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Yeo L, Romero R. How to Acquire Cardiac Volumes for Sonographic Examination of the Fetal Heart: Part 1. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1021-42. [PMID: 27091914 PMCID: PMC8475630 DOI: 10.7863/ultra.16.01081] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 02/29/2016] [Indexed: 05/13/2023]
Abstract
Four-dimensional sonography with spatiotemporal image correlation (STIC) technology allows acquisition of a fetal cardiac volume data set and displays a cine loop of a complete single cardiac cycle in motion. Part 1 of this 2-part article reviews STIC technology and its features, the importance of operator training/experience, and acquisition of high-quality STIC volumes, as well as factors that affect STIC volume acquisition rates. We also propose a detailed and practical stepwise approach to performing 4-dimensional sonography with STIC and begin herein by providing general recommendations. Part 2 will discuss specifics of the approach, along with how to determine whether such volumes are appropriate for analysis.
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Affiliation(s)
- Lami Yeo
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and Detroit, MI, USA
- Detroit Medical Center, Hutzel Women’s Hospital, Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Roberto Romero
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and Detroit, MI, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
- Department of Molecular Obstetrics and Genetics, Wayne State University, Detroit, MI, USA
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Abstract
PURPOSE OF REVIEW Real-time two-dimensional ultrasound guidance is undoubtedly one of the most important evolutions in the field of regional anesthesia techniques, for peripheral nerve blocks and neuraxial anesthesia. The recent literature has been analyzed for studies concerning new technological trends in ultrasound-guided regional anesthesia. This review focuses on electromagnetic tracking systems for ultrasound guidance and three/four-dimensional ultrasound imaging in regional anesthesia. RECENT FINDINGS Electromagnetic tracking can facilitate needle-beam alignment for in-plane approaches and indicates where the needle crosses the beam during out-of-plane ultrasound-guided procedures. Three-dimensional ultrasound imaging can provide more detailed anatomical information and better spatial orientation than two-dimensional imaging. Four-dimensional ultrasound imaging enhances the visualization of a particular anatomy and offers real-time assessment of local anesthetic spread during ultrasound-guided regional anesthesia. These techniques have some limitations and drawbacks limiting their expansion. SUMMARY This article describes the principles, technology and development of electromagnetic tracking system for ultrasound guidance and three/four-dimensional ultrasound imaging in regional anesthesia, considering whether these new technologies will have impending applications in clinical practice.
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Fontanarosa D, van der Meer S, Bamber J, Harris E, O'Shea T, Verhaegen F. Review of ultrasound image guidance in external beam radiotherapy: I. Treatment planning and inter-fraction motion management. Phys Med Biol 2015; 60:R77-114. [PMID: 25592664 DOI: 10.1088/0031-9155/60/3/r77] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
In modern radiotherapy, verification of the treatment to ensure the target receives the prescribed dose and normal tissues are optimally spared has become essential. Several forms of image guidance are available for this purpose. The most commonly used forms of image guidance are based on kilovolt or megavolt x-ray imaging. Image guidance can also be performed with non-harmful ultrasound (US) waves. This increasingly used technique has the potential to offer both anatomical and functional information.This review presents an overview of the historical and current use of two-dimensional and three-dimensional US imaging for treatment verification in radiotherapy. The US technology and the implementation in the radiotherapy workflow are described. The use of US guidance in the treatment planning process is discussed. The role of US technology in inter-fraction motion monitoring and management is explained, and clinical studies of applications in areas such as the pelvis, abdomen and breast are reviewed. A companion review paper (O'Shea et al 2015 Phys. Med. Biol. submitted) will extensively discuss the use of US imaging for intra-fraction motion quantification and novel applications of US technology to RT.
