Vascular Shear Wave Elastography in Atherosclerotic Arteries: A Systematic Review

Abstract

Ischemic stroke is a leading cause of death and disability worldwide, so adequate prevention strategies are crucial. However, current stroke risk stratification is based on epidemiologic studies and is still suboptimal for individual patients. The aim of this systematic review was to provide a literature overview on the feasibility and diagnostic value of vascular shear wave elastography (SWE) using ultrasound (US) in (mimicked) human and non-human arteries affected by different stages of atherosclerotic diseases or diseases related to atherosclerosis. An online search was conducted on Pubmed, Embase, Web of Science and IEEE databases to identify studies using US SWE for the assessment of vascular elasticity. A quality assessment was performed using Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) checklist, and relevant data were extracted. A total of 19 studies were included: 10 with human patients and 9 with non-human subjects (i.e., [excised] animal arteries and polyvinyl alcohol phantoms). All studies revealed the feasibility of using US SWE to assess individually stiffness of the arterial wall and plaques. Quantitative elasticity values were highly variable between studies. However, within studies, SWE could detect statistically significant elasticity differences in patient/subject characteristics and could distinguish different plaque types with good reproducibility. US SWE, with its unique ability to assess the elasticity of the vessel wall and plaque throughout the cardiac cycle, might be a good candidate to improve stroke risk stratification. However, more clinical studies have to be performed to assess this technique's exact clinical value.

Assessing radiation-induced carotid vasculopathy using ultrasound after unilateral irradiation: a cross-sectional study

“…Ultrafast imaging methods are independent of blood pressure, possibly providing more accurate stiffness estimations. Besides, a high reproducibility found in this and previous studies [ 10 , 17 ] point to its user-independence. Studies comparing different stiffness estimation methods are needed to determine optimal techniques for vasculopathy assessment.…”

“…The ROI was projected on all SW-frames and the mean SWV was calculated for every frame. Mean SWVs of all acquired SW-frames were averaged to obtain a representative SWV estimate, unaffected by the timing of a single SWV estimation, because SWV varies throughout the cardiac cycle [ 10 ].…”

Investigation on the differences of hemodynamics in normal common carotid, subclavian, and common femoral arteries using the vector flow technique

“…Early detection of PAD hemodynamics is therefore crucial for disease prevention. Vascular elasticity and arterial stiffness, which can be measured using strain imaging, shear wave elastography (SWE) and pulse wave velocity (PWV), are considered to be strongly related to atherosclerosis, but they mainly represent the current status of blood vessels and plaques, and sometimes are limited by the measurement accuracy on the vessel wall ( 7 , 8 ).…”

Artery Wall Viscoelasticity: Measurement, Assessment, and Clinical Implications

“…It can differentiate the local arterial tissue stiffnesses in the radial and transverse directions, but quantification of the stiffness value is difficult. The high variability in the stiffness values was found to be due to the non-uniform tissue composition, disease characteristics, different measurement tools, and settings (spatial and temporal differences) [88].…”