Measurement of common carotid artery intima-media thickness in clinical practice: comparison of B-mode and RF-based technique

PURPOSE

The common carotid artery intima-media thickness (CCA-IMT) is usually measured using B-mode ultrasound images. A different approach for CCA-IMT detection is based on radio frequency (RF) multiple M-line analysis.

MATERIALS AND METHODS

The present study explores the relationship between B-mode and RF measurement of CCA-IMT, as well as the reproducibility of both methods in 136 patients recently diagnosed with cardiovascular disease. Within one session, repeated measurements were made in the distal CCA bilaterally, using the B-mode (averaged over 10 mm) and RF technique (averaging 12 M-lines over 14 mm).

RESULTS

The two methods correlate well (Pearson r = 0.765). The CCA-IMT values measured with B-mode and RF were 0.779 +/- 0.196 mm and 0.734 +/- 0.172 mm, respectively. B-mode CCA-IMT is significantly larger than RF CCA-IMT (mean difference of 0.045 mm, SEM 7.8 microm; t = 5.82; p < 0.001). In the multivariate regression analysis, carotid artery stenosis, inhomogeneous IMT and diabetes mellitus were the main predictors of differences between B-mode and RF CCA-IMT. The intrapatient variation for B-mode and RF-based CCA-IMT is comparable (0.05 +/- 0.04 mm and 0.07 +/- 0.05 mm, respectively).

CONCLUSION

CCA-IMT values measured with RF and B-mode have similar reproducibility and exhibit acceptable correlation, but RF CCA-IMT is significantly smaller. The difference between both methods is mainly due to advanced atherosclerosis. Hence, both methods can be used reliably to measure CCA-IMT in clinical practice.

Does B-mode common carotid artery intima-media thickness differ from M-model?

An increased intima-media thickness of the common carotid artery is thought to be an early sign of atherosclerosis. Both B- and M-mode ultrasonographic techniques are used to measure the intima-media thickness of the common carotid artery (B-IMT and M-IMT, respectively). The present study compares intima-media thickness of the common carotid artery measured with the two techniques. Intima-media thickness was measured in a random population sample of 250 subjects. Comparison was made by mean and 95% confidence intervals of differences between B-IMT and M-IMT, by linear regression analysis, and by intraclass and concordance correlation coefficients. M-IMT was + 0.011 +/- 0.091 mm (95% confidence intervals: -0.167 to + 0.188 mm) larger than B-IMT, which was 0.661 +/- 0.136 mm (range: 0.380 to 1.120 mm). Intraclass and concordance correlation coefficients were 0.802 and 0.801, respectively. In conclusion, acceptable agreement exists between the two methods and there was no important systematic difference between B-IMT and M-IMT.

Assessment of local pulse wave velocity in arteries using 2D distension waveforms

The reciprocal of the arterial pulse wave velocity contains crucial information about the mechanical characteristics of the arterial wall but is difficult to assess noninvasively in vivo. In this paper, a new method to assess local pulse wave velocity (PWV) is presented. To this end, multiple adjacent distension waveforms are determined simultaneously along a short arterial segment, using a single 2D-vessel wall tracking system with a high frame rate (651 Hz). Each B-mode image consists of 16 echo lines spanning a total width of 15.86 mm. Dedicated software has been developed to extract the end-diastolic diameter from the B-mode image and the distension waveforms from the underlying radiofrequency (rf) information for each echo-line. The PWV is obtained by determining the ratio of the temporal and spatial gradient of adjacent distension velocity waveforms. The proposed method is verified in a phantom and in the common carotid artery (CCA) of humans. Phantom experiments show a high concordance between the PWV obtained from 2D distension velocity waveforms (4.21 +/- 0.02 m/s) and the PWV determined using two pressure catheters (4.26 +/- 0.02 m/s). Assuming linear spatial gradients, the PWV can also be obtained in vivo for CCA and averages to 5.5 +/- 1.5 m/s (intersubject variation, n = 23), which compares well to values found in literature. Furthermore, intrasubject PWV compares well with those calculated using the Bramwell-Hill equation. It can be concluded that the PWV can be obtained from the spatial and temporal gradient if the spatial gradient is linear over the observed length of the artery, i.e. the artery should be homogenous in diameter and distension and the influence of reflections must be small.

Non-invasive assessment of local arterial pulse pressure: comparison of applanation tonometry and echo-tracking

OBJECTIVES

Pulse pressure is not constant throughout the arterial tree. Use of pulse pressure at one arterial site as surrogate for pulse pressure at another arterial site may be erroneous. The present study compares three non-invasive techniques to measure local pulse pressure: (i) internally calibrated readings from applanation tonometry, (ii) alternative calibration of pressure waves obtained with applanation tonometry and (iii) alternative calibration of arterial distension waves obtained with echo-tracking. Alternative calibration assumes mean and diastolic blood pressure constant throughout the large artery tree.

DESIGN AND METHODS

Study 1 used invasive measurements in the ascending aorta as a reference method and internally calibrated tonometer readings and alternatively calibrated pressure waves at the common carotid artery as test methods. Study 2 used alternatively calibrated pressure waves as a reference method and alternatively calibrated distension waves and internally calibrated applanation tonometer readings as test methods.

RESULTS

In study 1, pulse pressure from internally calibrated tonometer readings was 10.2+/-14.3 mmHg lower and pulse pressure from alternatively calibrated pressure waves was 1.8+/-5.2 mmHg higher than invasive pulse pressure. Pulse pressure from calibrated distension waves was 3.4+/-6.9 mmHg lower than pulse pressure from alternatively calibrated pressure waves. According to British Hypertension Society criteria, pulse pressure from the internally calibrated tonometer achieved grade D and pulse pressure from alternatively calibrated pressure waves achieved grade A. Pulse pressure from calibrated distension waves achieved grade B when alternatively calibrated pressure waves were used as a reference method.

CONCLUSIONS

Pulse pressure obtained from alternatively calibrated tonometer-derived pressure waves and echo-tracking-derived distension waves demonstrates good accuracy. Accuracy of pulse pressure from internally calibrated applanation tonometer readings at the carotid artery is poor.

Assessment of the spatial homogeneity of artery dimension parameters with high frame rate 2-D B-mode

To elicit vessel wall inhomogeneities in diameter and distension along an arterial segment, a 2-D vessel wall-tracking system based on fast B-mode has been developed. The frame rate of a 7.5-MHz linear-array transducer (length 36 mm) is enhanced by increasing the pulse-repetition frequency to 10 kHz, decreasing the number of echo lines per frame from 128 to 64, or increasing the interspacing between echo lines with a factor of two or four. Dedicated software has been developed to extract for each echo-line the end-diastolic diameter from the B-mode image and the 2-D distension waveform from the underlying radiofrequency (RF) information. The method is validated in tubes with various focal lesion sizes. Straight segments of presumably homogeneous common carotid arteries have also been tested. The temporal and spatial SD of diameter or distension reveals inhomogeneities in time or space (i.e., inhomogeneities in artery characteristics). The method can be implemented in echo systems supporting high frame rates and real-time processing of radiofrequency data.

High-resolution functional imaging with ultrasound contrast agents based on RF processing in an in vivo kidney experiment

Knowledge of the relative tissue perfusion distribution is valuable in the diagnosis of numerous diseases. Techniques for the assessment of the relative perfusion distribution, based on ultrasound (US) contrast agents, have several advantages compared to established nuclear techniques. These are, among others, a better spatial and temporal resolution, the lack of exposure of the patient to ionizing radiation and the relatively low cost. In the present study, US radiofrequency (RF) image sequences are acquired, containing the signal intensity changes associated with the transit of a bolus contrast agent through the microvasculature of a dog kidney. The primary objective is to explore the feasibility of calculating functional images with high spatial resolution. The functional images characterize the transit of the contrast agent bolus and represent distributions of peak time, peak value, transit time, peak area, wash-in rate and wash-out decay constant. For the evaluation of the method, dog experiments were performed under optimized conditions where motion artefacts were minimized and an IA injection of the contrast agent Levovist was employed. It was demonstrated that processing of RF signals obtained with a 3.5-MHz echo system can provide functional images with a high spatial resolution of 2 mm in axial resolution, 2 to 5 mm in lateral resolution and a slice thickness of 2 mm. The functional images expose several known aspects of kidney perfusion, like perfusion heterogeneity of the kidney cortex and a different peripheral cortical perfusion compared to the inner cortex. Based on the findings of the present study, and given the results of complimentary studies, it is likely that the functional images reflect the relative perfusion distribution of the kidney.

