Left and right atrial volume by freehand three-dimensional echocardiography: in vivo validation using magnetic resonance imaging.

INTRODUCTION: Measurement of left and right atrial size is important for the management of arrhythmias, valvular and congenital heart disease. We have demonstrated that freehand three-dimensional (3D) echocardiography is more accurate and reproducible than two-dimensional (2D) echocardiography for measurement of left ventricular mass and volume. However, no prior study has validated the accuracy of freehand 3D for the determination of left or right atrial volume. METHODS: End-systolic (maximum) left and right atrial volumes were determined in 21 volunteer patients and normal subjects by one, two, and freehand 3D transthoracic echocardiography and compared to volumes obtained by gradient recalled magnetic resonance imaging. Three-dimensional echocardiographic determination of atrial volume was obtained using an acoustic spatial locator, a line-of-intersection display, and a surface reconstruction algorithm. Two-dimensional echocardiographic atrial volumes were obtained from apical biplane images of the left atrium and an apical single plane image of the right atrium using a summation of disks method. One-dimensional (ID) estimates of left atrial volume were determined by cubing the M-mode ID antero-posterior dimension obtained on the parasternal long axis view. RESULTS: An excellent correlation was Obtained between freedhand 3D echocardiography and magnetic resonce imaging (MRI) for the left atrium (r = 0.90, SEE=9.6 ml) and for the right atrium (r = 0.91, SEE = 8.8 ml) with a small bias (left atrium 5.25 ml, right atrium 12.06 ml) and narrow limits of agreement (left atrium 22.14 ml, right atrium 25.54 ml). Two-dimensional echocardiography correlated less well (left atrium r = 0.87, SEE = 10.23 ml, right atrium r = 0.79, SEE = 19.74 ml), and had a higher bias (left atrium 14.46 ml, right atrium 8.99 ml) and larger limits of agreement (left atrium 24.37 ml, right atrium 41.16 ml). One-dimensional estimates of left atrial volume correlated poorly with magnetic resonance determined left atrial volume (r = 0.80, SEE = 6.61 ml) and had unacceptably high bias (45.09 ml) and limits of agreement (35.52 ml). Interobserver variability was lowest for 3D echocardiography (left atrium 7.2 ml, 11%, right atrium 8.7 ml, 16%). CONCLUSIONS: Freehand 3D echocardiography using the line of intersection display for guidance of image positioning and a polyhedral surface reconstruction algorithm is a valid, accurate, reproducible method for determining left and right atrial volume in humans that is comparable to magnetic resonance imaging and is superior to current ID and 2D echocardiographic techniques.     

Unbiased and efficient estimation of left ventricular volumes by three-dimensional echocardiography with coaxial sections. Validation with magnetic resonance imaging

The objective of this study was to investigate the degree of bias with coaxial three-dimensional echocardiography in an experimental animal setup and to establish the minimum number of sections needed for estimation of left ventricular (LV) volume. Epicardial coaxial echocardiography and magnetic resonance imaging (MRI) was used to measure LV volume in 14 pigs, with chronic remodeled left ventricles induced by repeated intracoronary microembolizations. In addition, six animals underwent serial MRI at baseline, immediately after intracoronary microembolization, and after 119–165 days (mean 129 days). Coaxial echocardiography was performed by rotational acquisition of long-axis sections starting from an arbitrary angle. Planimetered MRI contours of LV endocardial borders were analyzed to investigate the relationship between the number of coaxial sections, and the precision of volume estimates. The mean ± 2SD of the differences between coaxial epicardial echocardiography with six sections and MRI were −2.5 ± 16.4 ml, 0.8 ± 13. 1 ml, and 2% ± 14% for end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF), respectively. Numerical analysis conducted on MRI contours of LV endocardial borders showed that with six coaxial sections the average coeffi-cient of error was <1% for the EDV and ESV. Three-dimensional echocardiography with six coaxial sections provides unbiased LV volume estimation with minimal geometric error. Received: February 10, 2000 / Accepted: May 23, 2000     

New digital measurement methods for left ventricular volume using real-time three-dimensional echocardiography: comparison with electromagnetic flow method and magnetic resonance imaging.

