Tissue Doppler imaging of carotid plaque wall motion: a pilot study

BackgroundStudies suggest the physical and mechanical properties of vessel walls and plaque may be of clinical value in the diagnosis and treatment of cardiovascular atherosclerotic disease. The purpose of this pilot study was to investigate the potential clinical application of ultrasound Tissue Doppler Imaging (TDI) of Arterial Wall Motion (AWM) and to quantify simple wall motion indices in normal and diseased carotid arteries.Methods224 normal and diseased carotid arteries (0–100% stenoses) were imaged in 126 patients (age 25–88 years, mean 68 ± 11). Longitudinal sections of the carotid bifurcation were imaged using a Philips HDI5000 scanner and L12-5 probe under optimized TDI settings. Temporal and spatial AWMs were analyzed to evaluate the vessel wall displacements and spatial gradients at peak systole averaged over 5 cardiac cycles.ResultsAWM data were successfully extracted in 91% of cases. Within the carotid bifurcation/plaque region, the maximum wall dilation at peak systole ranged from -100 to 750 microns, mean 335 ± 138 microns. Maximum wall dilation spatial gradients ranged 0–0.49, mean 0.14 ± 0.08. The AWM parameters showed a wide variation and had poor correlation with stenoses severity. Case studies illustrated a variety of pertinent qualitative and quantitative wall motion features related to the biophysics of arterial disease.ConclusionOur clinical experience, using a challenging but realistic imaging protocol, suggests the use of simple quantitative AWM measures may have limitations due to high variability. Despite this, pertinent features of AWM in normal and diseased arteries demonstrate the potential clinical benefit of the biomechanical information provided by TDI.

[1]  H. Barnett,et al.  The inappropriate use of carotid endarterectomy , 2004, Canadian Medical Association Journal.

[2]  T Länne,et al.  Abdominal aortic aneurysm: a general defect in the vasculature with focal manifestations in the abdominal aorta? , 1997, Journal of vascular surgery.

[3]  D. Sackett,et al.  Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. , 1991, The New England journal of medicine.

[4]  G. Mundigler,et al.  Tissue Doppler Imaging: Myocardial Velocities and Strain - Are there Clinical Applications? , 2002 .

[5]  C. Kasai,et al.  Real-Time Two-Dimensional Blood Flow Imaging Using an Autocorrelation Technique , 1985, IEEE Transactions on Sonics and Ultrasonics.

[6]  F Beux,et al.  Automatic evaluation of arterial diameter variation from vascular echographic images. , 2001, Ultrasound in medicine & biology.

[7]  P. Dobrin,et al.  Mechanical properties of arteries , 1978, Physiological reviews.

[8]  K Ferrara,et al.  Color flow mapping. , 1997, Ultrasound in medicine & biology.

[9]  V R Newey,et al.  Online artery diameter measurement in ultrasound images using artificial neural networks. , 2002, Ultrasound in medicine & biology.

[10]  P J Brands,et al.  Assessment of the spatial homogeneity of artery dimension parameters with high frame rate 2-D B-mode. , 2001, Ultrasound in medicine & biology.

[11]  D. Webb,et al.  Noninvasive assessment of arterial stiffness and risk of atherosclerotic events. , 2003, Arteriosclerosis, thrombosis, and vascular biology.

[12]  A. Versluis,et al.  Atherosclerotic plaque rupture: a fatigue process? , 2000, Medical hypotheses.

[13]  K W Beach,et al.  In vivo ultrasonic measurement of tissue vibration at a stenosis: a case study. , 2001, Ultrasound in medicine & biology.

[14]  O. Bonnefous,et al.  Non invasive echographic techniques for arterial wall characterization , 1996, 1996 IEEE Ultrasonics Symposium. Proceedings.

[15]  R. Lees,et al.  Comparison of B-mode, M-mode and echo-tracking methods for measurement of the arterial distension waveform. , 1997, Ultrasound in medicine & biology.

[16]  O. Bonnefous,et al.  Arterial Wall Motion imaging: a new ultrasound approach to vascular characterization , 2000 .

[17]  H. Meldrum,et al.  Appropriate Use of Carotid Endarterectomy , 2000, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[18]  Spyretta Golemati,et al.  Carotid artery wall motion estimated from B-mode ultrasound using region tracking and block matching. , 2003, Ultrasound in medicine & biology.

[19]  Alan D. Lopez,et al.  Mortality by cause for eight regions of the world: Global Burden of Disease Study , 1997, The Lancet.

[20]  R S Reneman,et al.  Assessment of the arterial distension waveform using Doppler signal processing , 1992, Journal of hypertension. Supplement : official journal of the International Society of Hypertension.

[21]  Kathleen Mullen,et al.  Brachial Artery Elastic Mechanics in Patients With Heart Failure , 2001, Hypertension.

[22]  M. Eliasziw,et al.  the North American Symptomatic Carotid Endarterectomy Trial (NASCET) Collaborators , 2002 .

[23]  A. Seifalian,et al.  Arterial elastic properties and cardiovascular risk/event. , 2002, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[24]  K V Ramnarine,et al.  Construction and geometric stability of physiological flow rate wall-less stenosis phantoms. , 2001, Ultrasound in medicine & biology.

[25]  Jon Harald Kaspersen,et al.  A new method for analysis of motion of carotid plaques from RF ultrasound images. , 2003, Ultrasound in medicine & biology.

[26]  E. Lehmann,et al.  CONFERENCE Elastic properties of the aorta , 1993, The Lancet.

[27]  R S Reneman,et al.  Assessment of the distensibility of superficial arteries. , 1990, Ultrasound in medicine & biology.

[28]  H Handa,et al.  Stiffness and elastic behavior of human intracranial and extracranial arteries. , 1980, Journal of biomechanics.

[29]  J. Slattery,et al.  Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST) , 1998, The Lancet.

[30]  E D Lehmann.  Elastic properties of the aorta. , 1993, Lancet.

[31]  S. Laurent,et al.  Aortic Stiffness Is an Independent Predictor of Fatal Stroke in Essential Hypertension , 2003, Stroke.

[32]  A. Nowicki,et al.  Assessment of wall velocity gradient imaging using a test phantom. , 1996, Ultrasound in medicine & biology.

[33]  R. Reneman,et al.  Inhomogeneities in arterial wall properties under normal and pathological conditions , 1992, Journal of hypertension. Supplement : official journal of the International Society of Hypertension.

[34]  Peter D. Richardson,et al.  Biomechanics of Plaque Rupture: Progress, Problems, and New Frontiers , 2002, Annals of Biomedical Engineering.

[35]  J. Staessen,et al.  Carotid and Femoral Artery Stiffness in Relation to Three Candidate Genes in a White Population , 2001, Hypertension.

[36]  J. Keul,et al.  Assessment of carotid wall motion and stiffness with tissue Doppler imaging. , 1998, Ultrasound in medicine & biology.

[37]  M S van Leeuwen,et al.  Reproducibility of measurements of intima-media thickness and distensibility in the common carotid artery. , 1998, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[38]  P B Dobrin.  Mechanical properties of arterises. , 1978 .

[39]  E. Metter,et al.  The carotid artery as a noninvasive window for cardiovascular risk in apparently healthy individuals. , 2002, Ultrasound in medicine & biology.