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

A comment on the physiological basis for longitudinal motion of the arterial wall

The longitudinal motion and the intramural shear strain of the arterial wall increase dramatically in response to blood pressure, thereby impacting the vascular wall microenvironment. Exposure to a sedentary lifestyle has been identified as an independent risk factor for cardiovascular disease, but it has been shown that intermittent physical activity embedded into everyday life is enough to improve cardiovascular health. Marked changes in longitudinal motion already at a low workload may explain this finding. However, to understand the mechanism linking longitudinal motion and cardiovascular health, an understanding of the physiological basis for the longitudinal motion of the arterial wall is needed. The factors underlying the longitudinal motion of the arterial wall in vivo are numerous and intertwined. As a comment and complement to the recent review by Athaide et al. (Am J Physiol Heart Circ Physiol 322: H689-H701, 2022), we propose and discuss a comprehensive cardiovascular mechanical scenario based on the current literature. In this scenario, blood pressure, typically acting in the radial direction, also acts directly in the longitudinal direction through a tapered geometry. This complements ventricular contraction, ventricular-vascular coupling, arterial diameter change, arterial stiffness in both the radial and longitudinal directions, and prestretch of the arterial wall. In addition, we consider the geometry of the arterial tree and intramural friction of the arterial wall. Together, these important cardiovascular mechanical factors form the pattern of longitudinal motion of the arterial wall, indicating that the longitudinal motion of the arterial wall is important for cardiovascular health.

A Novel Poroelastography Method for High-Quality Estimation of Lateral Strain, Solid Stress, and Fluid Pressure In Vivo

Assessment of mechanical and transport properties of tissues using ultrasound elasticity imaging requires accurate estimations of the spatiotemporal distribution of volumetric strain. Due to physical constraints such as pitch limitation and the lack of phase information in the lateral direction, the quality of lateral strain estimation is typically significantly lower than the quality of axial strain estimation. In this paper, a novel lateral strain estimation technique based on the physics of compressible porous media is developed, tested and validated. This technique is referred to as "Poroelastography-based Ultrasound Lateral Strain Estimation" (PULSE). PULSE differs from previously proposed lateral strain estimators as it uses the underlying physics of internal fluid flow within a local region of the tissue as theoretical foundation. PULSE establishes a relation between spatiotemporal changes in the axial strains and corresponding spatiotemporal changes in the lateral strains, effectively allowing assessment of lateral strains with comparable quality of axial strain estimators. We demonstrate that PULSE can also be used to accurately track compression-induced solid stresses and fluid pressure in cancers using ultrasound poroelastography (USPE). In this study, we report the theoretical formulation for PULSE and validation using finite element (FE) and ultrasound simulations. PULSE-generated results exhibit less than 5% percentage relative error (PRE) and greater than 90% structural similarity index (SSIM) compared to ground truth simulations. Experimental results are included to qualitatively assess the performance of PULSE in vivo. The proposed method can be used to overcome the inherent limitations of non-axial strain imaging and improve clinical translatability of USPE.

Ultrasound Speckle Decorrelation Analysis-Based Velocimetry for 3D-Velocity-Components Measurement Using a 1D Transducer Array

Ultrasound velocimetry has been widely used for blood flow imaging. However, the flow measurements are constrained to resolve the in-plane 2D flow components when using a 1D transducer array. In this work, an ultrasound speckle decorrelation analysis-based velocimetry (3C-vUS) is proposed for 3D velocity components measurement using a 1D transducer array. The 3C-vUS theory is first derived and validated with numerical simulations and phantom experiments. The in vivo testing results show that 3C-vUS can accurately measure the blood flow 3D-velocity-components of the human carotid artery at arbitrary probe-to-vessel angles throughout the cardiac cycle. With such capability, the 3C-vUS will alleviate the requirement of operators and promote disease screening for blood flow-related disorders.

Dynamic Coronary Blood Flow Velocity and Wall Shear Stress Estimation Using Ultrasound in an Ex Vivo Porcine Heart

PURPOSE

Wall shear stress (WSS) is a critically important physical factor contributing to atherosclerosis. Mapping the spatial distribution of local, oscillatory WSS can identify important mechanisms underlying the progression of coronary artery disease.

METHODS

In this study, blood flow velocity and time-varying WSS were estimated in the left anterior descending (LAD) coronary artery of an ex vivo beating porcine heart using ultrasound with an 18 MHz linear array transducer aligned with the LAD in a forward-viewing orientation. A pulsatile heart loop with physiologically-accurate flow was created using a pulsatile pump. The coronary artery wall motion was compensated using a local block matching technique. Next, 2D and 3D velocity magnitude and WSS maps in the LAD coronary artery were estimated at different time points in the cardiac cycle using an ultrafast Doppler approach. The blood flow velocity estimated using the presented approach was compared with a commercially-available, calibrated single element blood flow velocity measurement system.

RESULTS

The resulting root mean square error (RMSE) of 2D velocity magnitude acquired from a high frequency, linear array transducer was less than 8% of the maximum velocity estimated by the commercial system.

CONCLUSION

When implemented in a forward-viewing intravascular ultrasound device, the presented approach will enable dynamic estimation of WSS, an indicator of plaque vulnerability in coronary arteries.

