overestimated as a result of geometric spectral broadening, by typically up to 30%, but by much larger amounts as the angle approaches 90°. Though not used in clinical practice, a simple correction technique using a string phantom can substantially reduce these errors. For volumetric flow and wall shear rate, methods such as specialist multi-gate ultrasound systems, magnetic resonance imaging and image guided modelling are available. Before resorting to these more complex methods users might consider that, with care and attention to procedure, high quality information may be obtained using commercial ultrasound systems. Manufacturers could make more use of the colour flow image for quantification of velocity, and adopt vector Doppler techniques.

Measurement of flow velocity fields in small vessel-mimic phantoms and vessels of small animals using micro ultrasonic particle image velocimetry (micro-EPIV)

Determining a multidimensional velocity field within microscale opaque fluid flows is needed in areas such as microfluidic devices, biofluid mechanics and hemodynamics research in animal studies. The ultrasonic particle image velocimetry (EchoPIV) technique is appropriate for measuring opaque flows by taking advantage of PIV and B-mode ultrasound contrast imaging. However, the use of clinical ultrasound systems for imaging flows in small structures or animals has limitations associated with spatial resolution. This paper reports on the development of a high-resolution EchoPIV technique (termed as micro-EPIV) and its application in measuring flows in small vessel-mimic phantoms and vessels of small animals. Phantom experiments demonstrate the validity of the technique, providing velocity estimates within 4.1% of the analytically derived values with regard to the flows in a small straight vessel-mimic phantom, and velocity estimates within 5.9% of the computationally simulated values with regard to the flows in a small stenotic vessel-mimic phantom. Animal studies concerning arterial and venous flows of living rats and rabbits show that the micro-EPIV-measured peak velocities within several cardiac cycles are about 25% below the values measured by the ultrasonic spectral Doppler technique. The micro-EPIV technique is able to effectively measure the flow fields within microscale opaque fluid flows.

Experimental characterization of a vector Doppler system based on a clinical ultrasound scanner

We have developed a vector Doppler system using a clinical ultrasound scanner with a research interface. In this system, vector Doppler estimation is performed by electronically dividing a linear array transducer into a transmit sub-aperture and two receive sub-apertures. The receive beams are electronically steered, and two velocity components are estimated from echoes received from the beam overlap region. The velocity vector is reconstructed from these two estimates. The goal of this study was to characterize this vector Doppler system in vitro using a string phantom with a pulsatile velocity waveform. We studied the effect of four parameters on the estimation error: beam steering angle, angle of the velocity vector, depth of the scatterer relative to the beam overlap region and the transmit focus depth. Our results show that changing these parameters have minimal effect on the velocity and angle estimates, and robust velocity vector estimates can be obtained under a variety of conditions. The mean velocity error was less than 0.06 x pulse repetition frequency. The velocity estimates are sensitive to the Doppler estimation method. Our results indicate that vector Doppler using a linear array transducer is feasible for a wide range of imaging parameters. Such a system would facilitate the investigation of complex blood flow and tissue motion in human subjects.

A dual-phantom system for validation of velocity measurements in stenosis models under steady flow

A dual-phantom system is developed for validation of velocity measurements in stenosis models. Pairs of phantoms with identical geometry and flow conditions are manufactured, one for ultrasound and one for particle image velocimetry (PIV). The PIV model is made from silicone rubber, and a new PIV fluid is made that matches the refractive index of 1.41 of silicone. Dynamic scaling was performed to correct for the increased viscosity of the PIV fluid compared with that of the ultrasound blood mimic. The degree of stenosis in the models pairs agreed to less than 1%. The velocities in the laminar flow region up to the peak velocity location agreed to within 15%, and the difference could be explained by errors in ultrasound velocity estimation. At low flow rates and in mild stenoses, good agreement was observed in the distal flow fields, excepting the maximum velocities. At high flow rates, there was considerable difference in velocities in the poststenosis flow field (maximum centreline differences of 30%), which would seem to represent real differences in hydrodynamic behavior between the two models. Sources of error included: variation of viscosity because of temperature (random error, which could account for differences of up to 7%); ultrasound velocity estimation errors (systematic errors); and geometry effects in each model, particularly because of imperfect connectors and corners (systematic errors, potentially affecting the inlet length and flow stability). The current system is best placed to investigate measurement errors in the laminar flow region rather than the poststenosis turbulent flow region.