Association between arterial stiffness and atherosclerosis: the Rotterdam Study

BACKGROUND AND PURPOSE

Studies of the association between arterial stiffness and atherosclerosis are contradictory. We studied stiffness of the aorta and the common carotid artery in relation to several indicators of atherosclerosis.

METHODS

This study was conducted within the Rotterdam Study in >3000 elderly subjects aged 60 to 101 years. Aortic stiffness was assessed by measuring carotid-femoral pulse wave velocity, and common carotid artery stiffness was assessed by measuring common carotid distensibility. Atherosclerosis was assessed by common carotid intima-media thickness, plaques in the carotid artery and in the aorta, and the presence of peripheral arterial disease. Data were analyzed by ANCOVA with adjustment for age, sex, mean arterial pressure, and heart rate.

RESULTS

Both aortic and common carotid artery stiffness were found to have a strong positive association with common carotid intima-media thickness, severity of plaques in the carotid artery, and severity of plaques in the aorta (P: for trend <0.01 for all associations). Subjects with peripheral arterial disease had significantly increased aortic stiffness (P:=0.001) and borderline significantly increased common carotid artery stiffness (P:=0.08) compared with subjects without peripheral arterial disease. Results were similar after additional adjustment for cardiovascular risk factors and after exclusion of subjects with prevalent cardiovascular disease.

CONCLUSIONS

This population-based study shows that arterial stiffness is strongly associated with atherosclerosis at various sites in the vascular tree.

Effects of assessment and processing techniques on the shape of arterial pressure-distension loops

The dynamic mechanical characteristics of the arterial wall, especially its alinearity and viscoelastic behaviour, are revealed by pressure-distension loops, where the change in diameter (distension) of a lumen is plotted as a function of the change in transmural pressure. For linearity, the pressure-distension loop should be closed and straight, while viscous behavior results in an open loop. For a correct interpretation of the loops, it is essential that both distension and pressure are recorded simultaneously at the same location and processed by circuitries having the same frequency characteristics. The present paper aims at quantifying the effect of misalignment in recording position and of mismatch in frequency characteristics by analyzing the distension and pressure waveforms obtained at known locations in a phantom rig under pulsatile conditions with equipment with a validated frequency response. It is concluded that misalignment of only a few millimeters or mismatch in frequency response, even if the cutoff frequencies are far beyond the signal frequencies of interest, strongly affects the shape of the pressure-distension loop. If the forward and reflected pressure wave partially coincide, position misalignment cannot adequately be corrected for. The frequency mismatch, however, can be corrected for by crosswise preprocessing a waveform by a filter with the frequency response of the registration equipment used for the recording of the other waveform. It is important to consider these artifacts in interpreting pressure-distension loops in the clinical situation.

The effect of pregnancy on the compliance of large arteries and veins in healthy parous control subjects and women with a history of preeclampsia

OBJECTIVE

Early pregnancy is characterized by a fall in total peripheral vascular resistance. In this study we tested the hypothesis that this phenomenon is accompanied by rising compliances of the large arteries and veins.

STUDY DESIGN

In 42 women with a history of preeclampsia and 10 healthy parous control subjects we measured the following variables in the midfollicular phase and the midluteal phase during the menstrual cycle and again at 5 and at 7 weeks of amenorrhea: cardiac output, mean arterial pressure, carotid and femoral artery compliances, and venous compliance. The total peripheral vascular resistance was determined as the ratio of mean arterial pressure and cardiac output. After screening for thrombophilia and hypertension, women with a history of preeclampsia were divided into subgroups with hypertension, thrombophilic disorders, and no underlying abnormalities.

RESULTS

In parallel with the fall in total peripheral vascular resistance during early pregnancy, femoral artery compliance and venous compliance increased in the control group. Except for venous compliance, these changes were also observed in the women with thrombophilia and a history of preeclampsia. In the subgroups of the women with a history of preeclampsia with hypertension and with no underlying disorder both arterial and venous compliance failed to increase despite a drop in total peripheral vascular resistance.

CONCLUSION

These data support the concept that during normal pregnancy the fall in total peripheral vascular resistance is paralleled by improved macrovascular compliance. The latter adaptive change did not occur in women with a history of preeclampsia with hypertension or without an underlying disorder.

Variables of the insulin resistance syndrome are associated with reduced arterial distensibility in healthy non-diabetic middle-aged women

AIMS/HYPOTHESIS

The insulin resistance syndrome is related to arterial stiffness in diabetic subjects. Whether the insulin resistance syndrome is also related to arterial stiffness in non-diabetic subjects is less clear. We studied the association between variables of the insulin resistance syndrome in relation to arterial distensibility in healthy middle-aged non-diabetic women.

METHODS

This study was done in 180 non-diabetic women, aged 43-55, selected from the general population. Arterial distensibility was assessed in the carotid artery. The associations were evaluated using linear regression analyses.

RESULTS

Strong associations were found between arterial distensibility and the variables of the insulin resistance syndrome: body mass index, waist-to-hip ratio, high-density-lipoprotein-cholesterol, triglycerides, glucose, insulin, apolipoprotein A1, plasminogen activator inhibitor-1-antigen and tissue-type plasminogen activator-antigen. After additional adjustment for mean arterial pressure, common carotid arterial distensibility remained associated with body mass index: beta-coefficient (95% confidence interval) per kg/m2: -0.24 (-0.42; -0.06); waist-to-hip ratio: -26.62 (-40.59; -12.65) per m/m; triglycerides: -1.42(-2.77; -0.08) per mmol/l; plasminogen activator inhibitor-1-antigen: -0.01 (-0.02; -0.00) per ng/ml and borderline significant associated with high-density-lipoprotein-cholesterol: 1.93 (-0.01; 3.87; p = 0.07) per mmol/l. Clustering of variables of the insulin resistance syndrome was strongly related to decreased arterial distensibility which remained after adjustment for mean arterial pressure. No association was found between arterial distensibility and variables that are not part of the insulin resistance syndrome: total cholesterol, LDL-cholesterol and apolipoprotein B.

CONCLUSION/INTERPRETATION

The results of this study show that variables of the insulin resistance syndrome are associated with decreased arterial distensibility of the common carotid artery in healthy non-diabetic subjects.

In spontaneously hypertensive rats alterations in aortic wall properties precede development of hypertension

In hypertension arterial wall properties do not necessarily depend on increased blood pressure alone. The present study investigates the relationship between the development of hypertension and thoracic aortic wall properties in 1.5-, 3-, and 6-mo-old spontaneously hypertensive rats (SHR); Wistar-Kyoto rats (WKY) served as controls. During ketamine-xylazine anesthesia, compliance and distensibility were assessed by means of a noninvasive ultrasound technique combined with invasive blood pressure measurements. Morphometric measurements provided in vivo media cross-sectional area and thickness, allowing the calculation of the incremental elastic modulus. Extracellular matrix protein contents were determined as well. Blood pressure was not significantly different in 1.5-mo-old SHR and WKY, but compliance and distensibility were significantly lower in SHR. Incremental elastic modulus was not significantly different between SHR and WKY at this age. Media thickness and media cross-sectional area were significantly larger in SHR than in WKY, but there was no consistent difference in collagen density and content between the strains. Blood pressure was significantly higher in 3- and 6-mo-old SHR than in WKY, and compliance was significantly lower in SHR. The findings in this study show that in SHR, in which hypertension develops over weeks, alterations in functional aortic wall properties precede the development of hypertension. The decrease in compliance and distensibility at a young age most likely results from media hypertrophy rather than a change in intrinsic elastic properties.

Experimental investigation of the pulse inversion technique for imaging ultrasound contrast agents

The application of ultrasound contrast agents aims to detect low velocity blood flow in the microcirculation. To enhance discrimination between tissue and blood containing the contrast agent, harmonic imaging is used. Harmonic imaging requires the application of narrow-band signals and is obscured by high levels of native harmonics generated in an intervening medium. To improve discrimination between contrast agent and native harmonics, a pulse inversion technique has been proposed. Pulse inversion allows wide-band signals, thus preserving the axial resolution. The present study examines the interference of native harmonics and discusses the practical difficulties of wide-band pulse inversion measurements of harmonics by a single transducer. Native harmonics are not eliminated by pulse inversion. Furthermore, only even harmonics remain and are amplified by 6 dB, alleviating the requirement for selective filtering. Finally, it is shown that the contaminating third harmonic contained in the square wave activation signal leaks through in the emitted signal. The spectral location of the contaminating third harmonic is governed by the transducer spectral characteristics while the location of the native and contrast agent second harmonics is not. Thus the contaminating third harmonic and the native and contrast agent second harmonics may overlap and interfere. Optimal discrimination requires a balance between maximal sensitivity for the second harmonic at reception and minimal interference from the contaminating third harmonic.

