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2-D and 3-D high frame-rate Pulse Wave Imaging for the characterization of focal vascular disease
Cardiovascular diseases are major causes of morbidity and mortality in Western-style populations. Atherosclerosis and Abdominal Aortic Aneurysms (AAAs) are two prevalent vascular diseases that may progress without symptoms and contribute to acute cardiovascular events such as stroke and AAA rupture, which are consistently among the leading causes of death worldwide. The imaging methods used in the diagnosis of these diseases, have been reported to present several limitations. Given that both are associated with mechanical changes in the arterial wall, imaging of the arterial mechanical properties may improve early disease detection and patient care.
Pulse wave velocity (PWV) refers to the velocity at which arterial waves generated by ventricular ejection travel along the arterial tree. PWV is a surrogate marker of arterial stiffness linked to cardiovascular mortality. The foot-to-foot method that is typically used to calculate PWV suffers from errors of distance measurements and time-delay measurements. Additionally, a single PWV estimate is provided over a relatively long distance, thus inherently lacking the capability to provide regional arterial stiffness measurements. Pulse Wave Imaging (PWI) is a noninvasive, ultrasound-based technique for imaging the propagation of pulse waves along the wall of major arteries and providing a regional PWV value for the imaged artery.
The aim of this work was to enable PWI to provide more localized PWV and stiffness measurements within the imaged arterial segment and to further extend it into a 2-D and 3-D technique for the detection and monitoring of focal vascular disease at high temporal and spatial resolution. The improved modality was integrated with blood flow imaging modalities aiming to render PWI a comprehensive methodology for the study of arterial biomechanics in vivo.
Spatial information was increased with the introduction of piecewise PWI. This novel technique was used to measure PWV within small sub-regions of the imaged vessel in murine aneurysmal (n = 8) and atherosclerotic aortas (n = 11) in vivo. It provided PWV and stiffness maps while capturing the progressive arterial stiffening caused by atherosclerosis. PWI was further augmented with a sophisticated adaptive algorithm, enabling it to optimally partition the imaged artery into relatively homogeneous segments, automatically isolating arterial stiffness inhomogeneities. Adaptive PWI was validated in silicone phantoms consisting of segments of varying stiffness and then tested in murine aortas in vivo.
Subsequently, the conventional tradeoff between spatial and temporal resolution was addressed with a plane wave compounding implementation of PWI, allowing the acquisition of full field of view frames at over 2000 Hz. A GPU-accelerated PWI post-processing framework was developed for the processing of the big bulk of generated data. The parameters of coherent compounding were optimized in vivo. The optimized sequences were then used in the clinic to assess the mechanical properties of atherosclerotic carotids (n=10) and carotids of patients after endarterectomy (n=7), a procedure to remove the plaque and restore blood flow to the brain. In the case of atherosclerotic patients undergoing carotid endarterectomy, the results were compared against the histology of the excised plaques. Investigation of the mechanical properties of plaques was also conducted for the first time with a high-frequency transducer (18.5 MHz).
Additionally, 4-D PWI was introduced, utilizing high frame rate 3-D plane wave acquisitions with a 2-D matrix array transducer (16x16 elements, 2.5 MHz). A novel methodology for PWV estimation along the direction of pulse wave propagation was implemented and validated in silicone phantoms. 4-D PWI provided comprehensive views of the pulse wave propagation in a plaque phantom and the results were compared against conventional PWI. Finally, its feasibility was tested in the carotid arteries of healthy human subjects (n=6). PWVs derived in 3-D were within the physiological range and showed good agreement with the results of conventional PWI.
