Википедија

Trodimenzionalna ehokardiografija

Trodimenzionalna ehokardiografija ili 3D ehokardiografijaje prikaz srčanih struktura u realnom vremenu u tri dimenzije upotrebom različitih tehnika računarske grafike.[1] Kako je konvencionalna ehokardiografija (koja je značajno doprinela razumevanju morfologije i funkcije srca) limitirana prikazom u dve dimenzije, ona zahteva mentalnu rekonstrukciju treće dimenzije od strane ehokardiografera. Zato je koncept trodimenzijskog prikaza (3D) prihvaćen kao prirodna evolucija ove tehnologije, koja je značajno smanjila subjektivnost tumačenja dobijenih rezultata. [2] Iako 3D ehokardiografija predstavlja značajan korak u tehnologiji digitalnih slika, njihova procena i interpretacija je kompleksna, jer zahteva razumevanje prostorne anatomije i hemodinamike, poznavanje ograničenja ove metode i interpretaciju nalaza uz pažljiv klinički pregled.[3]

Trodimenzionalna ehokardiografija
Trodimenzionalni ehokardiogram vrha srca
ICD-9-CM88.72
MeSHD004452
OPS-301 code3-052
MedlinePlus003869

Istorija уреди

Posledih 50 godina ehokardiografija je, pored elektrokardiografije, postala osnovna dijagnostička metoda u kardiologiji. Ehokardiografija je vremenom postala glavni neinvazivni dijagnostički alat za snimanje srčane strukture i funkcije srca u realnom vremenu.[3] Sa napretkom tehnologije mikroprocesora i računara dijagnostičke mogućnosti ehokardiografije su se stalni uvećavale. Iako je konvencionalna ehokardiografija značajno doprinela razumevanju morfologije i funkcije srca, ona je ograničena prikazom u dve dimenzije, što zahteva mentalnu rekonstrukciju treće dimenzije od strane ehokardiografera. Zato je koncept trodimenzijskog prikaza (3D) koji je doveo do značajnog napretka u ovoj oblasti (nakon razvoj i usavršavanje trodimenzionalnog (3D) snimanja) prihvaćen kao prirodna evolucija ove tehnologije.[4]

Lakoća prikupljanja podataka matričnom sondom, mogućnost da se slika gotovo celo srce u realnom vremenu, kao i mogućnost da se fokusira na određene strukture u jednom otkucaju, dovele su 3D ehokardiografiju bliže rutinskoj kliničkoj upotrebi.

Tehnički principi уреди

Trodimenzionalna ehokardiografija (poznata i kao četvorodimenzionalna ehokardiografija kada se slika kreće) koristi ultrazvučnu sondu sa matričnim nizom i odgovarajući sistem za obradu podataka. Ovo omogućava detaljnu anatomsku procenu srčane patologije, posebno valvularnih defekata,[5] i kardiomiopatija.[6]

Sposobnost presecanja virtuelnog srca u beskonačnim ravninama na anatomski odgovarajući način i rekonstrukcije trodimenzionalnih slika anatomskih struktura čine je jedinstvenom za razumevanje urođenih mana srca.[7]

Trodimenzionalna ehokardiografija u realnom vremenu može se koristiti za usmeravanje lokacije bioptoma tokom endomiokardijalne biopsije desne komore, postavljanja valvularnih uređaja isporučenih kateterom i u mnogim drugim intraoperativnim procenama.[8]

Trodimenzionalna ehokardiografska tehnologija može sadržati anatomsku inteligenciju ili upotrebu tehnologije modeliranja organa za automatsku identifikaciju anatomije na osnovu generičkih modela. Svi generički modeli odnose se na skup anatomskih podataka koji se jedinstveno prilagođava varijabilnosti anatomije pacijenta za obavljanje specifičnih zadataka.

Prikupljanje podataka u tri dimenzije je moguće upotrebom različitih tehnika kao što su:

  • 3DE u realnom vremenu, (Real- time 3D, live 3D) sa specijalnim sistemom matričnih (matrix-array) pretvarača. 3DE prikaz u realnom vremenu (RT3DE) odnosi se na prikupljanje više piramidalnih grupa podataka u sekundi u jednom srčanom otkucaju.
  • 3DE rekonstrukcija u više srčanih ciklusa, bazirana na brojnim u nizu dobijenim, 2D presecima (slično multi-plane TEE), koji se kasnije prikazuju zajedno.

Zasnovana na algoritmima za prepoznavanje funkcija i segmentaciju, ova tehnologija može pružiti dijagnostičaru specifično trodimenzionalno modeliranje srca i drugih aspekata anatomije, uključujući mozak, pluća, jetru, bubrege, grudni koš i kičmeni stub.