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Affiliation(s)
- Davide Fontanarosa
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center (MUMC), Maastricht 6201 BN, the Netherlands. Oncology Solutions Department, Philips Research, High Tech Campus 34, Eindhoven 5656 AE, the Netherlands
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Vijayalakshmi S, Sriraam N, Suresh S, Muttan S. Automated region mask for four-chamber fetal heart biometry. J Clin Monit Comput 2012; 27:205-9. [PMID: 23085836 DOI: 10.1007/s10877-012-9404-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Accepted: 10/12/2012] [Indexed: 11/28/2022]
Abstract
This letter proposes an automated region mask for the detection of cardiac chambers from ultrasonic fetal heart biometry. The fetal biometry consists of two dimensional ultrasonic cine-loop sequences of apical four chamber view of fetal heart, which are comparatively The clinical motion information of individual frame is extracted by keeping a constant frame rate of 25 frames per second (fps). The region mask is designed based on the superimposition of motion information from a set of consecutive frames that belong to one cardiac cycle followed by connected component labelling. The borders and edges of all four chambers are thus recognized leading to formation of binary region mask. Experimental study based on second trimester cine-loop sequences confirms the suitability of the proposed technique for detection of heart chambers.
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Andonotopo W, Stanojevic M, Kurjak A, Azumendi G, Carrera JM. Assessment of fetal behavior and general movements by four-dimensional sonography. ACTA ACUST UNITED AC 2011. [DOI: 10.3109/14722240400016895] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Prager RW, Ijaz UZ, Gee AH, Treece GM. Three-dimensional ultrasound imaging. Proc Inst Mech Eng H 2010; 224:193-223. [PMID: 20349815 DOI: 10.1243/09544119jeim586] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This review is about the development of three-dimensional (3D) ultrasonic medical imaging, how it works, and where its future lies. It assumes knowledge of two-dimensional (2D) ultrasound, which is covered elsewhere in this issue. The three main ways in which 3D ultrasound may be acquired are described: the mechanically swept 3D probe, the 2D transducer array that can acquire intrinsically 3D data, and the freehand 3D ultrasound. This provides an appreciation of the constraints implicit in each of these approaches together with their strengths and weaknesses. Then some of the techniques that are used for processing the 3D data and the way this can lead to information of clinical value are discussed. A table is provided to show the range of clinical applications reported in the literature. Finally, the discussion relating to the technology and its clinical applications to explain why 3D ultrasound has been relatively slow to be adopted in routine clinics is drawn together and the issues that will govern its development in the future explored.
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Affiliation(s)
- R W Prager
- Department of Engineering, University of Cambridge, Cambridge, UK.
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Yagel S, Cohen SM, Messing B, Valsky DV. Three-dimensional and four-dimensional ultrasound applications in fetal medicine. Curr Opin Obstet Gynecol 2009; 21:167-74. [DOI: 10.1097/gco.0b013e328329243c] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE OF REVIEW Several technological advances have greatly improved three-dimensional sonography, which have improved acquisition and display capabilities. This review describes these technical changes as well as current applications of 3D sonography in prenatal diagnosis. RECENT FINDINGS Recently published papers have emphasized the potential of getting a precise 'any plane of choice' from a three-dimensional volume, as a new way of scanning, based on the off-line analysis of a volume dataset. Surface mode has been used to demonstrate malformations and genetic diseases. The maximum rendering mode, which highlights bones, has great potential for imaging the nasal bones and the frontal bones with the metopic suture. Organ volume can be measured, but the utility of this in clinical practice remains to be determined. Three-dimensional ultrasound needs to be standardized. SUMMARY Three-dimensional ultrasonography is the most rapidly developing technique in fetal imaging. New features will permit the transition from the era of 'sonography in two-dimensional planes' to 'volume ultrasound'.
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Affiliation(s)
- Rabih Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany.