Mean wall shear stress in the femoral arterial bifurcation is low and independent of age at rest

In elastic arteries, mean wall shear stress appears to be close to 1. 5 Pa, the value predicted by the theory of minimal energy loss. This finding in elastic arteries does not necessarily represent the situation in muscular arteries. Elastic arteries have to store potential energy, while muscular arteries have mainly a conductive function. Therefore, we determined wall shear stress and its age dependency in the common and superficial femoral arteries, 2-3 cm from the flow divider in 54 presumed healthy volunteers between 21 and 74 years of age, using a non-invasive ultrasound system. Prior to the study, the reliability of this system was determined in terms of intrasubject variation. Mean wall shear stress was significantly lower in the common femoral artery (0.35 +/- 0.18 Pa) than in the superficial femoral artery (0.49 +/- 0.15 Pa). In all age categories, peak systolic wall shear stress and the maximal cyclic change in wall shear stress were not significantly different in the common and the superficial femoral arteries. Peak systolic wall shear stress in the common and the superficial femoral arteries was not significantly different from the value previously determined in the common carotid artery, but mean wall shear stress was lower in the common and superficial femoral arteries than in the common carotid artery by a factor of 2-4. In both the common and the superficial femoral arteries, mean, peak systolic and maximal cyclic change in wall shear stress did not change significantly with age, nor did diameter. We conclude that, as compared to elastic arteries, mean wall shear stress is low in the conductive arteries of a resting leg, due to backflow during the first part of the diastolic phase of the cardiac cycle and the absence of flow during the rest of the diastolic phase. Mean wall shear stress is lower in the common than in the superficial femoral artery due to additional reflections from the deep femoral artery.

Effect of age on brachial artery wall properties differs from the aorta and is gender dependent: a population study

Compliance and distensibility are wall properties of large arteries, which may play a role in cardiovascular disease. The purpose of this study was to investigate whether the influence of age on these vessel wall properties differs between vascular territories and is gender-dependent. In a population sample of 498 men and women 20 to 79 years of age, diameter, distensibility, and compliance coefficient of the muscular brachial artery were measured with an echo-tracking device. Distensibility of the aorta was measured with the use of pulse-wave velocity. The effects of age and gender were assessed and adjusted for confounding factors such as mean blood pressure, pulse rate, body mass index, smoking, alcohol intake, and antihypertensive treatment. Covariance analysis showed no relation between gender and distensibility of the elastic aorta. Distensibility of the muscular brachial artery was lower in men, whereas men had a larger diameter and larger compliance of the brachial artery. With age, distensibility of the aorta decreased in both sexes to the same extent, whereas distensibility of the brachial artery did not change significantly. With age, brachial artery diameter increased; this increase was more pronounced in women. In men brachial artery compliance did not change with age, whereas in women compliance of the brachial artery increased with age. This study (1) confirms that distensibility of the aorta, an elastic artery, decreases with age. (2) In contrast to the aorta, after adjustment for confounding factors, in both men and women, no relation exists between age and distensibility of the muscular brachial artery. (3) Brachial artery diameter increase with age is more pronounced in women than in men. (4) In contrast to the well-known decrease in arterial compliance of elastic arteries with age, brachial artery compliance is not decreased with age and is increased in women. In conclusion, the effect of age on large-artery wall properties is not uniform but depends on gender and vascular territory.

In the femoral artery bifurcation, differences in mean wall shear stress within subjects are associated with different intima-media thicknesses

In elastic arteries, intima-media thickening is more pronounced in areas with low than with high mean and peak wall shear stress. These findings in elastic arteries are not necessarily representative of the situation in muscular arteries. The former arteries have to store volume energy, whereas the latter are mainly conductive vessels. It was the aim of the present study to investigate noninvasively whether differences in wall shear stress within a muscular artery bifurcation, if any, were associated with different intima-media thicknesses (IMTs). The effect of age on the possible differences was assessed as well. We determined IMT and mean, peak systolic, and the maximum cyclic change in shear stress near the posterior wall in the common (FC) and the superficial (FS) femoral artery 20 to 30 mm from the flow divider in 54 presumed healthy subjects between 21 and 74 years of age. Results were considered in terms of intrasubject differences. Before the study, the reliability of the ultrasonic system to assess wall shear rate and IMT was determined in terms of intrasubject variability. IMT at the posterior wall was significantly larger in the FC than in the FS, probably owing to the significantly lower mean wall shear stress at this site in the FC. The relative differences in IMT and mean wall shear stress between FC and FS were independent of age. The difference in wall shear stress between both arteries can likely be explained by a different influence of reflections. In both the FC and FS, mean, peak systolic, and maximum cyclic change in shear stress near the posterior wall did not change significantly with age, whereas IMT did increase significantly with age.

Measurement of the contrast agent intrinsic and native harmonic response with single transducer pulse waved ultrasound systems

Ultrasound contrast agents, i.e., small gas filled microbubbles, enhance the echogenicity of blood and have the potential to be used for tissue perfusion assessment. The contrast agents scatter ultrasound in a nonlinear manner and thereby introduce harmonics in the ultrasound signal. This property is exploited in new ultrasound techniques like harmonic imaging, which aims to display only the contrast agent presence. Much attention has already been given to the physical properties of the contrast agent. The present study focuses on practical aspects of the measurement of the intrinsic harmonic response of ultrasound contrast agents with single transducer pulse waved ultrasound systems. Furthermore, the consequences of two other sources of harmonics are discussed. These sources are the nonlinear distortion of ultrasound in a medium generating native harmonics, and the emitted signal itself which might contain contaminating harmonics. It is demonstrated conceptually and by experiments that optimization of the contrast agent harmonic response measured with a single transducer is governed by the transducer spectral sensitivity distribution rather than the resonance properties of the contrast agent. Both native and contaminating harmonics may be of considerable strength and can be misinterpreted as intrinsic harmonics of the contrast agent. Practical difficulties to filter out the harmonic component selectively, without deteriorating the image, may cause misinterpretation of the fundamental as a harmonic.

Non-invasive measurement of mechanical properties of arteries in health and disease

Major conduit arteries should, by their elastic nature, be able to store blood volume temporarily during systole and release it during diastole. This reduces the systolic blood pressure required for the flow of a given volume quantity and gradually suppresses the pulsatile flow pattern. The haemodynamic characteristics of arteries have consequences for the load of the heart but also for the mechanical load of the arterial wall. The repetitive stretching of the wall (strains of up to 10 per cent) may cause fragmentation of the elastic fibres in the wall, modifying wall elasticity. To maintain wall stress the elastic arteries respond with a diameter increase in combination with an increase of arterial wall thickness. A larger diameter for a smaller distension (change in artery diameter from diastole to systole) will restrict the reduction in storage capacity. Alternatively, pulse pressure may go up increasing the mechanical load on the wall. In recent years various methods have been developed to assess and monitor the above interaction. Most of these methods are based on ultrasound techniques because of its wide availability and its non-invasive and non-traumatic nature. Presently these techniques enable the assessment of wall thickness, diastolic diameter, distension waveform, i.e., the tie-dependent change in diameter, the relative pulsatile increase in diameter, and pulse wave velocity, for elastic and muscular arteries in humans but also in small animals such as rats and mice. The present paper discusses the techniques in more detail.

An integrated system for the non-invasive assessment of vessel wall and hemodynamic properties of large arteries by means of ultrasound

OBJECTIVES

To integrate methods for non-invasive assessment of vessel wall properties (diastolic diameter, distension waveform and intima-media thickness) and hemodynamic properties (blood flow velocity and shear rate distribution) of large arteries by means of dedicated ultrasound signal processing.

METHODS

we have developed an arterial laboratory (ART-lab) system. ART-lab consists of software running on a standard personal computer, equipped with a data acquisition card for the acquisition of radio frequency (RF) ultrasound signals obtained with a conventional echo scanner. It operates either (1) off-line or (2) in real-time. Real-time operation is restricted to the assessment of vessel wall properties because of limitations in computational power.

RESULTS

This paper provides an overview of ART-lab ultrasound radio frequency data acquisition and dedicated RF-signal processing methods. The capabilities of the system are illustrated with some typical applications.