A Transverse Velocity Spectral Estimation Method for Ultrafast Ultrasound Doppler Imaging

A novel transverse velocity spectral estimation method is proposed to estimate the velocity component in the direction transverse to the beam axis for ultrafast imaging. The transverse oscillation was introduced by filtering the envelope data after the axial oscillation was removed. The complex transverse oscillated signal was then used to estimate the transverse velocity spectrum and mean velocity. In simulations, both steady flow with a parabolic flow profile and temporally varying flow were simulated to investigate the performance of the proposed method. Next, the proposed approach was used to estimate the flow velocity in a phantom with pulsatile flow, and finally, this method was applied in vivo in a small animal model. Results of the simulation study indicate that the proposed method provided an accurate velocity spectrogram for beam-to-flow angles from 45° to 90°, without significant performance degradation as the angle decreased. For the simulation of temporally varying flow, the proposed method had a reduced bias ( % versus 73.3%) and higher peak-to-background ratio (PBR) (>15.6 versus 10.5 dB) compared to previous methods. Results in a vessel phantom show that the temporally varying flow velocity can be estimated in the transverse direction obtained using the spectrogram produced by the proposed method operating on the envelope data. Finally, the proposed method was used to map the microvascular blood flow velocity in the mouse spinal cord, demonstrating the estimation of pulsatile blood flow in both the axial and transverse directions in vivo over several cardiac cycles.

The impact of geometry, intramural friction, and pressure on the antegrade longitudinal motion of the arterial wall: A phantom and finite element study

Longitudinal motion of the carotid arterial wall, as measured with ultrasound, has shown promise as an indicator of vascular health. The underlying mechanisms are however not fully understood. We have found, in in vivo studies, that blood pressure has a strong relation to the antegrade longitudinal displacement in early systole. Further, we have identified that a tapered geometry and the intramural friction in-between two parts of a vessel wall influence the longitudinal displacement. We therefore studied the interaction between pressure, vessel geometry and intramural friction, tapered and straight ultrasound phantoms in a paralleled hydraulic bench study and corresponding numerical models. Profound antegrade longitudinal motion was induced in the innermost part of both tapered phantoms and the numerical models, but to a lesser extent when intramural friction was increased in the simulations. Strong correlations (R = 0.82-0.96; p < 1e-3; k = 9.3-14 μm/mmHg) between longitudinal displacement and pulse pressure were found in six of seven regions of interest in tapered phantoms. The motion of the straight phantom and the corresponding numerical model was smaller, on average zero or close to zero. This study demonstrates that tapering of the lumen, low intramural friction, and pressure might be important conducive features to the antegrade longitudinal motion of the arterial wall in vivo.

Lateral M-Mode: Ultrasound Visualization of Displacement Along Longitudinal Direction at Intima-Media Complex

Quantification of the dynamics of the carotid artery wall is useful in evaluating arteriosclerosis and atherosclerosis. As the carotid artery wall moves not only in the radial direction but also in the longitudinal direction, longitudinal movement should be considered in the analysis of the dynamic properties of the carotid artery wall. In this study, we propose a "lateral M-mode" method for visualizing the longitudinal movement of the intima-media complex (IMC). For the lateral M-mode, we set the target line in the longitudinal direction along the IMC and visualize the signals on the target line frame-by-frame by correcting the position of the target line along the radial displacement estimated by the phased tracking method. Differentiating the envelope signals between consecutive ultrasound beams was effective in visualizing the lateral movement of the IMC. The precision of the longitudinal displacement of the IMC estimated using the conventional block-matching method was validated by comparing it with the lateral M-mode. Because the conventional M-mode sequence plays an important role in evaluation of the dynamics of various tissues, the proposed "lateral M-mode" contributes to a detailed understanding of vascular dynamics and the development of diagnostic methods for vascular diseases.

Evaluation of carotid artery elastic function using ultrafast pulse wave velocity in patients with rheumatoid arthritis

PURPOSE

Ultrafast pulse wave velocity (UFPWV) is an innovative and practical technology that can assess blood vessel elastic function. This study explored the elastic function of the carotid artery using UFPWV and factors influencing pulse wave velocity (PWV) in patients with rheumatoid arthritis (RA).

METHODS

Overall, 120 patients with RA and 60 healthy controls were evaluated. Participants underwent UFPWV and carotid artery intima-media thickness (cIMT) assessment. The patients were classified into a mild activity group (group A) and a moderate-to-severe activity group (group B). Differences in clinical indicators among the groups were determined, and the correlation between each indicator and PWV values was analyzed.

RESULTS

The PWV values were higher in group B than in group A and were higher in group A than in the control group (p < .05). The PWV values in the patient group positively correlated with anticyclic citrullinated peptide (anti-CCP) antibody, disease course, age, platelets (PLT) count, rheumatoid factor (RF), body mass index (BMI), total cholesterol (TC) level, and triglycerides (TG) level and were negatively correlated with 25-hydroxyvitamin D3 (25[OH]D3) and hemoglobin (Hb) levels (p < .05). In addition, anti-CCP antibody, age, RF, and low-density lipoprotein cholesterol were risk factors for arteriosclerosis, whereas Hb and 25(OH)D3 were protective factors (p < .05).

CONCLUSION

UFPWV allows early and accurate detection of changes in arterial elasticity and enables early intervention to reduce the incidence of cardiovascular events in patients with RA.

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.