Transezofagealna trodimenzionalna ehokardiografija

Klinička primena уреди

Klinička korist 3D ehokardiografije dokazana je u brojnim oblastima:

  • Direktna i automatizovana procena volumena srčane komore bez potrebe za geometrijskim modelovanjem i bez štetnih efekata skraćenih apikalnih pogleda, što rezultiuje preciznijom i reproduktivnijom zapreminom leve (LV) i desne komore (RV) i izbacivanjem (EF) merenja kod 2D ehokardiografija u poređenju sa referentnim vrednostima snimanja magnetnom rezonancom srca.[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]
  • Takođe, pokazalo se da 3D merenja funkcije i naprezanja miokarda imaju dodatnu prognostičku vrednost.[28]
  • interventne kardiologije kao vodič u brojnim perkutanim procedurama kao „hirurški” pogledi na mitralne, trikuspidalne i aortne srčane zaliske, susedne strukture i intrakardijalne mase.[29][30][31][32][33][34][35][36][37][38][39][40]

Ograničenja уреди

Osnovna ograničenja trodimenzionalne ehokardiografije odnose se na suboptimalne prikaze koji su uzrokovani:[3]

  • pomeranjem ultrazvučne sonde tokom akvizicije
  • varijacija tokom respiratornih faza i/ili RR intervala.
  • ćinjenicom da je rekonstrukcija prikaza zavisna od operatera,
  • da se originalne sive vrednosti delimično gube u 3D prikazu, zbog čega se ne mogu dobiti karakteristike tkiva.

