Clinical Doppler ultrasound for the assessment of plaque ulceration in the stenosed carotid bifurcation by detection of distal turbulence intensity: A matched model study

Emily Y. Wong; Hristo N. Nikolov; Meghan L. Thorne; Tamie L. Poepping; Richard N. Rankin; David W. Holdsworth

doi:10.1007/s00330-009-1457-8

Clinical Doppler ultrasound for the assessment of plaque ulceration in the stenosed carotid bifurcation by detection of distal turbulence intensity: A matched model study

Emily Y. Wong, Hristo N. Nikolov, Meghan L. Thorne, Tamie L. Poepping, Richard N. Rankin, David W. Holdsworth

Earl E. Bakken Medical Device Center

Research output: Contribution to journal › Article › peer-review

24 Scopus citations

Abstract

The assessment of flow disturbances due to carotid plaque ulceration may provide added diagnostic information to Doppler ultrasound (DUS) of the carotid stenosis, and indicate whether the associated hemodynamics are a potential thromboembolic source. We evaluated the effect of ulceration in a moderately stenosed carotid bifurcation on distal turbulence intensity (TI) measured using clinical DUS in matched anthropomorphic models. Several physiologically relevant ulcer geometries (hemispherical, mushroom-shaped, and ellipsoidal pointing distally and proximally) and sizes (2-mm, 3-mm and 4-mm diameter hemispheres) were investigated. An offline analysis was performed to determine several velocity-based parameters from ensemble-averaged spectral data, including TI. Significant elevations in TI were observed in the post-stenotic flow field of the stenosed carotid bifurcation by the inclusion of ulceration (P < 0.001) in a region two common carotid artery diameters distal to the site of ulceration during the systolic peak and the diastolic phase of the cardiac cycle. Both the size and shape of ulceration had a significant effect on TI in the distal region (P < 0.001). Due to the use of a clinical system, this method provides the means to evaluate for plaque ulcerations in patients with carotid atherosclerosis using DUS.

Original language	English (US)
Pages (from-to)	2739-2749
Number of pages	11
Journal	European Radiology
Volume	19
Issue number	11
DOIs	https://doi.org/10.1007/s00330-009-1457-8
State	Published - 2009

Bibliographical note

Funding Information:
The authors would like to acknowledge ATL (Advanced Technology Laboratories, Philips, Seattle, USA) for the UM9 ultrasound unit. Financial support has been provided by the Heart and Stroke Foundation of Ontario (grant #T-6427). Vessel models were fabricated with support from the Canadian Institutes of Health Research (operating grant #MOP-77964). Dr. Holdsworth is the Dr. Sandy Kirkley Chair of Musculoskeletal Research in the Schulich School of Medicine and Dentistry. Dr. Poepping is supported by a University Faculty Award from the Natural Sciences and Engineering Research Council of Canada. E. Y. Wong is supported by a Canadian Institutes of Health Research Frederick Banting and Charles Best Canada Graduate Scholarships Doctoral Award.

Keywords

Carotid artery
Doppler ultrasound
Flow models
Plaque ulceration
Turbulence intensity

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title = "Clinical Doppler ultrasound for the assessment of plaque ulceration in the stenosed carotid bifurcation by detection of distal turbulence intensity: A matched model study",

abstract = "The assessment of flow disturbances due to carotid plaque ulceration may provide added diagnostic information to Doppler ultrasound (DUS) of the carotid stenosis, and indicate whether the associated hemodynamics are a potential thromboembolic source. We evaluated the effect of ulceration in a moderately stenosed carotid bifurcation on distal turbulence intensity (TI) measured using clinical DUS in matched anthropomorphic models. Several physiologically relevant ulcer geometries (hemispherical, mushroom-shaped, and ellipsoidal pointing distally and proximally) and sizes (2-mm, 3-mm and 4-mm diameter hemispheres) were investigated. An offline analysis was performed to determine several velocity-based parameters from ensemble-averaged spectral data, including TI. Significant elevations in TI were observed in the post-stenotic flow field of the stenosed carotid bifurcation by the inclusion of ulceration (P < 0.001) in a region two common carotid artery diameters distal to the site of ulceration during the systolic peak and the diastolic phase of the cardiac cycle. Both the size and shape of ulceration had a significant effect on TI in the distal region (P < 0.001). Due to the use of a clinical system, this method provides the means to evaluate for plaque ulcerations in patients with carotid atherosclerosis using DUS.",

keywords = "Carotid artery, Doppler ultrasound, Flow models, Plaque ulceration, Turbulence intensity",

author = "Wong, {Emily Y.} and Nikolov, {Hristo N.} and Thorne, {Meghan L.} and Poepping, {Tamie L.} and Rankin, {Richard N.} and Holdsworth, {David W.}",

