K.W. Johnston

Factors influencing blood flow patterns in the human right coronary artery.

AbstractEvidence suggests that atherogenesis is linked to local hemodynamic factors such as wall shear stress. We investigated the velocity and wall shear stress patterns within a human right coronary artery (RCA), an important site of atherosclerotic lesion development. Emphasis was placed on evaluating the effect of flow waveform and inlet flow velocity profile on the hemodynamics in the proximal, medial, and distal arterial regions. Using the finite-element method, velocity and wall shear stress patterns in a rigid, anatomically realistic model of a human RCA were computed. Steady flow simulations (ReD=500) were performed with three different inlet velocity profiles; pulsatile flow simulations utilized two different flow waveforms (both with Womersley parameter=1.82, mean ReD=233),1 as well as two of the three inlet profiles. Velocity profiles showed Dean-like secondary flow features that were remarkably sensitive to the local curvature of the RCA model. Particularly noteworthy was the “rotation” of these Dean-like profiles, which produced large local variations in wall shear stress along the sidewalls of the RCA model. Changes in the inlet velocity profiles did not produce significant changes in the arterial velocity and wall shear stress patterns. Pulsatile flow simulations exhibited remarkably similar cycle-average wall shear stress distributions regardless of waveform and inlet velocity profile. The oscillatory shear index was very small and was attributed to flow reversal in the waveform, rather than separation. Cumulatively, these results illustrate that geometric effects (particularly local three-dimensional curvature) dominate RCA hemodynamics, implying that studies attempting to link hemodynamics with atherogenesis should replicate the patient-specific RCA geometry.

A comparative study and assessment of doppler ultrasound spectral estimation techniques part II: Methods and results

Various alternative spectral estimation methods are examined and compared in order to assess their possible application for real-time analysis of Doppler ultrasound arterial signals. Specifically, five general frequency domain models are examined, including the periodogram, the general autoregressive moving average (ARMA) model which has the autoregressive (AR) and moving average (MA) models as special cases, and Capons maximum likelihood spectral model. A stimulated stationary Doppler signal with a known theoretical spectrum was used as the reference test sequence, and white noise was added to enable various signal/noise conditions to be created. The performance of each method representative of each spectral model was assessed using both qualitative and quantitative schemes that convey information related to the bias and variance of the spectral estimates. Three integrated performance indices were implemented for quantitative analysis. The relative computational complexity for each algorithm was also investigated. Our results indicate that both the AR(Yule-Walker) and ARMA(singular value decomposition) models of orders (8) and (4,4), respectively, show good agreement with the theoretical spectrum, and yield estimates with variances considerably less than the Fast Fourier Transform (FFT). Preliminary results obtained with these methods using a clinical, non-stationary Doppler signal supports these observations.

DOPPLER METHODS FOR QUANTITATIVE MEASUREMENT AND LOCALIZATION OF PERIPHERAL ARTERIAL OCCLUSIVE DISEASE BY ANALYSIS OF THE BLOOD FLOW VELOCITY WAVEFORM

Errors concerned with the use of continuous wave Doppler ultrasound for the quantitative assessment of peripheral arterial occlusive disease by analysis of the blood flow velocity waveform are briefly examined. It is shown that, while some of the simpler signal processing techniques are inadequate, techniques such as real-time frequency analysis of the Doppler signal can yield information of quantitative value. A new multifilter system is described that yields the instantaneous maximum velocity waveform. From the results of preliminary patient studies using this system, it is concluded that clinically significant peripheral arterial disease can be quantified and regionally localized.

Comparative study of four methods for quantifying doppler ultrasound waveforms from the femoral artery

Currently, there is no agreement as to the best method for quantifying Doppler ultrasound recordings from peripheral arteries in order to detect occlusive disease. The four methods assessed in this study are: the pulsatility index, height-width index, path length index, and a Laplace transform function index. Recordings of the Doppler ultrasound spectral waveforms from the common femoral artery of 232 limbs were digitized to obtain the maximum velocity waveforms. This data was analyzed and the various indices were computed and then compared with the arteriographic grades. The effect of distal disease was also examined. The diagnostic accuracy of each index was determined from receiver operating characteristics curves. We concluded that all four indices were capable of detecting significant aortoiliac disease with approximately equal diagnostic accuracy of 90-95% but that pulsatility index had the advantages of simplicity and ease of calculation.

A critical study of ultrasound Doppler spectral analysis for detecting carotid disease

The results of in vitro and in vivo studies to determine the application and limitations of frequency analysis for CW Doppler ultrasound assessment of carotid stenoses are reported. In the in vitro study, the peak Doppler frequency and a new spectral broadening index were determined proximal to, at, and distal to axisymmetric and asymmetrical model stenoses. Good correlations with percent area stenoses were found. In the clinical study, 162 cases were examined using a 4 MHz Doppler system and by standard four-vessel arteriography. Peak frequencies of greater than 3.8 KHz were diagnostic of internal carotid stenoses of 3.2 mm minimum lumen diameter or less, with a sensitivity of 92% and a specificity of 94%. Spectral broadening, evaluated by subjective grading, yielded similar results.

