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CC BY-NC-ND 4.0 · Ultrasound Int Open 2019; 05(02): E53-E59
DOI: 10.1055/a-0853-2002
Original Article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2018

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

Kristoffer Lindskov Hansen
1   Department of Diagnostic Radiology, Copenhagen University Hospital, Copenhagen, Denmark
2   Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
,
Peter Møller Hansen
1   Department of Diagnostic Radiology, Copenhagen University Hospital, Copenhagen, Denmark
,
Caroline Ewertsen
1   Department of Diagnostic Radiology, Copenhagen University Hospital, Copenhagen, Denmark
2   Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
,
Lars Lönn
1   Department of Diagnostic Radiology, Copenhagen University Hospital, Copenhagen, Denmark
3   Department of Vascular Surgery, Copenhagen University Hospital, Copenhagen, Denmark
,
Jørgen Arendt Jensen
4   Center for Fast Ultrasound Imaging, Technical University of Denmark, DTU Elektro, Kgs. Lyngby, Denmark
,
Michael Bachmann Nielsen
1   Department of Diagnostic Radiology, Copenhagen University Hospital, Copenhagen, Denmark
2   Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
› Author Affiliations
Further Information

Publication History

received 19 September 2018
revised 01 December 2018

accepted 29 January 2019

Publication Date:
15 March 2019 (online)

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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.

Key words

vector flow imaging - vector concentration - velocity ratio - digital subtraction angiography - peripheral arterial disease
 