CONCLUSIONS

ART-lab in real-time mode is a useful tool for monitoring arterial vessel wall dynamics, while off-line it can be employed to investigate the elastic vessel wall properties in combination with hemodynamics, such as blood flow velocity and shear rate distribution.

Angle-independent motion measurement by correlation of ultrasound signals assessed with a single circular-shaped transducer

In medicine, pulsed ultrasound is a widespread noninvasive technique that measures motion in the direction of the ultrasound beam, i.e., axial motion. The magnitude of the actual motion can be determined only if the angle between the ultrasound beam and the direction of motion (transducer-to-motion angle) is known. For blood flow measurements, current pulsed ultrasound systems assume this angle to be equal to the angle between the ultrasound beam and the longitudinal direction of the vessel, as can be estimated from a two-dimensional brightness-mode (B-mode) image that is obtained prior to the blood flow measurement. For tissue motion measurements, current pulsed ultrasound systems are mostly unable to determine the transducer-to-motion angle. Recently, a model has been derived for the correlation of(analytic) radiofrequency (rf) signals, assessed with a circular-shaped ultrasound transducer along the same line of observation. In the present paper, this model is used to derive estimators, requiring only the calculation of a few correlation coefficients, for the motion components (axial, lateral and actual) and for some of the signal parameters (center frequency, bandwidth and signal-to-noise ratio) of the assessed rf signals. The transducer-to-motion angle can be derived from the estimated motion components. For the evaluation of the estimators, rf signals were acquired with a motion-controlled experimental arrangement. The results of the evaluation study show that the transducer-to-motion angle can be estimated with a mean standard deviation of less than 2 degrees.

Three months use of third-generation oral contraceptives does not affect artery wall properties

In several studies, artery wall properties have been shown to differ between men and women. It has been hypothesized that these differences may result from hormonal influences but, in a previous study, we were unable to detect any influence of the menstrual cycle on artery wall properties. Therefore, we investigated the differences in artery wall properties, if any, between the menstrual cycle and the use of a third-generation oral contraceptive for 3 months. We investigated the right common carotid (CCA) and femoral (CFA) arteries of normotensive young (18-25-y-old) women volunteers (n = 14). The arterial cross-sectional distensibility and compliance coefficients were determined by means of a specially designed ultrasonic wall-tracking device and automatic brachial artery cuff blood-pressure measurements. The menstrual cycles and the cycles during oral contraceptive use (30 microg ethinylestradiol and 75 microg gestodene) were monitored by ultrasonographic evaluation and the assessment of plasma levels of 17beta-oestradiol and progesterone. The distensibility and cross-sectional compliance coefficients of both the CCA and CFA did not differ significantly between the menstrual cycle and the use of oral contraceptives, despite different ovarian hormone levels. Brachial arterial blood pressure was also not affected. We conclude that 3 months use of a third-generation oral contraceptive does not influence the wall properties of peripheral arteries and cannot explain the observed difference between genders. The absence of a rise in blood pressure and the low androgenic profile of this specific oral contraceptive may have contributed to our findings.

Assessment of local differences in intima-media thickness in the human common carotid artery

Intimal thickening may be focal in nature and is especially found in areas with low shear rate. To be able to study the relation between intima-media thickness (IMT) and wall shear rate appropriately, a method to assess IMT locally is required. It was the aim of the present study to investigate the ability of a recently developed automated method to assess local differences in IMT, if any, in relatively short arterial segments. Therefore, intrasession interlocation differences in IMT were assessed at the posterior wall of the common carotid artery close to the bulb (0 mm) and 10 and 20 mm more upstream in terms of mean difference +/- 2 standard deviations. Prior to this study we investigated the ability of the system to reproducibly assess IMT locally (intersession intralocation) in terms of repeatability coefficient (= 2 standard deviations). The measurements were performed in the common carotid artery 20 mm proximal to the bulb. The study was performed on young and older subjects presumed to be healthy. The intersession intralocation repeatability coefficient was 0.07 mm in the young group and 0.11 mm in the older group. The IMT close to the bulb (0 mm) was significantly larger (+/-0.050-0.065 mm) than that at the other locations in both age groups. We conclude that local IMT can be assessed reproducibly and local differences in wall morphology in short arterial segments can be studied reliably.

Conductance method for the measurement of cross-sectional areas of the aorta

A modified conductance method to determine the cross-sectional areas (CSAs) of arteries in piglets was evaluated in vivo. The method utilized a conductance catheter having four electrodes. Between the outer electrodes an alternating current was applied and between the inner electrodes the induced voltage difference was measured and converted into a conductance. CSA was determined from measured conductance minus parallel conductance, which is the conductance of the tissues surrounding the vessel times the length between the measuring electrodes of the conductance catheter divided by the conductivity of blood. The parallel conductance was determined by injecting hypertonic saline to change blood conductivity. The conductivity of blood was calculated from temperature and hematocrit and corrected for maximal deformation and changes in orientation of the erythrocytes under shear stress conditions. The equations to calculate the conductivity of blood were obtained from in vitro experiments. In vivo average aortic CSAs. determined with the conductance method CSA(G) in five piglets, were compared to those determined with the intravascular ultrasound method CSA(IVUS). The regression equation between both values was CSA(G)=-0.09+1.00 x CSA(IVUS), r=0.97, n=53. The mean difference between the values was -0.29%+/-5.57% (2 standard deviations). We conclude that the modified conductance method is a reliable technique to estimate the average cross-sectional areas of the aorta in piglets.

Menopausal status and distensibility of the common carotid artery

Although several studies have shown that exogenous estrogens have beneficial effects on arterial characteristics, the effect of endogenous estrogen on the vascular system is still unknown. In this study, distensibility, an indicator of arterial elasticity, of the common carotid artery was compared in pre- and postmenopausal women. The study comprised 93 premenopausal and 93 postmenopausal women of similar age (range, 43 to 55 years). Women were selected from respondents to a mailed questionnaire about the menopause, which was sent to all women aged 40 to 60 years in the Dutch town of Zoetermeer (n=12 675). Postmenopausal women who were at least 3 years past natural menopause or whose menses had stopped naturally before age 48, were age-matched with premenopausal women with regular menses and without menopausal complaints. The selection aimed at maximizing the contrast in estrogen status between pre- and postmenopausal women of the same age. Distensibility of the carotid artery was measured noninvasively with B-mode ultrasound and a vessel wall movement detector system. Arterial distensibility is expressed as the change in arterial diameter (distension, DeltaD) with the cardiac cycle, adjusted for lumen diameter, pulse pressure, and mean arterial blood pressure. Compared with premenopausal women, postmenopausal women had significantly lower arterial distension (DeltaD 370.5 microm [SE 9.5] versus 397.3 microm [SE 9.6]). These results suggest that the distensibility of the common carotid artery is negatively affected by natural menopause in presumed healthy women.

Evaluation of off-line automated intima-media thickness detection of the common carotid artery based on M-line signal processing

Intima-media thickness (IMT) measurements have gained increasing attention, because IMT is assumed to represent the endothelial adaptive response to physiological and pathophysiological processes. The main aim of the present study was to assess the intrasubject intrasession variability of a new off-line automated radio frequency (RF) IMT method in comparison with an already established off-line manual B-mode IMT method. IMT also was assessed by means of an on-line manual B-mode and an on-line manual RF IMT method. We investigated posterior wall IMT 0-1 cm proximal to the bulb in both common carotid arteries of 16 young (20-31 y; mean 25 y) female and male and 13 elderly (51-65 y; mean 56 y) female volunteers. Two commercially available ultrasound devices (Pie Medical Scanner 200 and Ultramark 9) were used to assess the effects of signal processing on the off-line automated RF IMT method. Intrasubject intrasession variability was determined using the standard deviation to evaluate and compare the various methods. Spearman rank correlation coefficients and Bland and Altman bias and limits of agreement were calculated to objectivate the comparability between the various methods. Intrasubject intrasession variation of IMT estimates was not statistically different between any of the methods. We observed a good comparability between the commonly used off-line manual B-mode IMT method and the off-line automated RF IMT method at the level of the common carotid artery.

