Quantitative real-time blood flow estimation with intravascular ultrasound in the presence of in-plane flow

Previously, we showed a source of error in blood flow estimation introduced by in-plane flow using a slow-time finite-impulse response (FIR) filter-bank method measuring blood flow through the image plane of an intravascular ultrasound (IVUS) catheter array. There is a monotonic relationship between flow velocity and the normalized second moment of the slow-time spectrum when flow is orthogonal to the image plane of a side-looking catheter array. However, this relationship changes in the presence of in-plane flow, as slow-time spectra shift and spread with varying in-plane and out-of-plane components. These two effects increase the normalized spectral second moment, resulting in flow overestimates. However, by resampling the received signal with variable time delay from pulse to pulse (i.e., tilting the slow-time signals), the slow-time spectrum shifts back to direct current (DC), and the orthogonal estimation method can be used. We present a method to correct this overestimation and accurately estimate blood flow through the image plane in real time. Initially, the tilt delay needed to shift the slow-time spectrum back to DC at each point within the flow field is calculated. Knowing this tilt delay, a tilted slow-time signal is obtained for the velocity component normal to the image plane, and its spectrum is estimated using a filter-bank. That spectrum then is used to estimate the flow speed using a mapping function closely related to the monotonic relationship between the slow-time spectrum and flow speed observed for orthogonal flow. To accurately estimate flow angles, we modified the filter-bank algorithm, applying slow-time filter coefficients in a tilted arrangement and studying the slow-time spectral energy as a function of tilt. The slow-time spectral estimate is constructed with the tilted output of eight narrow, band-pass filters from a filter-bank. Independent simulations show that, for blood slowing at angles between +/-6 degrees and +/-15 degrees at a speed of 300 mm/s, flow velocity would be overestimated by as much as 38.79% and 249%, respectively, using the direct filter-bank approach. However, this error can be corrected using the modified method presented here, reducing the maximum overestimation error by a factor of 2.69 and 10.88 for those angles, respectively. Although the remaining error is not negligible, the volume flow rate, calculated by integrating the flow velocity over the entire vessel lumen, differs by only 3% or less from the true value over the angular range considered here. This represents an improvement of a factor of 40 over uncompensated estimates at maximum flow angles. Consequently, the modified real-time method can quantitatively measure flow in most IVUS applications in which the catheter's image plane is not precisely orthogonal to the flow direction.