Skip to main content
Erschienen in: European Radiology 6/2013

01.06.2013 | Ultrasound

Evaluation of distal turbulence intensity for the detection of both plaque ulceration and stenosis grade in the carotid bifurcation using clinical Doppler ultrasound

verfasst von: Emily Y. Wong, Hristo N. Nikolov, Richard N. Rankin, David W. Holdsworth, Tamie L. Poepping

Erschienen in: European Radiology | Ausgabe 6/2013

Einloggen, um Zugang zu erhalten

Abstract

Objectives

To determine the interrelationship of stenosis grade and ulceration with distal turbulence intensity (TI) in the carotid bifurcation measured using conventional clinical Doppler ultrasound (DUS) in vitro, in order to establish the feasibility of TI as a diagnostic parameter for plaque ulceration.

Methods

DUS TI was evaluated in a matched set of ulcerated and smooth-walled carotid bifurcation phantoms with various stenosis severities (30, 50, 60 and 70 %), where the ulcerated models incorporated a type 3 ulceration.

Results

Post-stenotic TI was significantly elevated owing to ulceration in the mild and moderate stenoses (P < 0.001). TI increased with stenosis severity in both the ulcerated and non-ulcerated series, with a statistically significant effect of increasing stenosis severity (P < 0.001). Whereas TI in the mild and non-ulcerated moderate stenoses was less than 20.4 ± 1.3 cm s−1, TI in the ulcerated moderate and severe models was higher than 25.6 ±1.3 cm s−1, indicating a potential diagnostic threshold.

Conclusion

We report a two-curve relationship of stenosis grade and ulceration to distal TI measured using clinical DUS in vitro. Clinical DUS measurement of distal TI may be a diagnostic approach to detecting ulceration in the mild and moderately stenosed carotid artery.

