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Improved Carotid Stenosis Quantification on Novel 4D/3D-Doppler Ultrasonography Indexing to the Common Carotid Artery
Abstract
Purpose The accuracy of internal carotid artery stenosis (ICAS) quantification depends on the method of stenosis measurement, impacting therapeutic decisions and outcomes. The NASCET method references the stenotic to the distal ICAS lumen, the ECST method to the local outer and the common carotid artery (CC) method to the CC diameter. Direct morphometric stenosis measurement with four-dimensionally guided three-dimensional ultrasonography (4D/3DC-US) demonstrated good validity for the commonly used NASCET method. The NASCET definition has clinically relevant drawbacks. Our purpose was to investigate the validity of the ECST and CC methods.
Materials and Methods 4D/3DC-US percent-stenosis measures of 103 stenoses (80 patients) were compared to quantitative catheter angiography and duplex ultrasonography (DUS) in a blinded fashion.
Results The 4D/3DC-US versus angiography intermethod standard deviation of differences (SDD, n = 103) was lower for the CC method (5.7 %) compared to the NASCET (8.1 %, p < 0.001) and ECST methods (9.1 %, p < 0.001). Additionally, it was lower than the NASCET angiography interrater SDD of 52 stenoses (SDD 7.2 %, p = 0.047) and non-inferior for the ECST method (p = 0.065). Interobserver analysis of equivalent grading methods showed no differences for the SDDs between angiography and 4D/3DC-US observers (p > 0.076). Binary comparison to angiography showed equal Kappa values > 0.7 and an accuracy ≥ 85 % for the NASCET and CC methods, higher than for the ECST method. The binary accuracy of ICAS grading did not differ from DUS for all methods.
Conclusion The new 4D/3DC-US CC method is an accurate and well reproducible alternative to the NASCET and ECST methods and offers potential for clinical application.
... In contrast, studies that have found an impact of WSR on the plaque progression often use advanced 3D reconstruction or simulation techniques to record very localized changes in wall shear stress as well as a more global visualization of the plaque geometry [20,21,22,23]. This is arguably more accurate than the 2D Doppler images used in this study because the 3D reconstructions allow for direct measurement of stenosis area instead of an estimation calculated from a diameter. ...
Background: The rate of carotid plaque progression is believed to be related to blood flow hemodynamics and shear stress. Our objective was to determine if wall shear rate (WSR) and the energy loss coefficient (ELC) measured by Doppler ultrasound could predict atherosclerotic carotid disease progression. Patients and methods: Patients at a large tertiary center with an initial ultrasound between 2016 and 2018 with a significant carotid plaque were included if they had at least one 6 months follow-up comparative study. Stenosis progression was assessed according to the NASCET (The North American Symptomatic Carotid Endarterectomy Trial) percentage criterion. Results: The average annual progression rate for the 74 plaques included was 5.7% NASCET per year. We identified 18 plaques with ≥10% NASCET progression and 56 plaques without significant progression <10% NASCET. Among the plaques with progression, only four plaques had progression greater than 20% NASCET. Median WSR was 6266 s-1 [5813-8974] in plaques with progression and 6564 s-1 [5285-8766] in stable plaques (p=0.643). Median ELC was 3.86 m2 [2.78-5.53] in plaque with progression and 4.32 m2 [3.42-6.81] in stable plaques (p=0.296). Conclusions: Although it is a widely accepted hypothesis that shear stress and hemodynamics of the carotid bifurcation contribute to plaque progression, we found that WSR and ELC estimated by Doppler ultrasound do not reliably predict atherosclerotic plaque progression in the carotid artery. Other ultrasound modalities, such as 3D imaging, may be used to assess the influence of plaque geometry and hemodynamics in plaque progression.
... We agree that the method used in this study is not perfect, but it is quite commonly used in China [34][35][36]. In addition, the NASCET method has its limitations [37]. Especially, NASCET underestimates the degree of stenosis [38][39][40], and the relation between NASCET and other systems, such as ECST, is not linear [41]. ...
Purpose
To obtain normal ranges for the inner diameters of the carotid arteries.
Methods
This retrospective analysis included consecutive patients with disease-free carotid arteries who had undergone 3D-DSA at two hospitals in Nanning, Guangxi, between March 2013 and March 2018. Demographic and clinical characteristics, including Essen Stroke Risk Score (ESRS), were extracted from the medical records. The 3D-DSA data were used to calculate the inner diameters of the carotid arteries.
Results
The analysis included 1182 patients (837 males) aged 58.81 ± 11.02 years. The inner diameters of the proximal carotid sinus (CS), CS bulge, distal CS, and common carotid artery (CCA) were larger on the right than on the left ( P < 0.05). The inner diameters of the proximal CS, CS bulge, distal CS, and CCA on both sides were larger for males than females ( P < 0.05). The inner diameters of the proximal CS, CS bulge, and distal CS on both sides were smaller for patients aged > 65 years than for patients aged ≤ 55 years ( P < 0.05). Right CCA inner diameter did not vary with age, whereas left CCA inner diameter was larger for patients aged > 55 years than for patients aged ≤ 45 years ( P < 0.05). The inner diameters of the proximal CS, CS bulge, and distal CS on both sides were smaller for patients with ESRS ≥ 3 than those with ESRS < 3 ( P < 0.05).
Conclusion
This study provides reference values for the internal diameters of normal carotid arteries. Carotid artery diameters varied with side, sex, and age.
... Furthermore, peak velocities that are not located centrally in the lumen (Ford et al. 2008;Kamenskiy et al. 2011) may go unnoticed with conventional spectral Doppler ultrasound, but will be detected with VFI as long as they are in-plane with the ultrasound beam. Alternatively, a 4-D/3-D ultrasound method has been proposed and found to be in good agreement with DSA in carotid stenosis (Macharzina et al. 2020). ...
Non-invasive assessment is preferred for monitoring arteriovenous dialysis fistulas (AVFs). Vector concentration assesses flow complexity, which may correlate with stenosis severity. We determined whether vector concentration could assess stenosis severity in dysfunctional AVFs. Vector concentration was estimated in four stenotic phantoms at different pulse repetition frequencies. Spectral Doppler peak velocity and vector concentration were measured in 12 patients with dysfunctional AVFs. Additionally, 5 patients underwent digital subtraction angiography (DSA). In phantoms, vector concentration exhibited an inverse relationship with stenosis severity and was less affected by aliasing in severe stenoses. In nine stenoses of 5 patients undergoing DSA, vector concentration correlated strongly with stenosis severity (first stenosis: r = –0.73, p = 0.04; other stenoses; r = –0.69, p = 0.02) and mid-stenotic diameter (first stenosis: r = 0.87, p = 0.006; other stenoses: r = 0.70, p = 0.02) as opposed to peak velocities (p > 0.05). Vector concentration is less affected by aliasing in severe stenoses and correlates with DSA in patients with dysfunctional AVF.
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