Erik Widman

Arterial Stiffness Estimation by Shear Wave Elastography: Validation in Phantoms with Mechanical Testing.

Arterial stiffness is an independent risk factor found to correlate with a wide range of cardiovascular diseases. It has been suggested that shear wave elastography (SWE) can be used to quantitatively measure local arterial shear modulus, but an accuracy assessment of the technique for arterial applications has not yet been performed. In this study, the influence of confined geometry on shear modulus estimation, by both group and phase velocity analysis, was assessed, and the accuracy of SWE in comparison with mechanical testing was measured in nine pressurized arterial phantoms. The results indicated that group velocity with an infinite medium assumption estimated shear modulus values incorrectly in comparison with mechanical testing in arterial phantoms (6.7 ± 0.0 kPa from group velocity and 30.5 ± 0.4 kPa from mechanical testing). To the contrary, SWE measurements based on phase velocity analysis (30.6 ± 3.2 kPa) were in good agreement with mechanical testing, with a relative error between the two techniques of 8.8 ± 6.0% in the shear modulus range evaluated (40-100 kPa). SWE by phase velocity analysis was validated to accurately measure stiffness in arterial phantoms.

Ultrasound Speckle Tracking Strain Estimation of in Vivo Carotid Artery Plaque with in Vitro Sonomicrometry Validation

Our objective was to validate a previously developed speckle tracking (ST) algorithm to assess strain in common carotid artery plaques. Radial and longitudinal strain was measured in common carotid artery gel phantoms with a plaque-mimicking inclusion using an in-house ST algorithm and sonomicrometry. Moreover, plaque strain by ST for seven patients (77 ± 6 y) with carotid atherosclerosis was compared with a quantitative visual assessment by two experienced physicians. In vitro, good correlation existed between ST and sonomicrometry peak strains, both radially (r = 0.96, p < 0.001) and longitudinally (r = 0.75, p < 0.01). In vivo, greater pulse pressure-adjusted radial and longitudinal strains were found in echolucent plaques than in echogenic plaques. This illustrates the feasibility of ultrasound ST strain estimation in plaques and the possibility of characterizing plaques using ST strain in vivo.

Shear wave elastography for characterization of carotid artery plaques - A feasibility study in an experimental setup

Characterization of vulnerable plaques in the carotid artery is critical for the prevention of ischemic stroke. However, ultrasound-based methods for plaque characterization used in the clinics today are limited to visual assessment and evaluation of plaque echogenicity. Shear Wave Elastography (SWE) is a new tissue characterization technique based on radiation force-induced shear wave propagation with potential use in plaque vulnerability assessment. The purpose of this study was to develop an experimental setup to test the feasibility of SWE for carotid plaque characterization. A carotid artery phantom with a soft inclusion in the wall, mimicking a vulnerable plaque, was constructed (10% polyvinyl alcohol (PVA), 3% graphite) by exposing the vessel and plaque to three and one freeze-thaw cycles (6h freeze, 6h thaw) respectively. An Aixplorer SWE system (Supersonic Imagine) was used to measure the shear wave speed (cT) in the vessel wall and plaque. The Youngs modulus (E) was then calculated via the Moens-Korteweg (M-K) equation. For comparison, eight cylinders (d = 4 cm, h = 4 cm) were constructed for mechanical testing from the same PVA batch, of which four were exposed to three freeze-thaw cycles (mimicking the vessel wall) and four to one freeze-thaw cycle (mimicking the plaque). The Youngs moduli for the cylinders were obtained via a displacement controlled mechanical compression test (Instron 5567) by applying 5% strain. The mean shear wave speed was 2.6 (±0.7) m/s in the vessel wall, 1.8 (±0.7) m/s in the plaque, resulting in Evessel = 11.5 (±0.5) kPa, Eplaque = 4.3 (±0.5) kPa. The compression tests resulted in E = 64.2 (±11.1) kPa in the hard cylinder and E = 9.7 (±3.1) kPa in the soft cylinder. The results showed that it was possible to distinguish between the arterial wall and the plaque. The disagreement between mechanical testing and SWE can be explained by the fact tha- the shear wave does not propagate monochromatically in cylindrical geometry. To achieve a better calculation of the elastic modulus, the frequency dependency of the shear wave velocity must be considered.

Speckle tracking strain estimation of a carotid artery plaque phantom - Validation via sonomicrometry

Current clinical ultrasound-based methods for plaque characterization are limited to visual assessment of plaque echogenicity creating demand for quantitative diagnostic tools. Our objective was to validate radial and longitudinal speckle tracking (ST) strain in phantom plaques via sonomicrometry (sono), and to compare the peak plaque and arterial wall strain. Four carotid artery gel-phantoms with a soft wall inclusion, mimicking a vulnerable plaque, were constructed. The phantoms were connected to a programmable pump simulating a carotid flow. Cineloops were acquired using a GE Vivid E9 where radial and longitudinal strain were calculated using a normalized cross-correlation ST algorithm. The region of interest was adjusted according to the plaque size. Sonomicrometry was used as a reference measurement. The correlation between estimated mean peak strain and the reference peak strain was r = 0.96 (p <; 0.001) radially and r = 0.75 (p ≤ 0.005) longitudinally. The soft plaque exhibited 35.1% (SD 16.9%) greater radial (p <; 0.001) and 88.6% (SD 72.0%) greater longitudinal (p <; 0.001) peak strain than the arterial wall when measured with speckle tracking. It was possible to estimate plaque strain by ST and to distinguish a soft plaque from the vessel wall via strain measurements.