Revealing Intraosseous Blood Flow in the Human Tibia With Ultrasound

Intraosseous blood circulation is thought to have a critical role in bone growth and remodeling, fracture healing, and bone disorders. However, it is rarely considered in clinical practice because of the absence of a suitable noninvasive in vivo measurement technique. In this work, we assessed blood perfusion in tibial cortical bone simultaneously with blood flow in the superficial femoral artery with ultrasound imaging in five healthy volunteers. After suppression of stationary signal with singular‐value‐decomposition, pulsatile blood flow in cortical bone tissue is revealed, following the heart rate measured in the femoral artery. Using a method combining transverse oscillations and phase‐based motion estimation, 2D vector flow was obtained in the cortex of the tibia. After spatial averaging over the cortex, the peak blood velocity along the long axis of the tibia was measured at four times larger than the peak blood velocity across the bone cortex. This suggests that blood flow in central (Haversian) canals is larger than in perforating (Volkmann's) canals, as expected from the intracortical vascular organization in humans. The peak blood velocity indicates a flow from the endosteum to the periosteum and from the heart to the foot for all subjects. Because aging and the development of bone disorders are thought to modify the direction and velocity of intracortical blood flow, their quantification is crucial. This work reports for the first time an in vivo quantification of the direction and velocity of blood flow in human cortical bone. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Spontaneous extension wave for in vivo assessment of arterial wall anisotropy

Another type of natural wave, traced from longitudinal wall motion and propagation along the artery, is observed in our in vivo human carotid artery experiments. We coin it as extension wave (EW) and hypothesize that EW velocity (EWV) is associated with arterial longitudinal stiffness. The EW is thus assumed to complement the pulse wave (PW), whose velocity (PWV) is tracked from the radial wall displacement and linked to arterial circumferential stiffness through the Moens-Korteweg equation, as indicators for arterial mechanical anisotropy quantification by noninvasive high-frame-rate ultrasound. The relationship between directional arterial stiffnesses and the two natural wave speeds was investigated in wave theory, finite-element simulations based on isotropic and anisotropic arterial models, and in vivo human common carotid artery (n = 10) experiments. Excellent agreement between the theory and simulations showed that EWV was 2.57 and 1.03 times higher than PWV in an isotropic and an anisotropic carotid artery model, respectively, whereas in vivo EWV was consistently lower than PWV in all 10 healthy human subjects. A strong linear correlation was substantiated in vivo between EWV and arterial longitudinal stiffness quantified by a well-validated vascular-guided wave imaging technique (VGWI). We thereby proposed a novel index calculated as EWV²/PWV² as an alternative to assess arterial mechanical anisotropy. Simulations and in vivo results corroborated the effect of mechanical anisotropy on the propagation of spontaneous waves along the arterial wall. The proposed anisotropy index demonstrated the feasibility of the concurrent EW and PW imaged by high frame-rate ultrasound in grading of arterial wall anisotropy.NEW & NOTEWORTHY An extension wave formed by longitudinal wall displacements was observed by high-frame-rate ultrasound in the human common carotid artery in vivo. A strong correlation between extension wave velocity and arterial longitudinal stiffness complements the well-established pulse wave, which is linked to circumferential stiffness, to noninvasively assess direction-dependent wall elasticity of the major artery. The proposed anisotropy index, which directly reflects arterial wall microstructure and function, might be a potential risk factor for screening (sub-) clinical cardiovascular diseases.

Comparison of the multi-phasic longitudinal displacement of the left and right common carotid artery in healthy humans

BACKGROUND

During the cardiac cycle, there is a multi-phasic bidirectional longitudinal movement (LMov) of the intima-media complex of large arteries, i.e. along the arteries. On the left side the common carotid artery (CCA) arises directly from the aortic arc, whereas on the right side the CCA originate from the innominate artery.

AIM

The aim of this study was to compare LMov of the left and right CCA of healthy subjects to investigate whether the difference in anatomy is of importance for LMov.

MATERIAL AND METHODS

The CCA's of 93 healthy subjects were investigated using in-house developed ultrasound methods.

RESULTS

Although the basic pattern were the same in the majority of subjects, several phases of LMov were significantly larger on the left side (the first retrograde phase, p = 0.0006; the second antegrade, "returning" phase, p < 0.00001; and the rapid retrograde phase of movement at the end of the cardiac cycle, p < 0.000001). In contrast, no significant side-difference in the amplitude of the first antegrade movement was seen. The maximal (peak-to-peak) LMov was significantly larger on the left side (p = 0.002).

DISCUSSION AND CONCLUSION

The side-differences found in LMov may be related to the difference in anatomy, including possible difference in distance to the heart and especially the presence of an extra bifurcation on the right side. Our data provide an important base for the further study of the relation between LMov and cardiovascular risk factors and atherosclerosis.

Multifrequency Phased Tracking Method for Estimating Velocity in Heart Wall

Local high-accuracy velocity estimation is important for the ultrasound-based evaluation of regional myocardial function. The ultrasound phase difference at the center frequency of the transmitted signal has been conventionally used for velocity estimation. In the conventional method, spatial averaging is necessary owing to the frequency-dependent attenuation and interference of backscattered waves. Here, we propose a method for suppressing these effects using multifrequency phase differences. The resulting improvement in velocity estimation in the heart wall was validated by in vivo experiments. In the conventional method, the velocity waveform exhibits spike-like changes. The velocity waveform estimated using the proposed method did not exhibit such changes. Because the proposed method estimates myocardium velocity without spatial averaging, it can be used for measuring heart wall dynamics involving thickness changes.

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.

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.

