Cardiac imaging has become fully integrated in the management of patients, with echocardiography being the most widely used modality. Two-dimensional echocardiography (2DE) offers a detailed assessment of ventricular function, valvular pathology, and hemodynamics, but its comprehensiveness is limited by the fact that images represent a single plane, and may thus inadequately represent a heart whose function is not uniform. For example, when evaluating 2-D images to calculate ventricular volumes, geometrical assumptions need to be made regarding the ventricular shape, which may not be valid in the presence of regional wall motion abnormalities. More than 15 years ago, 3DE was developed to provide a more accurate assessment of ventricular volume, mass, and function to enhance the ability to assess the spatial relations between cardiac structures and provide a more complete view of the valves. While multiple studies demonstrated the advantages of 3DE, it too had several limitations. 3-D images were actually reconstructed from multiplanar 2-D images taken over several cardiac cycles. This increased the risk of introducing artifact from patient respiration or motion. Analysis was performed off-line and required tedious manual tracing of endocardial borders. In addition, limited computer technology caused slow data processing. As a result, 3DE remained a research tool that was not used widely in the clinical arena.
The past years have seen significant developments in transducer technology, allowing pyramidal shaped blocks to be acquired in realtime. It is now possible to image an entire ventricle or valve and analyze it online, thus obviating the need for complicated and time-consuming reconstructions. Advances in computer technology have also contributed to streamlining and expediting data analysis. Realtime 3-D echocardiography (RT3DE) has thus greatly enhanced the potential clinical utility for the evaluation of left ventricular (LV) and valvular function. This article examines the technological improvements in RT3DE and the evidence to support its routine use in the clinical setting.
Early models of RT3DE transducers used only 256 elements, which did not fire simultaneously, resulting in an image quality that was often inferior to that of 2DE. Displayed images still consisted of computer-generated 2-D cut planes obtained from the 3-D dataset, and the size of the pyramidal scan volume was incapable of accommodating larger ventricles.
- Sugeng L,Weinert L, Lang R M, ÔÇ£Left ventricular assessment using real time three dimensional echocardiographyÔÇØ, Heart (2003);89: pp. iii29-iii36.
- Caiani E G, Corsi C, Zamorano J et al.,ÔÇ£Improved semiautomated quantification of left ventricular volumes and ejection fraction using 3-dimensional echocardiography with a full matrix-array transducer: comparison with magnetic resonance imagingÔÇØ, J.Am. Soc. Echocardiogr. (2005);18: pp. 779-788.
- Corsi C, Lang R M,Veronesi F,Weinert L, Caiani E G, MacEneaney P, Lamberti C, Mor-Avi V,ÔÇ£Volumetric quantification of global and regional left ventricular function from real-time three-dimensional echocardiographic imagesÔÇØ, Circulation (2005);112: pp. 1,161-1,170.
- Kuhl H P, Schreckenberg M, Rulands D, Katoh M, Schafer W, Schummers G, Bucker A, Hanrath P, Franke A, ÔÇ£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 imagingÔÇØ, J.Am. Coll. Cardiol. (2004);43: pp. 2,083-2,090.
- Qin J X, Jones M, Shiota T, Greenberg N L,Tsujino H, Firstenberg M S, Gupta P C, Zetts A D, Xu Y, Ping S J, Cardon L A, Odabashian J A, Flamm S D,White R D, Panza J A,Thomas J D,ÔÇ£Validation of real-time three-dimensional echocardiography for quantifying left ventricular volumes in the presence of a left ventricular aneurysm: in vitro and in vivo studiesÔÇØ, J.Am. Coll. Cardiol. (2000);36: pp. 900-907.
- Caiani E G, Coon P, Corsi C et al.,ÔÇ£Dual triggering improves the accuracy of left ventricular volume measurements by contrastenhanced real-time 3-dimensional echocardiographyÔÇØ, J.Am. Soc. Echocardiogr. (2005), in press.
- Mor-Avi V, Sugeng L,Weinert L, MacEneaney P, Caiani E G, Koch R, Salgo I S, Lang R M, ÔÇ£Fast measurement of left ventricular mass with real-time three-dimensional echocardiography: comparison with magnetic resonance imagingÔÇØ, Circulation (2004);110: pp. 1,814-1,818.
