Validation of a volumic reconstruction in 4-d echocardiography and gated SPECT using a dynamic cardiac phantom

Valid and Reproducible Quantitative Assessment of Cardiac Volumes by Echocardiography in Patients with Valvular Heart Diseases-Possible or Wishful Thinking?

The analysis of left ventricular function is predominantly based on left ventricular volume assessment. Especially in valvular heart diseases, the quantitative assessment of total and effective stroke volumes as well as regurgitant volumes is necessary for a quantitative approach to determine regurgitant volumes and regurgitant fraction. In the literature, there is an ongoing discussion about differences between cardiac volumes estimated by echocardiography and cardiac magnetic resonance tomography. This viewpoint focuses on the feasibility to assess comparable cardiac volumes with both modalities. The former underestimation of cardiac volumes determined by 2D and 3D echocardiography is presumably explained by methodological and technical limitations. Thus, this viewpoint aims to stimulate an urgent and critical rethinking of the echocardiographic assessment of patients with valvular heart diseases, especially valvular regurgitations, because the actual integrative approach might be too error prone to be continued in this form. It should be replaced or supplemented by a definitive quantitative approach. Valid quantitative assessment by echocardiography is feasible once echocardiography and data analysis are performed with methodological and technical considerations in mind. Unfortunately, implementation of this approach cannot generally be considered for real-world conditions.

Ultrasonic sensor concept to fit a ventricular assist device cannula evaluated using geometrically accurate heart phantoms

Future left ventricular assist devices (LVADs) are expected to respond to the physiologic need of patients; however, they still lack reliable pressure or volume sensors for feedback control. In the clinic, echocardiography systems are routinely used to measure left ventricular (LV) volume. Until now, echocardiography in this form was never integrated in LVADs due to its computational complexity. The aim of this study was to demonstrate the applicability of a simplified ultrasonic sensor to fit an LVAD cannula and to show the achievable accuracy in vitro. Our approach requires only two ultrasonic transducers because we estimated the LV volume with the LV end-diastolic diameter commonly used in clinical assessments. In order to optimize the accuracy, we assessed the optimal design parameters considering over 50 orientations of the two ultrasonic transducers. A test bench was equipped with five talcum-infused silicone heart phantoms, in which the intra-ventricular surface replicated papillary muscles and trabeculae carnae. The end-diastolic LV filling volumes of the five heart phantoms ranged from 180 to 480 mL. This reference volume was altered by ±40 mL with a syringe pump. Based on the calibrated measurements acquired by the two ultrasonic transducers, the LV volume was estimated well. However, the accuracies obtained are strongly dependent on the choice of the design parameters. Orientations toward the septum perform better, as they interfere less with the papillary muscles. The optimized design is valid for all hearts. Considering this, the Bland-Altman analysis reports the LV volume accuracy as a bias of ±10% and limits of agreement of 0%-40% in all but the smallest heart. The simplicity of traditional echocardiography systems was reduced by two orders of magnitude in technical complexity, while achieving a comparable accuracy to 2D echocardiography requiring a calibration of absolute volume only. Hence, our approach exploits the established benefits of echocardiography and makes them applicable as an LV volume sensor for LVADs.

Elevational spatial compounding for enhancing image quality in echocardiography

INTRODUCTION

Echocardiography is commonly used in clinical practice for the real-time assessment of cardiac morphology and function. Nevertheless, due to the nature of the data acquisition, cardiac ultrasound images are often corrupted by a range of acoustic artefacts, including acoustic noise, speckle and shadowing. Spatial compounding techniques have long been recognised for their ability to suppress common ultrasound artefacts, enhancing the imaged cardiac structures. However, they require extended acquisition times as well as accurate spatio-temporal alignment of the compounded data. Elevational spatial compounding acquires and compounds adjacent partially decorrelated planes of the same cardiac structure.

METHODS

This paper employs an anthropomorphic left ventricle phantom to examine the effect of acquisition parameters, such as inter-slice angular displacement and 3D sector angular range, on the elevational spatial compounding of cardiac ultrasound data.