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Abstract
PURPOSE OF REVIEW Over the last few years, great progress has been made in imaging technology, which is changing the way prenatal visualization of the fetal heart is used for diagnosis and therapy. RECENT FINDINGS This paper reviews recent clinical research using these new techniques, namely dynamic three-dimensional (4D) echocardiography, myocardial Doppler imaging, B-flow ultrasonography, endoscopic ultrasound, and magnetic resonance imaging. Of them, 4D echocardiography is the most significant development and is discussed in greater detail. This includes real-time volumetric data acquisition using matrix-array transducer technology, motion artefact elimination using spatio-temporal image correlation, and various display options. The advantages and limitations of each are also addressed. SUMMARY These techniques can provide (1) sequential assessment of the entire heart using a full 4D dataset, (2) 4D delineation of trabeculation patterns on the ventricular walls, en-face dynamic shapes of ventricular septal defects and spatially complex malformations, (3) derivation of cardiac indices to myocardial contractility and strain rate by Doppler tissue imaging, and/or (4) the use of transoesophageal ultrasound to guide in-utero cardiac intervention. All of these techniques expand our ability to evaluate the morphology and function of the in-utero heart.
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Affiliation(s)
- Jing Deng
- Department of Medical Physics and Bioengineering, University College London, London, UK.
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Chatterjee R, Deng J, Pellerin D, Todd-Pokropek A, Neild GH, Lees WR, Rodeck CH. Feasibility of dynamic 3-D color Doppler ultrasound for imaging penile vascular change in renal transplant patients with erectile dysfunction responding to sildenafil. ULTRASOUND IN MEDICINE & BIOLOGY 2008; 34:885-891. [PMID: 18295391 DOI: 10.1016/j.ultrasmedbio.2007.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Revised: 10/16/2007] [Accepted: 11/21/2007] [Indexed: 05/25/2023]
Abstract
Renal transplant recipients (RTRs) have a high incidence of erectile dysfunction (ED). Differentiation of penile vasculogenic impotence from other causes is important for treatment. Conventional 2-D color Doppler assessment after intracavernosal stimulant injection often fails to produce reliable results because of limited views by the cross-sectional imaging and the painful procedure. In comparison to the findings in three healthy volunteers, we determined cavernosal vascular hemodynamics in eight RTRs with ED before and after oral sildenafil by using live 3-D ultrasound and dynamic 3-D color Doppler. Results showed that, before sildenafil, penile arterial flow signals could only be reliably detected in one patient. After sildenafil, all had reliably detectable flow with grades II to III erection. Our data suggest that 3-D volumetric changes of the penis and its vasculature during erection can be studied by this technique and that this method could be useful for the evaluation of new drugs and therapeutic biofeedback.
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Affiliation(s)
- Ratna Chatterjee
- Department of Obstetrics and Gynaecology, University College London, London, UK.
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Tutschek B, Sahn DJ. Three-Dimensional Echocardiography for Studies of the Fetal Heart: Present Status and Future Perspectives. Cardiol Clin 2007; 25:341-55. [PMID: 17765115 DOI: 10.1016/j.ccl.2007.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Three-dimensional (3D) ultrasound of the fetal heart is increasingly being used in prenatal diagnosis. While very detailed fetal cardiac studies can be performed using the various 3D ultrasound modalities, their utility for screening for fetal heart disease is yet to be proven. With the emergence of even newer technologies such as quantification techniques and two-dimensional matrix arrays, further improvements are imminent.
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Affiliation(s)
- Boris Tutschek
- Prenatal Medicine Munich, Heinrich Heine University, Lachnerstr 6, 80639 München, Düsseldorf, Germany
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Yagel S, Cohen SM, Shapiro I, Valsky DV. 3D and 4D ultrasound in fetal cardiac scanning: a new look at the fetal heart. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 29:81-95. [PMID: 17200988 DOI: 10.1002/uog.3912] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Over the last decade we have been witness to a burgeoning literature on three-dimensional (3D) and four-dimensional (4D) ultrasound-based studies of the fetal cardiovascular system. Recent advances in the technology of 3D/4D ultrasound systems allow almost real-time 3D/4D fetal heart scans. It appears that 3D/4D ultrasound in fetal echocardiography may make a significant contribution to interdisciplinary management team consultation, health delivery systems, parental counseling, and professional training. Our aim is to review the state of the art in 3D/4D fetal echocardiography through the literature and index cases of normal and anomalous fetal hearts.
