Chikai J. Ohazama

Real-time three-dimensional echocardiography for measurement of left ventricular volumes

Left ventricular (LV) volumes are important prognostic indexes in patients with heart disease. Although several methods can evaluate LV volumes, most have important intrinsic limitations. Real-time 3-dimensional echocardiography (RT3D echo) is a novel technique capable of instantaneous acquisition of volumetric images. The purpose of this study was to validate LV volume calculations with RT3D echo and to determine their usefulness in cardiac patients. To this end, 4 normal subjects and 21 cardiac patients underwent magnetic resonance imaging (MRI) and RT3D echo on the same day. A strong correlation was found between LV volumes calculated with MRI and with RT3D echo (r = 0.91; y = 20.1 + 0.71x; SEE 28 ml). LV volumes obtained with MRI were greater than those obtained with RT3D echo (126 +/- 83 vs 110 +/- 65 ml; p = 0.002), probably due to the fact that heart rate during MRI acquisition was lower than that during RT3D echo examination (62 +/- 11 vs 79 +/- 16 beats/min; p = 0.0001). Analysis of intra- and interobserver variability showed strong indexes of agreement in the measurement of LV volumes with RT3D echo. Thus, LV volume measurements with RT3D echo are accurate and reproducible. This technique expands the use of ultrasound for the noninvasive evaluation of cardiac patients and provides a new tool for the investigational study of cardiovascular disease.

Assessment of Regional Wall Motion Abnormalities with Real-Time 3-Dimensional Echocardiography

Accurate characterization of regional wall motion abnormalities requires a thorough evaluation of the entire left ventricle (LV). Although 2-dimensional echocardiography is frequently used for this purpose, the inability of tomographic techniques to record the complete endocardial surface is a limitation. Three-dimensional echocardiography, with real-time volumetric imaging, has the potential to overcome this limitation by capturing the entire volume of the LV and displaying it in a cineloop mode. The purpose of this study was to assess the feasibility of using real-time 3-dimensional (RT3D) echocardiography to detect regional wall motion abnormalities in patients with abnormal LV function and to develop a scheme for the systematic evaluation of wall motion by using the 3-dimensional data set. Twenty-six patients with high-quality 2-dimensional echo images and at least 1 regional wall motion abnormality were examined with RT3D echocardiography. For 2-dimensional echocardiography, wall motion was analyzed with a 16-segment model and graded on a 4-point scale from normal (1) to dyskinetic (4), from which a wall motion score index was calculated. Individual segments were then grouped into regions (anterior, inferoposterior, lateral, and apical) and the number of regional wall motion abnormalities was determined. The RT3D echocardiogram was recorded as a volumetric, pyramid-shaped data set that contained the entire LV. Digital images, consisting of a single cardiac cycle cineloop, were analyzed off-line with a computerized display of the apical projection. Two intersecting orthogonal apical projections were simultaneously displayed in cineloop mode, each independently tilted to optimize orientation and endocardial definition. The 2 planes were then slowly rotated about the major axis to visualize the entire LV endocardium. Wall motion was then graded in 6 equally spaced views, separated by 30 degrees, yielding 36 segments per patient. A higher percentage of segments were visualized with 2-dimensional versus RT3D echocardiography (97% vs 83%, respectively, P <.001). With the use of the 2-dimensional echocardiographic results as the standard, RT3D echocardiography detected 55 (96%) of 57 regional wall motion abnormalities. Analysis of the RT3D echocardiograms resulted in 3 false-negative and 5 false-positive findings. The total number of regional wall motion abnormalities was correctly classified by RT3D echocardiography in 19 (73%) of 26 patients. RT3D echocardiography detected 11 of 13 anterior, 19 of 20 inferoposterior, 9 of 9 lateral, and 15 of 15 apical wall motion abnormalities. An excellent correlation was found between the 2 techniques for assessment of the regional wall motion score index (r = 0.89, P <.001). This initial clinical study demonstrates the feasibility and potential advantages of RT3D echocardiography for the assessment of regional LV function. Compared with 2-dimensional echocardiography, this new method permits recording of the entire LV in a single beat, allowing the extent and location of the regional wall motion abnormalities to be determined.