- van der Heide J A, Mannaerts H F, Spruijt H J, van Campen L M, de Cock C,Visser C A, Kamp O,ÔÇ£Noninvasive mapping of left ventricular electromechanical asynchrony by three-dimensional echocardiography and semi-automatic contour detectionÔÇØ, Am. J. Cardiol. (2004);94: pp. 1,449-1,453.
- Ahmad M, Xie T, McCulloch M, Abreo G, Runge M, ÔÇ£Real-time three-dimensional dobutamine stress echocardiography in assessment of ischemia: comparison with two-dimensional dobutamine stress echocardiographyÔÇØ, J.Am. Coll. Cardiol. (2001);37: pp. 1,303-1,309.
- Sugeng L, Kirkpatrick J, Lang R M, Bednarz J E, Decara J M, Lammertin G, Spencer K T, ÔÇ£Biplane stress echocardiography using a prototype matrix-array transducerÔÇØ, J.Am. Soc. Echocardiogr. (2003);16: pp. 937-941.
- Takeuchi M, Shinichiro O,Weinert L, Spencer K T, Lang R M, ÔÇ£Comparison of contrast-enhanced real time live threedimensional dobumatine stress echocardiography with contrast two-dimensional echocardiography for detecting stress-induced wall motion abnormalitiesÔÇØ, J.Am. Soc. Echocardiogr. (2005), in press.
- Binder T M, Rosenhek R, Porenta G, Maurer G, Baumgartner H, ÔÇ£Improved assessment of mitral valve stenosis by volumetric real-time three-dimensional echocardiographyÔÇØ, J.Am. Coll. Cardiol. (2000);36: pp. 1,355-1,361.
- Zamorano J, Cordeiro P, Sugeng L, Perez de Isla L,Weinert L, Macaya C, Rodriguez E, Lang R M, ÔÇ£Real-time threedimensional echocardiography for rheumatic mitral valve stenosis evaluation: an accurate and novel approachÔÇØ, J. Am. Coll. Cardiol. (2004);43: pp. 2,091-2,096.
- Zamorano J, Perez de Isla L, Sugeng L, Cordeiro P, Rodrigo J L, Almeria C,Weinert L, Feldman T, Macaya C, Lang R M, Hernandez A R,ÔÇ£Non-invasive assessment of mitral valve area during percutaneous balloon mitral valvuloplasty: role of real-time 3D echocardiographyÔÇØ, Eur. Heart J. (2004);25: pp. 2,086-2,091.
- Kwan J, Shiota T,Agler D A, Popovic Z B, Qin J X, Gillinov M A, Stewart W J, Cosgrove D M, McCarthy P M,Thomas J D, ÔÇ£Geometric differences of the mitral apparatus between ischemic and dilated cardiomyopathy with significant mitral regurgitation: real-time three-dimensional echocardiography studyÔÇØ, Circulation (2003);107: pp. 1,135-1,140.
- Watanabe N, Ogasawara Y,Yamaura Y, Kawamoto T,Toyota E, Akasaka T,Yoshida K, ÔÇ£Quantitation of mitral valve tenting in ischemic mitral regurgitation by transthoracic real-time three-dimensional echocardiographyÔÇØ, J. Am. Coll. Cardiol. (2005);45: pp. 763-769.
- Kapetanakis S, Kearney M T, Siva A, Gall N, Cooklin M, Monaghan M J,ÔÇ£Real-time three-dimensional echocardiography: a novel technique to quantify global left ventricular mechanical dyssynchronyÔÇØ, Circulation (2005);112: pp. 992-1,000.
- Camarano G, Jones M, Freidlin R Z, Panza J A, ÔÇ£Quantitative assessment of left ventricular perfusion defects using real-time three-dimensional myocardial contrast echocardiographyÔÇØ, J.Am. Soc. Echocardiogr. (2002);15: pp. 206-213.
- Pemberton J, Li X, Hickey E, Karamlou T, Sandquist C A, Ungerleider R, Sahn D J, ÔÇ£Live real-time three-dimensional echocardiography for the visualization of myocardial perfusionÔÇöa pilot study in open-chest pigsÔÇØ, J. Am. Soc. Echocardiogr. (2005);18: pp. 956-958.
- Toledo E, Lang R M, Collins K A, Lammertin G,Willams U,Weinert L, Bolotin G, Coon P, Raman J, Jacobs L D, Mor-Avi V, ÔÇ£Imaging and quantification of myocardial perfusion using real-time three-dimensional echocardiographyÔÇØ, J. Am. Coll. Cardiol. (2005), in press.