In vitro performance of echoPIV for assessment of laminar flow profiles in a carotid artery stent

Purpose: Detailed blood flow studies may contribute to improvements in carotid artery stenting. High-frame-rate contrast-enhanced ultrasound followed by particle image velocimetry (PIV), also called echoPIV, is a technique to study blood flow patterns in detail. The performance of echoPIV in presence of a stent has not yet been studied extensively. We compared the performance of echoPIV in stented and nonstented regions in an in vitro flow setup.

Approach: A carotid artery stent was deployed in a vessel-mimicking phantom. High-frame-rate contrast-enhanced ultrasound images were acquired with various settings. Signal intensities of the contrast agent, velocity values, and flow profiles were calculated.

Results: The results showed decreased signal intensities and correlation coefficients inside the stent, however, PIV analysis in the stent still resulted in plausible flow vectors.

Conclusions: Velocity values and laminar flow profiles can be measured in vitro in stented arteries using echoPIV.

Carotid Wall Longitudinal Motion in Ultrasound Imaging: An Expert Consensus Review

Motion extracted from the carotid artery wall provides unique information for vascular health evaluation. Carotid artery longitudinal wall motion corresponds to the multiphasic arterial wall excursion in the direction parallel to blood flow during the cardiac cycle. While this motion phenomenon has been well characterized, there is a general lack of awareness regarding its implications for vascular health assessment or even basic vascular physiology. In the last decade, novel estimation strategies and clinical investigations have greatly advanced our understanding of the bi-axial behavior of the carotid artery, necessitating an up-to-date review to summarize and classify the published literature in collaboration with technical and clinical experts in the field. Within this review, the state-of-the-art methodologies for carotid wall motion estimation are described, and the observed relationships between longitudinal motion-derived indices and vascular health are reported. The vast number of studies describing the longitudinal motion pattern in plaque-free arteries, with its putative application to cardiovascular disease prediction, point to the need for characterizing the added value and applicability of longitudinal motion beyond established biomarkers. To this aim, the main purpose of this review was to provide a strong base of theoretical knowledge, together with a curated set of practical guidelines and recommendations for longitudinal motion estimation in patients, to foster future discoveries in the field, toward the integration of longitudinal motion in basic science as well as clinical practice.

3-D Intravascular Characterization of Blood Flow Velocity Fields with a Forward-Viewing 2-D Array

Risk stratification in coronary artery disease is an ongoing challenge for which few tools are available for quantifying physiology within coronary arteries. Recently, anatomy-driven computational fluid dynamic modeling has enabled the mapping of local flow dynamics in coronary stenoses, with derived parameters such as WSS exhibiting a strong capability for predicting adverse clinical events on a patient-specific basis. As cardiac catheterization is common in patients with coronary artery disease, minimally invasive technologies capable of identifying pathologic flow in situ in real time could have a significant impact on clinical decision- making. As a step toward in vivo quantification of slow flow near the arterial wall, proof-of-concept for 3-D intravascular imaging of blood flow dynamics is provided using a 118-element forward-viewing ring array transducer and a research ultrasound system. Blood flow velocity components are estimated in the direction of primary flow using an unfocused wave Doppler approach, and in the lateral and elevation directions, using a transverse oscillation approach. This intravascular 3-D vector velocity system is illustrated by acquiring real-time 3-D data sets in phantom experiments and in vivo in the femoral artery of a pig. The effect of the catheter on blood flow dynamics is also experimentally assessed in flow phantoms with both straight and stenotic vessels. Results indicate that 3-D flow dynamics can be measured using a small form factor device and that a hollow catheter design may provide minimal disturbance to flow measurements in a stenosis (peak velocity: 54.97 ± 2.13 cm/s without catheter vs. 51.37 ± 1.08 cm/s with hollow catheter, 6.5% error). In the future, such technologies could enable estimation of 3-D flow dynamics near the wall in patients already undergoing catheterization.

Point Spread Function Formation in Plane-Wave Imaging: A Theoretical Approximation in Fourier Migration

The point spread function (PSF) is often analyzed to determine the image quality of an ultrasound system. The formation of PSF is determined by practical factors, such as transducer aperture, element directivity, apodization, pitch, imaging position, and steering angle. Conventional numerical simulations provide an iterative approach to examine those factors' effects but cannot explain the inherent mechanism of PSF formation. This article presents a theoretical approximation of PSF formation for plane-wave imaging throughout the Fourier-based reconstruction process. Aforementioned factors are incorporated in the theory. The proposed theory is used to analyze the effects of those factors and presents a high degree of consistency with numerical simulations and experiments.

Clutter Filter Wave Imaging

The elastic properties of human tissue can be evaluated through the study of mechanical wave propagation captured using high frame rate ultrasound imaging. Methods such as block-matching or phase-based motion estimation have been used to estimate the displacement induced by the mechanical waves. In this paper, a new method for detecting mechanical wave propagation without motion estimation is presented, where the motion of interest is accentuated by an appropriate clutter filter. Thus, the mechanical wave propagation will directly appear as bands of the attenuated signal moving in the B-mode sequence and corresponding anatomical M-mode images. While only the locality of tissue velocity induced by the mechanical wave is detected, it is shown that the method is more sensitive to subtle tissue displacements when compared to motion estimation techniques. The technique was evaluated for the propagation of the pulse wave in a carotid artery, mechanical waves on the left ventricle, and shear waves induced by radiation force on a tissue-mimicking phantom. The results were compared to tissue Doppler imaging (TDI) and demonstrated that clutter filter wave imaging (CFWI) was able to detect the mechanical wave propagating in tissue with a relative temporal and spatial resolution 30% higher and a relative consistency 40% higher than TDI. The results showed that CFWI was able to detect mechanical waves with a relative frequency content 40% higher than TDI in a shear wave imaging experiment.

