Comparison of Two Different Ultrasound Systems for the Evaluation of Tissue Doppler Velocities in Fetuses

Abstract

Introduction: Recent studies have reported variations of up to 30% between different ultrasound machines for tissue Doppler imaging (TDI), a problem that can significantly impact clinical diagnosis, patient management and research studies. The objective of this study was to assess repeatability and agreement between fetal myocardial peak velocities evaluated by TDI with two different ultrasound systems. Materials and Methods: Systolic (S'), early (E') and late (A') diastolic myocardial peak velocities at mitral and tricuspid annuli as well as at the basal septum were evaluated by spectral TDI in 150 fetuses using two different ultrasound systems: Siemens Antares (Siemens Medical Systems, Malvern, Pa., USA) and Vivid Q (General Electric Healthcare, Horten, Norway). A method comparison study was performed, calculating intraclass correlation coefficients (ICC), and agreement was assessed by Bland-Altman plots. Results: Annular peak velocities showed lower values when measured by Vivid Q compared to values measured by Siemens Antares. ICC ranged from 0.07 (septal S') to 0.33 (right A'), showing very poor repeatability for clinical application. Agreement between the two systems was also poor, with high coefficients of variation for all measurements. Conclusions: Fetal annular peak velocities obtained with different ultrasound systems are not directly comparable. This is consistent with previous data in adults and warrants the need of system-specific reference values, suggesting that the same ultrasound machine should be used for longitudinal follow-up.

Gestational Age-Adjusted Reference Ranges for Fetal Left Ventricle Longitudinal Strain by Automated Cardiac Motion Quantification between 24 and 37 Weeks’ Gestation

“…We must also acknowledge this study's limitations. First, it is unlikely these results can be transferred to other software vendors since, as mentioned before, commercial software has been found to provide different results due to different algorithms used [13,22,[47][48][49]55]. Another important limitation is that our study only analyses LV fetal measurements since, at this moment, this novel software only contemplates analysis of the LV, although studies are being conducted to validate evaluation of the right ventricle (RV); however, this is a limitation of the software used, and not of the study itself.…”

“…In conclusion, our study demonstrated that assessment of global and regional LV longitudinal strain by aC-MQ-QLab is feasible and reproducible. We provide reference ranges adjusted by the GA of the software most currently used in postnatal evaluation, and therefore, it may help to eliminate variations given when evaluating the same parameter with different ultrasound equipment or software [43,55]. Our study also provides more information regarding the fetal cardiac function assessment, aiding in the introduction of this software in research, encouraging the realization of more studies, and probably helping for future use in clinical practice, allowing longitudinal surveillance of strain without intervendor variability by aiding in follow-up of fetal cardiac conditions before and after birth.…”

Reference ranges for left, right and interventricular septum indices at 20 to 36+6 weeks of gestation derived using spectral myocardial tissue Doppler on Voluson ultrasound machines

“…Halpern et al [7] reported a variation of up to 30% between measurements of MTD when using different ultrasound equipment in adults. Cruz-Lemini et al [3] show that, in fetuses, agreement among MTD values obtained using two different ultrasound equipment (Vivid Q and Siemens Antares) was low with a high coefficient of variation (S' LV 25%, E' LV 26%, A' RV, S' RV 22%, E' RV 24% and A' RV A': late diastolic annular peak velocity, E': early diastolic annular peak velocity,E'/A': early diastolic annular peak velocity / late-diastolic annular peak velocity ratio, ET': ejection time using spectral tissue Doppler, GA: gestational age, ICT': isovolumetric contraction time using spectral tissue Doppler, IRT': isovolumetric relation time using spectral tissue Doppler, IVS: interventricular septum, LV: left ventricle, MPI': myocardial performance index (MPI') using spectral tissue Doppler, RV: right ventricle,S': systolic annular peak velocity. A': late diastolic annular peak velocity, E': early diastolic annular peak velocity, E'/A': early diastolic annular peak velocity / late-diastolic annular peak velocity ratio, IVS: interventricular septum, LV: left ventricle, RV: right ventricle, S': systolic annular peak velocity.…”

“…New technologies in fetal echocardiography are being used increasingly as clinical and research tools to evaluate fetal cardiac function [1,2]. While conventional echocardiographic techniques are based on blood flow, tissue Doppler imaging (TDI) is a preload-independent technique that allows direct measurement of regional myocardial velocities and duration of myocardial motion with greater accuracy [3][4][5]. TDI is a sensitive method of evaluating even mild impairments in systolic or diastolic function, and is therefore, useful for identifying subtle cardiac dysfunction in the preclinical stage [3].…”

“…Reference ranges for the peak myocardial tissue Doppler velocities (MTD) have been previously published for various populations using diverse equipment and settings [1,[4][5][6], and recent data in adults have shown variations of up to 30% between the various ultrasound machines used for deriving these values [7]. Importantly, agreement among the various ultrasound systems is poor for fetal measurements with high coefficients of variation seen in all measurements [3]. Therefore, it is recommended that the fetal cardiac function be evaluated using the same equipment and settings in routine clinical practice.…”