Key Points

Patients with carotid artery plaque ulcerations are at higher risk of stroke.
Clinical Doppler ultrasound is routinely used to detect carotid artery stenosis.
Doppler ultrasound turbulence intensity can detect ulceration in realistic flow models.
Turbulence intensity also increases with stenosis severity independent of ulceration.
Doppler ultrasound should help in assessing both stenosis severity and ulceration.
Literatur
1.
Zurück zum Zitat Hankey GJ (1999) Stroke prediction and prevention by carotid endarterectomy: keep an eye on the doughnut and not just the hole. Cerebrovasc Dis 9:345–350PubMedCrossRef Hankey GJ (1999) Stroke prediction and prevention by carotid endarterectomy: keep an eye on the doughnut and not just the hole. Cerebrovasc Dis 9:345–350PubMedCrossRef
2.
Zurück zum Zitat Eliasziw M, Streifler JY, Fox AJ et al (1994) Significance of plaque ulceration in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial. Stroke 25:304–308PubMedCrossRef Eliasziw M, Streifler JY, Fox AJ et al (1994) Significance of plaque ulceration in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial. Stroke 25:304–308PubMedCrossRef
3.
Zurück zum Zitat Rothwell PM, Gibson R, Warlow CP (2000) Interrelation between plaque surface morphology and degree of stenosis on carotid angiograms and the risk of ischemic stroke in patients with symptomatic carotid stenosis. On behalf of the European Carotid Surgery Trialists’ Collaborative Group. Stroke 31:615–621PubMedCrossRef Rothwell PM, Gibson R, Warlow CP (2000) Interrelation between plaque surface morphology and degree of stenosis on carotid angiograms and the risk of ischemic stroke in patients with symptomatic carotid stenosis. On behalf of the European Carotid Surgery Trialists’ Collaborative Group. Stroke 31:615–621PubMedCrossRef
4.
Zurück zum Zitat Prabhakaran S, Rundek T, Ramas R et al (2006) Carotid plaque surface irregularity predicts ischemic stroke: the northern Manhattan study. Stroke 37:2696–2701PubMedCrossRef Prabhakaran S, Rundek T, Ramas R et al (2006) Carotid plaque surface irregularity predicts ischemic stroke: the northern Manhattan study. Stroke 37:2696–2701PubMedCrossRef
5.
Zurück zum Zitat Rothwell PM, Gutnikov SA, Warlow CP (2003) Reanalysis of the final results of the European Carotid Surgery Trial. Stroke 34:514–523PubMedCrossRef Rothwell PM, Gutnikov SA, Warlow CP (2003) Reanalysis of the final results of the European Carotid Surgery Trial. Stroke 34:514–523PubMedCrossRef
6.
Zurück zum Zitat Wong EY, Nikolov HN, Thorne ML et al (2009) Clinical Doppler ultrasound for the assessment of plaque ulceration in the stenosed carotid bifurcation by detection of distal turbulence intensity: a matched model study. Eur Radiol 19:2739–2749PubMedCrossRef Wong EY, Nikolov HN, Thorne ML et al (2009) Clinical Doppler ultrasound for the assessment of plaque ulceration in the stenosed carotid bifurcation by detection of distal turbulence intensity: a matched model study. Eur Radiol 19:2739–2749PubMedCrossRef
7.
Zurück zum Zitat Stein PD, Sabbah HN (1974) Measured turbulence and its effect on thrombus formation. Circ Res 35:608–614PubMedCrossRef Stein PD, Sabbah HN (1974) Measured turbulence and its effect on thrombus formation. Circ Res 35:608–614PubMedCrossRef
8.
Zurück zum Zitat Cloutier G, Shung KK (1993) Study of red cell aggregation in pulsatile flow from ultrasonic Doppler power measurements. Biorheology 30:443–461PubMed Cloutier G, Shung KK (1993) Study of red cell aggregation in pulsatile flow from ultrasonic Doppler power measurements. Biorheology 30:443–461PubMed
9.
Zurück zum Zitat Fox AJ (1993) How to measure carotid stenosis. Radiology 186:316–318PubMed Fox AJ (1993) How to measure carotid stenosis. Radiology 186:316–318PubMed
10.
Zurück zum Zitat Smith RF, Rutt BK, Fox AJ et al (1996) Geometric characterization of stenosed human carotid arteries. Acad Radiol 3:898–911PubMedCrossRef Smith RF, Rutt BK, Fox AJ et al (1996) Geometric characterization of stenosed human carotid arteries. Acad Radiol 3:898–911PubMedCrossRef
