title: "3D fusion" echocardiography improves 3D left ventricular assessment: comparison with 2D contrast echocardiography.
abstract: BACKGROUND
  Three-dimensional fusion echocardiography (3DFE) is a novel postprocessing approach that utilizes imaging data acquired from multiple 3D acquisitions. We assessed image quality, endocardial border definition, and cardiac wall motion in patients using 3DFE compared to standard 3D images (3D) and results obtained with contrast echocardiography (2DC).
  
  
  METHODS
  Twenty-four patients (mean age 66.9 ± 13 years, 17 males, 7 females) undergoing 2DC had three, noncontrast, 3D apical volumes acquired at rest. Images were fused using an automated image fusion approach. Quality of the 3DFE was compared to both 3D and 2DC based on contrast-to-noise ratio (CNR) and endocardial border definition. We then compared clinical wall-motion score index (WMSI) calculated from 3DFE and 3D to those obtained from 2DC images.
  
  
  RESULTS
  Fused 3D volumes had significantly improved CNR (8.92 ± 1.35 vs. 6.59 ± 1.19, P < 0.0005) and segmental image quality (2.42 ± 0.99 vs. 1.93 ± 1.18, P < 0.005) compared to unfused 3D acquisitions. Levels achieved were closer to scores for 2D contrast images (CNR: 9.04 ± 2.21, P = 0.6; segmental image quality: 2.91 ± 0.37, P < 0.005). WMSI calculated from fused 3D volumes did not differ significantly from those obtained from 2D contrast echocardiography (1.06 ± 0.09 vs. 1.07 ± 0.15, P = 0.69), whereas unfused images produced significantly more variable results (1.19 ± 0.30). This was confirmed by a better intraclass correlation coefficient (ICC 0.72; 95% CI 0.32-0.88) relative to comparisons with unfused images (ICC 0.56; 95% CI 0.02-0.81).
  
  
  CONCLUSIONS
  3DFE significantly improves left ventricular image quality compared to unfused 3D in a patient population and allows noncontrast assessment of wall motion that approaches that achieved with 2D contrast echocardiography.
authors.affiliation: Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom.
authors.forename: Daniel
authors.initials: D
authors.lastname: Augustine
authors.forename: Mohammad
authors.initials: M
authors.lastname: Yaqub
authors.forename: Cezary
authors.initials: C
authors.lastname: Szmigielski
authors.forename: Eduardo
authors.initials: E
authors.lastname: Lima
authors.forename: Steffen E
authors.initials: SE
authors.lastname: Petersen
authors.forename: Harald
authors.initials: H
authors.lastname: Becher
authors.forename: J Alison
authors.initials: JA
authors.lastname: Noble
authors.forename: Paul
authors.initials: P
authors.lastname: Leeson
mesh_terms: D000368:Aged; D003287:Contrast Media; D004452:Echocardiography / Q000379:methods; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008297:Male; D015588:Observer Variation; D010743:Phospholipids; D015203:Reproducibility of Results; D013459:Sulfur Hexafluoride; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride
keywords: 3D; contrast; echocardiography; image fusion