An in vitro model and its application for the study of carotid Doppler spectral broadening.

A new in vitro model has been developed for studying the changes in the ultrasound Doppler spectrum that occur in the region of a stenosis. Pulsatile flow in rigid acrylic tubes was produced by means of a modified hemodialysis pump. The Doppler spectral waveforms were measured using a continuous wave Doppler system, a probe of a known field pattern, a real-time high resolution frequency analyzer, and a video display and recording system. The flow velocity waveforms were found to be nearly identical to those seen in the human carotid. Measurements were made to determine the critical stenosis and the results are similar to those reported from in vivo studies. In a preliminary study, the extent of spectral broadening was found to be dependent on the recording site in relation to the stenosis, the severity of the stenosis, and the flow rate. Using qualitative methods it was not possible to determine either the influence of the shape of the stenosis or the phase of the cardiac cycle on spectral broadening.

On the design and evaluation of a steady flow model for doppler ultrasound studies

For experimental studies of pulsed and continuous wave Doppler systems, a steady flow model has the important advantage of simplicity in interpreting the results. However, there are a number of important aspects of the design that require careful consideration before a satisfactory design can be achieved. This paper discusses these aspects and some of the difficulties that can arise. It also describes the design and evaluation of a steady flow model that uses a rigid tube with a suspension of glutaraldehyde hardened red blood cells in physiological saline as the scattering medium.

In vitro comparison of alternative methods for quantifying the severity of doppler spectral broadening for the diagnosis of carotid arterial occlusive disease

Quantitative analysis of continuous wave Doppler recordings is of clinical value in the noninvasive diagnosis of carotid arterial disease. Peak frequency measurements are useful and accurately detect severe stenoses but do not reliably diagnose minor or moderate stenoses because the measurement is dependent upon the probe to vessel angle, which cannot be measured accurately. Recent investigations have focused on efforts to overcome this limitation by quantifying the degree of spectral broadening that occurs as the result of flow disturbances downstream from a stenosis. In this study, an in vitro model was used to determine the optimum method for quantifying the instantaneous Doppler spectrum. The model generates blood flow velocity waveforms that are virtually identical to those found in the human internal carotid artery. Doppler recordings were made from normal tubes and distal to stenoses (39-87% cross-sectional area reduction). The spectra were quantified by the following angle-independent measurements: spectral broadening index and three standard statistical shape descriptors, namely the coefficients of variation, skewedness and kurtosis. Using this model, the results demonstrate an excellent relationship between the severity of the stenosis and each of spectral broadening index (r = 0.99), coefficient of variation (r = 0.96), and coefficient of skewedness (r = 0.99). The calculation of each of the measurements can be implemented quite easily, and a prospective trial is warranted to evaluate their clinical diagnostic accuracy.

Method for estimating the Doppler mean velocity waveform

Abstract Practical aspects of a method for estimating the mean velocity waveform for a CW ultrasound system are described. The method, based on the technique proposed by Gerzberg and Meindl (1977), generates an analog mean signal for both forward and reverse flow with an accuracy of better than ± 5%. Application of the circuit for arterial assessment are presented, and its potential use for determining carotid spectral broadening is considered.

RELATION OF THE FLOW FIELD DISTAL TO A MODERATE STENOSIS TO THE DOPPLER POWER

An experimental investigation was undertaken to establish how different flow regimes affect the Doppler signal. A rigid tube model consisting of a 70% asymmetric area stenosis was used with steady and pulsatile flow conditions. The characteristics of the flow field at various sites was determined using a photochromic flow visualization method. Continuous-wave Doppler measurements were made using a 41% suspension of human red blood cells (RBCs) in saline as well as a dilute suspension of 4% fixed RBCs. For steady flow, the photochromic results indicated that for Reynolds numbers (Re) of 545 and 1410, turbulence was generated and the length of the turbulent region was found to increase with increasing Re. Under pulsatile flow conditions, turbulence was triggered around peak systole and began to dissipate in late deceleration, and by the end of diastole the flow field almost relaminarized. During the turbulent phase of the flow cycle, the poststenotic flow field was seen to consist of four distinct flow regimes similar to those observed for steady flow. For higher Womersley parameters and Reynolds numbers the turbulent zone was found to be larger and to occupy a greater fraction of the flow cycle. These flow visualization results were compared with the Doppler power measurements made at the same locations and under similar flow conditions. At physiological hematocrits (41%) the onset of turbulence for both steady and pulsatile flow increased the backscattered Doppler power. The location of the peak Doppler power coincided with the region of maximum turbulence observed using the photochromic technique.