title: Measurements of carotid intima media thickness in non-invasive high-frequency ultrasound images: the effect of dynamic range setting.
abstract: BACKGROUND
  Carotid intima media thickness (CIMT) measured with ultrasound (US) is widely used as biomarker for arteriosclerosis and as surrogate endpoint in interventional studies to assess efficacy of drug therapies. Strict US protocols are necessary to ensure reproducibility. The range of US signal intensities used for image formation, the dynamic range (DR), is rarely reported in studies and little is known about its effect on CIMT measurements in humans. The purpose of this study was to quantify the impact of DR on measurements of CIMT.
  
  
  METHODS
  US was used to examine 313 carotid arteries in participants from two different clinical studies. For each artery, images with DR of 40, 55, 70 and 85 dB were captured from the same frozen US frame. Mean CIMT (CIMTmean), maximum CIMT (CIMTmax) and standard deviation of CIMT (CIMTsd) were obtained for all images. CIMT for different DRs were compared using student t-test.
  
  
  RESULTS
  CIMTmean for 40, 55, 70 and 85 dB were 0.529, 0.564, 0.590 and 0.605 mm respectively. For CIMTmax the corresponding values were 0.626, 0.667, 0.698, and 0.716 mm. CIMTmean and CIMTmax increased significantly for increasing DR steps (p < 0.01). The relative change in CIMTmean and CIMTmax were largest between 40 and 55 dB (6.7% and 7.0%) and smallest between 70 and 85 dB (2.6% and 2.7%) indicating a declining dependency for increasing DR.
  
  
  CONCLUSIONS
  DR significantly changes CIMT measurements and the changes are most prominent for lower DRs. The effect of changing DR is larger in human arteries than in phantoms. Reporting the DR will therefore increase the validity of CIMT data.
authors: Department of Radiology and Nuclear Medicine, Oslo University Hospital, P,O, Box 4950, Nydalen 0424, Oslo, Norway. s.m.gaarder@medisin.uio.no.
authors: Mario
authors: M
authors: Gaarder
authors: Therese
authors: T
authors: Seierstad
mesh_terms: D000293:Adolescent; D000328:Adult; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging*; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D059168:Carotid Intima-Media Thickness; D048909:Diabetes Complications / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D015203:Reproducibility of Results; D055815:Young Adult
references: Circulation. 1986 Dec;74(6):1399-406
references: 3536154
references: Cerebrovasc Dis. 2012;34(4):290-6
references: 23128470
references: Cardiovasc Ultrasound. 2008;6:6
references: 18208623
references: Curr Atheroscler Rep. 2008 Oct;10(5):444-50
references: 18706287
references: Postgrad Med. 2010 Jan;122(1):10-8
references: 20107284
references: Arterioscler Thromb Vasc Biol. 2014 Jun;34(6):1298-306
references: 24743431
references: Eur J Prev Cardiol. 2012 Aug;19(4):585-667
references: 22763626
references: N Engl J Med. 1999 Jan 7;340(1):14-22
references: 9878640
references: J Atheroscler Thromb. 2013;20(1):108-21
references: 23095240
references: Postgrad Med. 2013 Mar;125(2):108-23
references: 23816777
references: Lancet. 2012 Jun 2;379(9831):2053-62
references: 22541275