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Brandt AH, Olesen JB, Moshavegh R, Jensen JA, Nielsen MB, Hansen KL. Common Carotid Artery Volume Flow: A Comparison Study between Ultrasound Vector Flow Imaging and Phase Contrast Magnetic Resonance Imaging. Neurol Int 2021; 13:269-278. [PMID: 34201493 PMCID: PMC8293467 DOI: 10.3390/neurolint13030028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/19/2021] [Accepted: 06/20/2021] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Andreas Hjelm Brandt
- Department of Diagnostic Radiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark; (M.B.N.); (K.L.H.)
- Correspondence:
| | | | | | - Jørgen Arendt Jensen
- Center for Fast Ultrasound Imaging, Department of Health Technology, Technical University of Denmark, 2800 Lyngby, Denmark;
| | - Michael Bachmann Nielsen
- Department of Diagnostic Radiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark; (M.B.N.); (K.L.H.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Kristoffer Lindskov Hansen
- Department of Diagnostic Radiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark; (M.B.N.); (K.L.H.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
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Brandt AH, Nguyen TQ, Gutte H, Frederik Carlsen J, Moshavegh R, Jensen JA, Bachmann Nielsen M, Hansen KL. Carotid Stenosis Assessment with Vector Concentration before and after Stenting. Diagnostics (Basel) 2020; 10:E420. [PMID: 32575759 PMCID: PMC7345475 DOI: 10.3390/diagnostics10060420] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/08/2020] [Accepted: 06/18/2020] [Indexed: 11/16/2022] Open
Abstract
Digital subtraction angiography (DSA) is considered the reference method for the assessment of carotid artery stenosis; however, the procedure is invasive and accompanied by ionizing radiation. Velocity estimation with duplex ultrasound (DUS) is widely used for carotid artery stenosis assessment since no radiation or intravenous contrast is required; however, the method is angle-dependent. Vector concentration (VC) is a parameter for flow complexity assessment derived from the angle independent ultrasound method vector flow imaging (VFI), and VC has shown to correlate strongly with stenosis degree. The aim of this study was to compare VC estimates and DUS estimated peak-systolic (PSV) and end-diastolic velocities (EDV) for carotid artery stenosis patients, with the stenosis degree obtained with DSA. Eleven patients with symptomatic carotid artery stenosis were examined with DUS, VFI, and DSA before and after stent treatment. Compared to DSA, VC showed a strong correlation (r = -0.79, p < 0.001), while PSV (r = 0.68, p = 0.002) and EDV (r = 0.51, p = 0.048) obtained with DUS showed a moderate correlation. VFI using VC calculations may be a useful ultrasound method for carotid artery stenosis and stent patency assessment.
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Affiliation(s)
- Andreas Hjelm Brandt
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (T.-Q.N.); (H.G.); (J.F.C.); (M.B.N.); (K.L.H.)
| | - Tin-Quoc Nguyen
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (T.-Q.N.); (H.G.); (J.F.C.); (M.B.N.); (K.L.H.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Henrik Gutte
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (T.-Q.N.); (H.G.); (J.F.C.); (M.B.N.); (K.L.H.)
| | - Jonathan Frederik Carlsen
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (T.-Q.N.); (H.G.); (J.F.C.); (M.B.N.); (K.L.H.)
| | | | - Jørgen Arendt Jensen
- Center for Fast Ultrasound Imaging, Department of Health Technology, Technical University of Denmark, 2800 Lyngby, Denmark;
| | - Michael Bachmann Nielsen
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (T.-Q.N.); (H.G.); (J.F.C.); (M.B.N.); (K.L.H.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Kristoffer Lindskov Hansen
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (T.-Q.N.); (H.G.); (J.F.C.); (M.B.N.); (K.L.H.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
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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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Hansen KL, Møller-Sørensen H, Kjaergaard J, Jensen MB, Jensen JA, Nielsen MB. Aortic Valve Stenosis Increases Helical Flow and Flow Complexity: A Study of Intra-Operative Cardiac Vector Flow Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:1607-1617. [PMID: 28495300 DOI: 10.1016/j.ultrasmedbio.2017.03.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 03/21/2017] [Accepted: 03/27/2017] [Indexed: 06/07/2023]
Abstract
Aortic valve stenosis alters blood flow in the ascending aorta. Using intra-operative vector flow imaging on the ascending aorta, secondary helical flow during peak systole and diastole, as well as flow complexity of primary flow during systole, were investigated in patients with normal, stenotic and replaced aortic valves. Peak systolic helical flow, diastolic helical flow and flow complexity during systole differed between the groups (p < 0.0001), and correlated to peak systolic velocity (R = 0.94, 0.87 and 0.88, respectively). The study indicates that aortic valve stenosis increases helical flow and flow complexity, which are measurable with vector flow imaging. For assessment of aortic stenosis and optimization of valve surgery, vector flow imaging may be useful.