AIM: The aim of this study was to investigate the feasibility and accuracy of using symmetrically rotated apical long axis planes for the determination of left ventricular (LV) volumes with real-time three-dimensional echocardiography (3DE). METHODS AND RESULTS: Real-time 3DE was performed in six sheep during 24 haemodynamic conditions with electromagnetic flow measurements (EM), and in 29 patients with magnetic resonance imaging measurements (MRI). LV volumes were calculated by Simpson's rule with five 3DE methods (i.e. apical biplane, four-plane, six-plane, nine-plane (in which the angle between each long axis plane was 90 degrees, 45 degrees, 30 degrees or 20 degrees, respectively) and standard short axis views (SAX)). Real-time 3DE correlated well with EM for LV stroke volumes in animals (r=0.68-0.95) and with MRI for absolute volumes in patients (r-values=0.93-0.98). However, agreement between MRI and apical nine-plane, six-plane, and SAX methods in patients was better than those with apical four-plane and bi-plane methods (mean difference = -15, -18, -13, vs. -31 and -48 ml for end-diastolic volume, respectively, P<0.05). CONCLUSION: Apically rotated measurement methods of real-time 3DE correlated well with reference standards for calculating LV volumes. Balancing accuracy and required time for these LV volume measurements, the apical six-plane method is recommended for clinical use.     

Feasibility of left ventricular volume measurements by three-dimensional speckle tracking echocardiography depends on image quality and degree of left ventricular enlargement: Validation study with cardiac magnetic resonance imaging

BackgroundNovel 3-dimensional echocardiography with speckle tracking imaging (3D-STE) may have advantages in assessing left ventricular (LV) volume through a cardiac cycle. The feasibility of 3D-STE may be affected by image quality and LV morphology.Methods and resultsWe studied 64 patients (38 men, age 55 ± 12 years) who underwent cardiac magnetic resonance imaging (CMRI) and 3D-STE on the same day. LV end-diastolic volume (EDV) and end-systolic volume (ESV) were measured by both modalities. Imaging qualities were quantified in each of 6 LV segments by an imaging quality score (IQS) of 1–3, and scores were averaged (mean IQS) at end-diastole and end-systole. Compared to CMRI, 3D-STE showed a tendency to underestimate LV volume measurements, but not significantly (EDV: bias = −18 ± 37 ml; ESV: bias = −10 ± 34 ml), and measurements correlated well with those by CMRI (EDV: R = 0.80, ESV: R = 0.86, ejection fraction: R = 0.75, p < 0.001). The absolute differences of LVEDV and ESV between 3D-STE and CMRI correlated significantly with mean IQS (LVEDV, R = −0.35, p = 0.005; LVESV, R = −0.30, p = 0.02). Based on the medium value of LVEDV by CMRI (127 ml), subjects were classified into the small (<127 ml) and large LVEDV (≧127 ml) groups. In the large LVEDV group, mean IQS significantly correlated with the absolute differences of LVEDV (mean IQS, r = −0.45, p = 0.01), despite no significant correlation in the small LVEDV group.Conclusion3D-STE could measure LV volume as well as CMRI, however, its accuracy depends on the quality of the acquired image and particularly on enlargement of the left ventricle.     

Left ventricular volume measurement with echocardiography: a comparison of left ventricular opacification, three-dimensional echocardiography, or both with magnetic resonance imaging

Aims: Both contrast enhanced (CE) two-dimensional echocardiography(2DE) and three-dimensional echocardiography (3DE) have beenproposed as techniques to improve the accuracy of left ventricular(LV) volume measurements. We sought to examine the accuracyof non-contrast (NC) and CE-2DE and 3DE for calculation of LVvolumes and ejection fraction (EF), relative to cardiac magneticresonance imaging (MRI). Methods and results: We studied 50 patients (46 men, age 63 ± 10 year) withpast myocardial infarction who underwent echocardiographic assessmentof LV volume and function. All patients sequentially underwentNC-2DE followed by NC-3DE. CE-2DE and CE-3DE were acquired duringcontrast infusion. Resting echocardiographic image quality wasevaluated on the basis of NC-2DE. The mean LV end-diastolicvolume (LVEDV) of the group by MRI was 207 ± 79 mL andwas underestimated by 2DE (125 ± 54 mL, P = 0.005), andless by CE-2DE (172 ± 58 mL, P = 0.02) or 3DE (177 ±64 mL, P = 0.08), but EDV was comparable by CE-3DE (196 ±69 mL, P = 0.16). Limits of agreement with MRI were similarfor NC-3DE and CE-2DE, with the best results for CE-3D. Resultswere similar for calculation of LVESV. Patients were categorizedinto groups of EF (35, 35–50, >50%) by MRI. NC-2DEdemonstrated a 68% agreement (kappa 0.45, P = 0.001), CE-2DEa 62% agreement (kappa 0.20, P = 136), NC-3DE a 74% agreement(kappa 0.39, P = 0.005) and CE-3DE an 80% agreement (kappa 0.56,P < 0.001). Conclusion: CE-2DE is analogous to NC-3DE in accurate categorization ofLV function. However, CE-3DE is feasible and superior to otherNC- and CE-techniques in patients with previous infarction.     