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Affiliation(s)
- S Yagel
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | - S M Cohen
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | - I Shapiro
- Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa, Israel
| | - D V Valsky
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
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Deng J, Crouch NS, Creighton SM, Linney AD, Todd-Pokropek A, Rodeck CH. Minimally-compressive, three- and four-dimensional ultrasound imaging of the clitoris: a feasibility study. ULTRASOUND IN MEDICINE & BIOLOGY 2006; 32:1479-84. [PMID: 17045867 DOI: 10.1016/j.ultrasmedbio.2006.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2006] [Revised: 06/01/2006] [Accepted: 06/08/2006] [Indexed: 05/12/2023]
Abstract
There has been no objective means for imaging the three-dimensional (3D) morphology of the clitoris-a poorly understood, complex structure. A Live 3D ultrasound system with a matrix-array transducer was used for data acquisition from eight women. The transducer was positioned in front of and about 3 cm away from the clitoris, with a gel pad or water pad being placed in between. The pads allowed the delicate structures to be imaged without noticeable deformation. Quality images could be obtained with use of a water pad in all patients. The imaging volume was big enough to cover the clitoral glans and body simultaneously, allowing real-time 3D visualisation. To cover the entire clitoris, the probe was moved from one side of the crus to the other, or a four subvolume scan was performed. 3D clitoral anatomy was depicted from 71% of 51 water pad data-sets. The study demonstrates the feasibility of obtaining 3D clitoral ultrasound images. This will improve scientific and clinical understanding of the clitoral role in sexual activity. The minimally-compressive scanning offers an opportunity to visualise dynamic 3D (4D) morphology of other deformable body parts.
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Affiliation(s)
- Jing Deng
- Department of Obstetrics and Gynaecology, University College London, London, UK.
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Gonçalves LF, Espinoza J, Kusanovic JP, Lee W, Nien JK, J JSF, Mari G, Treadwell MC, Romero R. Applications of 2-dimensional matrix array for 3- and 4-dimensional examination of the fetus: a pictorial essay. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2006; 25:745-55. [PMID: 16731891 PMCID: PMC1513649 DOI: 10.7863/jum.2006.25.6.745] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
OBJECTIVES Two-dimensional (2D) matrix array is a new technology for the performance of 3-dimensional and 4-dimensional (4D) ultrasonography. In this study, we report the use of a 2D matrix array transducer for examination of fetal structures including the fetal heart. METHODS Thirty-four fetuses without abnormalities and 19 fetuses with congenital anomalies were examined with a 2D matrix array transducer (x3-1, IE-33; Philips Medical Systems, Bothell, WA). Median gestational age was 25 6/7 weeks (range, 13 0/7-40 1/7 weeks). RESULTS (1) A 360 degrees rotation and examination of selected structures was possible in the second trimester. (2) Structures were examined by maintaining the transducer in a fixed position and rotating the volume using the system trackball. (3) Dorsal and ventral parts of the hands and feet were visualized in a single volume data set, in real time, without moving the transducer. (4) Real-time en face visualization of atrioventricular valves was possible from the ventricular or atrial chambers. (5) Four-dimensional images of bones were obtained by decreasing gain settings only, with no need for cropping. (6) Four-dimensional reconstruction of vascular structures was possible with color Doppler imaging. Two limitations were identified: (1) lower resolution than mechanical volumetric transducers, and (2) narrow volume display. CONCLUSIONS Real-time direct 4D imaging with 360 degrees rotation for examination of fetal anatomic structures is feasible. This technology allows examination of fetal structures from multiple perspectives, in real time, without the need to move the transducer in the maternal abdomen. Further technological developments may overcome the limitations identified in this study.