Fast Flow-Line-Based Analysis of Ultrasound Spectral and Vector Velocity Estimators

A new technique, termed FLUST (FlowLine Ultrasound Simulation Tool), is proposed as a computationally cheap alternative to simulations based on randomly positioned scatterers for the simulation of stationary blood velocity fields. In FLUST, the flow field is represented as a collection of flow lines. Point spread functions are first calculated at regularly spaced positions along the flow lines before realizations of single scatterers traversing the flow lines are generated using temporal interpolation. Several flow-line realizations are then generated by convolution with temporal noise filters, and finally, flow-field realizations are obtained by the summation of the individual flow-line realizations. Flow-field realizations produced by FLUST are shown to correspond well with conventional Field II simulations both quantitatively and qualitatively. The added value of FLUST is demonstrated by using the proposed simulation technique to obtain multiple realizations of realistic 3-D flow fields at a significantly reduced computational cost. This information is utilized for a performance assessment of different spectral and vector velocity estimators for carotid and coronary imaging applications. The computational load of FLUST does not increase substantially with the number of realizations or simulated frames, and for the examples shown, it is the fastest alternative when the total number of simulated frames exceeds 48. In the examples, the standard deviation and bias of the velocity estimators are calculated using 100 FLUST realizations, in which case the proposed method is two orders of magnitude faster than simulations based on random scatterer positions.

Two-dimensional affine model-based estimators for principal strain vascular ultrasound elastography with compound plane wave and transverse oscillation beamforming

Polar strain (radial and circumferential) estimations can suffer from artifacts because the center of a nonsymmetrical carotid atherosclerotic artery, defining the coordinate system in cross-sectional view, can be misregistered. Principal strains are able to remove coordinate dependency to visualize vascular strain components (i.e., axial and lateral strains and shears). This paper presents two affine model-based estimators, the affine phase-based estimator (APBE) developed in the framework of transverse oscillation (TO) beamforming, and the Lagrangian speckle model estimator (LSME). These estimators solve simultaneously the translation (axial and lateral displacements) and deformation (axial and lateral strains and shears) components that were then used to compute principal strains. To improve performance, the implemented APBE was also tested by introducing a time-ensemble estimation approach. Both APBE and LSME were tested with and without the plane strain incompressibility assumption. These algorithms were evaluated on coherent plane wave compounded (CPWC) images considering TO. LSME without TO but implemented with the time-ensemble and incompressibility constraint (Porée et al., 2015) served as benchmark comparisons. The APBE provided better principal strain estimations with the time-ensemble and incompressibility constraint, for both simulations and in vitro experiments. With a few exceptions, TO did not improve principal strain estimates for the LSME. With simulations, the smallest errors compared with ground true measures were obtained with the LSME considering time-ensemble and the incompressibility constraint. This latter estimator also provided the highest elastogram signal-to-noise ratios (SNRs) for in vitro experiments on a homogeneous vascular phantom without any inclusion, for applied strains varying from 0.07% to 4.5%. It also allowed the highest contrast-to-noise ratios (CNRs) for a heterogeneous vascular phantom with a soft inclusion, at applied strains from 0.07% to 3.6%. In summary, the LSME outperformed the implemented APBE, and the incompressibility constraint improved performances of both estimators.

Longitudinal Movement of the Common Carotid Artery Wall: New Information on Cardiovascular Aging

Putative changes in the multiphasic pattern of longitudinal movement of the common carotid artery wall in the normal aging process are unknown. The aim of this study was to explore the phases, and resulting patterns, of the longitudinal movement of the intima-media complex of the human common carotid artery with respect to age and gender. One hundred thirty-five healthy non-smoking patients of different ages were investigated using in-house-developed ultrasound methods. The patterns of longitudinal movement seen in middle-aged and older patients were markedly different from those commonly seen in young patients, including the appearance of two additional phases of motion and, thus, new complex patterns. The displacement and maximum velocity of one of the phases, occurring at the time of aortic valve closure, increased quadratically with age in both men and women.

Accuracy and Precision of a Plane Wave Vector Flow Imaging Method in the Healthy Carotid Artery

The objective of the study described here was to investigate the accuracy and precision of a plane wave 2-D vector flow imaging (VFI) method in laminar and complex blood flow conditions in the healthy carotid artery. The approach was to study (i) the accuracy for complex flow by comparing the velocity field from a computational fluid dynamics (CFD) simulation to VFI estimates obtained from the scan of an anthropomorphic flow phantom and from an in vivo scan; (ii) the accuracy for laminar unidirectional flow in vivo by comparing peak systolic velocities from VFI with magnetic resonance angiography (MRA); (iii) the precision of VFI estimation in vivo at several evaluation points in the vessels. The carotid artery at the bifurcation was scanned using both fast plane wave ultrasound and MRA in 10 healthy volunteers. The MRA geometry acquired from one of the volunteers was used to fabricate an anthropomorphic flow phantom, which was also scanned using the fast plane wave sequence. The same geometry was used in a CFD simulation to calculate the velocity field. Results indicated that similar flow patterns and vortices were estimated with CFD and VFI in the phantom for the carotid bifurcation. The root-mean-square difference between CFD and VFI was within 0.12 m/s for velocity estimates in the common carotid artery and the internal branch. The root-mean-square difference was 0.17 m/s in the external branch. For the 10 volunteers, the mean difference between VFI and MRA was -0.17 m/s for peak systolic velocities of laminar flow in vivo. The precision in vivo was calculated as the mean standard deviation (SD) of estimates aligned to the heart cycle and was highest in the center of the common carotid artery (SD = 3.6% for velocity magnitudes and 4.5° for angles) and lowest in the external branch and for vortices (SD = 10.2% for velocity magnitudes and 39° for angles). The results indicate that plane wave VFI measures flow precisely and that estimates are in good agreement with a CFD simulation and MRA.