Feasibility of shear wave elastography for plaque characterization

Determining plaque vulnerability is critical when selecting the most suitable treatment for patients with atherosclerotic plaque in the common carotid artery and quantitative characterization methods are needed. In this study, shear wave elastography (SWE) was used to characterize soft plaque mimicking inclusions in three atherosclerotic arterial phantoms by using phase velocity analysis in a static environment. The results were validated with axial tensile mechanical testing (MT). SWE measured a mean shear modulus of 5.8 ± 0.3 kPa and 25.0 ± 1.2 kPa versus 3.0 kPa and 30.0 kPa measured by mechanical testing in the soft plaques and phantom walls respectively. The results show good agreement between MT and SWE for both the plaque and phantom wall.

Comparison of in vivo vs. ex situ obtained material properties of sheep common carotid artery

Patient-specific biomechanical modelling can improve preoperative surgical planning. This requires patient-specific geometry as well as patient-specific material properties as input. The latter are, however, still quite challenging to estimate in vivo. This study focuses on the estimation of the mechanical properties of the arterial wall. Firstly, in vivo pressure, diameter and thickness of the arterial wall were acquired for sheep common carotid arteries. Next, the animals were sacrificed and the tissue was stored for mechanical testing. Planar biaxial tests were performed to obtain experimental stress-stretch curves. Finally, parameters for the hyperelastic Mooney-Rivlin and Gasser-Ogden-Holzapfel (GOH) material model were estimated based on the in vivo obtained pressure-diameter data as well as on the ex situ experimental stress-stretch curves. Both material models were able to capture the in vivo behaviour of the tissue. However, in the ex situ case only the GOH model provided satisfactory results. When comparing different fitting approaches, in vivo vs. ex situ, each of them showed its own advantages and disadvantages. The in vivo approach estimates the properties of the tissue in its physiological state while the ex situ approach allows to apply different loadings to properly capture the anisotropy of the tissue. Both of them could be further enhanced by improving the estimation of the stress-free state, i.e. by adding residual circumferential stresses in vivo and by accounting for the flattening effect of the tested samples ex vivo. • Competing interests: none declared • Word count: 4716.

Application of a new four-channel vibrometer for determination of atherosclerosis: Further advances towards a handheld device

Cardiovascular diseases (CD) are the leading cause of death worldwide and their prevalence is expected to rise. Important in the etiology of CD is the stiffening of the large arteries (arteriosclerosis) and plaque formation (atherosclerosis) in the common carotid artery (CCA). Increasing evidence shows that both arteriosclerosis and atherosclerosis can be detected by assessing pulse wave velocity (PWV) in the CCA, and several techniques focus on the detection of PWV in this structure. In previous studies, laser Doppler vibrometry (LDV) was proposed as an approach to detect arterial stiffness. In the present work, a compact four-channel LDV system is introduced for PWV detection. Four phantom arteries were assessed mimicking real life cardiovascular pathologies. Due to the high sensitivity and the increased spatial and temporal resolution of the LDV system, PWV could be assessed, and even local changes in phantom architecture could be detected. The system could potentially be used to detect arteriosclerosis and arterial plaque during cardiovascular screening.

Evaluating arterial and plaque elasticity with shear wave elastography in an ex vivo porcine model

Our objective was to use shear wave elastography (SWE) to characterize the mechanical properties of an arterial wall with a simulated calcified plaque in an ex vivo setup. A small porcine aorta was used as a model for a human carotid artery and attached to a fixture while pressurized with a water column. The stiffness of the arterial wall and a simulated plaque were estimated using SWE. The mean arterial wall and plaque shear modulus varied from 42 ± 0 kPa to 100 ± 1 kPa and 81 ± 2 kPa to 174 ± 2 kPa respectively over a pressure range of 20-120 mmHg. The results show the ability of SWE to characterize the mechanical properties of an arterial wall with a simulated plaque and take steps toward an in vivo implementation for quantitative plaque assessment.

In vivo radial and longitudinal carotid artery plaque strain estimation via ultrasound-based speckle tracking

Our objective was to assess strain in common carotid artery (CCA) plaques using a previously validated speckle tracking algorithm. Radial and longitudinal strain was measured in 7 patients (77 ± 6 years) with carotid atherosclerosis and was compared with a quantitative visual assessment grading of plaques on the Gray-Weale scale by two experienced physicians. A greater pulse-pressure adjusted radial and longitudinal strain was found in echolucent plaques compared to echogenic plaques. This study shows the feasibility of ultrasound speckle tracking strain estimation in plaques and indicates the possibility to characterize plaques using speckle tracking strain in vivo.

Carotid strain estimation using an ultrasound-based speckle tracking algorithm

Carotid strain imaging using ultrasound-based speckle tracking has showed potential in risk stratification of cardiovascular diseases. However, assessing strain in the artery wall and in atherosclerotic plaques is challenging because of small dimensions and low deformations in relation to the applied ultrasound wavelength. High-resolution ultrasound has potential to improve the speckle tracking performance by increasing spatial resolution. The aim of this study was to compare carotid strain estimation by speckle tracking using standard clinical ultrasound and high-resolution ultrasound in an experimental setup. Ultrasound long-axis images were obtained using a standard clinical ultrasound system (Vivid7) and a high resolution ultrasound system (Vevo2100) in dynamic phantoms mimicking the carotid artery. Speckle tracking was performed to estimate radial and longitudinal strain whereas sonomicrometry was used as reference. The results showed a significant better performance for speckle tracking applied on images from the high-resolution system compared to the standard clinical system.