Value of real time three-dimensional echocardiography in patients with hypertrophic cardiomyopathy: comparison with two-dimensional echocardiography and magnetic resonance imaging

Real time three-dimensional echocardiography (RT3DE) has been demonstrated to be an accurate technique to quantify left ventricular (LV) volumes and function in different patient populations. We sought to determine the value of RT3DE for evaluating patients with hypertrophic cardiomyopathy (HCM), in comparison with cardiac magnetic resonance imaging (MRI). Methods: We studied 20 consecutive patients with HCM who underwent two-dimensional echocardiography (2DE), RT3DE, and MRI. Parameters analyzed by echocardiography and MRI included: wall thickness, LV volumes, ejection fraction (LVEF), mass, geometric index, and dyssynchrony index. Statistical analysis was performed by Lin agreement coefficient, Pearson linear correlation and Bland-Altman model. Results: There was excellent agreement between 2DE and RT3DE (Rc = 0.92), 2DE and MRI (Rc = 0.85), and RT3DE and MRI (Rc = 0.90) for linear measurements. Agreement indexes for LV end-diastolic and end-systolic volumes were Rc = 0.91 and Rc = 0.91 between 2DE and RT3DE, Rc = 0.94 and Rc = 0.95 between RT3DE and MRI, and Rc = 0.89 and Rc = 0.88 between 2DE and MRI, respectively. Satisfactory agreement was observed between 2DE and RT3DE (Rc = 0.75), RT3DE and MRI (Rc = 0.83), and 2DE and MRI (Rc = 0.73) for determining LVEF, with a mild underestimation of LVEF by 2DE, and smaller variability between RT3DE and MRI. Regarding LV mass, excellent agreement was observed between RT3DE and MRI (Rc = 0.96), with bias of − 6.3 g (limits of concordance = 42.22 to − 54.73 g) . Conclusion: In patients with HCM, RT3DE demonstrated superior performance than 2DE for the evaluation of myocardial hypertrophy, LV volumes, LVEF, and LV mass.     

实时三维超声心动图与磁共振对比评价老年患者的左心室质量

目的 评价实时三维超声心动图测量老年患者左心室质量的准确性和重复性,并与磁共振对比.方法 选取因各种不同原因进行心脏磁共振检查的老年患者31例,同时进行实时三维超声心动图检查.实时三维超声心动图检查采用Philips iE-33型超声心动图仪,左心室质量的分析通过TomTec工作站用人工描记法完成,并与磁共振所得结果相比较.结果 实时三维超声心动图测量所得的左心室质量与磁共振测量结果比较,有良好的相关性.磁共振测量的左心室质量为74.4～208.1 g,平均(123.9±35.0)g.实时三维超声心动图测量的左心室质量为67.0～222.9 g,平均(128.6±37.9)g.二者所测结果相似(r=0.869,y=0.943 x+11.69,标准误为19.09 g),平均相差(4.7±37.7)g.在不同观察者间及观察者自身不同时间内测量的实时三维超声心动图结果显示良好的重复性.结论 实时三维超声心动图可以用于测量老年患者的左心室质量.与磁共振比较,实时三维超声心动图测量老年患者的左心室质量有较好的准确性和重复性.     

实时三维超声心动图与磁共振对比评价左心室射血分数≥45%患者的左心室容量

目的:评价实时三维超声心动图(RT3D)测量左心室射血分数(LVEF)≥45% 成年人左心室容量的准确性和重复性.方法:选取因各种不同原因进行心脏磁共振(MRI)检查显示 LVEF ≥45%的患者37例,同时进行RT3D检查.RT3D检查采用Philips iE-33型超声心动图仪,左心室容量及左心室功能的分析通过TomTec工作站用人工描记法完成,并与MRI所得结果相比较.结果:MRI测量的左心室舒张末期容量(EDV)为:60～208.76(110.48±33.50)ml,左心室收缩末期容量(ESV)为:19～102.4(45.80±17.84 )ml,LVEF为:45.40～71.10(59.13±7.24)%.RT3D测量的EDV为:42.8～ 211.9(100.64±34.48)ml,ESV为:14.30 ～94.54(44.08 ±17.62)ml,LVEF为:35.1～73.4(56.70±7.02)%.与MRI相比,RT3D低估EDV(P＜0.01,r=0.842,y=0.867x+4.88,SEE=18.86ml),二者平均相差(-9.84±38.26) ml.RT3D同时低估ESV,二者相比差异无统计学意义(P＞0.05,r=0.846,y=0.835x+5.82,SEE=9.53 ml),二者平均相差(-1.71±19.68)ml.RT3D所测的LVEF稍小于MRI所测得的LVEF,二者相比差异有统计学意义(P＜0.05,r=0.616,y=0.597x+21.38,SEE=5.61%),平均相差(-2.42±12.5 )%.在不同观察者间及观察者自身不同时间内测量的RT3D,结果显示良好的重复性.结论:与MRI相比,RT3D测量成人患者的左心室容量及LVEF有较好的准确性和重复性.     

