Echo Particle Image Velocimetry for Estimation of Carotid Artery Wall Shear Stress: Repeatability, Reproducibility and Comparison with Phase-Contrast Magnetic Resonance Imaging

Measurement of hemodynamic wall shear stress (WSS) is important in investigating the role of WSS in the initiation and progression of atherosclerosis. Echo particle image velocimetry (echo PIV) is a novel ultrasound-based technique for measuring WSS in vivo that has previously been validated in vitro using the standard optical PIV technique. We evaluated the repeatability and reproducibility of echo PIV for measuring WSS in the human common carotid artery. We measured WSS in 28 healthy participants (18 males and 10 females, mean age: 56 ± 12 y). Echo PIV was highly repeatable, with an intra-observer variability of 1.0 ± 0.1 dyn/cm² for peak systolic (maximum), 0.9 dyn/cm² for mean and 0.5 dyn/cm² for end-diastolic (minimum) WSS measurements. Likewise, echo PIV was reproducible, with a low inter-observer variability (max: 2.0 ± 0.2 dyn/cm², mean: 1.3 ± 0.1 dyn/cm², end-diastolic: 0.7 dyn/cm²) and more variable inter-scan (test–retest) variability (max: 7.1 ± 2.3 dyn/cm², mean: 2.9 ± 0.4 dyn/cm², min: 1.5 ± 0.1 dyn/cm²). We compared echo PIV with the reference method, phase-contrast magnetic resonance imaging (PC-MRI); echo PIV-based WSS measurements agreed qualitatively with PC-MRI measurements (r = 0.89, p < 0.05). Significant differences were observed in some WSS measurements (echo PIV vs. PC-MRI): WSS at peak systole: 21 ± 7.0 dyn/cm² vs. 15 ± 5.0 dyn/cm²; time-averaged WSS: 8.9 ± 3.0 dyn/cm² vs. 7.1 ± 3.0 dyn/cm² (p < 0.05); WSS at end diastole: 3.8 ± 2.8 dyn/cm² vs. 3.9 ± 2 dyn/cm² (p > 0.05). For the first time, we report that echo PIV can measure WSS with good repeatability and reproducibility in adult humans with a broad age range. Echo PIV is feasible in humans and offers an easy-to-use, ultrasound-based, quantitative technique for measuring WSS in vivo in humans with good repeatability and reproducibility.