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Evaluation of distal turbulence intensity for the detection of both plaque ulceration and stenosis grade in the carotid bifurcation using clinical Doppler ultrasound

  • Ultrasound
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Abstract

Objectives

To determine the interrelationship of stenosis grade and ulceration with distal turbulence intensity (TI) in the carotid bifurcation measured using conventional clinical Doppler ultrasound (DUS) in vitro, in order to establish the feasibility of TI as a diagnostic parameter for plaque ulceration.

Methods

DUS TI was evaluated in a matched set of ulcerated and smooth-walled carotid bifurcation phantoms with various stenosis severities (30, 50, 60 and 70 %), where the ulcerated models incorporated a type 3 ulceration.

Results

Post-stenotic TI was significantly elevated owing to ulceration in the mild and moderate stenoses (P < 0.001). TI increased with stenosis severity in both the ulcerated and non-ulcerated series, with a statistically significant effect of increasing stenosis severity (P < 0.001). Whereas TI in the mild and non-ulcerated moderate stenoses was less than 20.4 ± 1.3 cm s−1, TI in the ulcerated moderate and severe models was higher than 25.6 ±1.3 cm s−1, indicating a potential diagnostic threshold.

Conclusion

We report a two-curve relationship of stenosis grade and ulceration to distal TI measured using clinical DUS in vitro. Clinical DUS measurement of distal TI may be a diagnostic approach to detecting ulceration in the mild and moderately stenosed carotid artery.

Key Points

• Patients with carotid artery plaque ulcerations are at higher risk of stroke.

• Clinical Doppler ultrasound is routinely used to detect carotid artery stenosis.

• Doppler ultrasound turbulence intensity can detect ulceration in realistic flow models.

• Turbulence intensity also increases with stenosis severity independent of ulceration.

• Doppler ultrasound should help in assessing both stenosis severity and ulceration.

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Acknowledgments

Financial support has been provided by the Heart and Stroke Foundation of Ontario (grant #T-6427), a University Faculty Award from the Natural Sciences and Engineering Research Council of Canada (T.L.P.), and a Canadian Institutes of Health Research Frederick Banting and Charles Best Canada Graduate Scholarships Doctoral Award (E.Y.W.). D.W.H. is the Dr. Sandy Kirkley Chair of Musculoskeletal Research in the Schulich School of Medicine and Dentistry. The authors would like to acknowledge Philips-ATL (Philips-ATL, Bothell, USA) for the UM9 and HDI 5000 ultrasound units.

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Authors and Affiliations

  1. Robarts Research Institute, University of Western Ontario, London, ON, Canada

    Emily Y. Wong, Hristo N. Nikolov & David W. Holdsworth

  2. Department of Medical Biophysics, University of Western Ontario, London, ON, Canada

    Emily Y. Wong, David W. Holdsworth & Tamie L. Poepping

  3. Department of Medical Imaging, University of Western Ontario, London, ON, Canada

    Richard N. Rankin

  4. Department of Surgery, University of Western Ontario, London, ON, Canada

    David W. Holdsworth

  5. Department of Physics and Astronomy, University of Western Ontario, 1151 Richmond Street, London, ON, Canada, N6A 3K7

    Tamie L. Poepping

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  1. Emily Y. Wong
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Correspondence to Tamie L. Poepping.

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Wong, E.Y., Nikolov, H.N., Rankin, R.N. et al. Evaluation of distal turbulence intensity for the detection of both plaque ulceration and stenosis grade in the carotid bifurcation using clinical Doppler ultrasound. Eur Radiol 23, 1720–1728 (2013). https://doi.org/10.1007/s00330-012-2741-6

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  • DOI: https://doi.org/10.1007/s00330-012-2741-6

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