  • References

  • 1 Hirsch AT, Haskal ZJ, Hertzer NR. ACC/AHA 2005 Practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic). Circulation 2006; 113: e463-e654
    CrossrefPubMedGoogle Scholar
  • 2 Selvin E, Erlinger TP. Prevalence of and risk factors for peripheral arterial disease in the United States: Results from the National Health and Nutrition Examination Survey, 1999-2000. Circulation 2004; 110: 738-743
    CrossrefPubMedGoogle Scholar
  • 3 Egglin TK, O'Moore PV, Feinstein AR. et al. Complications of peripheral arteriography: A new system to identify patients at increased risk. J Vasc Surg 1995; 22: 787-794
    CrossrefPubMedGoogle Scholar
  • 4 Flanigan DP, Ballard JL, Robinson D. 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. J Vasc Surg 2008; 47: 789-792; discussion 92-93
    CrossrefPubMedGoogle Scholar
  • 5 Khan SZ, Khan MA, Bradley B. et al. Utility of duplex ultrasound in detecting and grading de novo femoropopliteal lesions. J Vasc Surg 2011; 54: 1067-1073
    CrossrefPubMedGoogle Scholar
  • 6 Hoskins PR, Kenwright DA. Recent developments in vascular ultrasound technology. Ultrasound 2015; 23: 158-165
    CrossrefPubMedGoogle Scholar
  • 7 Bonnefous O. Measurement of the complete (3D) velocity vector of blood flows. Proc IEEE Ultrason Symp 1988; 795-799
    PubMedGoogle Scholar
  • 8 Fox MD. Multiple crossed-beam ultrasound doppler velocimetry. IEEE Trans Son Ultrason 1978; 25: 281-286
    CrossrefPubMedGoogle Scholar
  • 9 Newhouse VL, Censor D, Vontz T. et al. Ultrasound doppler probing of flows transverse with respect to beam axis. IEEE Trans Biomed Eng 1987; 34: 779-788
    PubMedGoogle Scholar
  • 10 Trahey GE, Allison JW, Ramm OT. Angle independent ultrasonic detection of blood flow. IEEE Trans Biomed Eng 1987; 34: 965-967
    PubMedGoogle Scholar
  • 11 Jensen JA, Munk P. A new method for estimation of velocity vectors. IEEE Trans Ultrason Ferroelect Freq Control 1998; 45: 837-851
    CrossrefPubMedGoogle Scholar
  • 12 Brandt AH, Hansen KL, Ewertsen C. et al. A comparison study of vector velocity, spectral doppler and magnetic resonance of blood flow in the common carotid artery. Ultrasound Med Biol 2018; 44: 1751-1761
    CrossrefPubMedGoogle Scholar
  • 13 Brandt AH, Moshavegh R, Hansen KL. et al. Vector flow imaging compared with pulse wave doppler for estimation of peak velocity in the portal vein. Ultrasound Med Biol 2018; 44: 593-601
    CrossrefPubMedGoogle Scholar
  • 14 Hansen KL, Juul K, Moller-Sorensen H. et al. Pediatric transthoracic cardiac vector flow imaging - A preliminary pictorial study. Ultrasound International Open 2018; 5: E20-E26
    PubMedGoogle Scholar
  • 15 Bechsgaard T, Hansen KL, Brandt AH. et al. Evaluation of peak reflux velocities with vector flow imaging and doppler ultrasound in varicose veins. Ultrasound International Open 2018; 4: E91-E98
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Lenge M, Ramalli A, Tortoli P. et al. Plane-wave transverse oscillation for high-frame-rate 2-D vector flow imaging. IEEE Trans Ultrason Ferroelectr Freq Control 2015; 62: 2126-2137
    CrossrefPubMedGoogle Scholar
  • 17 Alessandrini M, Basarab A, Boussel L. 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. IEEE Trans Med Imaging 2014; 33: 1148-1162
    CrossrefPubMedGoogle Scholar
  • 18 Varray F, Liebgott H. Multi-resolution transverse oscillation in ultrasound imaging for motion estimation. IEEE Trans Ultrason Ferroelectr Freq Control 2013; 60: 1333-1342
    CrossrefPubMedGoogle Scholar
  • 19 Hansen PM, Hansen KL, Pedersen MM. et al. Arteriosclerotic Lesions in the Superficial Femoral Artery (SFA) characterized with velocity ratios using vector velocity ultrasound. Ultrasound International Open 2018; 4: E79-E84
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Hansen KL, Moller-Sorensen H, Kjaergaard J. et al. Intra-operative vector flow imaging using ultrasound of the ascending aorta among 40 patients with normal, stenotic and replaced aortic valves. Ultrasound Med Biol 2016; 42: 2414-2422
    CrossrefPubMedGoogle Scholar
  • 21 Hansen KL, Moller-Sorensen H, Kjaergaard J. et al. Aortic valve stenosis increases helical flow and flow complexity: A study of intra-operative cardiac vector flow imaging. Ultrasound Med Biol 2017; 43: 1607-1617
    CrossrefPubMedGoogle Scholar
  • 22 Norgren L, Hiatt WR, Dormandy JA. et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg 2007; 45 Suppl S S5-S67
    CrossrefPubMedGoogle Scholar
  • 23 Jensen JA. A new estimator for vector velocity estimation. IEEE Trans Ultrason Ferroelec Freq Contr 2001; 48: 886-894
    CrossrefPubMedGoogle Scholar
  • 24 Udesen J, Jensen JA. Investigation of transverse oscillation method. IEEE Trans Ultrason Ferroelec Freq Contr 2006; 53: 959-971
    CrossrefPubMedGoogle Scholar
  • 25 Pedersen MM, Pihl MJ, Haugaard P. et al. Comparison of real-time in vivo spectral and vector velocity estimation. Ultrasound Med Biol 2012; 38: 145-151
    CrossrefPubMedGoogle Scholar
  • 26 Pedersen MM, Pihl MJ, Haugaard P. et al. Novel flow quantification of the carotid bulb and the common carotid artery with vector flow ultrasound. Ultrasound Med Biol 2014; 40: 2700-2706
    CrossrefPubMedGoogle Scholar
  • 27 Reynolds O. 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. Philos Trans R Soc Lond 1883; 174: 935-987
    CrossrefPubMedGoogle Scholar
  • 28 Hansen KL, Moller-Sorensen H, Pedersen MM. et al. First report on intraoperative vector flow imaging of the heart among patients with healthy and diseased aortic valves. Ultrasonics 2015; 56: 243-250
    CrossrefPubMedGoogle Scholar
  • 29 Hutchison SJ, Rosin BL, Curry S. et al. Transesophageal echocardiographic assessment of lesions of the right ventricular outflow tract and pulmonic valve. Echocardiography 1996; 13: 21-34
    CrossrefPubMedGoogle Scholar
  • 30 Cloutier G, Allard L, Durand LG. Changes in ultrasonic doppler backscattered power downstream of concentric and eccentric stenoses under pulsatile flow. Ultrasound Med Biol 1995; 21: 59-70
    CrossrefPubMedGoogle Scholar
  • 31 Stringer DA, O'Halpin D, Daneman A. et al. Duplex doppler sonography for renal artery stenosis in the post-transplant pediatric patient. Pediatr Radiol 1989; 19: 187-192
    CrossrefPubMedGoogle Scholar
  • 32 Manning WJ. Asymptomatic aortic stenosis in the elderly: A clinical review. JAMA 2013; 310: 1490-1497
    CrossrefPubMedGoogle Scholar
  • 33 Hansen KL, Udesen J, Thomsen C. et al. In vivo validation of a blood vector velocity estimator with MR angiography. IEEE Trans Ultrason Ferroelect Freq Control 2009; 56: 91-100
    CrossrefPubMedGoogle Scholar
  • 34 Hansen KL, Moller-Sorensen H, Kjaergaard J. et al. Vector flow imaging compared with conventional doppler ultrasound and thermodilution for estimation of blood flow in the ascending aorta. Ultrason Imaging 2015; 1-16
    PubMedGoogle Scholar
  • 35 Mohebali J, Patel VI, Romero JM. et al. Acoustic shadowing impairs accurate characterization of stenosis in carotid ultrasound examinations. J Vasc Surg 2015; 62: 1236-1244
    CrossrefPubMedGoogle Scholar