Discover the ESC Textbook of Cardiovascular Imaging 2nd edition
Section II New technical developments in imaging techniques 5 New developments in echocardiography/advanced echocardiography 67 Silvia Gianstefani, Jens-Uwe Voigt, and Mark J Monaghan 6 Hybrid imaging: combination of PET, SPECT, CT, and MRI 89 Juhani Knuuti and Philipp A Kaufmann 7 New technical developments in cardiac CT 99 Stephan Achenbach 8 New technical developments in CMR 107 Reza Razavi, Manav Sohal, Zhong Chen, and James Harrison 9 Imaging during cardiac interventions 116 Luis M. Rincó and José L. Zamorano
Chapter 5 New developments in echocardiography/ advanced echocardiography Silvia Gianstefani, Jens-Uwe Voigt, and Mark J. Monaghan Contents Three-dimensional echocardiography 67 Development of the 3D technique 67 Acquisition techniques 68 Display of 3D datasets 69 Pitfalls 71 Artefacts 71 Advantages and limitations of 3D versus conventional 2D echocardiography 71 Technical issues and future perspective 77 Deformation imaging: 2D and 3D techniques 77 Key concepts of myocardial function quantification 77 LV myocardial architecture and deformation 77 Tissue Doppler 77 Speckle tracking 80 Three-dimensional regional function estimation 82 Clinical applications 82 Conclusion 85 Acknowledgements 85 References 85 Three-dimensional echocardiography Development of the 3D technique The concept of, and indeed the ability to, perform three-dimensional echocardiography (3DE), has been around for some time now. It was back in 1974 that investigators first reported the acquisition of 3D ultrasound images of the heart , but it has not been until the last decade that 3DE has started to enter clinical practice. The early attempts at this form of imaging were based around computerized reconstruction from multiple 2D slices, achieved by carefully tracking a transducer through a number of 2D acquisitions over many cardiac cycles. Over subsequent years, the technique was gradually refined and improved upon; ECG gating was introduced and free hand scanning gave way to motorized rotary transducers, whose location in space was continually tracked. This approach appeared to produce accurate volumes  and impressive images; however, the time involved for reconstruction and the labour-intensive analysis, not to mention the requisite computing capabilities, meant that it was the preserve of dedicated research departments. The advent of a sparse matrix array transducer in the early 1990s  represented a marked improvement. The transducer was capable of obtaining direct volumetric data at volume rates high enough to demonstrate cardiac motion. Images were presented as 2D orthogonal planes, and both spatial and temporal resolutions were low. Transducer technology continued to advance and fully sampled matrix array technology facilitated the integration of 3DE into clinical practice. These transducers allowed rapid ECG-gated or real-time 3D image acquisition with temporal and spatial resolution sufficient for clinical applications. The last technical advancement consists of the introduction of broadband (1–5 MHz) monocrystal transducers. The electromechanical efficiency of these monocrystals is 80– 100% better than that of the currently used piezoelectric crystals making them twice as sensitive. This results in a better penetration, resolution, and signal-to-noise ratio. These transducers allow high-resolution harmonic imaging with improved cavity delineation. The efficiency of the monocrystal matrix array transducers and miniaturization has also led to the introduction of transoesophageal (TEE) real time 3D echocardiography (RT3DE).