In vivo comparison of three ultrasound vector velocity techniques to MR phase contrast angiography

The objective of this paper is to validate angle independent vector velocity methods for blood velocity estimation. Conventional Doppler ultrasound (US) only estimates the blood velocity along the US beam direction where the estimate is angle corrected assuming laminar flow parallel to vessel boundaries. This results in incorrect blood velocity estimates, when angle of insonation approaches 90 degrees or when blood flow is non-laminar. Three angle independent vector velocity methods are evaluated in this paper: directional beamforming (DB), synthetic aperture flow imaging (STA) and transverse oscillation (TO). The performances of the three methods were investigated by measuring the stroke volume in the right common carotid artery of 11 healthy volunteers with magnetic resonance phase contrast angiography (MRA) as reference. The correlation with confidence intervals (CI) between the three vector velocity methods and MRA were: DB vs. MRA: R = 0.84 (p < 0.01, 95% CI: 0.49-0.96); STA vs. MRA: R = 0.71 (p < 0.05, 95% CI: 0.19-0.92) and TO vs. MRA: R = 0.91 ( p < 0.01, 95% CI: 0.69-0.98). No significant differences were observed for any of the three comparisons (DB vs. MRA: p = 0.65; STA vs. MRA: p = 0.24; TO vs. MRA: p = 0.36). Bland-Altman plots were additionally constructed, and mean differences with limits of agreements (LoA) for the three comparisons were: DB vs. MRA = 0.17 ml (95% CI: -0.61-0.95) with LoA = -2.11-2.44 ml; STA vs. MRA = -0.55 ml (95% CI: -1.54-0.43) with LoA = -3.42-2.32 ml; TO vs. MRA = 0.24 ml (95% CI: -0.32-0.81) with LoA = -1.41-1.90 ml. According to the results, reliable volume flow estimates can be obtained with all three methods. The three US vector velocity techniques can yield quantitative insight into flow dynamics and visualize complex flow patterns, which potentially can give the clinician a novel tool for cardiovascular disease assessment. (C) 2009 Elsevier B.V. All rights reserved.