Non-invasive imaging for improved cardiovascular diagnostics : shear wave elastography, relative pressure estimation, and tomographic reconstruction

<p>Throughout the last century, medical imaging has come to revolutionise the way we diagnose disease, and is today an indispensable part of virtually any clinical practice. In cardiovascular care imaging is extensively utilised, and the development of novel techniques promises refined diagnostic abilities: ultrasound elastography allows for constitutive tissue assessment, 4D flow magnetic resonance imaging (MRI) enables full-field flow mapping, and micro-Computed Tomography (CT) permits high-resolution imaging at pre-clinical level. However, following the complex nature of cardiovascular disease, refined methods are still very much needed to accurately utilise these techniques and to effectively isolate disease developments.</p><p>The aim of this thesis has been to develop such methods for refined cardiovascular image diagnostics. In total eight studies conducted over three separate focus areas have been included: four on vascular shear wave elastography (SWE), three on non-invasive cardiovascular relative pressure estimations, and one on tomographic reconstruction for pre-clinical imaging. In Study I-IV, the accuracy and feasibility of vascular SWE was evaluated, with particular focus on refined carotid plaque characterisation. With confined arterial or plaque tissue restricting acoustic wave propagation, analysis of group and phase velocity was performed with SWE output validated against reference mechanical testing and imaging. The results indicate that geometrical confinement has a significant impact on SWE accuracy, however that a combined group and phase velocity approach can be utilised to identify vulnerable carotid plaque lesions in-vivo. In Study V-VII, a non-invasive method for the interrogation of relative pressure from imaged cardiovascular flow was developed. Using the concept of virtual work-energy, the method was applied to accurately assess relative pressures throughout complex, turbulence-inducing, branching vasculatures. The method was also applied on a dilated cardiomyopathy cohort, indicating arterial hemodynamic changes in cardiac disease. Lastly, in Study VIII a method for multigrid image reconstruction of tomographic data was developed, utilising domain splitting and operator masking to accurately reconstruct high-resolution regions-of-interests at a fraction of the computational cost of conventional full-resolution methods.</p><p>Together, the eight studies have incorporated a range of different imaging modalities, developed methods for both constitutive and hemodynamic cardiovascular assessment, and utilised refined pre-clinical imaging, all with the same purpose: to refine current state cardiovascular imaging and to improve our ability to non-invasively assess cardiovascular disease. With promising results reached, the studies lay the foundation for continued clinical investigations, advancing the presented methods and maturing their usage for an improved future cardiovascular care.</p><h3>List of scientific papers</h3><p>I. Arterial stiffness estimation by shear wave elastography: validation in phantoms with mechanical testing. E. Maksuti, E. Widman, D. Larsson*, M.W. Urban, M. Larsson, A. BjŠllmark. Ultrasound in Medicine & Biology. vol. 42, p. 309-321, 2016. *David Larsson is the pre-marital name of David Marlevi. <br><a href="https://doi.org/10.1016/j.ultrasmedbio.2015.08.012">https://doi.org/10.1016/j.ultrasmedbio.2015.08.012</a><br><br> </p><p>II. Plaque characterization using shear wave elastography Đ evaluation of differentiability and accuracy using a combined ex-vivo and in-vitro setup. D. Marlevi, E. Maksuti, M.W. Urban, R. Winter, M. Larsson. Physics in Medicine & Biology. vol. 63, no. 23, 235008 (17pp), 2018. <br><a href="https://doi.org/10.1088/1361-6560/aaec2b">https://doi.org/10.1088/1361-6560/aaec2b</a><br><br> </p><p>III. An ex-vivo setup for characterization of atherosclerotic plaque using shear wave elastography and micro-computed tomography. D. Larsson*, J. Roy, T.C. Gasser, M.W. Urban, M. Colarieti-Tosti, M. Larsson. 2016 IEEE International Ultrasonics Symposium (IUS). Tours, France, 2016. *David Larsson is the pre-marital name of David Marlevi. <br><a href="https://doi.org/10.1109/ULTSYM.2016.7728810">https://doi.org/10.1109/ULTSYM.2016.7728810</a><br><br></p><p>IV. Shear wave elastography enables detection of vulnerable carotid plaques Đ MRI-validation of combined spatiotemporal and frequency-dependent wave analysis. D. Marlevi, S. Mulvagh, R. Huang, J.K. DeMarco, H. Ota, J. Huston, R. Winter, T.A. Macedo, S.S. Abdelmoneim, M. Larsson, P. Pellikka, M.W. Urban. [Manuscript]</p><p>V. Estimation of cardiovascular relative pressure using virtual work-energy. D. Marlevi, B. Ruijsink, M. Balmus, D. Dillon-Murphy, D. Fovargue, K. Pushparajah, C. Bertoglio, M. Colarieti-Tosti, M. Larsson, P. Lamata, C.A. Figueroa, R. Razavi, D.A. Nordsletten. Scientific Reports. vol. 9, article number 1375, 2019. <br><a href="https://doi.org/10.1038/s41598-018-37714-0">https://doi.org/10.1038/s41598-018-37714-0</a><br><br> </p><p>VI. Non-invasive estimation of relative pressure in turbulent flow using virtual work-energy. D. Marlevi, H. Ha, D. Dillon-Murphy, J.F. Fernandes, D. Fovargue, M. Colarieti-Tosti, M. Larsson, P. Lamata, C.A. Figueroa, T. Ebbers, D.A. Nordsletten. [Manuscript]</p><p>VII. Altered aortic hemodynamics and relative pressure in patients with dilated cardiomyopathy. D. Marlevi, J. Mariscal-Harana, J. Sotelo, B. Ruijsink, M. Hadjicharalambous, L. Asner, E. Sammut, R. Chabiniok, S. Uribe, R. Winter, P. Lamata, J. Alastruey, D.A. Nordsletten. [Manuscript]</p><p>VIII. Multigrid reconstruction in tomographic imaging. D. Marlevi, H. Kohr, J.-W. Buurlage, B. Gao, K.J. Batenburg, M. Colarieti-Tosti. [Accepted] <br><a href="https://doi.org/0.1109/TRPMS.2019.2942186">https://doi.org/0.1109/TRPMS.2019.2942186</a><br><br></p>