Differences in near-wall shear rate in the carotid artery within subjects are associated with different intima-media thicknesses

In the common carotid artery, reflections originating from the periphery and the flow divider may affect the shape of the flow velocity profile and, hence, near-wall shear rate (WSR) differently just before the bifurcation (location B) than 20 to 30 mm farther upstream (location A). Recent developments in ultrasound technology allow the assessment of WSR and intima-media thickness (IMT) at the same site in the carotid artery in vivo. We therefore determined WSR at locations A and B and investigated whether the differences between both sites, if any, were associated with different IMTs and different mechanical properties of the arterial wall. The effect of age on the possible differences was assessed as well. The study was performed on presumably healthy volunteers (n=53). In all individuals, IMT was larger at location B than at location A. The relative difference in IMT between both locations was not affected by age. No significant differences in diameter and distension were found between locations. Near peak systolic and near mean WSR at the posterior wall (PWSRp and MWSRp, respectively) were significantly lower at location B than at location A. The relative differences in PWSRp and MWSRp between both locations within subjects were independent of age. The velocity profiles were more blunted at location A than at location B. PWSRp and MWSRp significantly decreased and IMT significantly increased with age at both locations. IMT was negatively correlated with PWSRP and MWSRP at location B, but this correlation was not significant at location A. In summary, in the common carotid artery, the lower WSR near the bifurcation, as compared with 20 to 30 mm upstream, is associated with a larger IMT than at the more proximal site. The relative difference between both locations within subjects is independent of age.

Experimental verification of the correlation behavior of analytic ultrasound radiofrequency signals received from moving structures

Conventional pulsed ultrasound systems are only able to detect motion along the ultrasound beam (i.e., axial motion). If the angle between the actual motion direction and the ultrasound beam is known, then the magnitude of the actual motion can be derived. This technique can be applied for laminar blood-flow measurements in straight vessels, but for tissue motion it is inadequate because the local tissue motion direction is unknown and may be position-dependent. Assessment of both the axial motion and the lateral motion (i.e., in the direction perpendicular to the ultrasound beam) makes angle-independent assessment of the magnitude of the actual motion feasible. Information about the axial and lateral motion is available in a set of radiofrequency (RF) signals obtained along the same line of observation (M-mode). The experiments described in the present paper show that axial and lateral motion can be estimated from the shape of the envelope of the 2-D (spatial and temporal) correlation function of analytic M-mode RF signals. Furthermore, it is demonstrated that the shape is also affected by the Band width of the received RF signals, signal-to-noise ratio, and local amplitude and phase characteristics of the ultrasound beam.

A noninvasive method to estimate pulse wave velocity in arteries locally by means of ultrasound

Noninvasive evaluation of vessel wall properties in humans is hampered by the absence of methods to assess directly local distensibility, compliance, and Young's modulus. Contemporary ultrasound methods are capable of assessing end-diastolic artery diameter, the local change in artery diameter as a function of time, and local wall thickness. However, to assess vessel wall properties of the carotid artery, for example, the pulse pressure in the brachial artery still must be used as a substitute for local pulse pressure. The assessment of local pulse wave velocity as described in the present article provides a direct estimate of local vessel wall properties (distensibility, compliance, and Young's modulus) and, in combination with the relative change in artery cross-sectional area, an estimate of the local pulse pressure. The local pulse wave velocity is obtained by processing radio frequency ultrasound signals acquired simultaneously along two M-lines spaced at a known distance along the artery. A full derivation and mathematical description of the method to assess local pulse wave velocity, using the temporal and longitudinal gradients of the change in diameter, are presented. A performance evaluation of the method was carried out by means of experiments in an elastic tube under pulsatile pressure conditions. It is concluded that, in a phantom set-up, the assessed local pulse wave velocity provides reliable estimates for local distensibility.

Modeling of the correlation of analytic ultrasound radiofrequency signals for angle-independent motion detection

Conventional pulsed ultrasound systems are able to assess motion of scatterers in the direction of the ultrasound beam, i.e., axial motion, by determining the lag at which the maximum correlation occurs between consecutively-received radiofrequency (rf) signals. The accuracy, resolution, and processing time of this technique is improved by making use of a model for the correlation of rf signals. All previously-described correlation models only include axial motion, but it is common knowledge that lateral motion, i.e., motion in the plane perpendicular to the beam axis, reduces the correlation of rf signals in time. In the present paper, a model for the correlation of analytic rf signals in depth and time is derived and verified. It also includes, aside of some signal and transducer parameters, both axial and lateral motion. The influence of lateral motion on the correlation of (analytic) rf signals is strongly related to local phase and amplitude characteristics of the ultrasound beam. It is shown how the correlation model, making use of an ultrasound transducer with a circular beam shape, can be applied to estimate, independent of angle, the magnitude of the actual motion. Furthermore, it is shown that the model can be applied to estimate the local signal-to-noise ratio and rf bandwidth.

A longitudinal study of vessel wall properties in normotensive and hypertensive renal transplant recipients

The mechanisms responsible for reduced arterial distensibility in renal transplant recipients remain to be evaluated. The present longitudinal study was aimed to evaluate the effect of hypertension on the evolution of vessel wall properties in renal transplant recipients. The mechanical properties of the common carotid artery were determined in 24 normotensive and 24 treated hypertensive renal transplant recipients 6-12 weeks after transplantation. The measurements were repeated after 2 years. Arterial distension was determined by using a multigate pulsed Doppler system, blood pressure (BP) was measured by a mercury sphygmomanometer. BP was 127 +/- 3/80 +/- 2 mm Hg at entry and 133 +/- 3/82 +/- 2 mm Hg after 2 years in the normotensive group, 146 +/- 4/90 +/- 3 mm Hg at entry and 145 +/- 3/87 +/- 2 mm Hg after 2 years in the hypertensive group (P < 0.01, normotensives vs hypertensives). The distensibility coefficient (DC) decreased significantly after 2 years in the hypertensive group (DC 18.3 +/- 1.3 10(-3)/kPa before, 15.1 +/- 1.2 10(-3)/kPa after 2 years, P < 0.05) whereas no significant change was observed in the normotensive group (DC 19.0 +/- 1.4 10(-3)/kPa before, DC 17.8 +/- 1.3 10(-3)/kPa after 2 years, NS). There was a significant correlation between the change of the distensibility coefficient after 2 years and mean arterial pressure (n = 48, r = 0.42, P < 0.01). The results show that the decrease of arterial distensibility after 2 years is accelerated in hypertensive renal transplant recipients despite effective anti-hypertensive treatment. Since BP levels were not different at entry into the study and after 2 years, differences in distending pressure along cannot explain the more pronounced decrease of arterial distensibility over time in hypertensive renal transplant recipients.

Baseband velocity estimation for second-harmonic signals exploiting the invariance of the Doppler equation

All Doppler systems, whether conventional Doppler domain or radio frequency (RF) processing is employed, relate the temporal frequency characteristics of the signal at a certain point in depth as function of time to the spatial frequency characteristics of the received signal as function of depth. The mean frequency of the latter may change as a result of depth-dependent attenuation, nonlinear scattering mechanisms, as in harmonic imaging of ultrasound contrast agents, or RF signal demodulation. For all these cases, the relationship between spatial and temporal mean frequency and target velocity is still governed by the familiar Doppler expression if the signal modifications have been properly accounted for. A major drawback of RF signal processing to extract the target velocity is the large number of data points to consider. The computational complexity increases further for harmonic imaging. It is shown conceptually, and demonstrated by signal simulations, that prior to velocity estimation RF demodulation followed by decimation 1) does not affect the Doppler equation, 2) enhances the information content of the samples, 3) reduces the computational load by a factor of four and for harmonic signals by a higher factor, and 4) while demodulation does not have to be actually performed, but can be accounted for by a scaling factor in the cross-correlation function. It is concluded that decimation hardly affects the precision of the velocity estimate if possible frequency aliasing is maintained within bounds, suggesting that the decimation factor is not critical.

Wall shear stress in the human common carotid artery as function of age and gender

OBJECTIVES

It has been postulated that in the arterial system mean wall shear stress is maintained at a constant value. The present study was performed to investigate the level of wall shear stress in the common carotid artery (CCA) as function of age and possible interactions between diameter and storage capacity, defined as the absolute area change per heart beat, with mean wall shear stress.

METHODS

Wall shear stress (wall shear rate multiplied by whole blood viscosity) was assessed in the right CCA of 111 presumed healthy male (n = 56) and female (n = 55) volunteers, varying in age between 10 and 60 years. Wall shear rate was measured with a high resolution ultrasound system. Simultaneously, arterial diameter and storage capacity were determined. Whole blood viscosity was calculated from haematocrit, plasma viscosity and shear rate.