11.
Zurück zum Zitat Wong EY, Thorne ML, Nikolov HN et al (2008) Doppler ultrasound compatible plastic material for use in rigid flow models. Ultrasound Med Biol 34:1846–1856PubMedCrossRef Wong EY, Thorne ML, Nikolov HN et al (2008) Doppler ultrasound compatible plastic material for use in rigid flow models. Ultrasound Med Biol 34:1846–1856PubMedCrossRef
12.
Zurück zum Zitat Lovett JK, Gallagher PJ, Hands LJ et al (2004) Histological correlates of carotid plaque surface morphology on lumen contrast imaging. Circulation 110:2190–2197PubMedCrossRef Lovett JK, Gallagher PJ, Hands LJ et al (2004) Histological correlates of carotid plaque surface morphology on lumen contrast imaging. Circulation 110:2190–2197PubMedCrossRef
13.
Zurück zum Zitat de Weert TT, Cretier S, Groen HC et al (2009) Atherosclerotic plaque surface morphology in the carotid bifurcation assessed with multidetector computed tomography angiography. Stroke 40:1334–1340PubMedCrossRef de Weert TT, Cretier S, Groen HC et al (2009) Atherosclerotic plaque surface morphology in the carotid bifurcation assessed with multidetector computed tomography angiography. Stroke 40:1334–1340PubMedCrossRef
14.
Zurück zum Zitat Ramnarine KV, Nassiri DK, Hoskins PR et al (1998) Validation of a new blood-mimicking fluid for use in Doppler flow test objects. Ultrasound Med Biol 24:451–459PubMedCrossRef Ramnarine KV, Nassiri DK, Hoskins PR et al (1998) Validation of a new blood-mimicking fluid for use in Doppler flow test objects. Ultrasound Med Biol 24:451–459PubMedCrossRef
15.
Zurück zum Zitat Thorne ML, Poepping TL, Rankin RN et al (2008) Use of an ultrasound blood-mimicking fluid for Doppler investigations of turbulence in vitro. Ultrasound Med Biol 34:1163–1173PubMedCrossRef Thorne ML, Poepping TL, Rankin RN et al (2008) Use of an ultrasound blood-mimicking fluid for Doppler investigations of turbulence in vitro. Ultrasound Med Biol 34:1163–1173PubMedCrossRef
16.
Zurück zum Zitat Holdsworth DW, Norley CJ, Frayne R et al (1999) Characterization of common carotid artery blood-flow waveforms in normal human subjects. Physiol Meas 20:219–240PubMedCrossRef Holdsworth DW, Norley CJ, Frayne R et al (1999) Characterization of common carotid artery blood-flow waveforms in normal human subjects. Physiol Meas 20:219–240PubMedCrossRef
17.
Zurück zum Zitat Frayne R, Holdsworth DW, Gowman LM et al (1992) Computer-controlled flow simulator for MR flow studies. J Magn Reson Imaging 2:605–612PubMedCrossRef Frayne R, Holdsworth DW, Gowman LM et al (1992) Computer-controlled flow simulator for MR flow studies. J Magn Reson Imaging 2:605–612PubMedCrossRef
18.
Zurück zum Zitat Poepping TL, Nikolov HN, Rankin RN et al (2002) An in vitro system for Doppler ultrasound flow studies in the stenosed carotid artery bifurcation. Ultrasound Med Biol 28:495–506PubMedCrossRef Poepping TL, Nikolov HN, Rankin RN et al (2002) An in vitro system for Doppler ultrasound flow studies in the stenosed carotid artery bifurcation. Ultrasound Med Biol 28:495–506PubMedCrossRef
19.
Zurück zum Zitat Hinze JO (1959) Turbulence: an introduction to its mechanism and theory. McGraw-Hill, New York Hinze JO (1959) Turbulence: an introduction to its mechanism and theory. McGraw-Hill, New York
20.
Zurück zum Zitat Yongchareon W, Young DF (1979) Initiation of turbulence in models of arterial stenoses. J Biomech 12:185–196PubMedCrossRef Yongchareon W, Young DF (1979) Initiation of turbulence in models of arterial stenoses. J Biomech 12:185–196PubMedCrossRef
21.
Zurück zum Zitat Tamura T, Fronek A (1990) Detection of moving flow separation in pulsatile flow and the degree of stenosis by power of Doppler shift signals. Circ Res 67:166–174PubMedCrossRef Tamura T, Fronek A (1990) Detection of moving flow separation in pulsatile flow and the degree of stenosis by power of Doppler shift signals. Circ Res 67:166–174PubMedCrossRef
22.