Vidi još уреди

Izvori уреди

  1. ^ Lang MR, Badano PL, Tsang W, at al. Guidelines and standards EAE/ASE. Recommendations for image acquisition and display using three-dimensional echocardiography. J Am Soc Echocardiogr 2012; 25:3-46.
  2. ^ Lang MR, Mor-Avi V, Sugeng L, at al. Three-dimensional echocardiography. The benefits of the additional dimension. J Am Coll Cardiol 2006;48:2053-69.
  3. ^ а б в Bosiljka Vujisić-Tešić1,2, Milan Petrović1,2, Marija Boričić1 , Gordana Draganić1 , Danijela Trifunović1, Trodimenzionalna ehokardiografija u realnom vremenu: Značaj treće dimenzije u svakodnevnom kliničkom radu, Srce i krvni sudovi 2012; 31(4): 258-262
  4. ^ Hung J, Lang MR Flachskampf F, at al. 3D echocardiography: A review of the current status and future directions. J Am Soc Echocardiogr 2007;20:213-33.
  5. ^ Poh, K. K.; Levine, R. A.; Solis, J.; Shen, L.; Flaherty, M.; Kang, Y.-J.; Guerrero, J. L.; Hung, J. (2008). „Assessing aortic valve area in aortic stenosis by continuity equation: A novel approach using real-time three-dimensional echocardiography”. European Heart Journal. 29 (20): 2526—2535. PMC 2721715  . PMID 18263866. doi:10.1093/eurheartj/ehn022. .
  6. ^ Goland, Sorel; Czer, Lawrence S.C.; Luthringer, Daniel; Siegel, Robert J. (2008). „A case of arrhythmogenic right ventricular cardiomyopathy”. Canadian Journal of Cardiology. 24 (1): 61—62. PMC 2631252  . PMID 18209772. doi:10.1016/s0828-282x(08)70551-8. .
  7. ^ Bharucha, Tara; Roman, Kevin S.; Anderson, Robert H.; Vettukattil, Joseph J. (2008). „Impact of Multiplanar Review of Three-Dimensional Echocardiographic Data on Management of Congenital Heart Disease”. The Annals of Thoracic Surgery. 86 (3): 875—881. PMID 18721576. doi:10.1016/j.athoracsur.2008.04.106. .
  8. ^ Platts, David; Brown, Martin; Javorsky, George; West, Cathy; Kelly, Natalie; Burstow, Darryl (2010). „Comparison of fluoroscopic versus real-time three-dimensional transthoracic echocardiographic guidance of endomyocardial biopsies”. European Heart Journal - Cardiovascular Imaging. 11 (7): 637—643. PMID 20335406. doi:10.1093/ejechocard/jeq036. .
  9. ^ Ota T, Fleishman CE, Strub M, et al. Real-time, three-dimensional echocardiography: feasibility of dynamic right ventricular volume measurement with saline contrast. Am Heart J 1999; 137:958.
  10. ^ Schmidt MA, Ohazama CJ, Agyeman KO, et al. Real-time three-dimensional echocardiography for measurement of left ventricular volumes. Am J Cardiol 1999; 84:1434.
  11. ^ Shiota T, McCarthy PM, White RD, et al. Initial clinical experience of real-time three-dimensional echocardiography in patients with ischemic and idiopathic dilated cardiomyopathy. Am J Cardiol 1999; 84:1068.
  12. ^ Qin JJ, Jones M, Shiota T, et al. New digital measurement methods for left ventricular volume using real-time three-dimensional echocardiography: comparison with electromagnetic flow method and magnetic resonance imaging. Eur J Echocardiogr 2000; 1:96.
  13. ^ Sugeng L, Weinert L, Thiele K, Lang RM. Real-time three-dimensional echocardiography using a novel matrix array transducer. Echocardiography 2003; 20:623.
  14. ^ Zeidan Z, Erbel R, Barkhausen J, et al. Analysis of global systolic and diastolic left ventricular performance using volume-time curves by real-time three-dimensional echocardiography. J Am Soc Echocardiogr 2003; 16:29.
  15. ^ Arai K, Hozumi T, Matsumura Y, et al. Accuracy of measurement of left ventricular volume and ejection fraction by new real-time three-dimensional echocardiography in patients with wall motion abnormalities secondary to myocardial infarction. Am J Cardiol 2004; 94:552.
  16. ^ Jenkins C, Bricknell K, Hanekom L, Marwick TH. Reproducibility and accuracy of echocardiographic measurements of left ventricular parameters using real-time three-dimensional echocardiography. J Am Coll Cardiol 2004; 44:878.
  17. ^ Kühl HP, Schreckenberg M, Rulands D, et al. 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. J Am Coll Cardiol 2004; 43:2083.
  18. ^ Corsi C, Lang RM, Veronesi F, et al. Volumetric quantification of global and regional left ventricular function from real-time three-dimensional echocardiographic images. Circulation 2005; 112:1161.
  19. ^ Fleming SM, Cumberledge B, Kiesewetter C, et al. Usefulness of real-time three-dimensional echocardiography for reliable measurement of cardiac output in patients with ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol 2005; 95:308.
  20. ^ Jenkins C, Bricknell K, Marwick TH. Use of real-time three-dimensional echocardiography to measure left atrial volume: comparison with other echocardiographic techniques. J Am Soc Echocardiogr 2005; 18:991.
  21. ^ Jacobs LD, Salgo IS, Goonewardena S, et al. Rapid online quantification of left ventricular volume from real-time three-dimensional echocardiographic data. Eur Heart J 2006; 27:460.
  22. ^ van den Bosch AE, Robbers-Visser D, Krenning BJ, et al. Real-time transthoracic three-dimensional echocardiographic assessment of left ventricular volume and ejection fraction in congenital heart disease. J Am Soc Echocardiogr 2006; 19:1.
  23. ^ Thavendiranathan P, Liu S, Verhaert D, et al. Feasibility, accuracy, and reproducibility of real-time full-volume 3D transthoracic echocardiography to measure LV volumes and systolic function: a fully automated endocardial contouring algorithm in sinus rhythm and atrial fibrillation. JACC Cardiovasc Imaging 2012; 5:239.
  24. ^ Khoo NS, Young A, Occleshaw C, et al. Assessments of right ventricular volume and function using three-dimensional echocardiography in older children and adults with congenital heart disease: comparison with cardiac magnetic resonance imaging. J Am Soc Echocardiogr 2009; 22:1279.
  25. ^ Leibundgut G, Rohner A, Grize L, et al. Dynamic assessment of right ventricular volumes and function by real-time three-dimensional echocardiography: a comparison study with magnetic resonance imaging in 100 adult patients. J Am Soc Echocardiogr 2010; 23:116.
  26. ^ van der Zwaan HB, Helbing WA, McGhie JS, et al. Clinical value of real-time three-dimensional echocardiography for right ventricular quantification in congenital heart disease: validation with cardiac magnetic resonance imaging. J Am Soc Echocardiogr 2010; 23:134.
  27. ^ Grewal J, Majdalany D, Syed I, et al. Three-dimensional echocardiographic assessment of right ventricular volume and function in adult patients with congenital heart disease: comparison with magnetic resonance imaging. J Am Soc Echocardiogr 2010; 23:127.
  28. ^ Medvedofsky D, Maffessanti F, Weinert L, et al. 2D and 3D Echocardiography-Derived Indices of Left Ventricular Function and Shape: Relationship With Mortality. JACC Cardiovasc Imaging 2018; 11:1569.
  29. ^ Levine RA, Handschumacher MD, Sanfilippo AJ, et al. Three-dimensional echocardiographic reconstruction of the mitral valve, with implications for the diagnosis of mitral valve prolapse. Circulation 1989; 80:589.
  30. ^ Cheng TO, Wang XF, Zheng LH, et al. Three-dimensional transesophageal echocardiography in the diagnosis of mitral valve prolapse. Am Heart J 1994; 128:1218.
  31. ^ Nanda NC, Roychoudhury D, Chung SM, et al. Quantitative assessment of normal and stenotic aortic valve using transesophageal three-dimensional echocardiography. Echocardiography 1994; 11:617.
  32. ^ Pai RG, Tanimoto M, Jintapakorn W, et al. Volume-rendered three-dimensional dynamic anatomy of the mitral annulus using a transesophageal echocardiographic technique. J Heart Valve Dis 1995; 4:623.
  33. ^ Salustri A, Becker AE, van Herwerden L, et al. Three-dimensional echocardiography of normal and pathologic mitral valve: a comparison with two-dimensional transesophageal echocardiography. J Am Coll Cardiol 1996; 27:1502.
  34. ^ Chen Q, Nosir YF, Vletter WB, et al. Accurate assessment of mitral valve area in patients with mitral stenosis by three-dimensional echocardiography. J Am Soc Echocardiogr 1997; 10:133.
  35. ^ Otsuji Y, Handschumacher MD, Schwammenthal E, et al. Insights from three-dimensional echocardiography into the mechanism of functional mitral regurgitation: direct in vivo demonstration of altered leaflet tethering geometry. Circulation 1997; 96:1999.
  36. ^ Ge S, Warner JG Jr, Abraham TP, et al. Three-dimensional surface area of the aortic valve orifice by three-dimensional echocardiography: clinical validation of a novel index for assessment of aortic stenosis. Am Heart J 1998; 136:1042.
  37. ^ Legget ME, Bashein G, McDonald JA, et al. Three-dimensional measurement of the mitral annulus by multiplane transesophageal echocardiography: in vitro validation and in vivo demonstration. J Am Soc Echocardiogr 1998; 11:188."
  38. ^ Yao J, Masani ND, Cao QL, et al. Clinical application of transthoracic volume-rendered three-dimensional echocardiography in the assessment of mitral regurgitation. Am J Cardiol 1998; 82:189.
  39. ^ Binder TM, Rosenhek R, Porenta G, et al. Improved assessment of mitral valve stenosis by volumetric real-time three-dimensional echocardiography. J Am Coll Cardiol 2000; 36:1355
  40. ^ Kaplan SR, Bashein G, Sheehan FH, et al. Three-dimensional echocardiographic assessment of annular shape changes in the normal and regurgitant mitral valve. Am Heart J 2000; 139:378.

