Real-time three-dimensional echocardiography: technological gadget or clinical tool?

Abstract

The complex anatomy of cardiac structures requires three-dimensional spatial orientation of images for a better understanding of structure and function, thereby improving image interpretation. Real-time three-dimensional echocardiography is a recently developed technique based on the design of an ultrasound transducer with a matrix array that rapidly acquires image data in a pyramidal volume. The simultaneous display of multiple tomographic images allows three-dimensional perspective and the anatomically correct examination of any structure within the volumetric image. As a consequence, it is less operator-dependent and hence more reproducible. Dedicated software systems and technologies are based on high-performance computers designed for graphic handling of three-dimensional images by providing possibilities beyond those obtainable with echocardiography. This methodology allows simultaneous display of multiple superimposed planes in an interactive manner as well as a quantitative assessment of cardiac volumes and ventricular mass in a three-dimensional format without a pre-established assumption of cardiac chamber geometry. In addition, myocardial contraction and/or perfusion abnormalities are clearly identified. Finally, real-time three-dimensional colour Doppler flow mapping enables complete visualisation of the regurgitant jet and new ways of assessing regurgitant lesion severity. Thus, this technique expands the abilities of non-invasive cardiology and may open new doors for the evaluation of cardiac diseases. In this article, current and future clinical applications of real-time three-dimensional echocardiography are reviewed.

Usefulness of Real‐time 3‐Dimensional Echocardiography to Identify and Quantify Left Ventricular Dyssynchrony in Patients With Kawasaki Disease

“…20 However, to our knowledge, the clinical meaning of this phenomenon has never been elucidated in Kawasaki disease. The approach has been documented to provide highly accurate measurements of the LVEF, 21 and another important advantage of the 3D technique is the ability to visualize and measure an object in arbitrary orientations without geometric assumptions 22 and image plane positioning, theoretically increasing accuracy in chamber quantification. Anatomic landmarks (such as the mitral annulus and apex) are identified by the user in both end-diastolic and end-systolic frames, and the software can make a semiautomatic tracing of the endocardial border through the entire cardiac cycle, allowing quantitative assessment of the global and regional LVEF.…”

Three-Dimensional Echocardiography in Adult Congenital Heart Disease

“…This technique required spatial information about the ultrasound probe itself, as well as gating to the cardiac and respiratory cycle after which an offline reconstruction of the 2D acquisition into a 3D rendering was made [1]. This approach was limited by long acquisition and reconstruction times, and frequently, the presence of artifacts.…”

“…Such an examination can be challenging in the setting of congenital heart disease, which can be further complicated by postoperative anatomy. Real-time 3DE (RT3DE) is a recently developed technique based on the design of an ultrasound transducer with a matrix array that rapidly acquires image data in a pyramidal volume [1]. The simultaneous display of multiple tomographic images allows 3D perspective and consequently examination of any structure within that volumetric image.…”

“…In contrast to offline 3D echocardiographic reconstruction techniques, RT3DE allows online acquisition of a volumetric dataset, without the need for reference systems and electrocardiographic or respiratory cycle gating. Current RT3DE transducers consist of 2D arrays with 3000 to 4000 simultaneously active ultrasound elements [1]. With the use of the scanning probe, multidirectional beam steering and signal processing takes place automatically.…”

Advantages and Pitfalls of Three-Dimensional Ultrasound Imaging of Carotid Bifurcation

“…Several specialists indeed benefit from 3D US: cardiologists use it as a valid corroborative diagnostic tool to standard two-dimensional imaging for cardiac diseases [1,2,3,4,5], obstetrics and gynecologists use it for fetal prenatal diagnosis [6,7] and uterine and ovarian evaluation [8,9], surgeons for breast cancer [10] and gastroenterologists for focal liver lesions [11]. Moreover, as US is a real-time imaging technique, it was possible to add ‘movement’ as the 4th dimension (4D), developing 4D US, with impressive results in cardiac and fetal prenatal imaging [12,13].…”