RESULTS AND CONCLUSION

Elevational spatial compounding can produce substantial noise and speckle suppression as well as visual enhancement of tissue structures even for small acquisition sector widths (2.5° to 6.5°). In addition, elevational spatial compounding eliminates the need for extended acquisition times as well as the need for temporal alignment of the compounded datasets. However, moderate spatial registration may still be required to reduce any tissue/chamber blurring side effects that may be introduced.

Accuracy of real-time single- and multi-beat 3-d speckle tracking echocardiography in vitro

With little data published on the accuracy of cardiac 3-D strain measurements, we investigated the agreement between 3-D echocardiography and sonomicrometry in an in vitro model with a polyvinyl alcohol phantom. A cardiac scanner with a 3-D probe was used to acquire recordings at 15 different stroke volumes at a heart rate of 60 beats/min, and eight different stroke volumes at a heart rate of 120 beats/min. Sonomicrometry was used as a reference, monitoring longitudinal, circumferential and radial lengths. Both single- and multi-beat acquisitions were recorded. Strain values were compared with sonomicrometer strain using linear correlation coefficients and Bland-Altman analysis. Multi-beat acquisition showed good agreement, whereas real-time images showed less agreement. The best correlation was obtained for a heart rate 60 of beats/min at a volume rate 36.6 volumes/s.

Development and characterization of rodent cardiac phantoms: comparison with in vivo cardiac imaging

The increasing availability of rodent models of human cardiovascular disease has led to a need to translate noninvasive imaging techniques such as magnetic resonance imaging (MRI) from the clinic to the animal laboratory. The aim of this study was to develop phantoms simulating the short-axis view of left ventricular motion of rats and mice, thus reducing the need for live animals in the development of MRI.

Cylindrical phantoms were moulded from polyvinyl alcohol (PVA) Cryogel and attached via stiff water-filled tubing to a gear pump. Pulsatile distension of the phantoms was effected by suitable programming of the pump. Cine MRI scanning was carried out at 7 T and compared with in vivo rodent cardiac imaging.

Suitable pulsatile performance was achieved with phantoms for which the PVA material had been subjected to two freeze–thaw cycles, resulting in T1 and T2 relaxation time constants of 1656±124 ms and 55±10 ms, respectively. For the rat phantom operating at 240 beats per min (bpm), the dynamic range of the outer diameter was from 10.3 to 12.4 mm with the wall thickness varying between 1.9 and 1.2 mm. Corresponding figures for the mouse phantom at 480 bpm were outer diameter range from 5.4 to 6.4 mm and wall thickness from 1.5 to 1.2 mm.

Dynamic cardiac phantoms simulating rodent left ventricular motion in the short-axis view were successfully developed and compared with in vivo imaging. The phantoms can be used for future development work with reduced need of live animals.

Harmonic 3-D echocardiography with a fast-rotating ultrasound transducer

Although the advantages of three-dimensional (3-D) echocardiography have been acknowledged, its application for routine diagnosis is still very limited. This is mainly due to the relatively long acquisition time. Only recently has this problem been addressed with the introduction of new real-time 3-D echo systems. This paper describes the design, characteristics, and capabilities of an alternative concept for rapid 3-D echocardiographic recordings. The presented fast-rotating ultrasound (FRU)-transducer is based on a 64-element phased array that rotates with a maximum speed of 8 Hz (480 rpm). The large bandwidth of the FRU-transducer makes it highly suitable for tissue and contrast harmonic imaging. The transducer presents itself as a conventional phased-array transducer; therefore, it is easily implemented on existing 2-D echo systems, without additional interfacing. The capabilities of the FRU-transducer are illustrated with in-vitro volume measurements, harmonic imaging in combination with a contrast agent, and a preliminary clinical study.

What's New in Urologic Ultrasound?

Ultrasonography allows providers to noninvasively image an area of interest in real time without the risks of ionizing radiation or nephrotoxic contrast agents. This article present basic concepts of ultrasound along with new advances in ultrasound technology and their applications in small parts evaluation.