Finally, PWI was integrated with flow imaging modalities (Color and Vector Doppler). Thus, full field-of-view, high frame-rate, simultaneous and co-localized imaging of the arterial wall dynamics and color flow as well as 2-D vector flow was implemented. The feasibility of both techniques was tested in healthy subjects (n=6) in vivo. The relationship between the timings of the flow and wall velocities was investigated at multiple locations of the imaged artery. Vector flow velocities were found to be aligned with the vesselâs centerline during peak systole in the common carotid artery and interesting flow patterns were revealed in the case of the carotid bifurcation
Consequently, with the aforementioned improvements and the inclusion of 3-D imaging, PWI is expected to provide comprehensive information on the mechanical properties of pathological arteries, providing clinicians with a powerful tool for the early detection of vascular abnormalities undetectable on the B-mode, while also enabling the monitoring of fully developed vascular pathology and of the recovery of post-operated vessels
Ultrafast Ultrasound Imaging
Among medical imaging modalities, such as computed tomography (CT) and magnetic resonance imaging (MRI), ultrasound imaging stands out due to its temporal resolution. Owing to the nature of medical ultrasound imaging, it has been used for not only observation of the morphology of living organs but also functional imaging, such as blood flow imaging and evaluation of the cardiac function. Ultrafast ultrasound imaging, which has recently become widely available, significantly increases the opportunities for medical functional imaging. Ultrafast ultrasound imaging typically enables imaging frame-rates of up to ten thousand frames per second (fps). Due to the extremely high temporal resolution, this enables visualization of rapid dynamic responses of biological tissues, which cannot be observed and analyzed by conventional ultrasound imaging. This Special Issue includes various studies of improvements to the performance of ultrafast ultrasoun
An investigation of real time ultrasound Doppler techniques for tissue motion and deformation analysis
Cardiovascular disease accounts for more than 50% of all deaths in the Western
world. Atherosclerosis is responsible for the vast majority of these diseases. There
are a
range of risk factors for atherosclerosis that affect the endothelial lining vessel
wall cells to cause endothelial dysfunction, which then predisposes to a localized
build-up of 'plaque' tissue that narrows the lumen of the arteries. Plaque rupture
promotes localized vasospasm, thrombosis and embolism causing downstream tissue
death, resulting in severe disability or death from, for instance, heart attack (in the
coronary circulation) or stroke (in the cerebral circulation). Narrowing of the lumen
and plaque rupture are associated with high tissue stresses and tissue under perfusion,
which will alter local arterial and myocardial wall dynamics and elastic properties.
Hence visualization of tissue dynamic and deformation property changes is crucial to
detect atherosclerosis in the earliest stages to prevent acute events.The objective of this dissertation research is to develop new techniques based on
Doppler ultrasound to investigate and visualize changes in tissue dynamic and
deformation properties due to atherosclerosis in cardiac and vascular applications. A
new technique, to correct for the Doppler angle dependence for tissue motion
analysis has been developed. It is based on multiple ultrasound beams, and has been
validated in vitro to study tissue dynamic properties. It can measure tissue velocity
magnitude with low bias (5%) and standard deviation (10%), and tissue velocity
orientation with a bias less than 5 degrees and a standard deviation below 5 degrees.
A new Doppler based method, called strain rate, has also been developed and
validated in vitro for the quantification of regional vessel or myocardial wall
deformation. Strain rate is derived from the velocity information and can assess
tissue deformation with an accuracy of 5% and a standard deviation less than 10%.
Some examples of cardiac strain rate imaging have been gathered and are described
in this thesis. Strain rate, as all Doppler based techniques, suffers from angle
dependence limitation. A method to estimate one-component strain rate in any
direction in the two-dimensional image not necessarily along the ultrasound beam
has been developed. The method allows correcting for the strain rate bias along any
user-defined direction. It is also shown that the full strain rate tensor can theoretically
be extracted from the velocity vector field acquired by multiple beam tissue vector
velocity technique. In vitro experiments have shown that qualitative two-component
strain rate tensor can be derived. Two-component vector velocity from the moving
tissue was acquired and two two-component strain rate images were derived. The
images showed agreement with the expected deformation pattern
Methods for Improved Estimation of Low Blood Velocities Using Vector Doppler Ultrasound
Accurate estimation of low 3D blood velocities, such as near the wall in recirculation or disturbed flow regions, is important for accurate mapping of velocities to improve estimations of wall shear stress and turbulence, which are associated risk factors for vascular disease and stroke. Doppler ultrasound non-invasively measures blood-velocities but suffers from two major limitations addressed in this thesis. These are angle dependence of the measurements, which requires the knowledge of beam-to-flow angle, and the wall-filter. The high-pass wall filter that is applied to attenuate the high-intensity low-frequency signal from tissue and slowly moving vessel wall also attenuates any low velocity signals from blood thus causing inaccurate estimation of these velocities. This thesis presents two methods to alleviate the angle-dependence limitation and to minimize the effect of the wall filter on low blood-velocity estimates: a multi-receiver technique â vector Doppler ultrasound (VDUS), and a novel method called aperture-translation technique.