Accuracy and reproducibility of a novel dual-beam vector Doppler method

Conventional Doppler ultrasound (US) investigations are limited to detect only the axial component of the blood velocity vector. A novel dual-beam method has been recently proposed in which the Doppler angle is estimated through a reference US beam, and the velocity magnitude through a measuring US beam, respectively. In this study, the performance of such a method has been assessed quantitatively through in vitro and in vivo measurements made in different experimental conditions. In vitro, more than 300 acquisitions were completed using seven transducers to insonify a straight tube phantom at different Doppler angles. In steady laminar flow conditions, the velocity magnitude was measured with mean error of -1.9% (95% confidence interval: -2.33% to -1.47%) and standard deviation of 3.4%, with respect to a reference velocity. In pulsatile flow conditions, reproducibility tests of the entire velocity waveforms provided an average coefficient of variation (CV) of 6.9%. For peak velocity measurements made at five Doppler angles and three flow rates, the intrasession and intersession CVs were in the range 0.8-3.7% and 2.9-10.6%, respectively. The peak systolic velocities (PSVs) in the common carotid arteries of 21 volunteers were estimated with 95% limits of agreement of +/- 9.6 cm/s (intersession). This analysis shows that the proposed dual-beam method is capable of overcoming the Doppler angle ambiguity by producing reliable velocity measurements over a large set of experimental conditions.

Haemodynamics and blood flow measured using ultrasound imaging

Visualization of, and measurements related to, haemodynamic phenomena in arteries may be made using ultrasound systems. Most ultrasound technology relies on simple measurements of blood velocity taken from a single site, such as the peak systolic velocity for assessment of the degree of lumen reduction caused by an arterial stenosis. Real-time two-dimensional (2D) flow field visualization is possible using several methods, such as colour flow, blood flow imaging, and echo particle image velocimetry; these have applications in the examination of the flow field in diseased arteries and in heart chambers. Three-dimensional (3D) and four-dimensional ultrasound systems have been described. These have been used to provide 2D velocity profile data for the estimation of volumetric flow. However, they are limited for haemodynamic evaluation in that they provide only one component of the velocity. The provision of all seven components (three space, three velocity, and one time) is possible using image-guided modelling, in which 3D ultrasound is combined with computational fluid dynamics. This method also allows estimation of turbulence data and of relevant quantities such as the wall shear stress.

Doppler ultrasound compatible plastic material for use in rigid flow models

A technique for the rapid but accurate fabrication of multiple flow phantoms with variations in vascular geometry would be desirable in the investigation of carotid atherosclerosis. This study demonstrates the feasibility and efficacy of implementing numerically controlled direct-machining of vascular geometries into Doppler ultrasound (DUS)-compatible plastic for the easy fabrication of DUS flow phantoms. Candidate plastics were tested for longitudinal speed of sound (SoS) and acoustic attenuation at the diagnostic frequency of 5 MHz. Teflon was found to have the most appropriate SoS (1376 +/- 40 m s(-1) compared with 1540 m s(-1) in soft tissue) and thus was selected to construct a carotid bifurcation flow model with moderate eccentric stenosis. The vessel geometry was machined directly into Teflon using a numerically controlled milling technique. Geometric accuracy of the phantom lumen was verified using nondestructive micro-computed tomography. Although Teflon displayed a higher attenuation coefficient than other tested materials, Doppler data acquired in the Teflon flow model indicated that sufficient signal power was delivered throughout the depth of the vessel and provided comparable velocity profiles to that obtained in the tissue-mimicking phantom. Our results indicate that Teflon provides the best combination of machinability and DUS compatibility, making it an appropriate choice for the fabrication of rigid DUS flow models using a direct-machining method.

