Vector Flow Imaging Compared with Digital Subtraction Angiography for Stenosis Assessment in the Superficial Femoral Artery – A Study of Vector Concentration, Velocity Ratio and Stenosis Degree Percentage

Abstract Purpose Stenosis of the superficial femoral artery (SFA) induces complex blood flow with increased velocities. Disease assessment is performed with Doppler ultrasound and digital subtraction angiography (DSA), but Doppler ultrasound is limited by angle dependency and DSA by ionizing radiation. An alternative is the vector flow imaging method based on transverse oscillation (TO), an angle-independent vector velocity technique using ultrasound. In this study, flow complexity and velocity measured with TO were compared with DSA for the assessment of stenosis in the SFA. Materials and Methods The vector concentration, a measure of flow complexity, and the velocity ratio obtained from the stenosis and a disease-free adjacent vessel segment, were estimated with TO in 11 patients with a total of 16 stenoses of the SFA. TO data were compared with the corresponding stenosis degree percentage obtained with DSA. Results The correlation between the vector concentration and DSA was very strong (R=0.93; p<0.001; 95% confidence interval (CI): 0.81–0.98), while only moderate for velocity ratio and DSA (R=0.50; p<0.07; 95% CI: 0.00–0.80). The correlation coefficients that were found were significantly different (p<0.005) without overlapping CI. Conclusion The study indicated that flow changes in the SFA induced by stenosis can be quantified with TO, and that stenosis grading may be improved by estimation of flow complexity instead of velocity ratio. TO is a potential diagnostic tool for the assessment of atherosclerosis and peripheral arterial disease.

[1]  Kristoffer Lindskov Hansen,et al.  Pediatric Transthoracic Cardiac Vector Flow Imaging – A Preliminary Pictorial Study , 2018, Ultrasound International Open.

[2]  L. Lönn,et al.  Atherosclerotic Lesions in the Superficial Femoral Artery (SFA) Characterized with Velocity Ratios using Vector Velocity Ultrasound , 2018, Ultrasound International Open.

[3]  C. Thomsen,et al.  A Comparison Study of Vector Velocity, Spectral Doppler and Magnetic Resonance of Blood Flow in the Common Carotid Artery. , 2018, Ultrasound in medicine & biology.

[4]  L. Lönn,et al.  Vector Flow Imaging Compared with Pulse Wave Doppler for Estimation of Peak Velocity in the Portal Vein. , 2017, Ultrasound in medicine & biology.

[5]  Kristoffer Lindskov Hansen,et al.  Aortic Valve Stenosis Increases Helical Flow and Flow Complexity: A Study of Intra-Operative Cardiac Vector Flow Imaging. , 2017, Ultrasound in medicine & biology.

[6]  J. Jensen,et al.  Vector Flow Imaging Compared with Conventional Doppler Ultrasound and Thermodilution for Estimation of Blood Flow in the Ascending Aorta , 2017, Ultrasonic imaging.

[7]  Kristoffer Lindskov Hansen,et al.  Intra-Operative Vector Flow Imaging Using Ultrasound of the Ascending Aorta among 40 Patients with Normal, Stenotic and Replaced Aortic Valves. , 2016, Ultrasound in medicine & biology.

[8]  Piero Tortoli,et al.  Plane-wave transverse oscillation for high-frame-rate 2-D vector flow imaging , 2015, IEEE Transactions on Ultrasonics, Ferroelectrics, and Frequency Control.

[9]  Javier M Romero,et al.  Acoustic shadowing impairs accurate characterization of stenosis in carotid ultrasound examinations. , 2015, Journal of vascular surgery.

[10]  P. Hoskins,et al.  Recent developments in vascular ultrasound technology , 2015, Ultrasound.

[11]  Kristoffer Lindskov Hansen,et al.  First report on intraoperative vector flow imaging of the heart among patients with healthy and diseased aortic valves. , 2015, Ultrasonics.

[12]  L. Lönn,et al.  Novel flow quantification of the carotid bulb and the common carotid artery with vector flow ultrasound. , 2014, Ultrasound in medicine & biology.

