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3D Echo Basics: Acquisition, Cropping and Display

Wendy Tsang, MD, SM, FRCP(C)

Toronto General Hospital

University of Toronto

Uses of 3D Echocardiography

Recommended Promising

Clinical Trials Areas of active

Research

LV Volumes LV Mass LV Shape

MV anatomy RV Volumes LV Dyssynchrony

MV Stenosis Ao Anatomy LA Volumes

Guidance of Transcatheter

Procedures Ao Stenosis MV Regurgitation

Prosthetic Valves

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Spatial vs temporal resolution Gating artifacts

2D Image Quality

• Before 3DE acquisition, the 2D image should be optimized – Poor 2D images, poor 3D images

Modes of Acquisition

Single-beat Multi-beat

Color Doppler

Wide angle/ Full volume

Zoom

Narrow volume/Live 3D

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Select Acquisition Mode

30o

60o

85o

90o

30o

30o

Zoom Mode

30o

30o

Zoom Mode

• Indications:

– Valves

– ASD

– VSD

– small, fast moving structures

• Beware of losing spatial orientation

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Narrow Volume

30o

60o

• Useful for procedures

Wide Angle/Full Volume

85o

90o

Narrow Volume vs Full Volume Acquisition

Narrow angle Full volume

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What acquisition mode to choose?

Narrow angle/Zoomed

• Valves

• Inter-atrial septum

• Inter-ventricular septum

Wide angle/Multi-beat

• LV

• RV

• Whole heart

Single or Multi-beat?

Single-beat acquisition

– acquisition of multiple pyramidal data sets per second in a single heartbeat

Single or Multi-beat? ECG-triggered multiple-beat acquisition

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FV 1 beat - 4 Hz FV 4 beats - 15Hz

Single or Multi-beat?

Single or Multi-beat?

Single Beat

• Advantage

– Overcomes limitations from rhythm disturbances and

respiratory motion

• Disadvantage – Limited by poor temporal

resolution

Multi-beat

• Advantage

– Images with higher temporal resolution

• Disadvantage

– Gated images are susceptible to artifacts from respiratory

motion or cardiac arrhythmias

Stitch Artifact

• MUST examine the imaging planes perpendicular to the sweep plane • Apical 4-chamber acquisition check SAX/side

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Check with Biplane Imaging/Multi-View

3DE color Doppler

Can be

obtained with

single beat or

multi-beat

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LV Cut Planes

•Transverse

• Sagittal

• Coronal

apical

basal

Short Axis

(transverse)

Long Axis (sagital)

Nanda et al. Echocardiography 2004;21:763.

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4-Chamber (coronal)

Nanda et al. Echocardiography 2004;21:763.

Cropping

• Can be performed before or after data acquisition

• Before acquisition allows better temporal and spatial resolution

• However if cropped image is stored, image may not be amenable to ‘uncropping’

• Wide data set can be acquired and then cropped, retains information but at expense of spatial and temporal resolution

Apply Cut-planes

3D Volume

Auto Crop Box Crop Plane Crop

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Cut-Planes

• Box Crop – Auto Crop

– Box Crop

Cut-Planes

• Arbitrary Crop

(Plane)

Left Ventricle Display Volume Rendering Surface Rendering

2D Tomographic Slices Wire-Frame

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Gain

“Snow”

Drop-out

Compress

Transparent

Solid

Vision • Menu of predefined

combinations of contrast, transparency, lighting and compositing algorithms

• Affects the spatial filtering and depth of colorization seen

•Ranges from A - H

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Colorization •Predefined Chroma maps which are colorized post-processing setting applied to the image data to highlight the data •1-8

Acquisition

Lang, Badano et al. EAE/ASE 3D Guidelines JASE 2012

Tricuspid Valve

Display the tricuspid valve with the septum placed inferiorly in the six o’clock position, regardless if the valve is oriented as viewed from the right atrium or the right ventricle.

Ant=anterior, Post=posterior, IAS=interatrial septum, IVS=interventricular septum

Mitral Valve

Display the mitral valve with the aortic valve placed superiorly, re-gardless if the valve is oriented as viewed from the left atrium or the left ventricle.

AV=aortic valve, Lat=lateral left ventricle, PMVL=posterior mitral valve leaflet

Pulmonic Valve

Display the pulmonic valve with the anterior cusp at the 12 o’clock posi-tion, regardless if the valve is ori-ented as viewed from the pulmo-nary artery or the right ventricle out-flow tract.

AC=anterior cusp, LA=left atrium

Aortic Valve

Display the aortic valve with right coronary cusp located inferiorly at the six o’clock position, regardless if the valve is oriented as viewed from the aorta or the left ventricular out-flow tract.

RCC=right coronary cusp RCC RCC

AV AV

PMVL PMVL

Lat Lat

AC

Left Atrium Left Ventricle

Right Atrium Right Ventricle

Aorta Left Ventricular Outflow Tract

Right Ventricular Outflow Tract Pulmonary Artery

Ant Post

IVS

IAS

Post Ant

AC AC

LA#

Display

Lang, Badano et al. EAE/ASE 3D Guidelines JASE 2012.

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Left Ventricle

Display

Questions/Comments

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B

C

Rotate to the left atrial en-face view

Rotate 90° to place the

aortic valve at the 12 o’clock

position

Standard mitral valve view from the left atrial perspective

E D

Rotate 180° to view the ventricular

side

Standard mitral valve view from the left ventricular perspective

A

Use biplane views to check that the mitral valve annulus is centered within the acquisition plane

PRESENTATION

ACQUISITION

B

C

Rotate 90° to view the valve en-face from the

aortic perspective

Standard aortic valve view from the ascending aorta perspective. The right coronary cusp should be located at the 6 o’clock position

D

Rotate 180° to view the ventricular

side

Standard aortic valve view from the left ventricular perspective. The right coronary

cusp should be located at the 6 o’clock position

A

Use biplane views to check that the aortic valve annulus is centered within the acquisition plane

PRESENTATION

ACQUISITION