Comparison of B-Mode with B-Flow Sonography for the Evaluation of Femoral Arteries in Infants

Michael Groth; Elena Dammann; Florian Arndt; Marielle Ernst; Jochen Herrmann

doi:10.1055/s-0043-112249

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, Inhaltsverzeichnis

Rofo 2017; 189(12): 1161-1167
DOI: 10.1055/s-0043-112249

Pediatric Radiology

Comparison of B-Mode with B-Flow Sonography for the Evaluation of Femoral Arteries in Infants

Vergleich von B-Bild und B-Flow Sonografie zur Evaluation der Femoralarterien bei Säuglingen

Michael Groth

¹Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Division of Pediatric Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

,

Elena Dammann

¹Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Division of Pediatric Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

,

Florian Arndt

²University Heart Center Hamburg, Department of Pediatric Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

,

Marielle Ernst

³Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

,

Jochen Herrmann

¹Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Division of Pediatric Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

› Institutsangaben

Abstract

Purpose To evaluate femoral arteries (FAs) in infants in the context of catheter angiography with B-mode (BMS) and B-flow sonography (BFS) and to compare both methods for vessel delineation and reliability of vessel diameter measurements.

Methods 21 consecutive infants who underwent ultrasound for the evaluation of FAs before or after cardiac catheterization were retrospectively included in this study. The diameter of the FAs and the maximum length of the vessel section displayed on a single ultrasound plane were recorded by two radiologists for BMS and BFS. The visual image quality was rated by one observer. Statistics included intraclass correlation coefficient, Bland-Altman analysis, Fisher´s exact test and t-test.

Results The intraobserver as well as interobserver correlation was excellent for BMS (0.7922 and 0.6521) and BFS (0.8094 and 0.7637). The Bland-Altman analysis revealed limits of agreement for BMS between +/–0.73 mm (intraobserver) and +/–0.55 mm (interobserver) and for BFS between +/–0.83 mm (intraobserver) and +/–0.7 mm (interobserver). BFS allowed visualization of a longer stretch of the FA than BMS (length 3.54 +/–0.85 vs. 2.21 +/–0.9 cm, p < 0.0001). The image quality was significantly higher for BFS (p = 0.0043).

Conclusion Since BFS shows excellent reproducibility for vessel measurements and superior image quality in infants, if available, BFS should be included in standard protocols when realistic measurements are required.

Key Points

B-flow sonography offers high image quality for the evaluation of femoral arteries.
Femoral artery diameter measurements performed with B-flow sonography show excellent reproducibility.
If available, additional B-flow sonography of femoral arteries in infants is recommended.

Citation Format

Groth M, Dammann E, Arndt F et al. Comparison of B-Mode with B-Flow Sonography for the Evaluation of Femoral Arteries in Infants. Fortschr Röntgenstr 2017; 189: 1161 – 1167

Zusammenfassung

Ziel Evaluation von Femoralarterien (FA) bei Neugeborenen im Rahmen einer Herzkatheteruntersuchung mittels B-Mode (BMS) und B-Flow Sonographie (BFS) und Vergleich beider Methoden bzgl. Bildqualität und Reliabilität von Diametermessungen.

Material und Methoden Das Studienkollektiv bestand aus 21 konsekutiven Säuglingen, welche einen Ultraschall zur Evalation der FA vor oder nach Herzkatheteruntersuchung erhielten. Die Ultraschalldatensätze wurden von zwei Radiologen ausgewertet. Es wurden Gefäßdiameter sowie die maximal auf einem Ultraschallbild darstellbare Gefäßlänge mittels BMS und BFS vermessen. Zusätzlich wurde die Bildqualiät von einem Radiologen bewertet. Die Statistik umfasste den Intra-Klassen-Korrelationskoeffizient, eine Bland-Altman Analyse, Fisher´s exakten Test sowie einen t-Test.

Ergebnisse Die Intra- und Interobserverkorrelation war exzellent für BMS (0,7922 and 0,6521) sowie BFS (0,8094 and 0,7637). Eine Bland-Altman Analyse zeigte mittlere Abweichungen zwischen +/–0,73 mm (intraobserver) und für BMS +/–0,55 mm (interobserver) sowie +/–0,83 mm (intraobserver) und +/–0,7 mm (interobserver) für BFS. BFS ermöglicht eine signifikant längere Gefäßabbildung auf einem Ultraschallbild (3,54 +/–0,85 vs. 2,21 +/–0,9 cm, p < 0,0001). Darüber hinaus war die Bildqualität mit BFS signifikant besser als mit BMS (p = 0,0043).

Schlussfolgerung Da BFS eine exzellente Reproduzierbarkeit bei Gefäßdiametermessungen sowie eine der BMS überlegende Bildqualität zeigt, sollte BFS, falls vorhanden, standardmäßig in Untersuchungsprotokolle integriert werden, wenn realistische Gefäßmessungen und -abbildungen erforderlich sind.