Zurück zum Zitat Loree HM, Kamm RD, Atkinson CM et al (1991) Turbulent pressure fluctuations on surface of model vascular stenoses. Am J Physiol 261:H644–H650PubMed Loree HM, Kamm RD, Atkinson CM et al (1991) Turbulent pressure fluctuations on surface of model vascular stenoses. Am J Physiol 261:H644–H650PubMed
23.
Zurück zum Zitat Hutchison KJ, Karpinski E (1985) In vivo demonstration of flow recirculation and turbulence downstream of graded stenoses in canine arteries. J Biomech 18:285–296PubMedCrossRef Hutchison KJ, Karpinski E (1985) In vivo demonstration of flow recirculation and turbulence downstream of graded stenoses in canine arteries. J Biomech 18:285–296PubMedCrossRef
24.
Zurück zum Zitat Hjortdal JO, Pedersen EM, Hjortdal VE et al (1991) Velocity field studies at surgically imposed arterial stenoses on the abdominal aorta in pigs. J Biomech 24:1081–1093PubMedCrossRef Hjortdal JO, Pedersen EM, Hjortdal VE et al (1991) Velocity field studies at surgically imposed arterial stenoses on the abdominal aorta in pigs. J Biomech 24:1081–1093PubMedCrossRef
25.
Zurück zum Zitat Nygaard H, Hasenkam JM, Pedersen EM et al (1994) A new perivascular multi-element pulsed Doppler ultrasound system for in vivo studies of velocity fields and turbulent stresses in large vessels. Med Biol Eng Comput 32:55–62PubMedCrossRef Nygaard H, Hasenkam JM, Pedersen EM et al (1994) A new perivascular multi-element pulsed Doppler ultrasound system for in vivo studies of velocity fields and turbulent stresses in large vessels. Med Biol Eng Comput 32:55–62PubMedCrossRef
26.
Zurück zum Zitat Solzbach U, Wollschlager H, Zeiher A et al (1987) Effect of stenotic geometry on flow behaviour across stenotic models. Med Biol Eng Comput 25:543–550PubMedCrossRef Solzbach U, Wollschlager H, Zeiher A et al (1987) Effect of stenotic geometry on flow behaviour across stenotic models. Med Biol Eng Comput 25:543–550PubMedCrossRef
27.
Zurück zum Zitat Young DF (1979) Fluid mechanics of arterial stenoses. J Biomech Eng 101:157–175CrossRef Young DF (1979) Fluid mechanics of arterial stenoses. J Biomech Eng 101:157–175CrossRef
28.
Zurück zum Zitat Ojha M, Cobbold RSC, Johnston KW et al (1989) Pulsatile flow through constricted tubes: an experimental investigation using photochromic tracer methods. J Fluid Mech 203:173–197CrossRef Ojha M, Cobbold RSC, Johnston KW et al (1989) Pulsatile flow through constricted tubes: an experimental investigation using photochromic tracer methods. J Fluid Mech 203:173–197CrossRef
29.
Zurück zum Zitat Casty M, Giddens DP (1984) 25 + 1 channel pulsed ultrasound Doppler velocity meter for quantitative flow measurements and turbulence analysis. Ultrasound Med Biol 10:161–172PubMedCrossRef Casty M, Giddens DP (1984) 25 + 1 channel pulsed ultrasound Doppler velocity meter for quantitative flow measurements and turbulence analysis. Ultrasound Med Biol 10:161–172PubMedCrossRef
30.
Zurück zum Zitat Isaaz K, Bruntz JF, Da Costa A et al (2003) Noninvasive quantitation of blood flow turbulence in patients with aortic valve disease using online digital computer analysis of Doppler velocity data. J Am Soc Echocardiogr 16:965–974PubMedCrossRef Isaaz K, Bruntz JF, Da Costa A et al (2003) Noninvasive quantitation of blood flow turbulence in patients with aortic valve disease using online digital computer analysis of Doppler velocity data. J Am Soc Echocardiogr 16:965–974PubMedCrossRef
31.
Zurück zum Zitat Thorne ML, Rankin RN, Steinman DA et al (2010) In vivo Doppler ultrasound quantification of turbulence intensity using a high-pass frequency filter method. Ultrasound Med Biol 36:761–771PubMedCrossRef Thorne ML, Rankin RN, Steinman DA et al (2010) In vivo Doppler ultrasound quantification of turbulence intensity using a high-pass frequency filter method. Ultrasound Med Biol 36:761–771PubMedCrossRef
32.
Zurück zum Zitat Thorne ML, Poepping TL, Nikolov HN et al (2009) In vitro Doppler ultrasound investigation of turbulence intensity in pulsatile flow with simulated cardiac variability. Ultrasound Med Biol 35:120–128PubMedCrossRef Thorne ML, Poepping TL, Nikolov HN et al (2009) In vitro Doppler ultrasound investigation of turbulence intensity in pulsatile flow with simulated cardiac variability. Ultrasound Med Biol 35:120–128PubMedCrossRef
