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Zhou D, Xu R, Liu Y, Yang Y, Wu Z, Luo Y, Zeng S. Left Ventricular Vortex Characteristics in Fetuses With Coarctation of the Aorta by Blood Speckle-Tracking Echocardiography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:841-849. [PMID: 38240409 DOI: 10.1002/jum.16412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 12/02/2023] [Accepted: 12/27/2023] [Indexed: 04/18/2024]
Abstract
OBJECTIVES The aims of this study were to assess the vortex characteristics of left ventricle (LV) in fetuses with coarctation of the aorta (CoA) using high-frame rate ultrasound with blood speckle-tracking (BST) and explore its relationships with cardiac function and morphology parameters. METHODS Thirty fetuses with CoA and 30 gestational-age matched normal fetuses were included in this cross-sectional study. The area, length, width, and position of the vortex in the LV were recorded and quantitatively analyzed by BST echocardiography. The associations of vortex properties with ventricular function and morphology were also determined. RESULTS Based on BST imaging, the LV vortex can be observed in 93% of the fetuses. The fetuses with CoA exhibited significantly larger and wider vortex than the controls (P < .05). Linear regression analysis indicated that vortex area was positively related to sphericity index of LV as well as isovolumic relaxation time (r = .52, P = .003 and r = .42, P = .021). There was a negative correlation between vortex area and mitral valve size (r = -.443, P = .014). No significant association was found between vortex area and myocardial performance index and aortic isthmus size. CONCLUSIONS It is feasible to quantitatively evaluate the left ventricular vortex in fetuses by BST. The fetuses with CoA exhibited greater vortex area and width, and the altered vortex property is associated with geometry of LV. This will facilitate our comprehension of the unique flow patterns and early cardiac remodeling in fetuses with CoA.
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Affiliation(s)
- Dan Zhou
- Department of Ultrasound, Second Xiangya Hospital, Central South University, Changsha, China
| | - Ran Xu
- Department of Ultrasound, Second Xiangya Hospital, Central South University, Changsha, China
- Department of Urology, Second Xiangya Hospital, Central South University, Changsha, China
| | - Yushan Liu
- Department of Ultrasound, Second Xiangya Hospital, Central South University, Changsha, China
| | - Yang Yang
- Department of Ultrasound, Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhongshi Wu
- Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Yuanchen Luo
- Department of Ultrasound, The First Hospital of Changsha, Changsha, China
| | - Shi Zeng
- Department of Ultrasound, Second Xiangya Hospital, Central South University, Changsha, China
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2
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Cantinotti M, Marchese P, Scalese M, Giordano R, Franchi E, Assanta N, Koestenberger M, Barnes BT, Celi S, Jani V, Voges I, Kutty S. Characterization of Aortic Flow Patterns by High-Frame-Rate Blood Speckle Tracking Echocardiography in Children. J Am Heart Assoc 2023; 12:e026335. [PMID: 37066781 PMCID: PMC10227241 DOI: 10.1161/jaha.122.026335] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 12/26/2022] [Indexed: 04/18/2023]
Abstract
Background Blood speckle tracking echocardiography allows for direct quantification of interventricular and aortic flow profiles, principally in children. Here, we sought to demonstrate the feasibility and reproducibility of blood speckle tracking echocardiography in the aortas of healthy children. Methods and Results One hundred healthy White children evaluated for the screening of congenital heart disease were prospectively enrolled. Echocardiographic examinations were performed using a Vivid E 95 ultrasound system, with blood speckle tracking from a focused and zoomed view of the aortic root and the ascending aorta. Vortex position, height (mm), width (mm), sphericity index, and area (cm2) were measured and indexed by body surface area. Median (interquartile range) age was 8.2 (5.6-11.0) years, median (interquartile range) weight was 28 (19-35) kg, and median (interquartile range) body surface area was 1.01 (0.79-1.16) m2. Vortices were visualized in only a single phase of the cardiac cycle in 25 subjects-14 (56.0%) were evident in early diastole and 11 (44.0%) in late systole. Vortices visualized in diastole had a mean area of 0.27±0.1 cm2/m2, while those in systole had a mean area of 0.34±0.12 cm2/m2. In a subset of 20 patients, inter- and intraobserver coefficient of variation and intraclass correlation coefficients were determined and showed good reproducibility. Conclusions We demonstrate feasibility and reproducibility of blood speckle tracking and identified vortical flow patterns in the aortic root and ascending aorta in healthy children. These data may serve as a baseline for evaluating aortic flow patterns in children with congenital and acquired heart disease.
