Diagnostic performance of vector flow imaging–derived wall shear stress and radiofrequency echo-tracking–derived arterial stiffness indices in severe carotid stenosis

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Yaylı N., Karabörk Kılıç A. C., Küçük Biçer B., Öncü F., Altıparmak T., Cerit M. N., ...Daha Fazla

Ultrasonography, cilt.45, sa.3, ss.252-263, 2026 (SCI-Expanded, Scopus)

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 45 Sayı: 3
  • Basım Tarihi: 2026
  • Doi Numarası: 10.14366/usg.25195
  • Dergi Adı: Ultrasonography
  • Derginin Tarandığı İndeksler: Scopus, Science Citation Index Expanded (SCI-EXPANDED)
  • Sayfa Sayıları: ss.252-263
  • Açık Arşiv Koleksiyonu: AVESİS Açık Erişim Koleksiyonu
  • Gazi Üniversitesi Adresli: Evet

Özet

Abstract

Purpose

This study aimed to evaluate the diagnostic performance of vector flow imaging (VFI)–derived hemodynamic parameters and radiofrequency echo-tracking–derived arterial stiffness indices (RF-ASI) for detecting severe carotid artery stenosis.

Methods

This prospective, single-center observational study included 90 patients with carotid artery disease examined between May and July 2024. Stenosis severity was categorized as <50%, 50%–69%, and ≥70% according to the Society of Radiologists in Ultrasound (SRU) Doppler criteria. In patients with stenosis ≥50%, severity was confirmed using digital subtraction angiography, computed tomography angiography, or magnetic resonance angiography. At the plaque level, VFI-derived wall shear stress (WSS) and turbulence metrics, as well as RF-ASI, were measured. Correlation analyses, group comparisons, and receiver operating characteristic analysis were performed to evaluate each parameter’s ability to detect ≥70% stenosis.

Results

Among the 90 patients (mean age, 70.4±8.7 years; 55.6% male), peak-segment mean wall shear stress (WSSmean) demonstrated the strongest correlation with stenosis severity (rs=0.87, P<0.001). WSSmean also showed the highest diagnostic performance for detecting ≥70% stenosis (area under the curve, 0.96; 95% confidence interval, 0.92 to 0.99; cutoff, 2.25 Pa), compared with other VFI-derived metrics and RF-ASI. Segmental analysis revealed that WSS values were highest at the plaque peak, whereas turbulence-related metrics were more pronounced in distal segments. In SRU-discordant cases (7 of 90), WSSmean agreed with anatomic imaging–based classification (≥70% vs. <70%) in six of seven lesions.

Conclusion

VFI-derived WSSmean demonstrated the highest diagnostic performance for detecting severe (≥70%) carotid stenosis. In contrast, RF-ASI showed limited discriminatory ability and may primarily reflect global arterial stiffness rather than focal plaque severity.

Keywords: Internal carotid artery; Carotid artery diseases; Ultrasonography; Pulse wave analysis; Hemodynamics

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Key points

Mean wall shear stress (WSSmean) at the plaque peak demonstrated the highest diagnostic performance in detecting severe (≥70%) stenosis (area under the curve, 0.96; 95% confidence interval, 0.92 to 0.99; cutoff, 2.25 Pa). Segmental analysis showed that wall shear stress and turbulence parameters were highest at the plaque peak and in distal segments, respectively, indicating spatial heterogeneity in flow patterns. WSSmean may complement conventional ultrasonographic findings in cases of borderline carotid stenosis and in Society of Radiologists in Ultrasound–anatomic imaging–discordant cases, with agreement observed in six of seven discordant lesions.