Literatura уреди

  • Mor-Avi V, Sugeng L, Lang RM. Real-time three-dimensional echocardiography:an integral component of the routine echocardiographic examination in adult patients? Circulation 2009;119:314-29.
  • Sugeng L, Weinert L, Thiele K, Lang RM. Real-time threedimensional echocardiography using a novel matrix array transducer. Echocardiography 2003;20:623-35.
  • Kuhl HP, Schreckenberg M, Rulands D et al. High resolution transthoracic real-time three dimensional echocardiography - Quantitation of cardiac volumes and function using semiautomatic border detection and comparison with cardiac magnetic resonance imaging. J Am Coll Cardiol 2004;43:2083-90.
  • Monaghan MJ. Role of real time 3D echocardiography in evaluating the left ventricle. Heart 2006;92:131-6.
  • Mor-Avi V, Sugeng L, Lang RM.Real-time 3-dimensional echocardiography:an integral component of the routine echocardiographic examination in adult patients? Circulation 2009;119:314-29.
  • Krenning BJ, Kirschbaum SW, Soliman OI, et al. Comparison of contrast agent-enhanced versus noncontrast agent-enhanced real-time three-dimensional echocardiography for analysis of left ventricular systolic function. Am J Cardiol 2007;100:1485-9.
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  • Matsumura Y, Hozumi T, Arai K, et al.Non-invasive assessment of myocardial ischaemia using new real-time three-dimensional dobutamine stress echocardiography: comparison with conventional two-dimensional methods. Eur Heart J 2005;26:1625-32.
  • Krenning BJ, Szili-Torok T,Voormolen MM, et al. Guiding and optimization of resynchronization therapy with dynamic threedimensional echocardiography and segmental volume—time curves: a feasibility study. Eur J Heart Fail 2004;6:619-25.
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  • Hofmann T, Franzen O, Koschyk DH, Von KY, Goldmann B, Meinertz T. Three-dimensional color Doppler echocardiography for assessing shunt volume in atrial septal defects. J Am Soc Echocardiogr 2004;17:1173-8.
  • Pemberton J, Li X, Karamlou T, et al. The use of live three dimensional Doppler echocardiography in the measurement of cardiac output: an in vivo animal study. J Am Coll Cardiol 2005;45:433-8.
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