RESULTS

From the second to the sixth age decade peak wall shear stress was significantly higher in males than in females and decreased from 4.3 Pa to 2.6 Pa (r = -0.56, p < 0.001) in males and from 3.3 Pa to 2.5 Pa (r = -0.54, p < 0.001) in females. Mean wall shear stress tended to decrease from 1.5 Pa to 1.2 Pa (r = -0.26, p = 0.057) in males and decreased significantly from 1.3 Pa to 1.1 Pa (r = -0.30, p = 0.021) in females. No significant difference in mean wall shear stress was found between males and females in any age decade. The diameter of the CCA increased significantly in both males (r = 0.26, p < 0.05) and females (r = 0.40, p < 0.003). Storage capacity decreased significantly in both sexes (males: r = -0.63, p < 0.001; females: r = -0.68, p < 0.001).

CONCLUSIONS

These observations suggest that the reduction in mean wall shear stress with age results from the concomitant increase in diameter in an attempt of the arterial system to limit the reduction in storage capacity of the arterial system with increasing age.

Effect of hyperparathyroidism on arterial distensibility in renal transplant recipients

BACKGROUND

The cushioning function of the arterial system is altered in patients with end-stage renal failure. The role of hyperparathyroidism for the altered vessel wall properties of large arteries not known.

METHODS

To exclude the confounding effects of fluid volume changes and hypercirculation as well as uremic toxicity on vessel wall properties from those of hyperparathyroidism, the present study was conducted in 54 normotensive renal transplant recipients with good graft function, three to six months after transplantation. The vessel wall properties of the common carotid artery were investigated in 32 of them, who had increased plasma intact parathyroid hormone (iPTH) levels (136 +/- 12 ng/liter, SEM), and compared to those of 22 control recipients of same age with normal plasma iPTH levels (34 +/- 4 ng/liter). Arterial distension was measured by Doppler analysis of the vessel wall movements, blood pressure was determined by sphygmomanometry.

RESULTS

Blood pressure was 140 +/- 3/85 +/- 2 mm Hg in renal transplant recipients with hyperparathyroidism, 135 +/- 3/83 +/- 1 mm Hg in patients with normal plasma iPTH levels (NS). There was no difference in enddiastolic diameter of the common carotid artery (7.4 +/- 0.2 mm) in renal transplant recipients with hyperparathyroidism as compared with the control patients (7.3 +/- 0.2 mm; NS). Renal transplant recipients with hyperparathyroidism had a lower distension (389 +/- 27 microns vs. 486 +/- 28 microns, P < 0.05) and distensibility coefficient of the common carotid artery (15.1 +/- 1.1 10(-3)/kPa vs. DC 19.0 +/- 1.0 10(-3)/kPa, P < 0.001) when compared with the control patients. Multiple regression analysis showed that the distensibility coefficient of the common carotid artery was negatively correlated with age (P < 0.001), mean arterial blood pressure (P < 0.05) and plasma iPTH levels (P < 0.05). The effects of plasma iPTH levels were not related to serum calcium concentrations or to differences in the enddiastolic diameter of the common carotid artery.

CONCLUSIONS

The data suggest that secondary hyperparathyroidism can affect the cushioning function of larger arteries in patients with end-stage renal failure independently of high blood pressure.

Bladder filling reduces femoral artery wall distension and strain: beware of a full bladder!

During a previous study, we noted that the distension and strain of the femoral artery were relatively low when the bladder was full, a situation normally necessary for transabdominal echography. Therefore, in the present study we investigated the influence of bladder filling, if any, on wall properties of the common femoral artery. The results obtained were compared with those obtained in the common carotid artery. The study was performed on the right common carotid and right common femoral arteries of normotensive young (18-35 y) female volunteers (n = 24). Using a specially designed ultrasonic wall-tracking device and automatic brachial artery cuff blood pressure measurements, arterial distension (absolute change in diameter during the cardiac cycle; deltaD), strain (deltaD/D), and cross-sectional distensibility (DC) and compliance (CC) were determined before and after voiding. Distension and strain of the common femoral artery were significantly lower for a full than for an empty bladder. DC and CC were lower when the bladder was filled, but these differences did not reach the level of significance. Blood pressure as measured at the level of the brachial artery and heart rate were not statistically significantly different during a full or an empty bladder. It is concluded that bladder filling affects femoral artery wall properties, an observation that should be kept in mind when performing studies on artery wall properties at this level of the circulation.

A single bit RF domain complex cross-correlation velocity estimator for color flow mapping

This paper evaluates the performance of a one bit mean frequency estimator to estimate blood flow velocity for ultrasound color flow mapping. This one bit mean frequency estimator, referred to as BC3 estimator, is derived from the recently introduced complex cross-correlation model (C3M) employing the full dynamic data range. The C3M velocity estimator is not suitable for application in color flow mapping because of its high hardware complexity and associated computational load. The BC3 estimator estimates the mean blood flow velocity using only two complex cross-correlation coefficients. For this purpose the latter are computed by means of a complex one bit cross-correlation operation. Each sample of the RF signals is converted into an one bit representation based on the sign of the real and imaginary part of the RF samples. A full derivation and mathematical description of the BC3 estimator is presented. In addition, a thorough performance evaluation of the BC3 estimator in comparison with the full dynamic range C3M velocity estimator is carried out by means of signal simulations to document the effect of signal to noise ratio, sample frequency and bandwidth. For the specific simulation conditions considered the standard deviation of both estimators (C3M and BC3) is comparable. The bias of the BC3 estimator appears to be a function of velocity, while the full dynamic range C3M velocity estimator exhibits no bias. The simulation results are confirmed by evaluation of data from an in vivo measurement. Taking into account the low hardware complexity and computational load in combination with the achieved precision, it may be concluded that the BC3 estimator is well suited for implementation in color flow mapping.

Female sex hormones do not influence arterial wall properties during the normal menstrual cycle

1. In previous studies, the elastic properties of the common carotid artery were found to differ between men and women. In these studies, however, the phase of the menstrual cycle was not taken into consideration. It was the aim of the present study to investigate the effect of changing ovarian hormone levels during the normal menstrual cycle on the arterial wall properties of female large arteries. 2. We investigated the elastic right common carotid artery and the muscular right common femoral artery of normotensive young (18-35 years) female subjects (n = 12). The arterial distensibility and cross-sectional compliance coefficients were determined by the use of a specially designed ultrasonic wall-tracking device and measurements of automatic brachial artery cuff blood pressure. The phase of the menstrual cycle was assessed by ultrasonographic evaluation and measurement of 17 beta-oestradiol and progesterone blood plasma levels. 3. The distensibility coefficient and the cross-sectional compliance coefficient of both the common carotid and the common femoral artery did not change significantly during the normal menstrual cycle despite evidently changing ovarian hormone levels. 4. We conclude that the menstrual cycle does not influence the arterial wall properties of either the elastic common carotid artery or the muscular common femoral artery.

Reproducibility of shear rate and shear stress assessment by means of ultrasound in the common carotid artery of young human males and females

In the present study, the reliability of an ultrasonic shear rate estimating system, in terms of intrasubject intrasession, intersubject intrasession and intersubject intersession variability coefficients for the assessment of wall shear rate (WSR) in the common carotid artery (CCA) was determined in eight presumed healthy volunteers. Measurements were performed on consecutive days (day 1, day 2 and day 7). To investigate whether there were differences in WSR due to gender, dynamic WSR in the CCA was assessed in 11 presumed healthy males (mean age 24 y) and 11 presumed healthy females (mean age 25 y). Wall shear stress (WSS) was estimated from WSR and calculated whole blood viscosity. The average intrasubject intrasession variability was about 15% for peak WSR and about 12% for mean WSR. The intersubject intrasession variability for peak WSR decreased from 19% on day 1 to 16% on day 7 and for mean WSR from 17% on day 1 to 11% on day 7. The intersubject intersession variability is on the order of 5% for peak WSR and about 4% for mean WSR. No significant differences could be detected between peak and mean WSR values on day 1, day 2 and day 7, indicating good short- and medium-term intersubject intersession reproducibilities. No differences in peak and mean WSR were found between the left and the right CCA in the male group as well as in the female group. Mean WSS was similar in males (1.3 +/- 0.3 Pa) and in females (1.2 +/- 0.2 Pa), but peak WSS was slightly, but significantly, higher in males (4.3 +/- 1.3 Pa) than in females (3.3 +/- 0.7 Pa). It can be concluded that peak and mean WSR can be reliably determined noninvasively using ultrasound.