实时心肌超声造影与磁共振心肌灌注延迟增强检测存活心肌的比较

目的评价实时心肌超声造影(RT-MCE)与磁共振心肌灌注延迟增强(DE-MRI)检测存活心肌的临床价值。方法入选2012年7月至2013年12月徐州矿务集团总医院(徐州医学院第二附属医院)心内科收治入院的冠状动脉粥样硬化性心脏病(冠心病)患者27例,男性16例,女性11例,平均年龄62.5岁。所有患者行RT-MCE、DE-MRI、冠状动脉造影(CAG)及冠状动脉介入治疗(PCI)。对患者的RT-MCE图像分析采用目测半定量法,判定存活心肌;对心肌灌注延迟增强情况进行分级,根据分级结果对心肌存活情况进行判定。术后1、3、6月时复查心脏超声,以冠状动脉血运重建后室壁节段收缩功能改善为判断存活心肌的金标准。结果 RT-MCE目测半定量法检测存活心肌的灵敏性、特异性及准确度分别是70.9%、85.7%、76.3%;DE-MRI法检测存活心肌的灵敏性、特异性及准确度分别是72.7%、76.2%、74.0%,RT-MCE目测半定量法检测存活心肌较DE-MRI法具有较高的特异度(76.2%vs.85.7%,P0.05)。两种检测方法的相关性良好。结论 RT-MCE目测半定量法与DE-MRI法检测存活心肌具有较高的临床价值,RT-MCE目测半定量法具有更高的特异性。     

Mitral annular motion as a surrogate for left ventricular ejection fraction: real-time three-dimensional echocardiography and magnetic resonance imaging studies.

AIMS: To validate the accuracy of mitral annular motion assessed by real-time three-dimensional echocardiography (RT3DE) as a surrogate for determination of the left ventricular function in comparison with magnetic resonance imaging (MRI). METHODS AND RESULTS: Forty-seven patients with a variety of cardiac pathologies underwent both RT3DE and MRI exams. After 3D data sets were transferred to a PC with a custom-made program, nine consecutive rotational apical plane images (20 degrees apart) were displayed. The two mitral leaflet insertion points were manually identified in each plane. The geometry of the mitral annulus was reconstructed from a total of 18 coordinates (x, y, z), and the changes in mitral annular area and mitral annular motion along the apical long axis were calculated. The left ventricular ejection fraction (LVEF) determined by MRI was 41+/-18%, and 24 patients had LVEF<50%. Mitral annular motion (y) obtained by RT3DE was 11+/-5 mm and correlated moderately well with LVEF (x) measured by MRI (r=0.84, y=0.25x+0.43, p<0.0001). The mitral annular motion<12 mm was a good threshold for detecting LVEF<50% with 96% sensitivity, 85% specificity, and 91% accuracy. CONCLUSION: Mitral annular motion determined by RT3DE correlated moderately well with LVEF; and systolic motion, <12 mm, accurately detected LV dysfunction.     

Transthoracic three-dimensional echocardiography is as good as magnetic resonance imaging in measuring dynamic changes in left ventricular volume during the heart cycle in children.

AIMS: The purpose of the study was to assess the dynamic changes in left ventricular (LV) volume by transthoracic three-dimensional echocardiography (3DE) and to compare the results with those obtained by magnetic resonance imaging (MRI). METHODS AND RESULTS: Thirty healthy children were studied by digitized 3DE and Doppler, and by MRI. Three-dimensional echocardiography of LV was performed by using rotational acquisition from the transthoracic apical view with ECG gating and without respiratory gating. The acquisition of 3DE data took 10-15s. Three-dimensional echocardiography gave similar values to MRI for EDV, ESV and LVM measurements, and the results correlated well. Peak emptying rates by 3DE and MRI were -236.6 and -169.6ml/s and peak filling rates were 215.0 and 215.9ml/s, respectively. Dynamic changes of LV volumes during the heart cycle were detectable with both methods. CONCLUSION: Digitized 3DE performed in the outpatient clinic and MRI were both useful methods for studying the physiological volume changes in left ventricle in children. These methods may be used for further study of the systolic and diastolic function of the left ventricle in various clinical conditions.     