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Affiliation(s)
- Massimiliano Cantinotti
- Fondazione G. Monasterio CNR‐Regione ToscanaMassa, PisaItaly
- Adult Institute of Clinical PhysiologyPisaItaly
| | - Pietro Marchese
- Fondazione G. Monasterio CNR‐Regione ToscanaMassa, PisaItaly
- Scuola Superiore Sant’AnnaPisaItaly
| | | | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Department Advanced Biomedical SciencesUniversity of Naples “Federico II”NapoliItaly
| | - Eliana Franchi
- Fondazione G. Monasterio CNR‐Regione ToscanaMassa, PisaItaly
| | - Nadia Assanta
- Fondazione G. Monasterio CNR‐Regione ToscanaMassa, PisaItaly
| | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of PediatricsMedical University GrazGrazAustria
| | - Benjamin T. Barnes
- Department of PediatricsTaussig Heart Center, Johns Hopkins HospitalBaltimoreMDUSA
| | - Simona Celi
- Fondazione G. Monasterio CNR‐Regione ToscanaMassa, PisaItaly
| | - Vivek Jani
- Department of PediatricsTaussig Heart Center, Johns Hopkins HospitalBaltimoreMDUSA
| | - Inga Voges
- Department for Congenital Cardiology and Pediatric CardiologyUniversity Hospital Schleswig‐HolsteinCampus KielGermany
| | - Shelby Kutty
- Department of PediatricsTaussig Heart Center, Johns Hopkins HospitalBaltimoreMDUSA
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3
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Nguyen TQ, Bechsgaard T, Schmidt MR, Juul K, Moshavegh R, Lönn L, Nielsen MB, Jensen JA, Hansen KL. Transthoracic Vector Flow Imaging in Pediatric Patients with Valvular Stenosis - A Proof of Concept Study. Ultrasound Int Open 2021; 7:E48-E54. [PMID: 34804771 PMCID: PMC8598391 DOI: 10.1055/a-1652-1261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 09/05/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose
Continuous wave Doppler ultrasound is routinely used to detect
cardiac valve stenoses. Vector flow imaging (VFI) is an angle-independent
real-time ultrasound method that can quantify flow complexity. We aimed to
evaluate if quantification of flow complexity could reliably assess valvular
stenosis in pediatric patients.
Materials and Methods
Nine pediatric patients with echocardiographically
confirmed valvular stenosis were included in the study. VFI and Doppler
measurements were compared with transvalvular peak-to-peak pressure differences
derived from invasive endovascular catheterization.
Results
Vector concentration correlated with the catheter measurements
before intervention after exclusion of one outlier (r=−0.83,
p=0.01), whereas the Doppler method did not (r=0.49,
p=0.22). The change in vector concentration after intervention
correlated strongly with the change in the measured catheter pressure difference
(r=−0.86, p=0.003), while Doppler showed a tendency for
a moderate correlation (r=0.63, p=0.07).
Conclusion
Transthoracic flow complexity quantification calculated from
VFI data is feasible and may be useful for assessing valvular stenosis severity
in pediatric patients.