For the first method â VDUS, theoretical and experimental studies were performed to assess the comparative benefit of three to eight receivers (3Râ8R) in Doppler ultrasound configurations in terms of the number of receiver beams, inter-beam angle, and beam- selection method (criterion for discriminating between tissue and blood Doppler signals) for a range of velocity orientations. Accuracy and precision for â„5 receivers were consistently better over all flow velocity orientations and for all beam-selection methods. Asymmetry in the 5R configuration led to improved accuracy and precision compared to symmetrical 6R and 8R configurations.
Second, a novel 2D-VDUS aperture-translation technique using mechanical or electronic translation of the transmit-receive apertures was introduced and assessed experimentally. Both versions of the technique outperformed the conventional 2D-VDUS method for detection of low flow velocities in terms of accuracy and precision. The electronic version, which is more relevant and feasible clinically, showed comparable reliability and better accuracy compared with the idealized mechanical version, therefore suggesting its potential for future development. This work demonstrated that a minimum of five receivers, preferably with an inherent asymmetry with respect to the flow direction, should be considered when designing a 2D-array configuration for improved estimation of low velocities. For estimation of low velocities not measurable with conventional VDUS methods, the aperture-translation technique could be a potential candidate
The Ultrasound Window Into Vascular Ageing: A Technology Review by the VascAgeNet COST Action
Arteriosclerosis; Ultrasound; Vascular ageingArteriosclerosi; Ecografia; Envelliment vascularArteriosclerosis; EcografĂa; Envejecimiento vascularNon-invasive ultrasound (US) imaging enables the assessment of the properties of superficial blood vessels. Various modes can be used for vascular characteristics analysis, ranging from radiofrequency (RF) data, Doppler- and standard B/M-mode imaging, to more recent ultra-high frequency and ultrafast techniques. The aim of the present work was to provide an overview of the current state-of-the-art non-invasive US technologies and corresponding vascular ageing characteristics from a technological perspective. Following an introduction about the basic concepts of the US technique, the characteristics considered in this review are clustered into: 1) vessel wall structure; 2) dynamic elastic properties, and 3) reactive vessel properties. The overview shows that ultrasound is a versatile, non-invasive, and safe imaging technique that can be adopted for obtaining information about function, structure, and reactivity in superficial arteries. The most suitable setting for a specific application must be selected according to spatial and temporal resolution requirements. The usefulness of standardization in the validation process and performance metric adoption emerges. Computer-based techniques should always be preferred to manual measures, as long as the algorithms and learning procedures are transparent and well described, and the performance leads to better results. Identification of a minimal clinically important difference is a crucial point for drawing conclusions regarding robustness of the techniques and for the translation into practice of any biomarker.This article is based upon work from COST Action CA18216 VascAgeNet, supported by COST (European Cooperation in Science and Technology, www.cost.eu). A.G. has received funding from âLa Caixaâ Foundation (LCF/BQ/PR22/11920008). R.E.C is supported by the National Health and Medical Research Council of Australia (reference: 2009005) and by a National Heart Foundation Future Leader Fellowship (reference: 105636). J.A. acknowledges support from the British Heart Foundation [PG/15/104/31913], the Wellcome EPSRC Centre for Medical Engineering at King's College London [WT 203148/Z/16/Z], and the Cardiovascular MedTech Co-operative at Guy's and St Thomas' NHS Foundation Trust [MIC-2016-019]
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