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Affiliation(s)
- Luís F. Gonçalves
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, Michigan, USA
| | - Jimmy Espinoza
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, Michigan, USA
| | - Juan Pedro Kusanovic
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
| | - Wesley Lee
- Division of Fetal Imaging, Department of Obstetrics and Gynecology, William Beaumont Hospital, Royal Oak, MI, USA
| | - Jyh Kae Nien
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
| | - Joaquin Santolaya-Forgas J
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, Michigan, USA
| | - Giancarlo Mari
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, Michigan, USA
| | - Marjorie C. Treadwell
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Address correspondence to:Roberto Romero, M.D., Perinatology Research Branch, NICHD, NIH, DHHS, Wayne State University/Hutzel Women’s Hospital, 3990 John R, Box 4, Detroit, MI 48201, USA, Telephone (313) 993-2700, Fax: (313) 993-2694, e-mail:
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Deng J, Hall-Craggs MA, Craggs MD, Richards R, Knight SL, Linney AD, Mundy AR. Three-dimensional MRI of the male urethrae with implanted artificial sphincters: initial results. Br J Radiol 2006; 79:455-63. [PMID: 16714745 DOI: 10.1259/bjr/56511504] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The aim of this study was to develop a method for simultaneous 3D visualization of a new type of artificial urethral sphincter (AUS) and adjacent urinary structures. Serial MR tomograms were acquired from seven men after AUS implantation. 3D reconstruction was performed by thresholding original (positive) and inverted (negative) image intensity and by subsequently fusing positive and negative images. Results show that the bladder, cuff and balloons of the AUS of originally high intensity were imaged in 3D by thresholding the positive datasets. The urethrae and corpora cavernosa penis of originally low intensity were displayed in 3D by thresholding the negative datasets. Fusion of the positive and negative datasets allowed simultaneous visualization of the AUS complex and adjacent urinary structures. All the structures of interest were also clearly seen by interactive multiplanar reformatting. Coronal tomographic datasets provided better 3D and reformatted 2D images than sagittal and transverse datasets. This technique offers a simple means for evaluating the complex urethral anatomy and the AUS, and has potential for improved 3D visualization of many other complex morphological and pathological conditions.
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Affiliation(s)
- J Deng
- Department of Medical Physics and Bioengineering, University College London, Gower Street, London WC1E 6BT, UK
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Deng J, Hall-Craggs MA, Pellerin D, Linney AD, Lees WR, Rodeck CH, Todd-Pokropek A. Real-time three-dimensional ultrasound visualization of erection and artificial coitus. INTERNATIONAL JOURNAL OF ANDROLOGY 2006; 29:374-9. [PMID: 16390496 DOI: 10.1111/j.1365-2605.2005.00617.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To investigate the feasibility of imaging penile erection and coitus in real time and in three dimensions, a 'Live' three-dimensional (3-D) ultrasound system was used to acquire the volume of interest at 25 Hz from five healthy men. Water baths and gel-made artificial vaginas were devised to facilitate the 3-D scans without the probe being in direct contact with the penis. For the first volunteer scanned with the water bath alone, the penis failed to erect within 30 min. For the other four volunteers, the 'vagina' successfully initiated and maintained the erection and allowed artificial intercourse. Results have shown that the 'Live' 3-D ultrasound and minimally compressive imaging techniques together can offer an objective means for visualizing erection and coitus in spatial totality and temporal reality. They can be further developed to reveal more reliable details about the dynamic morphology, improving scientific understanding of sexual activities and clinical management of related problems.
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Affiliation(s)
- Jing Deng
- Department of Medical Physics and Bioengineering, University College London, London, UK.
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Chaoui R, Heling KS. New developments in fetal heart scanning: three- and four-dimensional fetal echocardiography. Semin Fetal Neonatal Med 2005; 10:567-77. [PMID: 16242390 DOI: 10.1016/j.siny.2005.08.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article reviews the possibilities of three- and four-dimensional (3- and 4D) fetal echocardiography. A volume data set of a fetal heart can be acquired as a static volume, as a real-time 3D volume or as an offline 4D volume cine using spatial and temporal image correlation (STIC) software. STIC is explained and the potentials of this modality are emphasized. The display of a fetal heart volume data set demonstrates the cross-sections of interest, using the multiplanar mode or tomographic multislice imaging, and different volume rendering tools. The latter include: surface, minimum, inversion and glass body modes. This review highlights the potential of acquiring a digital volume data set of a heart cycle for later offline evaluation, either for an offline diagnosis, a second opinion (e.g. via Internet link) or for teaching fetal echocardiography to trainees and sonographers.
