Qiu Yijie, Dong Yi, Mao Feng, Zhang Qi, Yang Daohui, Chen Kailing, Shi Shuainan, Zuo Dan, Tian Xiaofan, Yu Lingyun, Wang Wen-Ping
Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.
Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China.
Front Cardiovasc Med. 2021 Mar 8;8:617391. doi: 10.3389/fcvm.2021.617391. eCollection 2021.
To investigate the value of high-frame rate vector flow imaging technique (V flow) in evaluating the hemodynamic changes of carotid stenosis caused by atherosclerotic plaques. In this prospective study, patients with stenosis rate (diameter) ≥30% caused by carotid atherosclerotic plaques were included. Degrees of carotid stenosis were graded according to North American Symptomatic Carotid Endarterectomy Trial criteria: moderate (30-69%) or severe (70-99%). Mindray Resona 7s ultrasound machine with a linear array transducer (3-11 MHz) was used for ultrasound examinations. The mean WSS value of carotid arteries was measured at the proximal, narrowest region and distal of carotid stenosis. The mean WSS values were correlated with peak systolic velocity (PSV) measured by color Doppler flow imaging and stenosis degree detected by digital subtraction angiography (DSA). The vector arrows and flow streamline detected by V flow dynamic imaging were analyzed. Imaging findings of DSA in carotid arteries were used as the gold standard. Finally, 51 patients were included. V flow measurements were performed successfully in 17 patients (100%) with moderate-grade stenosis and in 30 patients (88.2%) with severe-grade stenosis. Dynamic V flow imaging showed yellow or red vectors at the stenotic segment, indicating fast speed blood flow (up to 260.92 cm/s). Changes of streamlines were detected in the stenotic segment. The mean WSS value measured at the narrowest region of the carotid artery had a moderately positive correlation with stenosis degree ( = 0.58, < 0.05) and PSV value ( = 0.54, < 0.05), respectively. Significant difference was detected in mean WSS value at the narrowest region of the carotid artery between severe carotid stenosis (1.47 ± 0.97 Pa) and moderate carotid stenosis (0.96 ± 0.44 Pa) ( < 0.05). The hemodynamic changes detected by V flow of the carotid stenosis might be a potential non-invasive imaging tool for assessing the degree of carotid stenosis.
探讨高帧率矢量血流成像技术（V flow）在评估动脉粥样硬化斑块所致颈动脉狭窄血流动力学变化中的价值。在这项前瞻性研究中，纳入了颈动脉粥样硬化斑块导致狭窄率（直径）≥30%的患者。根据北美症状性颈动脉内膜切除术试验标准对颈动脉狭窄程度进行分级：中度（30%-69%）或重度（70%-99%）。使用配备线性阵列探头（3-11MHz）的迈瑞Resona 7s超声仪进行超声检查。在颈动脉狭窄的近端、最窄处和远端测量颈动脉的平均壁面切应力（WSS）值。将平均WSS值与彩色多普勒血流成像测量的收缩期峰值流速（PSV）以及数字减影血管造影（DSA）检测的狭窄程度进行相关性分析。对V flow动态成像检测到的矢量箭头和血流流线进行分析。以颈动脉DSA成像结果作为金标准。最终，纳入51例患者。17例中度狭窄患者（100%）和30例重度狭窄患者（88.2%）成功进行了V flow测量。V flow动态成像显示狭窄段出现黄色或红色矢量，表明血流速度较快（可达260.92cm/s）。在狭窄段检测到流线变化。在颈动脉最窄处测量的平均WSS值分别与狭窄程度（r = 0.58，P < 0.05）和PSV值（r = 0.54，P < 0.05）呈中度正相关。重度颈动脉狭窄（1.47±0.97Pa）与中度颈动脉狭窄（0.96±0.44Pa）在颈动脉最窄处的平均WSS值存在显著差异（P < 0.05）。V flow检测到的颈动脉狭窄血流动力学变化可能是评估颈动脉狭窄程度的一种潜在无创成像工具。
