Stress distribution analysis in healthy and stenosed carotid artery models reconstructed from in vivo ultrasonography.

PURPOSE: This study investigated the accuracy of models reconstructed from ultrasound image processing by comparing the radial displacement waveforms of a subject-specific artery model and evaluated stress changes in the proximal shoulder, throat, and distal shoulder of the plaques depending on the degree of carotid artery stenosis. METHODS: Three groups of subjects (healthy and with less than 50% or more carotid stenosis) were evaluated with ultrasonography. Two-dimensional transverse imaging of the common carotid artery was performed to reconstruct the geometry. A longitudinal view of the same region was recorded to extract the Kelvin viscoelastic model parameters. The pulse pressure waveform and the effective pressure of perivascular tissue were loaded onto the internal and external walls of the model. Effective, circumferential, and principal stresses applied to the plaque throat, proximal shoulder, and distal shoulder in the transverse planes were extracted. RESULTS: The radial displacement waveforms of the model were closely correlated with those of image processing in all three groups. The mean of the effective, circumferential, and principal stresses of the healthy arteries were 15.01±4.93, 12.97±5.07, and 12.39±2.86 kPa, respectively. As stenosis increased from mild to significant, the mean values of the effective, circumferential, and first principal stresses increased significantly (97%, 74%, and 103% at the plaque throat, respectively) (P<0.05). The minimum effective stress was at the lipid pool. The effective stress in calcified areas was higher than in other parts of the artery wall. CONCLUSION: This model can discriminate differences in stresses applied to mildly and severely stenotic plaques.

Estimation of Biomechanical Properties of Normal and Atherosclerotic Common Carotid Arteries.

PURPOSE: We developed a modified Kelvin model so that the periodic changes of the arterial intima-media thickness (IMT) over the cardiac cycle were involved. Modified model was implemented for carotid artery, solved via a parameter optimization technique and biomechanical parameters of the model. METHODS: Consecutive ultrasonic images of the common carotid artery of 30 male patients including 10 healthy subjects, 10 subjects with mild and 10 subjects with sever stenosis were recorded and processed offline. Temporal changes of the internal diameter and IMT were extracted using a combined maximum gradient and dynamic programming algorithm. The blood pressure waveforms were deduced calibrating the internal diameter waveforms using an empirical exponential relationship. RESULTS: According to the results of the ANOVA statistical analysis, mean values of the zero pressure radiuses, stress relaxation times, elastic moduli and strain relaxation times of the common carotid arteries of three groups were significantly different. Mentioned parameters increased 11, 24, 7 and 6% in patients with mild (< 50%) stenosis and 12, 73, 8 and 61% in the group with sever stenosis (> 50%) relative to healthy group. CONCLUSION: Present study can be an indicative of the general state of the vascular system and be used for discriminating atherosclerotic from healthy arteries.

Assessing the blood pressure waveform of the carotid artery using an ultrasound image processing method.

PURPOSE: The aim of this study was to introduce and implement a noninvasive method to derive the carotid artery pressure waveform directly by processing diagnostic sonograms of the carotid artery. METHODS: Ultrasound image sequences of 20 healthy male subjects (age, 36±9 years) were recorded during three cardiac cycles. The internal diameter and blood velocity waveforms were extracted from consecutive sonograms over the cardiac cycles by using custom analysis programs written in MATLAB. Finally, the application of a mathematical equation resulted in time changes of the arterial pressure. The resulting pressures were calibrated using the mean and the diastolic pressure of the radial artery. RESULTS: A good correlation was found between the mean carotid blood pressure obtained from the ultrasound image processing and the mean radial blood pressure obtained using a standard digital sphygmomanometer (R=0.91). The mean absolute difference between the carotid calibrated pulse pressures and those measured clinically was -1.333±6.548 mm Hg. CONCLUSION: The results of this study suggest that consecutive sonograms of the carotid artery can be used for estimating a blood pressure waveform. We believe that our results promote a noninvasive technique for clinical applications that overcomes the reproducibility problems of common carotid artery tonometry with technical and anatomical causes.

A mathematical model for estimating the axial stress of the common carotid artery wall from ultrasound images.

