- Research Article
- Open access
- Published:
Influence of Ultrasound Settings on Carotid Biomarker Assessment by B-mode Image Processing
Artery Research volume 25, pages 139–144 (2019)
Abstract
Introduction
This study aims to investigate how image settings affect carotid Intima-Media-Thickness (IMT) and diameter estimation performed with Carotid Studio (Quipu-Srl).
Methods
Fourteen healthy volunteers (24.4 ± 4.4 years; eight men) were recruited. Longitudinal scans 3-cm-deep of common-carotid-arteries with the same region-of-interest were obtained by expert operator, starting from a “default-setup” (central Time Gain Compensation-TGC; gain: 50 dB; no persistence filter) and adjusting one parameter at a time (oblique TGC; gain: 10 dB increments from 30 to 70 dB; persistence filter). The acquisition was performed twice, and repeatability was expressed for each setup as Coefficient of Variation (CV). Significant changes (p ≤ 0.05) compared with the “default-setup” were analysed by Wilcoxon signed-rank-test.
Results
Sixty and 70 dB gain resulted in overestimating IMT (from 0.460 ± 0.001 to 0.506 ± 0.030 mm and 0.538 ± 0.011 mm, p = 0.002 and 0.023 respectively vs. default-50 dB), underestimating the mean diameter (from 6.044 ± 0.040 mm to 5.763 ± 0.004 mm, p = 0.008 and to 5.698 ± 0.225 mm, p = 0.002), and for 70 dB, increasing IMT CV from 2.14 ± 1.92% to 6.85 ± 5.23% (p = 0.01) and diameter CV from 1.79 ± 1.22% to 4.77 ± 4.71% (p = 0.05). Distension CV increased from 5.71 ± 4.31% to 10.84 ± 5.91% (p = 0.041) and to 12.59 ± 7.97% (p = 0.021) for 60 and 70 dB respectively. Persistence and TGC did not affect repeatability, whereas diameter (5.955 ± 0.033 mm, p = 0.005) and distension (from 0.816 ± 0.019 mm to 0.655 ± 0.018 mm, p = 0.002) values were underestimated when persistence filter was active.
Discussion
Precision and reproducibility of carotid parameters, automatically assessed by Carotid Studio, are affected by high gain levels, due to image grey-level saturation. Persistence filter activation leads to underestimate diameter and distension, possibly due to mathematical operator behaviour and image temporal filtering. Since ultrasound setup significantly affects carotid parameter assessment, it should be reported and replicated in follow-up scans.
Highlights
-
We investigated how ultrasound imaging setup may affect carotid parameters.
-
Carotid parameters’ reproducibility was lower with high-gain values.
-
Persistence filter leads to underestimation of diameter and distension.
-
The scan projection seems to influence carotid parameter estimation.
-
Image depth should be kept at the lowest attainable value for best repeatability.
References
Williams B, Mancia G, Spiering W, Rosei EA, Azizi M, Burnier M, et al. 2018 practice guidelines for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: ESC/ESH task force for the Management of Arterial Hypertension. J Hypertens 2018;36:2284–309.
Vlachopoulos C, Xaplanteris P, Aboyans V, Brodmann M, Cífková R, Cosentino F, et al. The role of vascular biomarkers for primary and secondary prevention. A position paper from the European Society of Cardiology Working Group on peripheral circulation. Atherosclerosis 2015;241:507–32.
Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 2006;27:2588–605.
Bianchini E, Bozec E, Gemignani V, Faita F, Giannarelli C, Ghiadoni L, et al. Assessment of carotid stiffness and intima-media thickness from ultrasound data: comparison between two methods. J Ultrasound Med 2010;29:1169–75.
Potter K, Reed CJ, Green DJ, Hankey GJ, Arnolda LF. Ultrasound settings significantly alter arterial lumen and wall thickness measurements. Cardiovasc Ultrasound 2008;6:6.
Bianchini E, Giannarelli C, Bruno RM, Armenia S, Landini L, Faita F, et al. Functional and structural alterations of large arteries: methodological issues. Curr Pharm Des 2013;19:2390–400.
Rossi AC, Brands PJ, Hoeks APG. Nonlinear processing in B-Mode ultrasound affects carotid diameter assessment. Ultrasound Med Biol 2009;35:736–47.
Chen PW, Chen M, Leung TY, Lau TK. Effect of image settings on nuchal translucency thickness measurement by a semi-automated system. Ultrasound Obstet Gynecol 2012;39:169–74.
Faita F, Gemignani V, Bianchini E, Giannarelli C, Ghiadoni L, Demi M. Real-time measurement system for evaluation of the carotid intima-media thickness with a robust edge operator. J Ultrasound Med 2008;27:1353–61.
Moreno CC. Diagnostic ultrasound: physics and equipment, second edition. Acad Radiol 2012;19:774–5.
Szabo TL. Diagnostic ultrasound imaging: inside out; Boston, MA, USA: Academic Press; 2013, p. 832.
Touboul PJ, Hennerici MG, Meairs S, Adams H, Amarenco P, Bornstein N, et al. Mannheim carotid intima-media thickness and plaque consensus (2004-2006-2011). Cerebrovasc Dis 2012;34:290–6.
Stein JH, Korcarz CE, Hurst RT, Lonn E, Kendall CB, Mohler ER, et al. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr 2008;21:93–111.
Bianchini E, Andrei R, Faita F, Gemignani V, Plantinga Y, Demi M. Online measurement of the vasodilation of peripheral arteries on ultrasound images. In: Computers in Cardiology. Lyon, France: IEEE; 2005, pp. 779–82.
Gemignani V, Faita F, Ghiadoni L, Poggianti E, Demi M. A system for real-time measurement of the brachial artery diameter in B-mode ultrasound images. IEEE Trans Med Imaging 2007;26:393–404.
Dogan S, Duivenvoorden R, Grobbee DE, Kastelein JJP, Shear CL, Evans GW, et al. Ultrasound protocols to measure carotid intima-media thickness in trials; comparison of reproducibility, rate of progression, and effect of intervention in subjects with familial hypercholesterolemia and subjects with mixed dyslipidemia. Ann Med 2010;42:447–64.
Peters SAE, Palmer MK, den Ruijter HM, Grobbee DE, Crouse JR, O’Leary DH, et al. Sample size requirements in trials using repeated measurements and the impact of trial design. Curr Med Res Opin 2012;28:681–8.
Lobmaier SM, Cruz-Lemini M, Valenzuela-Alcaraz B, Ortiz JU, Martinez JM, Gratacos E, et al. Influence of equipment and settings on myocardial performance index repeatability and definition of settings to achieve optimal reproducibility. Ultrasound Obstet Gynecol 2014;43:632–9.
Author information
Authors and Affiliations
Corresponding author
Additional information
Peer review under responsibility of the Association for Research into Arterial Structure and Physiology
Rights and permissions
This is an open access article distributed under the CC BY-NC 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/).
About this article
Cite this article
Francesconi, M., Gemignani, V., Gherardini, R. et al. Influence of Ultrasound Settings on Carotid Biomarker Assessment by B-mode Image Processing. Artery Res 25, 139–144 (2019). https://doi.org/10.2991/artres.k.191127.001
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.2991/artres.k.191127.001