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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 (CIMT mean ), maximum CIMT (CIMT max ) and standard deviation of CIMT (CIMT sd ) were obtained for all images. CIMT for different DRs were compared using student  t -test.    Results  CIMT mean  for 40, 55, 70 and 85 dB were 0.529, 0.564, 0.590 and 0.605 mm respectively. For CIMT max  the corresponding values were 0.626, 0.667, 0.698, and 0.716 mm. CIMT mean  and CIMT max  increased significantly for increasing DR steps (p < 0.01). The relative change in CIMT mean  and CIMT max  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.

Measurements of carotid intima media thickness in non-invasive high-frequency ultrasound images: the effect of dynamic range setting