Sidelobe reduction for plane wave compounding with a limited frame number

BACKGROUND

In ultrasound plane wave imaging (PWI), image details are often blurred by the off-axis artefacts resulting from high sidelobe. Recently plane wave compounding (PWC) is proposed as a promising technique for the sidelobe suppression in the PWI. However, its high demand for the frame number results in an obvious frame rate loss, which is intolerable in the ultrafast imaging modality. To reduce the number of frames required for compounding, coherence in the compounding frames should be exploited.

METHODS

In this paper, we propose a global effective distance-based sidelobe suppressing method for the PWC with a limited frame number, where the global effective distance is introduced to measure the inter-frame coherence. Specifically, the effective distance is firstly computed by using a sparse representation-based algorithm. Then, the sidelobe localization is carried out on the basis of the effective distance. Finally, the target-dependent weighting factor is adopted to suppress the sidelobe.

RESULTS

To assert the superiority of our proposed method, we compare the performances of different sidelobe reduction methods on both simulated and experimental PWC data. In case of 5 steering angles, our method shows a 19 dB reduction in the peak sidelobe level compared to the normal PWC in the point spread function test, and the contrast ratio is enhanced by more than 10% in both the simulation and phantom studies.

CONCLUSIONS

Consequently, the proposed method is convinced to be a promising approach in enhancing the PWC image quality.

High-Frame-Rate Speckle-Tracking Echocardiography

Conventional echocardiography is the leading modality for noninvasive cardiac imaging. It has been recently illustrated that high-frame-rate echocardiography using diverging waves could improve cardiac assessment. The spatial resolution and contrast associated with this method are commonly improved by coherent compounding of steered beams. However, owing to fast tissue velocities in the myocardium, the summation process of successive diverging waves can lead to destructive interferences if motion compensation (MoCo) is not considered. Coherent compounding methods based on MoCo have demonstrated their potential to provide high-contrast B-mode cardiac images. Ultrafast speckle-tracking echocardiography (STE) based on common speckle-tracking algorithms could substantially benefit from this original approach. In this paper, we applied STE on high-frame-rate B-mode images obtained with a specific MoCo technique to quantify the 2-D motion and tissue velocities of the left ventricle. The method was first validated in vitro and then evaluated in vivo in the four-chamber view of 10 volunteers. High-contrast high-resolution B-mode images were constructed at 500 frames/s. The sequences were generated with a Verasonics scanner and a 2.5-MHz phased array. The 2-D motion was estimated with standard cross correlation combined with three different subpixel adjustment techniques. The estimated in vitro velocity vectors derived from STE were consistent with the expected values, with normalized errors ranging from 4% to 12% in the radial direction and from 10% to 20% in the cross-range direction. Global longitudinal strain of the left ventricle was also obtained from STE in 10 subjects and compared to the results provided by a clinical scanner: group means were not statistically different ( value = 0.33). The in vitro and in vivo results showed that MoCo enables preservation of the myocardial speckles and in turn allows high-frame-rate STE.

Arterial Phantoms with Regional Variations in Wall Stiffness and Thickness

Regional wall stiffening and thickening are two common pathological features of arteries. To account for these two features, we developed a new arterial phantom design framework to facilitate the development of vessel models that contain a lesion segment whose wall stiffness and thickness differ from those of other segments. This new framework is based on multi-part injection molding principles that sequentially casted the lesion segment and the flank segments of the vessel model using molding parts devised with computer-aided design tools. The vessel-mimicking material is created from polyvinyl alcohol cryogel, and its acoustic properties are similar to those of arteries. As a case demonstration, we fabricated a stenosed three-segment phantom composed of a central lesion segment (5.1-mm diameter, 1.95-mm wall thickness, 212.6-kPa elastic modulus) and two flank segments (6.0-mm diameter, 1.5-mm wall thickness, 133.7-kPa elastic modulus). B-mode imaging confirmed the difference in thickness between the lesion segment and flank segments of the phantom. Also, Doppler-based vessel wall displacement analysis revealed that when pulsatile flow was fed through the phantom (carotid pulse; 27 mL/s peak flow rate), the lesion segment distended less compared with the flank segments. Specifically, the three-beat averaged peak wall displacement in the lesion segment was measured as 0.28 mm, and it was significantly smaller than that of the flank segments (0.60 mm). It is anticipated that this new multi-segment arterial phantom can serve as a performance testbed for the evaluation of local arterial stiffness estimation algorithms.