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Affiliation(s)
- R Chaoui
- Centre for Prenatal Diagnosis and Human Genetics, Friedrichstr. 147, 10117 Berlin, Germany.
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Herberg U, Goldberg H, Breuer J. Three- and four-dimensional freehand fetal echocardiography: a feasibility study using a hand-held Doppler probe for cardiac gating. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2005; 25:362-371. [PMID: 15761914 DOI: 10.1002/uog.1839] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To evaluate the clinical feasibility of the signal from a hand-held Doppler probe as a real-time tracking signal for dynamic three-dimensional (3D) (so-called four-dimensional (4D)) fetal echocardiography in a random patient cohort. METHODS Seventy fetuses, with and without congenital heart disease, at various gestational ages (mean, 25 weeks; range, 18-38 weeks) were investigated using freehand 3D echocardiography. Time gating was achieved concurrently by obtaining a Doppler signal of the fetal heart without further signal averaging. In 10 fetuses, Doppler gating was compared to cardiotocogram (CTG)-gated 3D echo using signal averaging. Gray-scale and color Doppler dynamic 3D displays and multiplanar views were assessed according to their ability to accurately depict cardiac gating and cardiac morphology. RESULTS In 68/70 fetuses, valid Doppler-based trigger signals were obtained. Correct cardiac gating was achieved in 231/275 (84%) 4D datasets. Doppler tracing of the fetal heart allowed beat-to-beat triggering without the necessity for signal averaging. Doppler gating detected rapid changes in the fetal heart rate more reliably than CTG gating, but was more sensitive to acoustic interference between the gating and echo-transducer when color-coded Doppler imaging was used. Image quality was highly dependent on random motion and the acoustic window. A total of 171/231 (74%) correctly gated datasets successfully demonstrated clinically useful 4D images of the fetal heart. The reconstruction of 3D and multiplanar views provided additional views not obtainable by two-dimensional imaging. CONCLUSION These results show that a hand-held Doppler probe can be used as a reliable online gating source for 4D fetal echocardiography.
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MESH Headings
- Adult
- Cardiotocography/methods
- Cohort Studies
- Echocardiography, Doppler/instrumentation
- Echocardiography, Doppler/methods
- Echocardiography, Four-Dimensional/instrumentation
- Echocardiography, Four-Dimensional/methods
- Echocardiography, Three-Dimensional/instrumentation
- Echocardiography, Three-Dimensional/methods
- Feasibility Studies
- Female
- Fetal Heart/diagnostic imaging
- Fetal Heart/physiopathology
- Heart Defects, Congenital/diagnostic imaging
- Heart Defects, Congenital/physiopathology
- Heart Rate, Fetal/physiology
- Humans
- Image Interpretation, Computer-Assisted/methods
- Pregnancy
- Reproducibility of Results
- Ultrasonography, Prenatal/instrumentation
- Ultrasonography, Prenatal/methods
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Affiliation(s)
- U Herberg
- Division of Pediatric Cardiology, Children's Hospital, University of Bonn, Bonn, Germany.
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Dindoyal I, Lambrou T, Deng J, Ruff CF, Linney AD, Rodeck CH, Todd-Pokropek A. Level Set Segmentation of the Fetal Heart. FUNCTIONAL IMAGING AND MODELING OF THE HEART 2005. [DOI: 10.1007/11494621_13] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Abstract
PURPOSE OF REVIEW Fetal diagnosis and the supporting specialties of perinatology, neonatology, and surgery have made rapid strides in the last decade. Numerous centers are focusing on this multifaceted niche area as the medical field realizes its vast promise and potential. The authors review some of the major advancements in thought and practice in the field of fetal echocardiography while attempting to give a less detailed overview for the less involved perinatologist. RECENT FINDINGS First trimester fetal echocardiography has been an area of recent interest as transducer technology improves. As a result, optimum timing of first and subsequent scans and the population profile they are to be applied to have become an issue that begs consensus. Three-dimensional and four-dimensional fetal echocardiography have also received a boost for the same reasons, and both are being studied for feasibility and accuracy. Fetal tissue Doppler and spectral Doppler imaging are potential areas for exploration; the early steps have been taken. Awareness of associated ultrasound markers, such as exaggerated nuchal translucency, as clues to the presence of congenital heart disease is important, even if controversial. SUMMARY The issue of missed prenatal diagnosis is disturbing, especially when it arises against a background of tremendous skill and technologic support. Strategies to minimize mistakes in this critical aspect need to be agreed on by the involved teams and put in place in a multidisciplinary manner if they are to have an important impact.
