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High-resolution transthoracic real-time three-dimensional echocardiography

Quantitation of cardiac volumes and function using semi-automatic border detection and comparison with cardiac magnetic resonance imaging

Harald P. Kühl, MD^*,*, Marcus Schreckenberg, PhD, Dierk Rulands, MD^*, Markus Katoh, MD, Wolfgang Schäfer, MD, PhD, Georg Schummers, PhD, Arno Bücker, MD, Peter Hanrath, MD^* and Andreas Franke, MD^*

^* Medizinische Klinik I, Aachen, Germany
Department of Diagnostic Radiology, Aachen, Germany
Department of Nuclear Medicine, University Hospital, Aachen, Germany
TomTec Imaging Systems GmbH, Unterschleissheim, Germany

View larger version (113K): [in a new window]   Figure 1 Method of semi-automatic contour detection using real-time three-dimensional echocardiography (3DE): a stack of eight rotated long-axis images is automatically selected from the 3DE dataset (left panel). In each of these long-axis cross sections (only one shown), the left ventricular (LV) apex and mitral annulus are earmarked in an end-diastolic (middle upper panel) and end-systolic (middle lower panel) stop frame. The markers at the mitral annulus are subsequently used by the algorithm to set the mitral valve plane and to truncate the contours of the LV cavity. Thereafter, an ellipse is placed in each of the end-diastolic and end-systolic stop frames for initiation of the model. This ellipse is manually adapted (length, width, and rotation angle) to fit as closely to the endocardial border as possible. The contours are subsequently detected automatically by the algorithm (right upper and lower panels for end-diastolic and end-systolic stop frames, respectively, with detected contour). See text for further details.

View larger version (64K): [in a new window]   Figure 2 Example of semi-automatic contour detection in a patient with normal left ventricular function. In each of the 17 time frames of each of eight long-axis cut-planes, the endocardial border was detected by the semi-automatic algorithm.

View larger version (33K): [in a new window]   Figure 3 Linear regression plots and Bland-Altman plots for end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF), as assessed with real-time three-dimensional echocardiography (RT-3DE), as compared with cardiovascular magnetic resonance (CMR) imaging as the reference standard.