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Affiliation(s)
| | | | | | | | - Jørgen Arendt Jensen
- Center for Fast Ultrasound Imaging, DTU Elektro, Technical University of Denmark, Denmark
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Hansen KL, Møller-Sørensen H, Kjaergaard J, Jensen MB, Lund JT, Pedersen MM, Lange T, Jensen JA, Nielsen MB. Intra-Operative Vector Flow Imaging Using Ultrasound of the Ascending Aorta among 40 Patients with Normal, Stenotic and Replaced Aortic Valves. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2414-2422. [PMID: 27471116 DOI: 10.1016/j.ultrasmedbio.2016.06.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 06/01/2016] [Accepted: 06/06/2016] [Indexed: 06/06/2023]
Abstract
Stenosis of the aortic valve gives rise to more complex blood flows with increased velocities. The angle-independent vector flow ultrasound technique transverse oscillation was employed intra-operatively on the ascending aorta of (I) 20 patients with a healthy aortic valve and 20 patients with aortic stenosis before (IIa) and after (IIb) valve replacement. The results indicate that aortic stenosis increased flow complexity (p < 0.0001), induced systolic backflow (p < 0.003) and reduced systolic jet width (p < 0.0001). After valve replacement, the systolic backflow and jet width were normalized (p < 0.52 and p < 0.22), but flow complexity was not (p < 0.0001). Flow complexity (p < 0.0001), systolic jet width (p < 0.0001) and systolic backflow (p < 0.001) were associated with peak systolic velocity. The study found that aortic stenosis changes blood flow in the ascending aorta and valve replacement corrects some of these changes. Transverse oscillation may be useful for assessment of aortic stenosis and optimization of valve surgery.
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Affiliation(s)
| | | | | | - Maiken Brit Jensen
- Cardiothoracic Anesthesiology Department, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Theis Lange
- Biostatistics Department, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Arendt Jensen
- Center for Fast Ultrasound Imaging, DTU Elektro, Technical University of Denmark, Lyngby, Denmark
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Hansen KL, Møller-Sørensen H, Pedersen MM, Hansen PM, Kjaergaard J, Lund JT, Nilsson JC, Jensen JA, Nielsen MB. First report on intraoperative vector flow imaging of the heart among patients with healthy and diseased aortic valves. ULTRASONICS 2015; 56:243-250. [PMID: 25128079 DOI: 10.1016/j.ultras.2014.07.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 07/22/2014] [Accepted: 07/23/2014] [Indexed: 06/03/2023]
Abstract
The vector velocity method Transverse Oscillation (TO) implemented on a conventional ultrasound (US) scanner (ProFocus, BK Medical, Herlev, Denmark) can provide real-time, angle-independent estimates of the cardiac blood flow. During cardiac surgery, epicardial US examination using TO was performed on (A) 3 patients with healthy aortic valve and (B) 3 patients with aortic valve stenosis. In group B, the systolic flow of the ascending aorta had higher velocities, was more aliased and chaotic. The jet narrowed to 44% of the lumen compared to 75% in group A and with a vector concentration, a measure of flow complexity, of 0.41 compared to 0.87 in group A. The two groups had similar secondary flow of the ascending aorta with an average rotation frequency of 4.8 Hz. Simultaneous measurements were obtained with spectral Doppler (SD) and a thermodilution technique (TD). The mean difference in peak systolic velocity compared to SD in group A was 22% and 45% in B, while the mean difference in volume flow compared to TD in group A was 30% and 32% in B. TO can potentially reveal new information of cardiac blood flow, and may become a valuable diagnostic tool in the evaluation of patients with cardiovascular diseases.
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Affiliation(s)
| | - Hasse Møller-Sørensen
- Department of Cardiothoracic Anesthesiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Mads Møller Pedersen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Peter Møller Hansen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Jens Teglgaard Lund
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Jens Christian Nilsson
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Jørgen Arendt Jensen
- Center for Fast Ultrasound Imaging, DTU Elektro, Technical University of Denmark, Denmark
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Joyce JJ, Hwang EY, Wiles HB, Kline CH, Bradley SM, Crawford FA. Reliability of intraoperative transesophageal echocardiography during Tetralogy of Fallot repair. Echocardiography 2000; 17:319-27. [PMID: 10979000 DOI: 10.1111/j.1540-8175.2000.tb01143.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
UNLABELLED There is limited information available concerning the accuracy of intraoperative transesophageal echocardiography (TEE) in predicting the extent of residual abnormalities after recovery from surgical repair of tetralogy of Fallot. Therefore, we investigated differences between the results of final postbypass TEE and those of postrecovery (mean, 6 days after surgery) transthoracic echocardiography in a total of 28 consecutive pediatric patients who underwent repair of tetralogy of Fallot with biplane or multiplane TEE. Both postbypass and postrecovery echocardiographic examinations included measurements of the right ventricle (RV)-main pulmonary artery (PA) and the main PA-branch PA peak instantaneous gradients, the degree of pulmonary valvar insufficiency, and color Doppler interrogation of the ventricular septum for residual defects. The RV-main PA gradient did not change significantly: 15 +/- 13 vs 18 +/- 14 mmHg (postbypass versus postrecovery, mean +/- SD). None of the patients had a decrease of > or = 10 mmHg; and only one patient had an increase of > or = 15 mmHg. There also was no change in the degree of pulmonary insufficiency (3.0 +/- 1.2 versus 3.1 +/- 1.1, using a scale of 0 to 4). Only one of the seven very small (< or = 2 mm) residual ventricular septal defects was not discovered during postbypass TEE. However, postrecovery transthoracic echocardiography detected significant branch PA stenosis (peak gradient, > or = 15 mmHg) in five patients (18%) that was not detected during postbypass TEE (P < 0.03). Of the branch PA stenoses that were not detected during TEE, four were left and one was right. CONCLUSIONS Postbypass TEE after tetralogy of Fallot repair reliably predicts residual postrecovery hemodynamic abnormalities, except for branch PA stenosis.
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Affiliation(s)
- J J Joyce
- Division of Pediatric Cardiology, Harbor-UCLA Medical Center, 1000 West Carson St., Box 491, Torrance, CA 90509, USA
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Affiliation(s)
- A Houston
- Department of Cardiology, Royal Hospital for Sick Children, Glasgow, UK
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