33.
Zurück zum Zitat Grant EG, Benson CB, Moneta GL et al (2003) Carotid artery stenosis: grayscale and Doppler ultrasound diagnosis—Society of Radiologists in Ultrasound consensus conference. Ultrasound Q 19:190–198PubMedCrossRef Grant EG, Benson CB, Moneta GL et al (2003) Carotid artery stenosis: grayscale and Doppler ultrasound diagnosis—Society of Radiologists in Ultrasound consensus conference. Ultrasound Q 19:190–198PubMedCrossRef
34.
Zurück zum Zitat Dunmire B, Pagel G, Beach KW et al. (2001) Post stenotic flow disturbances in a steady flow model. Proc SPIE 4325:502–513. doi:10.1117/12.495782 Dunmire B, Pagel G, Beach KW et al. (2001) Post stenotic flow disturbances in a steady flow model. Proc SPIE 4325:502–513. doi:10.​1117/​12.​495782
35.
Zurück zum Zitat Evans DH, McDicken WN (2000) Doppler ultrasound: physics, instrumentation and signal processing, 2nd edn. Wiley, Chichester Evans DH, McDicken WN (2000) Doppler ultrasound: physics, instrumentation and signal processing, 2nd edn. Wiley, Chichester
36.
Zurück zum Zitat Cloutier G, Allard L, Durand LG (1996) Characterization of blood flow turbulence with pulsed-wave and power Doppler ultrasound imaging. J Biomech Eng 118:318–325PubMedCrossRef Cloutier G, Allard L, Durand LG (1996) Characterization of blood flow turbulence with pulsed-wave and power Doppler ultrasound imaging. J Biomech Eng 118:318–325PubMedCrossRef
37.
Zurück zum Zitat Ojha M, Johnston KW, Cobbold RS et al (1989) Potential limitations of center-line pulsed Doppler recordings: an in vitro flow visualization study. J Vasc Surg 9:515–520PubMed Ojha M, Johnston KW, Cobbold RS et al (1989) Potential limitations of center-line pulsed Doppler recordings: an in vitro flow visualization study. J Vasc Surg 9:515–520PubMed
38.
Zurück zum Zitat Haberman S, Friedman Z (1998) Multigated simultaneous spectral Doppler imaging: a new ultrasound modality. Obstet Gynecol 92:299–302PubMedCrossRef Haberman S, Friedman Z (1998) Multigated simultaneous spectral Doppler imaging: a new ultrasound modality. Obstet Gynecol 92:299–302PubMedCrossRef
39.
Zurück zum Zitat Tortoli P, Bassi L, Boni E et al (2009) ULA-OP: an advanced open platform for ultrasound research. IEEE Trans Ultrason Ferroelectr Freq Control 56:2207–2216PubMedCrossRef Tortoli P, Bassi L, Boni E et al (2009) ULA-OP: an advanced open platform for ultrasound research. IEEE Trans Ultrason Ferroelectr Freq Control 56:2207–2216PubMedCrossRef
40.
Zurück zum Zitat Imbesi SG, Kerber CW (1998) Why do ulcerated atherosclerotic carotid artery plaques embolize? A flow dynamics study. AJNR Am J Neuroradiol 19:761–766PubMed Imbesi SG, Kerber CW (1998) Why do ulcerated atherosclerotic carotid artery plaques embolize? A flow dynamics study. AJNR Am J Neuroradiol 19:761–766PubMed
41.
Zurück zum Zitat Giannattasio C, Mancia G (2002) Arterial distensibility in humans. Modulating mechanisms, alterations in diseases and effects of treatment. J Hypertens 20:1889–1899PubMedCrossRef Giannattasio C, Mancia G (2002) Arterial distensibility in humans. Modulating mechanisms, alterations in diseases and effects of treatment. J Hypertens 20:1889–1899PubMedCrossRef
42.
Zurück zum Zitat Benetos A, Waeber B, Izzo J et al (2002) Influence of age, risk factors, and cardiovascular and renal disease on arterial stiffness: clinical applications. Am J Hypertens 15:1101–1108PubMedCrossRef Benetos A, Waeber B, Izzo J et al (2002) Influence of age, risk factors, and cardiovascular and renal disease on arterial stiffness: clinical applications. Am J Hypertens 15:1101–1108PubMedCrossRef
43.
Zurück zum Zitat Van Bortel LM, Spek JJ (1998) Influence of aging on arterial compliance. J Hum Hypertens 12:583–586PubMedCrossRef Van Bortel LM, Spek JJ (1998) Influence of aging on arterial compliance. J Hum Hypertens 12:583–586PubMedCrossRef
44.