Real-Time Blood Velocity Vector Measurement Over a 2-D Region

Quantitative blood velocity measurements, as currently implemented in commercial ultrasound scanners, are based on pulsed-wave (PW) spectral Doppler and are limited to detect the axial component of the velocity in a single sample volume. On the other hand, vector Doppler methods produce angle-independent estimates by, e.g., combining the frequency shifts measured from different directions. Moreover, thanks to the transmission of plane waves, the investigation of a 2-D region is possible with high temporal resolution, but, unfortunately, the clinical use of these methods is hampered by the massive calculation power required for their real-time execution. In this paper, we present a novel approach based on the transmission of plane waves and the simultaneous reception of echoes from 16 distinct subapertures of a linear array probe, which produces eight lines distributed over a 2-D region. The method was implemented on the ULAO-OP 256 research scanner and tested both in phantom and in vivo. A continuous real-time refresh rate of 36 Hz was achieved in duplex combination with a standard B-mode at pulse repetition frequency of 8 kHz. Accuracies of -11% on velocity and of 2°on angle measurements have been obtained in phantom experiments. Accompanying movies show how the method improves the quantitative measurements of blood velocities and details the flow configurations in the carotid artery of a volunteer.

Fast Plane Wave 2-D Vector Flow Imaging Using Transverse Oscillation and Directional Beamforming

Several techniques can estimate the 2-D velocity vector in ultrasound. Directional beamforming (DB) estimates blood flow velocities with a higher precision and accuracy than transverse oscillation (TO), but at the cost of a high beamforming load when estimating the flow angle. In this paper, it is proposed to use TO to estimate an initial flow angle, which is then refined in a DB step. Velocity magnitude is estimated along the flow direction using cross correlation. It is shown that the suggested TO-DB method can improve the performance of velocity estimates compared with TO, and with a beamforming load, which is 4.6 times larger than for TO and seven times smaller than for conventional DB. Steered plane wave transmissions are employed for high frame rate imaging, and parabolic flow with a peak velocity of 0.5 m/s is simulated in straight vessels at beam-to-flow angles from 45° to 90°. The TO-DB method estimates the angle with a bias and standard deviation (SD) less than 2°, and the SD of the velocity magnitude is less than 2%. When using only TO, the SD of the angle ranges from 2° to 17° and for the velocity magnitude up to 7%. Bias of the velocity magnitude is within 2% for TO and slightly larger but within 4% for TO-DB. The same trends are observed in measurements although with a slightly larger bias. Simulations of realistic flow in a carotid bifurcation model provide visualization of complex flow, and the spread of velocity magnitude estimates is 7.1 cm/s for TO-DB, while it is 11.8 cm/s using only TO. However, velocities for TO-DB are underestimated at peak systole as indicated by a regression value of 0.97 for TO and 0.85 for TO-DB. An in vivo scanning of the carotid bifurcation is used for vector velocity estimations using TO and TO-DB. The SD of the velocity profile over a cardiac cycle is 4.2% for TO and 3.2% for TO-DB.

Robust cardiac motion estimation using ultrafast ultrasound data: a low-rank topology-preserving approach

Cardiac motion estimation is an important diagnostic tool for detecting heart diseases and it has been explored with modalities such as MRI and conventional ultrasound (US) sequences. US cardiac motion estimation still presents challenges because of complex motion patterns and the presence of noise. In this work, we propose a novel approach to estimate cardiac motion using ultrafast ultrasound data. Our solution is based on a variational formulation characterized by the L ²-regularized class. Displacement is represented by a lattice of b-splines and we ensure robustness, in the sense of eliminating outliers, by applying a maximum likelihood type estimator. While this is an important part of our solution, the main object of this work is to combine low-rank data representation with topology preservation. Low-rank data representation (achieved by finding the k-dominant singular values of a Casorati matrix arranged from the data sequence) speeds up the global solution and achieves noise reduction. On the other hand, topology preservation (achieved by monitoring the Jacobian determinant) allows one to radically rule out distortions while carefully controlling the size of allowed expansions and contractions. Our variational approach is carried out on a realistic dataset as well as on a simulated one. We demonstrate how our proposed variational solution deals with complex deformations through careful numerical experiments. The low-rank constraint speeds up the convergence of the optimization problem while topology preservation ensures a more accurate displacement. Beyond cardiac motion estimation, our approach is promising for the analysis of other organs that exhibit motion.

Evaluation of the Transverse Oscillation Technique for Cardiac Phased Array Imaging: A Theoretical Study

The transverse oscillation (TO) technique can improve the estimation of tissue motion perpendicular to the ultrasound beam direction. TOs can be introduced using plane wave (PW) insonification and bilobed Gaussian apodization (BA) on receive (abbreviated as PWTO). Furthermore, the TO frequency of PWTO can be doubled after a heterodyning demodulation process is performed (abbreviated as PWTO*). This paper is concerned with identifying the limitations of the PWTO technique in the specific context of myocardial deformation imaging with phased arrays and investigating the conditions in which it remains advantageous over traditional focused (FOC) beamforming. For this purpose, several tissue phantoms were simulated using Field II, undergoing a wide range of displacement magnitudes and modes (lateral, axial, and rotational motions). The Cramer-Rao lower bound was used to optimize TO beamforming parameters and theoretically predict the fundamental tracking performance limits associated with the FOC, PWTO, and PWTO* beamforming scenarios. This framework was extended to also predict the performance for BA functions that are windowed by the physical aperture of the transducer, leading to higher lateral oscillations. It was found that windowed BA functions resulted in lower jitter errors compared with traditional BA functions. PWTO* outperformed FOC at all investigated signal-to-noise ratio (SNR) levels but only up to a certain displacement, with the advantage rapidly decreasing when the SNR increased. These results suggest that PWTO* improves lateral tracking performance, but only when interframe displacements remain relatively low. This paper concludes by translating these findings into a clinical environment by suggesting optimal scanner settings.