Real-time, three-dimensional echocardiography : Feasibility of dynamic right ventricular volume measurement with saline contrast

BACKGROUND The asymmetry and complex shape of the right ventricle have made it difficult to determine right ventricular (RV) volume with 2-dimensional echocardiography. Three-dimensional cardiac imaging improves visualization of cardiac anatomy but is also complex and time consuming. A newly developed volumetric scanning system holds promise of obviating past limitations. METHODS Real-time, transthoracic 3-dimensional echocardiographic images of the right ventricle were obtained with a high-speed volumetric ultrasound system that uses a 16:1 parallel processing schema from a 2.5 MHz matrix phased-array scanner to interrogate an entire pyramidal volume in real time. The instrumentation was used to measure RV volume in 8 excised canine hearts; dynamic real-time 3-dimensional images were also obtained from 14 normal subjects. RESULTS Three-dimensional images were obtained in vitro and in vivo during intravenous hand-agitated saline injection to determine RV volumes. The RV volumes by real-time 3-dimensional echocardiography are well correlated with those of drained in vitro (y = 1.26x - 9.92, r = 0.97, P <.0001, standard error of the estimate = 3.26 mL). For human subjects, the end-diastolic and end-systolic RV volumes were calculated by tracing serial cross-sectional, inclined C scans; functional data were validated by comparing the scans with conventional 2-dimensional echocardiographic indexes of left ventricular stroke volume. CONCLUSIONS These data indicate that RV volume measurements of excised heart by real-time 3-dimensional echocardiography are accurate and that beat-to-beat RV quantitative measurement applying this imaging method is possible. The new application of real-time 3-dimensional echocardiography presents the opportunity to develop new descriptors of cardiac performance.

Real-time volumetric echocardiography: the technology and the possibilities.

The heart is a dynamic organ with complexities in its shape. As such, it places special demands on three‐dimensional techniques for reconstruction. Real‐time volumetric echocardiography, which is based on phased array and parallel processing principles to enhance line density within a scan volume, provides rapid image acquisition. We introduce the principle, potential clinical importance, current limitations, and future of volumetric imaging methods.

NIHmagic: 3D visualization, registration, and segmentation tool

Interactive visualization of multi-dimensional biological images has revolutionized diagnostic and therapy planning. Extracting complementary anatomical and functional information from different imaging modalities provides a synergistic analysis capability for quantitative and qualitative evaluation of the objects under examination. We have been developing NIHmagic, a visualization tool for research and clinical use, on the SGI OnyxII Infinite Reality platform. Images are reconstructed into a 3D volume by volume rendering, a display technique that employs 3D texture mapping to provide a translucent appearance to the object. A stack of slices is rendered into a volume by an opacity mapping function, where the opacity is determined by the intensity of the voxel and its distance from the viewer. NIHmagic incorporates 3D visualization of time-sequenced images, manual registration of 2D slices, segmentation of anatomical structures, and color-coded re-mapping of intensities. Visualization of MIR, PET, CT, Ultrasound, and 3D reconstructed electron microscopy images has been accomplished using NIHmagic.

Active contour based on the elliptical Fourier series, applied to matrix-array ultrasound of the heart

We describe an active contour based on the elliptical Fourier series, and its application to matrix-array ultrasound. Matrix-array ultrasound is a new medical imaging modality that scans a 3D-volume electronically without physically moving the transducer, allowing for real-time continuous 3D imaging of the heart. Unlike other 3D ultrasound modalities which physically move a linear array, matrix array ultrasound is rapid enough to capture an individual cardiac cycle, yielding a temporal resolution of 22 volumetric scans per second. With the goal of automatically tracking the heart wall, an active contour has been developed using the elliptical Fourier series to find perpendicular lines intersecting an initial contour. The neighborhood defined by these perpendiculars is mapped into a rectangular space, called the 1D swath, whose vertical axis represents the inside-vs.-outside dimension of the contour (along the perpendicular), and whose horizontal axis represents parametric distance along the contour (tangent to the contour). A dynamic programming technique is then used to find the optimum error function traversing the rectangle horizontally, and this error function is mapped back into image space to yield a new contour. The method does not iterate, but rather simultaneously searches for the optimum contour within a limited domain. Results are presented applying the technique to 3D ultrasound images of in vivo hearts.