Noninvasive simultaneous assessment of wall shear rate and wall distension in carotid arteries

A novel technique has been developed for the noninvasive real-time simultaneous assessment of both blood velocity profile and wall displacements in human arteries. The novel technique is based on the use of two ultrasound beams, one set at optimal angle for wall motion measurements and the other for blood velocity profile measurements. The technique was implemented on a linear array probe divided into two subapertures. A modified commercial ultrasound machine and a custom PC board based on a high-speed digital signal processor was used to process the quadrature demodulated echo signals and display results in realtime. Flow phantom experiments demonstrated the validity of the technique, providing wall shear rate (WSR) estimates within 10% of the theoretical values. The system was also tested in the common carotid arteries of 16 healthy volunteers (age 30 to 53 y). Results of simultaneous diameter distension and WSR measurements were in agreement with published data.

Accurate Doppler angle estimation for vector flow measurements

Traditional Doppler methods measure only the axial component of the velocity vector. The lack of information on the beam-flow angle creates an ambiguity that can lead to large errors in velocity magnitude estimates. Different triangulation techniques so far have been proposed, which basically perform multiple measurements of the Doppler frequency shift originating from the same region. In this work, an original approach is introduced, in which two ultrasound beams with known relative orientation are directed toward the same vessel, but only one of them is committed to perform a Doppler measurement; the second (reference) beam has the specific task of detecting the beam-flow angle. The latter goal is obtained by accurately identifying the achievement of the target 900 reference-beam-to-flow angle through the inspection of the backscattered Doppler signal spectrum. In transverse flow conditions, in fact, such spectrum is expected to be centered on the zero frequency, and even small deviations from the desired 900 orientation cause noticeable losses of spectral symmetry. Validation of the new method has been performed through experimental tests, which show that the beam-flow angle can be estimated with high accuracy (rms errors lower than 1 degree), and repeatable velocity magnitude measurements are possible. A procedure for automatically tracking the desired orientation by the reference beam is also introduced and shown suitable for implementation in steerable linear array transducers.

Variable-density one-shot fourier velocity encoding

In areas of highly pulsatile and turbulent flow, real-time imaging with high temporal, spatial, and velocity resolution is essential. The use of 1D Fourier velocity encoding (FVE) was previously demonstrated for velocity measurement in real time, with fewer effects resulting from off-resonance. The application of variable-density sampling is proposed to improve velocity measurement without a significant increase in readout time or the addition of aliasing artifacts. Two sequence comparisons are presented to improve velocity resolution or increase the velocity field of view (FOV) to unambiguously measure velocities up to 5 m/s without aliasing. The results from a tube flow phantom, a stenosis phantom, and healthy volunteers are presented, along with a comparison of measurements using Doppler ultrasound (US). The studies confirm that variable-density acquisition of kz-kv space improves the velocity resolution and FOV of such data, with the greatest impact on the improvement of FOV to include velocities in stenotic ranges.

Angle-dependence and reproducibility of dual-beam vector doppler ultrasound in the common carotid arteries of normal volunteers

Dual-beam vector Doppler has the potential to improve peak systolic blood velocity measurement accuracy by automatically correcting for the beam-flow Doppler angle. Using a modified linear-array system with a split receive aperture, we have assessed the angle-dependence over Doppler angles of 40 degrees -70 degrees and the reproducibility of the dual-beam blood maximum velocity estimate measured in the common carotid arteries (CCA) 1 to 2 cm prior to the bifurcation of 9 presumed-healthy volunteers. The velocity magnitude estimate was reduced by approximately 7.9% as the angle between the transmit beam and the vessel axis was increased from 40 degrees to 70 degrees. With repeat measurements made, on average, approximately 6 weeks apart, the 95% velocity magnitude limits of agreement were as follows: Intraobserver -41.3 to +45.2 cm/s; interobserver -29.6 to +46.8 cm/s. There was an 8.6 cm/s interobserver bias in velocity magnitude. We conclude that the dual-beam vector Doppler system can measure blood velocity within its scan plane with low dependence on angle and with similar reproducibility to that of single-beam systems.