Design and Fabrication of a Conceptual Arterial Ultrasound Phantom Capable of Exhibiting Longitudinal Wall Movement

The longitudinal movement of the arterial wall of large human arteries has shown promise to be an independent indicator of vascular health. Despite growing interest in this movement, its nature, causes, and implications are not fully understood, and existing phantoms have failed to show a pure longitudinal movement that is not secondary to the distension. An often overlooked aspect of the arterial wall is the interaction between the different layers. The longitudinal movement of the innermost layers, the intima and media, can be several hundred micrometers in the direction of flow during early systole. This is markedly larger than that of the adventitia, indicating that sliding occurs between the two layers. This feature was incorporated into a phantom by casting it in two parts. The molds were developed in-house using mainly a 3-D printer, a versatile and easy production method. Additionally, the phantom contains a tapered region. Using the phantom, we were able to demonstrate a pure longitudinal movement; when it was subjected to a pulsatile pressure, the wall displaced 220 [Formula: see text] (SD 40) radially and 560 [Formula: see text] (SD 74) longitudinally distal to the tapering. The motion followed the pressure variations. This paper serves as a guide for phantom production, explaining each step of the process.

A Sparse Reconstruction Framework for Fourier-Based Plane-Wave Imaging

Ultrafast imaging based on plane-wave (PW) insonification is an active area of research due to its capability of reaching high frame rates. Among PW imaging methods, Fourier-based approaches have demonstrated to be competitive compared with traditional delay and sum methods. Motivated by the success of compressed sensing techniques in other Fourier imaging modalities, like magnetic resonance imaging, we propose a new sparse regularization framework to reconstruct highquality ultrasound (US) images. The framework takes advantage of both the ability to formulate the imaging inverse problem in the Fourier domain and the sparsity of US images in a sparsifying domain. We show, by means of simulations, in vitro and in vivo data, that the proposed framework significantly reduces image artifacts, i.e., measurement noise and sidelobes, compared with classical methods, leading to an increase of the image quality.

Extension of Fourier-Based Techniques for Ultrafast Imaging in Ultrasound With Diverging Waves

Ultrafast ultrasound imaging has become an intensive area of research thanks to its capability in reaching high frame rates. In this paper, we propose a scheme that allows the extension of the current Fourier-based techniques derived for planar acquisition to the reconstruction of sectorial scan with wide angle using diverging waves. The flexibility of the proposed formulation was assessed through two different Fourier-based techniques. The performance of the derived approaches was evaluated in terms of resolution and contrast from both simulations and in vitro experiments. The comparisons of the current state-of-the-art method with the conventional delay-and-sum technique illustrated the potential of the derived methods for producing competitive results with lower computational complexity.

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

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

Ultrasound Vector Flow Imaging-Part II: Parallel Systems

This paper gives a review of the current state-of-the-art in ultrasound parallel acquisition systems for flow imaging using spherical and plane waves emissions. The imaging methods are explained along with the advantages of using these very fast and sensitive velocity estimators. These experimental systems are capable of acquiring thousands of images per second for fast moving flow as well as yielding the estimates of low velocity flow. These emerging techniques allow the vector flow systems to assess highly complex flow with transitory vortices and moving tissue, and they can also be used in functional ultrasound imaging for studying brain function in animals. This paper explains the underlying acquisition and estimation methods for fast 2-D and 3-D velocity imaging and gives a number of examples. Future challenges and the potentials of parallel acquisition systems for flow imaging are also discussed.

Towards estimating cardiac motion using low-rank representation and topology preservation for ultrafast ultrasound data

Estimation of the cardiac motion is very important in order to detect heart diseases. This work presents a cardiac motion estimation approach using ultrafast ultrasound data. We optimize a variational framework which has the benefits of combining low-rank data representation with topology preservation. We show through the analysis of experimental results that this combination offers a radical reduction in computational time and noise while ensuring preservation of the anatomical structure of the heart under complex deformations. Although in this work we use the heart as a study case, our solution is promising to analyze other organs experiencing motion.

Analysis of Systolic Backflow and Secondary Helical Blood Flow in the Ascending Aorta Using Vector Flow Imaging

Secondary rotational flow and systolic backflow are seen in the ascending aorta and, in this study, were analyzed with the vector velocity method transverse oscillation. Twenty-five patients were scanned intra-operatively, and the vector velocities were related to estimates of transesophageal echocardiography and pulmonary artery catheter thermodilution, and associated with gender, age, aortic diameter, atherosclerotic plaques, left ventricular ejection fraction and previous myocardial infarctions. Secondary flow was present for all patients. The duration and rotational frequency (p < 0.001) and the duration and flow direction of the secondary flow (p < 0.002) were associated. Systolic backflow was present in 40% of the patients and associated with systolic velocities (p < 0.002) and the presence of atherosclerotic plaques (p < 0.001). No other significant associations were observed. The study indicates that backflow is injurious and that secondary flow is a normal flow phenomenon. The study also shows that transverse oscillation can provide new information on blood flow in the ascending aorta.