Automated detection of local artery wall thickness based on M-line signal processing

The Young's modulus of an arterial segment, a measure of the elastic properties of the arterial wall, requires the simultaneous and local assessment of pulse pressure, wall thickness, diameter, and distensibility (relative increase in cross-sectional area per change in blood pressure). The diameter and relative increase in cross-sectional area can be obtained with a wall track system, processing the radiofrequency (r.f.) ultrasound signals received along a single line of observation (M-line processing). It will be demonstrated that it is feasible to combine, in a single measurement, the assessment of wall thickness and the (relative change in) diameter involving a minimum of user interaction. Phantom tests show a standard error of the estimate for intima-media thickness measurements of less than 20 microns; in vivo registrations exhibit a variation on the order of 45 microns. It is concluded that processing of the radiofrequency ultrasound signal, acquired along an M-line, provides an accurate and time-efficient alternative for videoprocessing of 2-dimensional B-mode ultrasound images to estimate artery wall thickness.

Reduction of the clutter component in Doppler ultrasound signals based on singular value decomposition: a simulation study

In pulsed Doppler ultrasound systems, the ultrasound radiofrequency (RF) signals received can be employed to estimate noninvasively the time-dependent blood velocity distribution within and artery. The RF signals are composed of signals originating from clutter (e.g., vessel walls) and scatterers (e.g., red blood cells). The clutter, which is induced by stationary or slowly-moving structure interfaces, must be suppressed to get reliable estimates of the mean blood flow velocities. In conventional pulsed Doppler systems, this is achieved with a static temporal high-pass filter. The static cut-off frequency and the roll-off of these filters cause the culture not always to be optimally suppressed. This paper introduces a clutter removal filter that is based on Singular Value Decomposition (SVD). Unlike conventional high-pass filters, which take into account only the information of the temporal direction, the SVD filter makes use of the information of the temporal and spatial directions. The advantage of this approach is that it does not matter where the clutter is located in the RF signal. The performance of the SVD filter is examined with computer-generated Doppler RF signals. The results are compared with those of standard linear regression (SLR) filter. The performance of the SVD filter is good, especially if a large temporal window (i.e., approximately 100 RF signals) is applied, which improves the performance for low blood flow velocities, A major disadvantage of the SVD filter is its computational complexity, which increases considerably for larger temporal windows.

A radio frequency domain complex cross-correlation model to estimate blood flow velocity and tissue motion by means of ultrasound

This article introduces a mean frequency estimator based on a radio frequency (RF) domain complex cross-correlation model (C3M). The C3M estimator differs from the real cross-correlation model (CCM) estimator in two respects; it is an unbiased estimator of blood flow velocity and/or tissue motion independent of the bandwidth of the RF ultrasound signals, and it provides an estimate of the spatial bandwidth of the RF-signal. The estimators derived from the complex cross-correlation model (mean spatial frequency, mean temporal frequency, spatial bandwidth and signal-to-noise ratio) are based on three complex cross-correlation coefficients. A full derivation and mathematical description of both estimators (C3M and CCM), starting from a Gaussian model of the complex power spectral density distribution of sampled RF signals, are presented. In addition, a thorough performance evaluation of the C3M estimator in comparison with the CCM estimator is carried out by means of simulations to document the effect of signal-to-noise ratio, bandwidth and sample frequency. In the context of the specific simulation conditions considered, the quality of the C3M estimator is shown to offer the best performance (no bias, low standard deviation of the estimate). Taking into account the computational load and the robustness of the C3M estimator, it may be concluded that the C3M estimator combines high quality and modest complexity.

Enhanced cellular proliferation in intact stenotic lesions derived from human arteriovenous fistulas and peripheral bypass grafts. Does it correlate with flow parameters?

BACKGROUND

Vascular interventions are often complicated by the development of intimal thickening, leading to stenosis. Cellular proliferation is a key event in stenosis formation in animals, but the role of cell proliferation in intimal thickening in humans is still unclear. Furthermore, the relation between proliferation in human stenotic lesions and flow parameters has not been established.

METHODS AND RESULTS

We studied the proliferation patterns of 35 anatomically intact human stenotic lesions derived from either peripheral bypasses (normal flow) or hemodialysis AV fistulas (high flow) with the use of Ki-67, a cell proliferation marker. Local flow parameters were assessed with ultrasound. Proliferation patterns were similar in AV fistula and bypass stenoses. In the intima, proliferation was highest in the area just below the endothelium (AV fistulas, 3.6%; bypasses, 3.5%; P = NS). In adjacent nonstenotic vessel segments that were used as controls, proliferation rate in the intima was 0.3%. Double-labeling studies revealed that subendothelial-intimal proliferation consisted mainly (90%) of vascular smooth muscle cells, whereas proliferation in the other layers of the vessel wall also consisted of endothelial cells and macrophages. Blood flow velocity was negatively correlated with subendothelial-intimal proliferation (r = -.61, P < .05). The endothelial cell coverage of the lumen was positively correlated with proliferation (r = .85, P < .01).

CONCLUSIONS

These data suggest enhanced cellular proliferation in human stenotic tissue derived from AV fistulas and peripheral bypass grafts. Furthermore, high proliferation rates seem to be associated with endothelial cell coverage of the lumen and low local flow velocities.

Reduced distensibility of the common carotid artery in patients treated with ergotamine

To investigate the effect of vascular smooth muscle contraction on mechanical vessel wall properties of proximal "elastic" arteries, we investigated the effect of the vasoconstrictor ergotamine on the distensibility of the common carotid artery in 10 migraine patients with ergotamine intake, in 10 control patients with migraine headache but no prior ergotamine intake, and in 10 healthy control subjects. The patients and control subjects were matched for age, blood pressure, and sex. In the ergotamine group, 2.2 +/- 1.4 mg ergotamine tartrate (0.25 to 6 mg) was taken within 12 hours before investigation. Differences in mean 24-hour blood pressure between the study groups were excluded by 24-hour blood pressure recording and differences in arterial wall thickness by high-resolution and differences in arterial wall thickness by high-resolution B-mode ultrasound. A multigate Doppler system was used for measurement of vessel wall movements by M-mode Doppler analysis. Blood pressure was determined by sphygmomanometry. The end-diastolic diameter of the common carotid artery was insignificantly reduced in the ergotamine group compared with the healthy control subjects and control patients (healthy control subjects, 6.6 +/- 0.4 mm; control patients, 6.7 +/- 0.5 mm; patients with ergotamine intake, 6.3 +/- 0.4 mm; P = NS). Arterial distensibility was significantly lower in the patients with ergotamine intake (17.4 +/- 4.0 10(-3)/kPa) than in the healthy control subjects (22.3 +/- 5.1 10(-3)/kPa) and control patients (22.8 +/- 3.6 10(-3)/kPa) (one-way ANOVA, P = .014). The results show that ergotamine reduces the distensibility of the common carotid artery. The data suggest that vascular smooth muscle contraction can modulate the buffering function of the arterial system independently of blood pressure changes.

A technique to assess aortic distensibility and compliance in anesthetized and awake rats

A noninvasive ultrasonic technique, based on tracking arterial wall displacements with a vessel wall-tracking device attached to a conventional B-mode imager, to assess end-diastolic aortic diameter (d) and aortic diameter changes during the cardiac cycle (delta d) in anesthetized and awake rats is presented. From these parameters and invasively measured aortic pulse pressure (delta P), aortic distensibility and compliance, the relative and absolute increases in lumen cross-sectional area for a given increase in delta P, respectively, can be calculated. d, delta d, and delta P could be determined with good intra-session (variations per day) and inter-session (variations between days) coefficients of variation (CV). The CVs for delta d were smaller in awake (4.6-6.0%) than in anesthetized rats (7.9-11.0%), probably due to variations in delta P during anesthesia (CV: 9.0-12.3%). The CVs for d in awake (3.3-6.5%) and anesthetized rats (2.6-5.0%) were comparable. In awake rats the CV for delta d, but not for d, increased after implantation of the aortic catheter. It is concluded that d, delta d, and delta P of the aorta can be reliably measured noninvasively in anesthetized and awake rats, allowing the in vivo assessment of aortic distensibility and compliance. The technique is sensitive enough to detect effects of agents on aortic wall properties.