Kernaussagen

Die B-Flow Sonographie bietet eine hohe Bildqualität für die Evaluation von Femoralarterien
Gefäßdiametermessungen können mit der B-Flow Sonographie mit exzellenter Reproduzierbarkeit durchgeführt werden
Eine ergänzende B-Flow Sonographie der Femoralarterien von Säuglingen wird empfohlen, falls vorhanden

Key words

femoral artery - measurement - ultrasound - B-flow sonography - B-mode sonography

Volltext

Referenzen

References
1 Weskott HP. B-flow--a new method for detecting blood flow. Ultraschall in Med 2000; 21: 59-65
2 Horng A, Reiser M, Clevert DA. Current developments in vascular ultrasound. Radiologe 2009; 49: 998-1004
3 Umemura A, Yamada K. B-mode flow imaging of the carotid artery. Stroke 2001; 32: 2055-2057
4 Bucek RA, Reiter M, Koppensteiner I. et al. B-flow evaluation of carotid arterial stenosis: initial experience. Radiology 2002; 225: 295-299
5 Wachsberg RH. B-flow imaging of the hepatic vasculature: correlation with color Doppler sonography. Am J Roentgenol 2007; 188: W522-W533
6 Russo E, Cerbone V, Sciano D. et al. Posttransplant renal monitoring with B-flow ultrasonography. Transplant Proc 2010; 42: 1127-1129
7 Hancerliogullari KO, Soyer T, Tosun A. et al. Is B-Flow USG superior to Color Doppler USG for evaluating blood flow patterns in ovarian torsion?. J Pediatr Surg 2015; 50: 1156-1161
8 Zhang D, Zhang Y, Ren W. et al. Prenatal Diagnosis of Fetal Interrupted Aortic Arch Type A by Two-Dimensional Echocardiography and Four-Dimensional Echocardiography with B-Flow Imaging and Spatiotemporal Image Correlation. Echocardiography 2015; 33: 90-98
9 Jung EM, Lutz R, Clevert DA. et al. B-Flow: sonographic assessment and therapy for femoral artery pseudoaneurysm. Rofo 2001; 173: 805-809
10 Clevert DA, Rupp N, Reiser M. et al. Improved diagnosis of vascular dissection by ultrasound B-flow: a comparison with color-coded Doppler and power Doppler sonography. Eur Radiol 2005; 15: 342-347
11 Kroger K, Nettelrodt J, Muntsches C. et al. Impact of age, height, and body mass index on arterial diameters in infants and children: a model for predicting femoral artery diameters prior to cardiovascular procedures. J Endovasc Ther 2004; 11: 419-423
12 Knirsch W, Kellenberger C, Dittrich S. et al. Femoral arterial thrombosis after cardiac catheterization in infancy: impact of Doppler ultrasound for diagnosis. Pediatr Cardiol 2013; 34: 530-535
13 Gurtelschmid M, Bjorck M, Wanhainen A. Comparison of three ultrasound methods of measuring the diameter of the abdominal aorta. Br J Surg 2014; 101: 633-636
14 Oktar SO, Yucel C, Karaosmanoglu D. et al. Blood-flow volume quantification in internal carotid and vertebral arteries: comparison of 3 different ultrasound techniques with phase-contrast MR imaging. AJNR Am J Neuroradiol 2006; 27: 363-369
15 Costa-Santos C, Bernardes J, Ayres-de-Campos D. et al. The limits of agreement and the intraclass correlation coefficient may be inconsistent in the interpretation of agreement. J Clin Epidemiol 2011; 64: 1049
16 Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307-310
17 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159-174
18 Schwemmer U, Arzet HA, Trautner H. et al. Ultrasound-guided arterial cannulation in infants improves success rate. Eur J Anaesthesiol 2006; 23: 476-480
19 Hollinger I, Mittnacht A. Cardiac catheterization laboratory: catheterization, interventional cardiology, and ablation techniques for children. Int Anesthesiol Clin 2009; 47: 63-99
20 Brotschi B, Hug MI, Kretschmar O. et al. Incidence and predictors of cardiac catheterisation-related arterial thrombosis in children. Heart 2015; 101: 948-953
21 Vitiello R, McCrindle BW, Nykanen D. et al. Complications associated with pediatric cardiac catheterization. J Am Coll Cardiol 1998; 32: 1433-1440
22 Lin PH, Dodson TF, Bush RL. et al. Surgical intervention for complications caused by femoral artery catheterization in pediatric patients. J Vasc Surg 2001; 34: 1071-1078
23 Wikstrand J. Methodological Considerations of Ultrasound Measurement of Carotid Artery Intima-Media Thickness and Lumen Diameter. In: Nicokaides A. ed Ultrasound and Carotid Bifurcation Atherosclerosis. London Dordrecht Heidelberg New York: Springer; 2012: 165-176
24 Machado P, Segal S, Lyshchik A. et al. A Novel Microvascular Flow Technique: Initial Results in Thyroids. Ultrasound Q 2016; 32: 67-74