[13]  Denis Friboulet,et al.  A New Technique for the Estimation of Cardiac Motion in Echocardiography Based on Transverse Oscillations: A Preliminary Evaluation In Silico and a Feasibility Demonstration In Vivo , 2014, IEEE Transactions on Medical Imaging.

[14]  W. Manning.  Asymptomatic aortic stenosis in the elderly: a clinical review. , 2013, JAMA.

[15]  H. Liebgott,et al.  Multi-resolution transverse oscillation in ultrasound imaging for motion estimation , 2013, IEEE Transactions on Ultrasonics, Ferroelectrics, and Frequency Control.

[16]  J. M. Hansen,et al.  Comparison of real-time in vivo spectral and vector velocity estimation. , 2012, Ultrasound in medicine & biology.

[17]  R. Dayal,et al.  Utility of duplex ultrasound in detecting and grading de novo femoropopliteal lesions. , 2011, Journal of vascular surgery.

[18]  C. Thomsen,et al.  In vivo validation of a blood vector velocity estimator with MR angiography , 2009, IEEE Transactions on Ultrasonics, Ferroelectrics and Frequency Control.

[19]  J. Ballard,et al.  Duplex ultrasound of the superficial femoral artery is a better screening tool than ankle-brachial index to identify at risk patients with lower extremity atherosclerosis. , 2008, Journal of vascular surgery.

[20]  L. Norgren,et al.  Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). , 2007, Journal of vascular surgery.

[21]  J. Jensen,et al.  Investigation of transverse oscillation method , 2006, IEEE Transactions on Ultrasonics, Ferroelectrics and Frequency Control.

[22]  John V. White,et al.  ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography , 2006, Circulation.

[23]  D. Geary,et al.  Duplex Doppler sonography for renal artery stenosis in the post-transplant pediatric patient , 2006, Pediatric Radiology.

[24]  Elizabeth Selvin,et al.  Prevalence of and Risk Factors for Peripheral Arterial Disease in the United States: Results From the National Health and Nutrition Examination Survey, 1999–2000 , 2004, Circulation.

[25]  J. Jensen,et al.  A new estimator for vector velocity estimation [medical ultrasonics] , 2001, IEEE Transactions on Ultrasonics, Ferroelectrics and Frequency Control.

[26]  J A Jensen,et al.  A new estimator for vector velocity estimation. , 2001, IEEE transactions on ultrasonics, ferroelectrics, and frequency control.

[27]  J. Jensen,et al.  A new method for estimation of velocity vectors , 1998, IEEE Transactions on Ultrasonics, Ferroelectrics and Frequency Control.

[28]  P. Chandraratna,et al.  Transesophageal Echocardiographic Assessment of Lesions of the Right Ventricular Outflow Tract and Pulmonic Valve , 1996, Echocardiography.

[29]  A. Feinstein,et al.  Complications of peripheral arteriography: a new system to identify patients at increased risk. , 1995, Journal of vascular surgery.

[30]  G Cloutier,et al.  Changes in ultrasonic Doppler backscattered power downstream of concentric and eccentric stenoses under pulsatile flow. , 1995, Ultrasound in medicine & biology.

[31]  O. Bonnefous.  Measurement of the complete (3D) velocity vector of blood flows , 1988, IEEE 1988 Ultrasonics Symposium Proceedings..

[32]  G. Trahey,et al.  Angle Independent Ultrasonic Detection of Blood Flow , 1987, IEEE Transactions on Biomedical Engineering.

[33]  V. Newhouse,et al.  Ultrasound Doppler Probing of Flows Transverse with Respect to Beam Axis , 1987, IEEE Transactions on Biomedical Engineering.

[34]  M. Fox.  Multiple crossed-beam ultrasound Doppler velocimetry , 1978 .

[35]  O. Reynolds.  III. An experimental investigation of the circumstances which determine whether the motion of water shall be direct or sinuous, and of the law of resistance in parallel channels , 1883, Proceedings of the Royal Society of London.