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Clinical Application of High-Frame-Rate Vector Flow Imaging in Evaluation of Carotid Atherosclerotic Stenosis
Yi-Jie Qiu1, Juan Cheng2, Qi Zhang1
1Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Insights
High-frame-rate vector flow imaging effectively assesses carotid atherosclerotic stenosis in older adults. This technique, combined with conventional ultrasound, improves the diagnosis of symptomatic stenosis, aiding in preoperative assessment.
Area of Science:
- Vascular Imaging
- Cardiovascular Ultrasound
- Medical Diagnostics
Background:
- Carotid atherosclerotic stenosis is a significant concern in aging populations.
- Accurate hemodynamic assessment is crucial for managing stenosis and preventing stroke.
- Existing imaging techniques may have limitations in fully characterizing flow dynamics.
Purpose of the Study:
- To evaluate the utility of high-frame-rate vector flow imaging (V Flow) in assessing hemodynamic changes in aging patients with carotid atherosclerotic stenosis.
- To compare the diagnostic performance of V Flow, conventional ultrasound, and a combined approach against gold-standard imaging.
Main Methods:
- Prospective enrollment of aging patients (>60 years) with diagnosed carotid atherosclerotic stenosis.
- Carotid ultrasound using high-frame-rate V Flow to measure wall shear stress (WSS) at stenosis sites.
- Comparison of V Flow WSS values, conventional ultrasound, and combined diagnosis with digital subtraction angiography/CT angiography.
Main Results:
- High-frame-rate V Flow imaging achieved a 96.7% success rate.
- Symptomatic stenosis showed significantly higher WSS (1.4 Pa) compared to asymptomatic stenosis (0.80 Pa) (p < 0.05).
- Combined diagnosis demonstrated superior performance (AUC 0.966) for severe stenosis compared to individual methods.
Conclusions:
- High-frame-rate V Flow imaging is a valuable non-invasive tool for assessing carotid atherosclerotic stenosis in aging individuals.
- The technique shows potential for preoperative assessment of symptomatic carotid stenosis.
- Combining V Flow with conventional ultrasound enhances diagnostic accuracy for carotid atherosclerotic stenosis.
Objective:
This study seeks to evaluate the value of the high-frame-rate vector flow imaging technique in assessing the hemodynamic changes of carotid atherosclerotic stenosis in aging people (>60 years old).
Methods:
Aging patients diagnosed with carotid atherosclerotic stenosis who underwent carotid high-frame-rate vector flow imaging examination were prospectively enrolled. A Mindray Resona7s ultrasound machine equipped with high-frame-rate vector flow function was used for ultrasound evaluation. First, B mode ultrasound and color Doppler flow imaging were used to evaluate carotid stenosis. Then, the vector arrows and flow streamline detected by V Flow were analyzed and the wall shear stress values (Pa) at the carotid stenosis site were measured. All patients were divided into symptomatic and asymptomatic groups according to whether they had acute/subacute stroke or other clinical symptoms within 2 weeks before ultrasound examination. The results of digital subtraction angiography or computed tomography angiography were used as the gold standard. The stenosis rate was calcified, according to North American Symptomatic Carotid Endarterectomy Trial criteria. The diagnostic values of wall shear stress, conventional ultrasound, and the combined diagnosis in carotid atherosclerotic stenosis were compared.
Results:
Finally, 88 patients with carotid atherosclerotic plaque were enrolled (71 males (80.7%), mean age 67.6 ± 5.4 years). The success rate of high-frame-rate vector flow imaging was 96.7% (88/91). The WSS value of symptomatic carotid stenosis (1.4 ± 0.15 Pa) was significantly higher than that of asymptomatic carotid stenosis (0.80 ± 0.08 Pa) (p < 0.05). Taking the wall shear stress value > 0.78 Pa as the diagnostic criteria for symptomatic carotid atherosclerotic plaque, the area under receiver operating characteristic curves was 0.79 with 87.1% sensitivity and 69.6% specificity. The area under receiver operating characteristic curves of the combined diagnosis (0.966) for differentiating severe carotid atherosclerotic stenosis was significantly higher than that of conventional ultrasound and WSS value, with 89.7% sensitivity and 93.2% specificity (p < 0.05).
Conclusion:
As a non-invasive imaging method, the high-frame-rate vector flow imaging technique showed potential value in the preoperative assessment of the symptomatic carotid atherosclerotic stenosis and diagnosing carotid atherosclerotic stenosis in aging patients.