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Affiliation(s)
- Tin-Quoc Nguyen
- Department of Diagnostic Radiology, Rigshospitalet Diagnostisk Center, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Thor Bechsgaard
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | | | - Klaus Juul
- Department of Pediatric Cardiology, Rigshospitalet, Copenhagen, Denmark
| | | | - Lars Lönn
- Department of Diagnostic Radiology, Rigshospitalet Diagnostisk Center, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Michael Bachmann Nielsen
- Department of Diagnostic Radiology, Rigshospitalet Diagnostisk Center, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Jørgen Arendt Jensen
- Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Kristoffer Lindskov Hansen
- Department of Diagnostic Radiology, Rigshospitalet Diagnostisk Center, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
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4
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Marchese P, Cantinotti M, Van den Eynde J, Assanta N, Franchi E, Pak V, Santoro G, Koestenberger M, Kutty S. Left ventricular vortex analysis by high-frame rate blood speckle tracking echocardiography in healthy children and in congenital heart disease. IJC HEART & VASCULATURE 2021; 37:100897. [PMID: 34786451 PMCID: PMC8579140 DOI: 10.1016/j.ijcha.2021.100897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022]
Abstract
Background High-frame rate blood speckle tracking (BST) echocardiography is a new technique for the assessment of intracardiac flow. The purpose of this study was to evaluate the characteristics of left ventricular (LV) vortices in healthy children and in those with congenital heart disease (CHD). Methods Characteristics of LV vortices were analyses based on 4-chamber BST images from 118 healthy children (median age 6.84 years, range 0.01-17 years) and 43 children with CHD (median age 0.99 years, range 0.01-14 years). Both groups were compared after propensity matching. Multiple linear regression was used to identify factors that independently influence vortex characteristics. Results Feasibility of vortex imaging was 93.7% for healthy children and 95.6% for CHD. After propensity matching, there were no overall significant differences in vortex distance to apex, distance to interventricular septum (IVS), height, width, sphericity index, or area. However, multiple regression analysis revealed significant associations of LV morphology with vortex characteristics. Furthermore, CHD involving LV volume overload and CHD involving LV pressure overload were both associated with vortices localized closer to the IVS. Conclusions LV vortex analysis using high-frame rate BST echocardiography is feasible in healthy children and in those with CHD. As they are associated with LV morphology and are modified in some types of CHD, vortices might yield diagnostic and prognostic value. Future studies are warranted to establish applications of vortex imaging in the clinical setting.
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Key Words
- -i, indexed to BSA
- AV, atrioventricular
- BMI, body mass index
- BSA, body surface area
- BST, blood speckle tracking
- Blood speckle imaging
- Bpm, beats per minute
- CHD, congenital heart disease
- CI, correlation index
- Congenital
- ED, end-diastolic
- Echocardiography
- Fps, frame per second
- Heart defects
- ICC, intraclass correlation coefficient
- IQR, interquartile range
- IVS, interventricular septum
- LV, left ventricle/ventricular
- LVEDA, left ventricular end-diastolic area
- LVEDD, left ventricular end-diastolic dimension
- LVEDV, left ventricular end-diastolic volume
- LVEF, left ventricular ejection fraction
- LVESD, left ventricular end-systolic dimension
- LVESV, left ventricular end-systolic volume
- LVOT, left ventricular outflow tract
- LVPO, CHD involving left ventricle pressure overload
- LVSV, left ventricular stroke volume
- LVVO, CHD involving left ventricular volume overload
- Left ventricle
- MV, mitral valve
- Pediatrics
- RVPO, CHD involving right ventricular pressure overload
- RVVO, CHD involving right ventricular volume overload
- TGA, transposition of the great arteries
- Vortex imaging
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Affiliation(s)
- Pietro Marchese
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy.,Adult Institute of Clinical Physiology, Pisa, Italy
| | | | - Jef Van den Eynde
- Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD, USA.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Vitali Pak
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Giuseppe Santoro
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | | | - Shelby Kutty
- Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD, USA
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5
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Voorneveld J, Keijzer LBH, Strachinaru M, Bowen DJ, Mutluer FO, van der Steen AFW, Cate FJT, de Jong N, Vos HJ, van den Bosch AE, Bosch JG. Optimization of Microbubble Concentration and Acoustic Pressure for Left Ventricular High-Frame-Rate EchoPIV in Patients. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:2432-2443. [PMID: 33720832 DOI: 10.1109/tuffc.2021.3066082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
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.
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6
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Shekhar A, Aristizabal O, Fishman GI, Phoon CKL, Ketterling JA. Characterization of Vortex Flow in a Mouse Model of Ventricular Dyssynchrony by Plane-Wave Ultrasound Using Hexplex Processing. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:538-548. [PMID: 32763851 PMCID: PMC8054309 DOI: 10.1109/tuffc.2020.3014844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
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.