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Affiliation(s)
- Aarti Hejmadi Bhat
- Clinical Care Center for Congenital Heart Disease, Oregon Health and Science University, Portland, Oregon 97239-3098, USA
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Bhat AH, Corbett VN, Liu R, Carpenter ND, Liu NW, Wu AM, Hopkins GD, Li X, Sahn DJ. Validation of volume and mass assessments for human fetal heart imaging by 4-dimensional spatiotemporal image correlation echocardiography: in vitro balloon model experiments. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2004; 23:1151-1159. [PMID: 15328429 DOI: 10.7863/jum.2004.23.9.1151] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE This study was designed to validate a slow-sweep real-time 4-dimensional (4D) spatiotemporal image correlation method for producing quantitatively accurate dynamic fetal heart images using an in vitro pulsatile balloon model and apparatus. METHODS To model fetal heart chambers, asymmetric double-walled finger stalls (tips of surgical latex gloves) were used and attached to a laboratory-designed circuit that allowed calibrated changes in the inner balloon volume as well as an intermediate gel mass interposed between the 2 layers. The water-submerged model was attached to a small-volume pulsatile pump to produce phasic changes in volume within the inner balloon at a fixed rate. A sonography system with 4D spatiotemporal image correlation (STIC) capabilities was used for 3-dimensional (3D) and 4D data acquisition. Volume data were analyzed by customized radial summation techniques with 4D data analysis software and compared with known volumes and masses. RESULTS Fifty-six individual volumes ranging from 2.5 to 10 mL were analyzed. Volume and mass measurements with 4D STIC were highly correlated (R2 > 0.90). The mean percentage error was better (<6%) for volumes exceeding 4 mL and was as low as 0.3% for 6-mL estimations. Measurements in the diastolic phase were the most accurate, followed by mass estimations equivalent to chamber walls. There was a wider range of percentage error in the lowest volumes tested (2.5 mL), which might have arisen from difficulties in spatial resolution or distortions from within the model apparatus itself. Resolution limitations of 4D technology in combination with extremely small volume targets may explain higher error rates at these small volumes. CONCLUSIONS Four-dimensional STIC is an acceptably accurate method for volume and mass estimations in the ranges comparable with mid- and late-gestation fetal hearts. It is particularly accurate for diastolic estimations, for chamber wall mass measurements, and at volumes of greater than 2.5 mL. This study validates use of 4D STIC technology to overcome the limitations of nongated 3D technology for phasic and quantitative assessments in fetal echocardiography.