note = "Funding Information: The authors would like to acknowledge ATL (Advanced Technology Laboratories, Philips, Seattle, USA) for the UM9 ultrasound unit. Financial support has been provided by the Heart and Stroke Foundation of Ontario (grant #T-6427). Vessel models were fabricated with support from the Canadian Institutes of Health Research (operating grant #MOP-77964). Dr. Holdsworth is the Dr. Sandy Kirkley Chair of Musculoskeletal Research in the Schulich School of Medicine and Dentistry. Dr. Poepping is supported by a University Faculty Award from the Natural Sciences and Engineering Research Council of Canada. E. Y. Wong is supported by a Canadian Institutes of Health Research Frederick Banting and Charles Best Canada Graduate Scholarships Doctoral Award.",

year = "2009",

doi = "10.1007/s00330-009-1457-8",

language = "English (US)",

volume = "19",

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T1 - Clinical Doppler ultrasound for the assessment of plaque ulceration in the stenosed carotid bifurcation by detection of distal turbulence intensity

T2 - A matched model study

AU - Wong, Emily Y.

AU - Nikolov, Hristo N.

AU - Thorne, Meghan L.

AU - Poepping, Tamie L.

AU - Rankin, Richard N.

AU - Holdsworth, David W.

N1 - Funding Information: The authors would like to acknowledge ATL (Advanced Technology Laboratories, Philips, Seattle, USA) for the UM9 ultrasound unit. Financial support has been provided by the Heart and Stroke Foundation of Ontario (grant #T-6427). Vessel models were fabricated with support from the Canadian Institutes of Health Research (operating grant #MOP-77964). Dr. Holdsworth is the Dr. Sandy Kirkley Chair of Musculoskeletal Research in the Schulich School of Medicine and Dentistry. Dr. Poepping is supported by a University Faculty Award from the Natural Sciences and Engineering Research Council of Canada. E. Y. Wong is supported by a Canadian Institutes of Health Research Frederick Banting and Charles Best Canada Graduate Scholarships Doctoral Award.

PY - 2009

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N2 - The assessment of flow disturbances due to carotid plaque ulceration may provide added diagnostic information to Doppler ultrasound (DUS) of the carotid stenosis, and indicate whether the associated hemodynamics are a potential thromboembolic source. We evaluated the effect of ulceration in a moderately stenosed carotid bifurcation on distal turbulence intensity (TI) measured using clinical DUS in matched anthropomorphic models. Several physiologically relevant ulcer geometries (hemispherical, mushroom-shaped, and ellipsoidal pointing distally and proximally) and sizes (2-mm, 3-mm and 4-mm diameter hemispheres) were investigated. An offline analysis was performed to determine several velocity-based parameters from ensemble-averaged spectral data, including TI. Significant elevations in TI were observed in the post-stenotic flow field of the stenosed carotid bifurcation by the inclusion of ulceration (P < 0.001) in a region two common carotid artery diameters distal to the site of ulceration during the systolic peak and the diastolic phase of the cardiac cycle. Both the size and shape of ulceration had a significant effect on TI in the distal region (P < 0.001). Due to the use of a clinical system, this method provides the means to evaluate for plaque ulcerations in patients with carotid atherosclerosis using DUS.

AB - The assessment of flow disturbances due to carotid plaque ulceration may provide added diagnostic information to Doppler ultrasound (DUS) of the carotid stenosis, and indicate whether the associated hemodynamics are a potential thromboembolic source. We evaluated the effect of ulceration in a moderately stenosed carotid bifurcation on distal turbulence intensity (TI) measured using clinical DUS in matched anthropomorphic models. Several physiologically relevant ulcer geometries (hemispherical, mushroom-shaped, and ellipsoidal pointing distally and proximally) and sizes (2-mm, 3-mm and 4-mm diameter hemispheres) were investigated. An offline analysis was performed to determine several velocity-based parameters from ensemble-averaged spectral data, including TI. Significant elevations in TI were observed in the post-stenotic flow field of the stenosed carotid bifurcation by the inclusion of ulceration (P < 0.001) in a region two common carotid artery diameters distal to the site of ulceration during the systolic peak and the diastolic phase of the cardiac cycle. Both the size and shape of ulceration had a significant effect on TI in the distal region (P < 0.001). Due to the use of a clinical system, this method provides the means to evaluate for plaque ulcerations in patients with carotid atherosclerosis using DUS.

KW - Carotid artery

KW - Doppler ultrasound

KW - Flow models

KW - Plaque ulceration

KW - Turbulence intensity

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JO - European Radiology

JF - European Radiology

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ER -

Clinical Doppler ultrasound for the assessment of plaque ulceration in the stenosed carotid bifurcation by detection of distal turbulence intensity: A matched model study

Abstract

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Keywords

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