Zurück zum Zitat Mancia G, Giannattasio C, Grassi G (1998) Arterial distensibility in cardiovascular diseases. J Nephrol 11:284–288PubMed Mancia G, Giannattasio C, Grassi G (1998) Arterial distensibility in cardiovascular diseases. J Nephrol 11:284–288PubMed
45.
Zurück zum Zitat Hansen F, Mangell P, Sonesson B et al (1995) Diameter and compliance in the human common carotid artery–variations with age and sex. Ultrasound Med Biol 21:1–9PubMedCrossRef Hansen F, Mangell P, Sonesson B et al (1995) Diameter and compliance in the human common carotid artery–variations with age and sex. Ultrasound Med Biol 21:1–9PubMedCrossRef
46.
Zurück zum Zitat Perktold K, Rappitsch G (1995) Computer simulation of local blood flow and vessel mechanics in a compliant carotid artery bifurcation model. J Biomech 28:845–856PubMedCrossRef Perktold K, Rappitsch G (1995) Computer simulation of local blood flow and vessel mechanics in a compliant carotid artery bifurcation model. J Biomech 28:845–856PubMedCrossRef
47.
Zurück zum Zitat Zhao SZ, Xu XY, Hughes AD et al (2000) Blood flow and vessel mechanics in a physiologically realistic model of a human carotid arterial bifurcation. J Biomech 33:975–984PubMedCrossRef Zhao SZ, Xu XY, Hughes AD et al (2000) Blood flow and vessel mechanics in a physiologically realistic model of a human carotid arterial bifurcation. J Biomech 33:975–984PubMedCrossRef
48.
Zurück zum Zitat Rundek T (2007) Beyond percent stenosis: carotid plaque surface irregularity and risk of stroke. Int J Stroke 2:169–171PubMedCrossRef Rundek T (2007) Beyond percent stenosis: carotid plaque surface irregularity and risk of stroke. Int J Stroke 2:169–171PubMedCrossRef
49.
Zurück zum Zitat Ahmed RM, Harris JP, Anderson CS et al (2010) Carotid endarterectomy for symptomatic, but “haemodynamically insignificant” carotid stenosis. Eur J Vasc Endovasc Surg 40:475–482PubMedCrossRef Ahmed RM, Harris JP, Anderson CS et al (2010) Carotid endarterectomy for symptomatic, but “haemodynamically insignificant” carotid stenosis. Eur J Vasc Endovasc Surg 40:475–482PubMedCrossRef
50.
Zurück zum Zitat Saba L, Caddeo G, Sanfilippo R, Montisci R, Mallarini G (2007) CT and ultrasound in the study of ulcerated carotid plaque compared with surgical results: potentialities and advantages of multidetector row CT angiography. AJNR Am J Neuroradiol 28:1061–1066PubMedCrossRef Saba L, Caddeo G, Sanfilippo R, Montisci R, Mallarini G (2007) CT and ultrasound in the study of ulcerated carotid plaque compared with surgical results: potentialities and advantages of multidetector row CT angiography. AJNR Am J Neuroradiol 28:1061–1066PubMedCrossRef
51.
Zurück zum Zitat Remonda L, Senn P, Barth A, Arnold M, Lovblad KO et al (2002) Contrast-enhanced 3D MR angiography of the carotid artery: comparison with conventional digital subtraction angiography. AJNR Am J Neuroradiol 23:213–219PubMed Remonda L, Senn P, Barth A, Arnold M, Lovblad KO et al (2002) Contrast-enhanced 3D MR angiography of the carotid artery: comparison with conventional digital subtraction angiography. AJNR Am J Neuroradiol 23:213–219PubMed
52.
Zurück zum Zitat Nesbitt WS, Westein E, Tovar-Lopez FJ et al (2009) A shear gradient-dependent platelet aggregation mechanism drives thrombus formation. Nat Med 15:665–673PubMedCrossRef Nesbitt WS, Westein E, Tovar-Lopez FJ et al (2009) A shear gradient-dependent platelet aggregation mechanism drives thrombus formation. Nat Med 15:665–673PubMedCrossRef
Metadaten
Titel
Evaluation of distal turbulence intensity for the detection of both plaque ulceration and stenosis grade in the carotid bifurcation using clinical Doppler ultrasound
verfasst von
Emily Y. Wong
Hristo N. Nikolov
Richard N. Rankin
David W. Holdsworth
Tamie L. Poepping
Publikationsdatum
01.06.2013
Verlag
Springer-Verlag
Erschienen in
European Radiology / Ausgabe 6/2013
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-012-2741-6

Weitere Artikel der Ausgabe 6/2013

European Radiology 6/2013 Zur Ausgabe

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.