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7
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Nguyen TQ, Traberg MS, Olesen JB, Heerwagen ST, Brandt AH, Bechsgaard T, Pedersen BL, Moshavegh R, Lönn L, Jensen JA, Nielsen MB, Hansen KL. Flow Complexity Estimation in Dysfunctional Arteriovenous Dialysis Fistulas using Vector Flow Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2493-2504. [PMID: 32595057 DOI: 10.1016/j.ultrasmedbio.2020.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 05/25/2020] [Accepted: 05/31/2020] [Indexed: 06/11/2023]
Abstract
Non-invasive assessment is preferred for monitoring arteriovenous dialysis fistulas (AVFs). Vector concentration assesses flow complexity, which may correlate with stenosis severity. We determined whether vector concentration could assess stenosis severity in dysfunctional AVFs. Vector concentration was estimated in four stenotic phantoms at different pulse repetition frequencies. Spectral Doppler peak velocity and vector concentration were measured in 12 patients with dysfunctional AVFs. Additionally, 5 patients underwent digital subtraction angiography (DSA). In phantoms, vector concentration exhibited an inverse relationship with stenosis severity and was less affected by aliasing in severe stenoses. In nine stenoses of 5 patients undergoing DSA, vector concentration correlated strongly with stenosis severity (first stenosis: r = -0.73, p = 0.04; other stenoses; r = -0.69, p = 0.02) and mid-stenotic diameter (first stenosis: r = 0.87, p = 0.006; other stenoses: r = 0.70, p = 0.02) as opposed to peak velocities (p > 0.05). Vector concentration is less affected by aliasing in severe stenoses and correlates with DSA in patients with dysfunctional AVF.
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Affiliation(s)
- Tin-Quoc Nguyen
- Department of Diagnostic Radiology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Marie Sand Traberg
- Center for Fast Ultrasound Imaging, Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Jacob Bjerring Olesen
- Center for Fast Ultrasound Imaging, Department of Health Technology, Technical University of Denmark, Lyngby, Denmark; BK Medical, Herlev, Denmark
| | | | | | - Thor Bechsgaard
- Department of Radiology, Odense University Hospital, Odense C, Denmark
| | | | - Ramin Moshavegh
- Center for Fast Ultrasound Imaging, Department of Health Technology, Technical University of Denmark, Lyngby, Denmark; BK Medical, Herlev, Denmark
| | - Lars Lönn
- Department of Diagnostic Radiology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Arendt Jensen
- Center for Fast Ultrasound Imaging, Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Michael Bachmann Nielsen
- Department of Diagnostic Radiology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kristoffer Lindskov Hansen
- Department of Diagnostic Radiology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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8
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Villemain O, Baranger J, Friedberg MK, Papadacci C, Dizeux A, Messas E, Tanter M, Pernot M, Mertens L. Ultrafast Ultrasound Imaging in Pediatric and Adult Cardiology. JACC Cardiovasc Imaging 2020; 13:1771-1791. [DOI: 10.1016/j.jcmg.2019.09.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/29/2019] [Accepted: 09/03/2019] [Indexed: 02/08/2023]
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9
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Saris AECM, Hansen HHG, Fekkes S, Menssen J, Nillesen MM, de Korte CL. In Vivo Blood Velocity Vector Imaging Using Adaptive Velocity Compounding in the Carotid Artery Bifurcation. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1691-1707. [PMID: 31079874 DOI: 10.1016/j.ultrasmedbio.2019.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/06/2019] [Accepted: 03/10/2019] [Indexed: 06/09/2023]
Abstract
Visualization and quantification of blood flow are considered important for early detection of atherosclerosis and patient-specific diagnosis and intervention. As conventional Doppler imaging is limited to 1-D velocity estimates, 2-D and 3-D techniques are being developed. We introduce an adaptive velocity compounding technique that estimates the 2-D velocity vector field using predominantly axial displacements estimated by speckle tracking from dual-angle plane wave acquisitions. Straight-vessel experiments with a 7.8-MHz linear array transducer connected to a Verasonics Vantage ultrasound system revealed that the technique performed with a maximum velocity magnitude bias and angle bias of -3.7% (2.8% standard deviation) and -0.16° (0.41° standard deviation), respectively. In vivo, complex flow patterns were visualized in two healthy and three diseased carotid arteries and quantified using a vector complexity measure that increased with increasing wall irregularity. This measure could potentially be a relevant clinical parameter which might aid in early detection of atherosclerosis.
