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EACVI Echo Handbook - sample

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Chapter 2 The Standard

Chapter 2 The Standard Transthoracic Echo Examination 2.4 3D echocardiography 3D echocardiography Provides real-time or near real-time three-dimensional images of the heart in motion ◆◆ Allows inspection and display of cardiac structures from all perspectives based on cropping and rendering (‘electronic dissection’ of the heart in motion) ◆◆ Temporal resolution (volume rate or frame rate)/spatial resolution (line density) trade-off ◆◆ Specific artefacts: ◆◆ Stitching artefact ◆◆ obvious demarcation of sub-volumes in multi-cycles acquisition (Fig. 2.4.1) ◆◆ how to avoid: ◆◆ ask the patient to hold their breath on inspiration ◆◆ use real-time 3D (Fig. 2.4.2 real-time 3D in the same patient as in Fig. 2.4.1) ◆◆ wait for a more regular RR interval in case of arrhythmia ◆◆ Dropout artefact ◆◆ false solutions of continuity due to low gain (Fig. 2.4.3) ◆◆ how to avoid → use higher gain than for 2D (Fig. 2.4.4) Fig. 2.4.1 Stitching artefact Fig. 2.4.3 Dropout artefact Fig. 2.4.2 Stitching artefact Fig. 2.4.4 Dropout artefact 68

Chapter 2 The Standard Transthoracic Echo Examination 2.5 Left ventricular opacification with contrast echocardiography General considerations ◆◆ Contrast agents comprise microbubbles that consist of an outer shell and an inner gas (Fig. 2.5.1, Table 2.5.1) ◆◆ The diameter of these microbubbles is usually less than 8 μm allowing their passage through the pulmonary capillaries and therefore their injection into a peripheral vein ◆◆ Microbubbles oscillate when exposed to ultrasound waves ◆◆ Non-linear oscillation produces harmonic signals at multiple frequencies of the fundamental frequency signal, which greatly improves image quality ◆◆ Act as red blood cell tracers—remain entirely intravascular at all times ◆◆ Entirely different from iodine-based contrast used in angiography/CT and gadolinium-based contrast used in CMR ◆◆ Used in rest and stress echocardiography to improve image quality, allowing accurate assessment of cardiac structure and function Outer shell Microbubble structure Inner gas Fig. 2.5.1 Structure of a contrast microsphere 88

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