Assessment of mitral prosthetic valve thrombosis by live three-dimensional echocardiography: comparison with transesophageal echocardiography

We report the feasibility of transthoracic live three-dimensional echocardiography in the diagnosis of a thrombus attached to the mitral bioprosthetic valve.     

Myxoma of the mitral valve detected by echocardiography and magnetic resonance imaging

Myxomas of the mitral valve diagnosed during life are exceedinglyrare. We employed transthoracic and transoesophageal echocardiographyand magnetic resonance imaging enhanced by gadolinium-diethylene-triamine-pentaaceticacid in a patient with palpitations. After these examinationsclearly demonstrated a myxoma on the atrial side of the posteriormitral valve leaflet, urgent surgery was performed When a smalltumour of the mitral valve exists, these examinations are usefulnot only for detecting and characterizing the tumour, but alsofor deciding the optimal surgical management.     

MRI检查在直肠癌诊断与术前分期的应用研究

目的探讨3.0T MRI对直肠癌患者术前判断T、N分期以及测量直肠肿瘤下缘与肛缘间曲线距离的准确性。 方法经术前肠镜活检病理证实为直肠癌的患者53例,于术前行MRI扫描,进行T、N分期并测量肿瘤下缘与肛缘间的距离。以术后病理结果为标准,验证3.0T MRI评价肿瘤T、N分期的准确性;用MRI测量出的肿瘤下缘与肛缘曲线的距离与手术标本测量的结果相比较,找出两种结果的相关性。 结果MRI对直肠癌患者T、N分期判定的准确率分别为83.1%、67.9%,统计学分析显示与病理结果有较好的一致性。MRI测量肿瘤下缘与肛缘的曲线距离与手术标本测得的数值无明显统计学差异。 结论MRI对直肠癌患者术前T、N分期的判定以及测量肿瘤下缘与肛缘间的曲线距离有较高的准确性,对术前治疗及手术方式的选择有很好的指导意义。     

MRI imaging of a left atrial mass misinterpreted by transesophageal echocardiography

Magnetic resonance imaging of the heart was used in a patient with a history of recurrent episodes of transient ischemic attacks in whom a left atrial mass was suspected on transesophageal echocardiography. The use of MRI clarified a diagnosis of a diaphragmatic hernia.     

Hemangioma of the left ventricular cavity: Presumptive diagnosis by magnetic resonance imaging

Summary In a 16-year-old boy, magnetic resonance imaging (MRI) revealed a 1 × 1.5-cm tumor on a stalk attached to the anterior ventricular wall. The tumor showed homogeneous enhancement after the administration of gadorinium(Gd)-DTPA, indicating it was highly vascular. The tumor was excised during surgery and the histological examination led to a diagnosis of juvenile hemangioendothelioma. MRI therefore allowed a definitive diagnosis of cardiac hemangioma to be made preoperatively. This case represents the first reported instance of a benign left ventricular hemangioma diagnosed by MRI.     

Determination of left ventricular volume by two-dimensional echocardiography: comparison with magnetic resonance imaging

Left ventricular volume was determined in 12 healthy volunteersusing a newly developed two-dimensional echocardio-graphic delineationmethod. The results were compared with those of magnetic resonanceimaging, which served as the method of reference. Left ventricularend-diastolic volume was 123 ± 12 ml, echocardiographicallydefined, and 121 ± 12 ml calculated with magnetic resonanceimaging. End-systolic volume was 41 ± 7 ml on echocardiographyand 37±6 ml on magnetic resonance imaging. Left ventricularejection fraction was 67 ± 4%, echocardiographicallydefined, and 70 ± 5%, calculated with magnetic resonanceimaging. There was no statistical difference for any of themeasured parameters. Interstudy and inter-observer variabilitywas minimal. In conclusion, in healthy volunteers left ventricularvolume was accurately defined, using this newly developed two-dimensionalechocardiographic delineation method. During endocardial delineationa dynamic display is continuously available on a second window,allowing precise visual edge-detection. Moreover, correctionscan be made easily and quickly. These two advantages enhancethe accuracy of the method, even in cases of poor echogenicity.