IIM2FieldII: A Framework for Validating Ultrasound Measurements of Volumetric Flow and WSS in Complex Carotid Plaque Geometries

High wall shear stress (WSS) is associated with risk of atherosclerotic plaque rupture, but there are numerous gaps in validating ultrasound-derived measurements of the parameter. Two major challenges are using simple models of stenosis and only evaluating WSS along a single 2D plane. To overcome these limitations, a novel simulation framework is herein demonstrated. The framework first models volumetric blood flow in actual stenosed human carotid artery geometries (using an immersed interface method (IIM) fluid structure interaction solver) and calculates the associated WSS. Then, the framework projects the modeled blood flow onto scatterers in Field II simulations of its ultrasonic interrogation. Volumetric ultrasound vector Doppler (VD) imaging using an elevationally swept L7-4 linear array was simulated in Field II, with variations in transmit sequences and flow conditions. In a ~55% stenosed human carotid artery under 600 mL/min flow, Bland-Altman analysis showed that a 3-angle plane wave (PW) transmit scheme estimated WSS with 0.04±0.64 Pa error (bias ± 95% CI) relative to the IIM ground truth, whereas transmitting with 5 angles increased accuracy, but decreased precision to -0.01±1.07 Pa, due to aliasing. These findings illustrate that the simulation framework enables direct comparison of data acquisition and processing methods for efficient development, validation, and refinement of WSS estimation methods in realistic clinical environments.