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Chaoui R, Hoffmann J, Heling KS. Three-dimensional (3D) and 4D color Doppler fetal echocardiography using spatio-temporal image correlation (STIC). ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2004; 23:535-545. [PMID: 15170792 DOI: 10.1002/uog.1075] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Color Doppler echocardiography is used to visualize three transverse planes: the four-chamber, five-chamber, and three vessels and trachea views. Color Doppler spatio-temporal image correlation (STIC) is a new three-dimensional (3D) technique allowing the acquisition of a volume of data from the fetal heart that is displayed as a cineloop of a single cardiac cycle. The aim of the study was to examine the potential of color Doppler STIC to evaluate normal and abnormal fetal hearts. METHODS This prospective study included 35 normal fetuses and 27 fetuses with congenital heart defects (CHD) examined between 18 and 35 weeks of gestation. Volume acquisition was achieved by initiating the image capture sequence from the transverse four-chamber view. Volumes were stored for later offline evaluation using a personal computer-based workstation in a multiplanar mode and as spatial volume rendering. RESULTS Successful acquisition was possible in all 62 cases. The three planes could be demonstrated in 31/35 healthy fetuses and in 24/27 fetuses with CHD. Spatial volume rendering was attempted in 18 fetuses with CHD. In the four normal fetuses with inadequate visualization using color Doppler STIC, the region of interest was perpendicular to the ultrasound beam. In two fetuses with CHD inadequate visualization was related to an enlarged heart in late gestation, in which the entire cardiac volume could not be acquired. The third case was an 18-week fetus with complex CHD and transposed great vessels in which artifacts were related to confluent color signals as a result of low resolution in the reconstructed plane. CONCLUSIONS STIC in combination with color Doppler ultrasound is a promising new tool for multiplanar and 3D/4D rendering of the fetal heart. Limitations may be found later in gestation in fetuses with large hearts and early in gestation as a result of low discrimination of signals. In addition, insonation perpendicular to the structure of interest does not image color Doppler signals and should be avoided during acquisition.
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Affiliation(s)
- R Chaoui
- Unit of Prenatal Diagnosis and Therapy, Charité University Hospital, Berlin, Germany.
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Gonçalves LF, Romero R, Espinoza J, Lee W, Treadwell M, Chintala K, Brandl H, Chaiworapongsa T. Four-dimensional ultrasonography of the fetal heart using color Doppler spatiotemporal image correlation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2004; 23:473-481. [PMID: 15098864 DOI: 10.7863/jum.2004.23.4.473] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To describe clinical and research applications of 4-dimensional imaging of the fetal heart using color Doppler spatiotemporal image correlation. METHODS Forty-four volume data sets were acquired by color Doppler spatiotemporal image correlation. Seven subjects were examined: 4 fetuses without abnormalities, 1 fetus with ventriculomegaly and a hypoplastic cerebellum but normal cardiac anatomy, and 2 fetuses with cardiac anomalies detected by fetal echocardiography (1 case of a ventricular septal defect associated with trisomy 21 and 1 case of a double-inlet right ventricle with a 46,XX karyotype). The median gestational age at the time of examination was 21 3/7 weeks (range, 19 5/7-34 0/7 weeks). Volume data sets were reviewed offline by multiplanar display and volume-rendering methods. Representative images and online video clips illustrating the diagnostic potential of this technology are presented. RESULTS Color Doppler spatiotemporal image correlation allowed multiplanar visualization of ventricular septal defects, multiplanar display and volume rendering of tricuspid regurgitation, volume rendering of the outflow tracts by color and power Doppler ultrasonography (both in a normal case and in a case of a double-inlet right ventricle with a double-outlet right ventricle), and visualization of venous streams at the level of the foramen ovale. CONCLUSIONS Color Doppler spatiotemporal image correlation has the potential to simplify visualization of the outflow tracts and improve the evaluation of the location and extent of ventricular septal defects. Other applications include 3-dimensional evaluation of regurgitation jets and venous streams at the level of the foramen ovale.
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Affiliation(s)
- Luís F Gonçalves
- Perinatology Research Branch, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
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Abstract
Rapid advances in graphics computing and micro-engineering have offered new techniques for prenatal cardiac imaging. Some of them can be non-invasively applied to both clinical and laboratory settings, including dynamic three-dimensional echocardiography, myocardial Doppler imaging, harmonic ultrasound imaging, and B-flow sonography. With clinical constraints, a few others have been mainly used in laboratories, such as endoscopic ultrasound, magnetic resonance imaging and biomicroscopy. Appropriate use and co-use of these new tools will not only provide unique information for better clinical assessment of fetal cardiac disease but also offer new ways to improved understanding of cardiovascular development and pathogenesis.
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Affiliation(s)
- Jing Deng
- Department of Medical Physics and Bioengineering, University College London, UK.
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25
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Current awareness in prenatal diagnosis. Prenat Diagn 2003; 23:1027-32. [PMID: 14703639 DOI: 10.1002/pd.536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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