Clarifying the complex interaction between mechanical and biological processes in healthy and diseased conditions requires constitutive models for arterial walls. In this study, a mathematical model for the displacement of the carotid artery wall in the longitudinal direction is defined providing a satisfactory representation of the axial stress applied to the arterial wall. The proposed model was applied to the carotid artery wall motion estimated from ultrasound image sequences of 10 healthy adults, and the axial stress waveform exerted on the artery wall was extracted. Consecutive ultrasonic images (30 frames per second) of the common carotid artery of 10 healthy subjects (age 44 ± 4 year) were recorded and transferred to a personal computer. Longitudinal displacement and acceleration were extracted from ultrasonic image processing using a block-matching algorithm. Furthermore, images were examined using a maximum gradient algorithm and time rate changes of the internal diameter and intima-media thickness were extracted. Finally, axial stress was estimated using an appropriate constitutive equation for thin-walled tubes. Performance of the proposed model was evaluated using goodness of fit between approximated and measured longitudinal displacement statistics. Values of goodness-of-fit statistics indicated high quality of fit for all investigated subjects with the mean adjusted R-square (0.86 ± 0.08) and root mean squared error (0.08 ± 0.04 mm). According to the results of the present study, maximum and minimum axial stresses exerted on the arterial wall are 1.7 ± 0.6 and -1.5 ± 0.5 kPa, respectively. These results reveal the potential of this technique to provide a new method to assess arterial stress from ultrasound images, overcoming the limitations of the finite element and other simulation techniques.

A novel non-invasive ultrasonic method to assess total axial stress of the common carotid artery wall in healthy and atherosclerotic men.

In the present study, developing a new non-invasive method independent from blood flow, we estimated and compared the total axial stress of the common carotid artery wall in healthy and atherosclerotic subjects. Consecutive ultrasonic images of the common carotid artery of 48 male subjects including healthy, with less and more than 50% stenosis in carotid artery were recorded. Longitudinal displacement and acceleration was extracted from ultrasonic image processing using a block matching algorithm. Furthermore, images were examined using a maximum gradient algorithm and time rate changes of the internal diameter and intima-media thickness were extracted. Finally, axial stress was estimated using an appropriate constitutive equation. Statistical analysis results showed that with stenosis initiation and its progression, axial acceleration and stress increase significantly. According to the results of the present study, maximum axial stress of the arterial wall is 1.713±0.546, 1.993±0.731 and 2.610±0.603 (kPa) in normal, with less and more than 50% stenosis in carotid artery respectively. Whereas minimum axial stress is -1.714±0.676, -1.982±0.663 and -2.593±0.661 (kPa) in normal, with less and more than 50% stenosis in carotid artery respectively. Moreover, internal diameter and intima-media thickness of the artery also increase significantly with stenosis initiation and its progression. In this study, the feasibility of axial wall stress computation for human common carotid arteries based on non-invasive in vivo clinical data is concluded. We found a strong and graded association between axial stress and severity of carotid stenosis, which might be used to discriminate healthy from atherosclerotic arteries.

Carotid Artery Wall Motion Estimation from Consecutive Ultrasonic Images: Comparison between Block-Matching and Maximum-Gradient Algorithms.

BACKGROUND: Radial movement of the arterial wall is a well-known indicator of the mechanical properties of arteries in arterial disease examinations. In the present study, two different motion estimation methods, based on the block-matching and maximum-gradient algorithms, were examined to extract the radial displacement of the carotid artery wall. METHODS: Each program was separately implemented to the same axial consecutive ultrasound images of the carotid artery of 10 healthy men, and the radial displacement waveform of this artery was extracted during two cardiac cycles. The results of the two methods were compared using the linear regression and Bland-Altman statistical analyses. The maximum and mean displacements traced by the block-matching algorithm were compared with the same parameters traced by the maximum-gradient algorithm. The frame numbers in which the maximum displacement of the wall occurred were compared too. RESULTS: There were no significant differences between the maximum and the mean displacements traced by the block-matching algorithm and the same parameters traced by the maximum-gradient algorithm according to the pair t-test analysis (p value > 0.05). There was a significant correlation between the radial movement of the common carotid artery measured with the block-matching and maximum-gradient methods (with a correlation coefficient of 0.89 and p value < 0.05). The Bland-Altman analysis results confirmed a good agreement between the two methods in measuring the radial movement, with a mean difference and limits of agreement of 0.044 ± 0.038. The results showed that both methods found the maximum displacement occurring in the same frame. CONCLUSION: Both block-matching and maximum-gradient algorithms can be used to extract the radial displacement of the carotid artery wall and in addition, with respect to the pixel size as error, the same results can be obtained.