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Affiliation(s)
- Anne E C M Saris
- Medical Ultrasound Imaging Centre (MUSIC), Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Hendrik H G Hansen
- Medical Ultrasound Imaging Centre (MUSIC), Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stein Fekkes
- Medical Ultrasound Imaging Centre (MUSIC), Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan Menssen
- Medical Ultrasound Imaging Centre (MUSIC), Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maartje M Nillesen
- Medical Ultrasound Imaging Centre (MUSIC), Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Chris L de Korte
- Medical Ultrasound Imaging Centre (MUSIC), Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; Physics of Fluid Group, MESA+ Institute for Nanotechnology, and MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
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10
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Hansen KL, Hansen PM, Ewertsen C, Lönn L, Jensen JA, Nielsen MB. Vector Flow Imaging Compared with Digital Subtraction Angiography for Stenosis Assessment in the Superficial Femoral Artery - A Study of Vector Concentration, Velocity Ratio and Stenosis Degree Percentage. Ultrasound Int Open 2019; 5:E53-E59. [PMID: 30886943 PMCID: PMC6420338 DOI: 10.1055/a-0853-2002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/01/2018] [Accepted: 01/29/2019] [Indexed: 10/27/2022] Open
Abstract
Purpose Stenosis of the superficial femoral artery (SFA) induces complex blood flow with increased velocities. Disease assessment is performed with Doppler ultrasound and digital subtraction angiography (DSA), but Doppler ultrasound is limited by angle dependency and DSA by ionizing radiation. An alternative is the vector flow imaging method based on transverse oscillation (TO), an angle-independent vector velocity technique using ultrasound. In this study, flow complexity and velocity measured with TO were compared with DSA for the assessment of stenosis in the SFA. Materials and Methods The vector concentration, a measure of flow complexity, and the velocity ratio obtained from the stenosis and a disease-free adjacent vessel segment, were estimated with TO in 11 patients with a total of 16 stenoses of the SFA. TO data were compared with the corresponding stenosis degree percentage obtained with DSA. Results The correlation between the vector concentration and DSA was very strong (R=0.93; p<0.001; 95% confidence interval (CI): 0.81-0.98), while only moderate for velocity ratio and DSA (R=0.50; p<0.07; 95% CI: 0.00-0.80). The correlation coefficients that were found were significantly different (p<0.005) without overlapping CI. Conclusion The study indicated that flow changes in the SFA induced by stenosis can be quantified with TO, and that stenosis grading may be improved by estimation of flow complexity instead of velocity ratio. TO is a potential diagnostic tool for the assessment of atherosclerosis and peripheral arterial disease.
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Affiliation(s)
- Kristoffer Lindskov Hansen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Peter Møller Hansen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Caroline Ewertsen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Lönn
- Department of Diagnostic Radiology, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Vascular Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jørgen Arendt Jensen
- Center for Fast Ultrasound Imaging, Technical University of Denmark, DTU Elektro, Kgs. Lyngby, Denmark
| | - Michael Bachmann Nielsen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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11
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Abstract
In children with congenital heart defects, Doppler ultrasound is the standard, bedside imaging modality. However, precise characterization of blood flow is challenging due to angle-dependent and one-dimensional velocity estimation. Contrast agent free Vector Flow Imaging is a new ultrasound technology that enables angle-independent visualization of the detailed flow field. Two piglets, one with normal cardiac anatomy and one with congenital heart disease comprised of valvular pulmonary stenosis, a dilated main pulmonary artery, and an incomplete atrioventricular canal defect, were imaged transthoracically and epicardially using a BK Ultrasound bk5000 with built-in vector flow imaging and a 5MHz linear probe. Subsequently, two children, one with normal cardiac anatomy and one with congenital heart disease comprised of aortic valve stenosis and coarctation of the aorta were imaged transthoracically. Transthoracic two-dimensional echocardiography and vector flow imaging were readily performed in both animals and were limited only by the geometry of the porcine thorax. In addition, transthoracic vector flow imaging was successfully performed in both children, and abnormal flow secondary to cardiac anomalies was visible. Adequate penetration was obtained to a depth of 6.5 cm. Our group has previously demonstrated for the first time that transthoracic vector flow imaging echocardiography is feasible and practicable in pediatric-sized patients, and this paper describes examples of these concepts and in-depth comparisons with traditional imaging modalities. This paper demonstrates that commercially available vector flow imaging technology can be utilized in pediatric cardiac applications as a bedside transthoracic imaging modality, providing advanced detail of blood flow patterns within the cardiac chambers, across valves, and in the great arteries.
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