TY - JOUR
T1 - The Impact of Vendor-Specific Ultrasound Beam-Forming and Processing Techniques on the Visualization of In Vitro Experimental “Scar”
T2 - Implications for Myocardial Scar Imaging Using Two-Dimensional and Three-Dimensional Echocardiography
AU - Papachristidis, Alexandros
AU - Queirós, Sandro
AU - Theodoropoulos, Konstantinos C.
AU - D'hooge, Jan
AU - Rafter, Patrick
AU - Masoero, Giovanni
AU - Zidros, Spyridon
AU - Pagnano, Gianpiero
AU - Huang, Marilou
AU - Dancy, Luke
AU - Sado, Daniel
AU - Shah, Ajay M.
AU - Murgatroyd, Francis D.
AU - Monaghan, Mark J.
N1 - Funding Information:
Prof. Monaghan has received research support from Philips and is a member of the Speakers? Bureau for Philips. Mr. Rafter is an employee of Philips Healthcare, Philips, Netherlands.
Publisher Copyright:
© 2021 American Society of Echocardiography
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/10
Y1 - 2021/10
N2 - Background: Myocardial scar appears brighter compared with normal myocardium on echocardiography because of differences in tissue characteristics. The aim of this study was to test how different ultrasound pulse characteristics affect the brightness contrast (i.e., contrast ratio [CR]) between tissues of different acoustic properties, as well as the accuracy of assessing tissue volume. Methods: An experimental in vitro “scar” model was created using overheated and raw pieces of commercially available bovine muscle. Two-dimensional and three-dimensional ultrasound scanning of the model was performed using combinations of ultrasound pulse characteristics: ultrasound frequency, harmonics, pulse amplitude, steady pulse (SP) emission, power modulation (PM), and pulse inversion modalities. Results: On both two-dimensional and three-dimensional imaging, the CR between the “scar” and its adjacent tissue was higher when PM was used. PM, as well as SP ultrasound imaging, provided good “scar” volume quantification. When tested on 10 “scars” of different size and shape, PM resulted in lower bias (−9.7 vs 54.2 mm3) and narrower limits of agreement (−168.6 to 149.2 mm3 vs −296.0 to 404.4 mm3, P = .03). The interobserver variability for “scar” volume was better with PM (intraclass correlation coefficient = 0.901 vs 0.815). Two-dimensional and three-dimensional echocardiography with PM and SP was performed on 15 individuals with myocardial scar secondary to infarction. The CR was higher on PM imaging. Using cardiac magnetic resonance as a reference, quantification of myocardial scar volume showed better agreement when PM was used (bias, −645 mm3; limits of agreement, −3,158 to 1,868 mm3) as opposed to SP (bias, −1,138 mm3; limits of agreement, −5,510 to 3,233 mm3). Conclusions: The PM modality increased the CR between tissues with different acoustic properties in an experimental in vitro “scar” model while allowing accurate quantification of “scar” volume. By applying the in vitro findings to humans, PM resulted in higher CR between scarred and healthy myocardium, providing better scar volume quantification than SP compared with cardiac magnetic resonance.
AB - Background: Myocardial scar appears brighter compared with normal myocardium on echocardiography because of differences in tissue characteristics. The aim of this study was to test how different ultrasound pulse characteristics affect the brightness contrast (i.e., contrast ratio [CR]) between tissues of different acoustic properties, as well as the accuracy of assessing tissue volume. Methods: An experimental in vitro “scar” model was created using overheated and raw pieces of commercially available bovine muscle. Two-dimensional and three-dimensional ultrasound scanning of the model was performed using combinations of ultrasound pulse characteristics: ultrasound frequency, harmonics, pulse amplitude, steady pulse (SP) emission, power modulation (PM), and pulse inversion modalities. Results: On both two-dimensional and three-dimensional imaging, the CR between the “scar” and its adjacent tissue was higher when PM was used. PM, as well as SP ultrasound imaging, provided good “scar” volume quantification. When tested on 10 “scars” of different size and shape, PM resulted in lower bias (−9.7 vs 54.2 mm3) and narrower limits of agreement (−168.6 to 149.2 mm3 vs −296.0 to 404.4 mm3, P = .03). The interobserver variability for “scar” volume was better with PM (intraclass correlation coefficient = 0.901 vs 0.815). Two-dimensional and three-dimensional echocardiography with PM and SP was performed on 15 individuals with myocardial scar secondary to infarction. The CR was higher on PM imaging. Using cardiac magnetic resonance as a reference, quantification of myocardial scar volume showed better agreement when PM was used (bias, −645 mm3; limits of agreement, −3,158 to 1,868 mm3) as opposed to SP (bias, −1,138 mm3; limits of agreement, −5,510 to 3,233 mm3). Conclusions: The PM modality increased the CR between tissues with different acoustic properties in an experimental in vitro “scar” model while allowing accurate quantification of “scar” volume. By applying the in vitro findings to humans, PM resulted in higher CR between scarred and healthy myocardium, providing better scar volume quantification than SP compared with cardiac magnetic resonance.
KW - Contrast ratio
KW - Myocardial scar
KW - Power modulation
KW - Ultrasound beam forming
UR - http://www.scopus.com/inward/record.url?scp=85108547495&partnerID=8YFLogxK
U2 - 10.1016/j.echo.2021.05.016
DO - 10.1016/j.echo.2021.05.016
M3 - Article
C2 - 34082020
AN - SCOPUS:85108547495
SN - 0894-7317
VL - 34
SP - 1095-1105.e6
JO - Journal of The American Society of Echocardiography
JF - Journal of The American Society of Echocardiography
IS - 10
ER -