3D echocardiography (3DE) will gain increasing acceptance as a routine clinical tool as the technology evolves due to advances in technology andcomputer processing power. Images obtained from 3DE provide more accurate assessment of complex cardiac anatomy and sophisticatedfunctional mechanisms compared with conventional 2D echocardiography (2DE), and are comparable to those achieved with magnetic resonanceimaging. Many of the limitations associated with the early iterations of 3DE prevented their widespread clinical application; however, recentsignificant improvements in transducer and post-processing software technologies have addressed many of these issues. Furthermore, the mostrecent advances in the ability to image the entire heart in realtime and fully automated quantification have poised 3DE to become more ubiquitousin clinical routine. Realtime 3DE (RT3DE) systems offer further improvements in the diagnostic and treatment planning capabilities of cardiacultrasound. Innovations such as the ability to acquire non-stitched, realtime, full-volume 3D images of the heart in a single heart cycle promise toovercome some of the current limitations of current RT3DE systems, which acquire images over four to seven cardiac cycles, with the need forgating and the potential for stitch artifacts.
2D echocardiography (2DE) is a common diagnostic and treatment planning tool in clinical cardiology, especially for the assessment of left ventricular (LV) volume and function. However, traditional 2DE is severely limited by its dependence on geometrical assumptions, which can lead to inaccuracies in volume quantification.1 Because 3D echocardiographic (3DE) imaging eliminates geometrical assumptions and image plane positioning error, the technique offers the potential for more accurate assessment of complex cardiac anatomy and sophisticated functional mechanisms.
Early attempts at 3DE using images produced by freehand reconstruction from multiple gated 2D images required spatial tracking of each image. These initial attempts at 3DE of LV volumes and mass and LV ejection fractions (LVEF) produced superior results to 2DE, comparable to those of nuclear magnetic resonance (NMR) imaging.2,3 Although 3DE has been around for nearly two decades, limitations in the early iterations of the technology prevented their widespread clinical application. While advances in transducer and post-processing software technologies have addressed many issues, it is the most recent advances in the ability to image the entire heart in realtime and fully automated quantification that have poised 3DE to become more ubiquitous in clinical routine. The introduction and increasing availability of realtime 3DE (RT3DE) have the potential to further improve the diagnostic and treatment planning capabilities of cardiac ultrasound. While cardiac magnetic resonance imaging (MRI) is the current gold standard, this imaging modality may require the injection of a contrast agent, is not suitable for patients with implanted cardiac devices, and can be more costly.
The Evolution of 3D Echocardiography
The acquisition of the first 3D cardiac ultrasound images dates back to 1974.4 This was followed by the development of early 3DE techniques, whereby 3DE images were obtained by offline sequential reconstruction of 2D images.2,3,5 However, these methods had limitations related to acquisition and post-processing: the images obtained were often of a relatively poor spatial and temporal resolution, while the reconstruction of the 2D data sets to produce 3D images was time-consuming and only available offline. More recently, matrix-array transducers have been introduced. These transducers contain an array of piezoelectric elements that are capable of scanning pyramidal volumes rather than 2D thin slices.
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