Transcutaneous very-high-resolution ultrasound to quantify arterial wall layers of muscular and elastic arteries: Validation of a method

doi:10.1016/j.atherosclerosis.2010.06.043

Atherosclerosis

Volume 212, Issue 2, October 2010, Pages 516-523

https://doi.org/10.1016/j.atherosclerosis.2010.06.043 Get rights and content

Abstract

Background

High-resolution ultrasound (HRU) is used to measure carotid intima-media thickness (IMT). We postulated that very-high-resolution ultrasound (VHRU, 25–55 MHz) provides more detailed information on arterial morphology.

Methods

Rabbit and pig arterial specimens and artificial elastin membranes were studied with HRU and VHRU, and compared to histology. Bilateral carotid, brachial, radial, ulnar, femoral, and tibial arteries were imaged in vivo in 15 humans to determine the precision of VHRU and in 53 teenagers to compare VHRU to HRU.

Results

The assessment of IMT, adventitia thickness (AT) and combined intima-media-adventitia thickness (IMAT) in muscular arteries was accurate and precise by VHRU with the exception that the AT of the smallest arteries was not delineated with 25 MHz. VHRU was accurate and precise for IMAT in small and for IMT in large elastic arteries and allowed to qualitatively assess elastin fibers of the media. HRU was accurate for IMT of large muscular and elastic arteries only. Intima thickness (IT) was grossly overestimated by both VHRU and HRU.

Conclusion

Transcutaneous VHRU provides a noninvasive method of quantifying elastic and muscular arterial AT, IMT and IMAT in children and adults, but neither VHRU nor HRU is able to assess IT in non-diseased vessels.

Introduction

The noninvasive measurement of the combined intima-media thickness (IMT) by conventional high-resolution B-mode vascular ultrasound imaging (HRU) with transducers in the 5–15 MHz range has become widely used as a surrogate marker for the progression of atherosclerotic disease [1], [2], [3], [4]. HRU has been validated for the carotid [5], [6], [7], [8] and femoral arteries [9] and applied in a wide range of clinical settings both in adults and adolescents [10], [11]. Nevertheless, the spatial resolution of HRU systems appears insufficient for more detailed imaging of different arterial wall layers and for the examination of the peripheral vasculature and the carotid arteries of the younger child.

The recent emergence of commercially available very-high frequency ultrasound systems (VHRU) with transducers in the 25–55 MHz range allows imaging of more superficial tissues in almost microscopic detail. VHRU is, however, precluded in the imaging of more deep structures due to attenuation of the ultrasound beam. To date, VHRU has mainly been used to image coronary arteries by intravascular ultrasound (IVUS [12]), for small animal research [13] and, most recently, to evaluate the morphology of peripheral arteries [14], [15]. According to these studies it was possible to accurately determine media and total wall thickness in superficial arteries of pigs [14]. Furthermore, the measurement of the intima thickness (IT) separately from the media was validated against silicone phantoms and vascular specimens in the IT range of 0.15–0.40 mm. This method was then applied to study peripheral muscular arteries in healthy volunteers in vivo, but their measurements appeared to be out of the physiologic range [15]. To the best of our knowledge, the utility of VHRU has not been examined systematically, in terms of varying transducer frequencies, and their ability to measure the intima, media and adventitia separately and together in muscular and elastic arteries in adults and children.

The primary aims of this study were therefore to investigate the accuracy and precision of VHRU in the assessment of the intima, media and adventitia in small and large muscular and elastic arteries as well as to compare VHRU with HRU.

Section snippets

Methods

The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Research Ethics Board. The use of VHRU in human subjects was in addition approved by Health Canada. Study participation required written informed consent by all human participants.

Effect of formalin fixation and storage

A set of arterial specimens (n = 9) was imaged with the 55 MHz transducer before and after 24 h of fixation. While formalin fixation resulted in no obvious change in the qualitative appearance of the vessel, mild shrinkage of 3.2% and 3.7% was observed for IMT and IMAT, respectively (p = ns). Another set of vessel specimens (n = 17) was imaged with the 55 MHz transducer two and 26 days, respectively, after formalin fixation, and again no significant change in the qualitative appearance was observed

Discussion

To the best of our knowledge, this is the first study to compare noninvasive VHRU to conventional HRU in the assessment of arterial wall layers in vivo and in vitro. We demonstrate that VHRU is an accurate and precise tool in the assessment of IMT, AT and IMAT in a wide range of normal elastic and muscular arteries. However, contrary to previous reports [15], [20], IT appeared grossly overestimated.

The feasibility, precision and clinical utility of assessing carotid IMT with conventional

Conflicts of interest

The authors have no conflicts of interest.

Acknowledgements

Dr Jon Yeung and Dr Tor Steensrud are acknowledged for invaluable help in collecting the animal vessel samples. Mr. Cameron Slorach and Mr. Wei Hui are acknowledged for expert technical assistance in obtaining and analyzing the carotid images with conventional ultrasound and for help with the interobserver variability assessment. Mrs. Eva Sitarz and Mrs. Huimin Wang are acknowledged for preparing the elastin membranes and for histological processing, respectively.

The study was supported by

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¹: Dr Sarkola's address (after 1.7.2010): Division of Cardiology, Helsinki University Central Hospital for Children and Adolescents, POB 00029, HUS, Finland.

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Transcutaneous very-high-resolution ultrasound to quantify arterial wall layers of muscular and elastic arteries: Validation of a method

Abstract

Background

Methods

Results

Conclusion

Introduction

Section snippets

Methods

Effect of formalin fixation and storage

Discussion

Conflicts of interest

Acknowledgements

Atherosclerosis

Ultrasound Med Biol

J Am Soc Echocardiogr

J Am Coll Cardiol

Ultrasound Med Biol

Ultrasound Med Biol

J Am Coll Cardiol

Am Heart J

Atherosclerosis

Am Heart J

Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group

N Engl J Med

Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study

Circulation

Carotid artery intima-media thickness measured by ultrasonography in normal clinical practice correlates well with atherosclerosis risk factors

Stroke