Different effects of ageing on elastic and muscular arterial bifurcations in men

In a previous study we have shown that the wall of the elastic carotid artery bifurcation (CAB) stiffens inhomogeneously with increasing age, the carotid artery bulb being most affected. In the present study the effect of ageing on the elastic properties of the wall and the strain the wall is exposed to along the muscular femoral artery bifurcation (FAB) was investigated using the CAB for comparison. The study was performed with 10 young (aged 20-30 years) and 10 old (50-60 years) presumed healthy volunteers. Distensibility along the bifurcation was determined by measuring noninvasively the maximum relative diameter changes of the artery during systole (peak delta d/d.100%), which is also a measure of strain, at various sites along both bifurcations by means of a vessel wall moving detector system. This system also makes the assessment of (end-diastolic) diameter possible. At all levels along the CAB, the diameter was significantly larger in the old than in the young. In the FAB, the diameter was only significantly larger in the old than in the young in the common and superficial femoral arteries. At all levels in the CAB, peak delta d/d.100% was significantly lower in the old than in the young, the carotid artery bulb being more affected than the common carotid artery (CCA), while in the FAB this parameter was lower in the old than in the young only in the common femoral artery (CFA). Peak delta d/d.100% was similar in the CCA and in the bulb in the young, but significantly higher in the CCA than at all levels in the bulb in the old. In the FAB, in the young peak delta d/d 100% was significantly higher in the CFA than at both levels in the deep and superficial femoral arteries, while in the old no significant differences in peak delta d/d.100% along the FAB could be detected. These findings indicate that the loss of wall elasticity with increasing age is different in the muscular and elastic arterial bifurcations investigated. The homogeneous distribution of wall elasticity in the elastic CAB at a younger age becomes inhomogeneous at an older age, while the opposite is observed in the muscular FAB. The changes in strain the different parts of the bifurcations are exposed to with increasing age are different in the CAB and the FAB. Differences in distensibility along bifurcations will make them deform inhomogeneously during the cardiac cycle.

Prosthetic arteriovenous fistulas and venous anastomotic stenosis: influence of a high flow velocity on the development of intimal hyperplasia

Stenotic intimal thickening at the venous end of prosthetic arteriovenous (AV) fistulas for hemodialysis has been associated with perianastomotic mismatch in elastic properties between prosthesis and vein and high flow velocities. In a prospective study, we investigated the role of flow velocity on the occurrence of intimal hyperplasia in prosthetic AV fistulas in hemodialysis patients. In 24 patients, the flow velocities were assessed in the distal graft and the outflow vein postoperatively, with the use of vessel wall Doppler tracking, a noninvasive ultrasound technique. The initial velocity in the venous anastomoses was correlated with the occurrence of stenoses during follow-up (2 years). The detection of a stenosis was performed with both Duplex ultrasound and angiography. In 4 cases a stenosis developed in the venous anastomosis, in 8 cases in the venous outflow segment, and in 4 cases at both sites. Higher flow velocities around the venous anastomosis was observed in fistulas developing a stenosis at this site as compared with the nonstenotic fistulas (p < 0.05). The occurrence of stenoses in prosthetic AV fistulas in or adjacent to the venous anastomosis is not associated with a mismatch in elastic properties, but with high flow velocity.

A noninvasive method to estimate arterial impedance by means of assessment of local diameter change and the local center-line blood flow velocity using ultrasound

Vascular impedance is defined as the ratio between the frequency components of the local blood pressure waveform and those of the local blood volume flow waveform. Assessment of vascular impedance is, for example, important to study heart load and distal vascular bed vasomotricity. However, only a few studies on vascular impedance have been performed in humans because pulsatile pressure and volume flow waveforms, simultaneously recorded at the same location, are difficult to obtain noninvasively. The noninvasive assessment of arterial impedance as described in this study is based on the replacement of the pressure waveform by the distension (change in diameter) waveform and the volume flow waveform by the center-line blood flow velocity waveform. Both waveforms can simultaneously and accurately be assessed by means of pulsed ultrasound. It will be shown that, depending on the Womersley number, the volume flow waveform may be replaced by the center-line blood flow velocity waveform for a given frequency range and that the pressure waveform may be replaced by the distension waveform for a wide frequency range. The validation of the proposed ultrasound method was performed through an in vitro study in a flow model with a distensible tube terminated with a hydraulic load (modified windkessel model). It is shown that, in vitro, the proposed method gives the same results as the local spectral pressure-flow relationship.

Different effects of hypertension, atherosclerosis and hyperlipidaemia on arterial distensibility

OBJECTIVE

To investigate the different effects of hypertension, hyperlipidaemia and atherosclerosis on the visco-elastic properties of large arteries.

DESIGN

Vessel wall properties were determined in patients who had been subjected for the first time to coronary arteriography. Normotensive patients with no coronary disease (n = 15), one-vessel disease (n = 15) or two- or three-vessel disease (n = 15), 15 treated hypertensive patients (mean +/- SEM duration of hypertension 9.6 +/- 1.7 years) with no coronary disease and normocholesterolaemia and 15 healthy controls were matched for blood pressure, age and sex.

METHODS

Arterial distension of the common carotid artery was determined by using a multigate Doppler system. The blood pressure curve was recorded by finger plethysmography.

RESULTS

The end-diastolic diameter was significantly higher in the hypertensives (P<0.05) but not significantly different in the normotensives compared with the controls. Arterial distensibility was significantly lower in the hypertensive group [(13.3 +/- 0.8) x 10(-3)/kPa] than in the controls [(19.1 +/- 1.5) x 10(-3)/kP; P<0.01), in the group with no coronary disease [(18.8 +/- 1.3) x 10(-3)/kPa; P<0.01] and in those with one-vessel disease [(17.7 +/- 1.4) x 10(-3)/kPa; P<0.05]. Arterial distensibility was not significantly lower in the hypertensives than in the group with two- or three-vessel disease [(15.0 +/- 1.0) x 10(-3)/kPa; NS). No significant correlation was found between cholesterol or lipoprotein(a) levels and arterial distensibility in the normotensive patients.

CONCLUSIONS

Hypertension is the predominant factor affecting the visco-elastic properties of large arteries. Arterial compliance is significantly altered only in extensive atherosclerosis.

Anastomotic intimal hyperplasia in prosthetic arteriovenous fistulas for hemodialysis is associated with initial high flow velocity and not with mismatch in elastic properties

Stenotic intimal thickening at the venous end of prosthetic arteriovenous (AV) fistulas for hemodialysis has been associated with perianastomotic mismatch in elastic properties, and low shear rates. In a prospective way, the role of these factors on the occurrence of intimal hyperplasia in prosthetic AV fistulas in hemodialysis patients was investigated. In 24 hemodialysis patients, the elastic properties were assessed in the distal graft segment and the outflow vein postoperatively with the use of Vessel Wall Doppler Tracking (VWDT), a noninvasive ultrasound technique. In addition, normalized peak systolic velocity (nPSV) was calculated from diameter (VWDT) and peak systolic velocity. The initial mismatch around the venous anastomoses and local nPSV were correlated with the occurrence of stenoses during follow-up (2 yr). The detection of a stenosis was performed with both Duplex ultrasound and angiography. In four cases, a stenosis developed in the venous anastomosis; in eight cases, a stenosis developed in the venous outflow segment; and in four cases, stenoses developed at both sites. A better initial match in elastic properties around the venous anastomosis was observed in the fistulas developing a stenosis at this site as compared with the nonstenotic fistulas (P < 0.05). The initial local nPSV values at the site of the later stenosis were higher in the fistulas developing a stenosis as compared with the nonstenotic fistulas (P < 0.05). It was concluded that the occurrence of stenoses in prosthetic AV fistulas for hemodialysis in or adjacent to the venous anastomoses is associated with a high initial flow velocity but not with a mismatch in elastic properties.

Arterial distensibility and compliance in hypertension

Under normal circumstances arteries, especially the larger elastic ones, distend during systole, and hence are able to store volume energy during this phase of the cardiac cycle. In this way the increase in blood pressure during systole will be leveled off. The amount of energy that can be stored depends not only on the degree of distension (distensibility), but also on the initial diameter of the vessel--two parameters actually determining the compliance of an artery. In both established and borderline hypertension distensibility and compliance of the larger elastic arteries are reduced, as compared with normotensives, but not of the radial artery, at least in patients with established hypertension. In these patients this artery shows a pronounced increase in intima-media thickness. The elastic modulus of the radial artery is not different in hypertensive and normotensive subjects. In the present state of the art, it cannot be concluded whether the loss of artery wall distensibility is caused solely by the increase in blood pressure or that also structural wall changes are involved. In borderline hypertensive patients distensibility and compliance of the elastic arteries are diminished as compared with normotensive subjects. The loss of distensibility already occurs in the fourth age decade and is not homogeneous along the carotid artery bifurcation. The distensibility is significantly lower at all levels in the carotid artery bulb than in the common carotid artery, the proximal part of the bulb, where the baroreceptors are predominantly located, being most affected. This pattern is similar to that observed in normotensive subjects in the sixth age decade, indicating that the carotid arteries age faster in borderline hypertensive than in normotensive subjects.