title: Transoesophageal echocardiography of aortic atherosclerosis: the additive value of three-dimensional over two-dimensional imaging.
abstract: OBJECTIVE
  Complex aortic atherosclerotic plaques (AAPs) carry a significant risk of embolism. Currently, two-dimensional (2D) transoesophageal echocardiography (TOE) is the principal diagnostic tool of AAPs. However, we hypothesized that the data obtained from three-dimensional (3D) imaging may improve AAPs' spatial assessment.
  
  
  RESULTS
  The study included 67 patients (aged 70 ± 15 years, 35 men), who had routine TEE studies. The thoracic aorta was studied from arch to distal descending aorta, using the x-plane mode (simultaneous short- and long-axis views). If focal intimal thickening (suggestive of AAP) was detected, the 3D zoom algorithm was exercised on the specific site with further post-processing on a Q-lab workstation to measure its thickness in the X, Y, and Z dimensions. The AAP contour was defined qualitatively as regular or irregular in each mode. A total of 100 AAPs were investigated. The AAP thickness estimation was significantly greater in the 3D mode than in the 2D mode (0.51 ± 0.33 vs. 0.28 ± 0.20 cm, P < 0.001). The rate of complex AAPs (defined by AAP thickness of ≥4 mm) was two-fold higher with 3D imaging than with 2D imaging (27% with 2D imaging alone vs. 53% with the addition of 3D imaging). The rate of irregular AAPs increased from 29 to 65% when assessed with 3D imaging compared with 2D imaging.
  
  
  CONCLUSIONS
  This study has shown a significant difference in the estimation of AAPs between 2D and 3D TEE. The significant shift to a more complex AAPs profile may suggest that 3D imaging is preferable for the assessment of aortic atherosclerosis burden.
authors.affiliation: The Echocardiography Unit and Valve Clinic, Department of Cardiology, Rabin Medical Center, Beilinson Hospital, Petah-Tikva and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel adayawe@clalit.org.il adayaw@gmail.com.
authors.forename: Adaya
authors.initials: A
authors.lastname: Weissler-Snir
authors.affiliation: The Echocardiography Unit and Valve Clinic, Department of Cardiology, Rabin Medical Center, Beilinson Hospital, Petah-Tikva and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Gaby
authors.initials: G
authors.lastname: Greenberg
authors.affiliation: The Echocardiography Unit and Valve Clinic, Department of Cardiology, Rabin Medical Center, Beilinson Hospital, Petah-Tikva and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Yaron
authors.initials: Y
authors.lastname: Shapira
authors.affiliation: The Echocardiography Unit and Valve Clinic, Department of Cardiology, Rabin Medical Center, Beilinson Hospital, Petah-Tikva and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Daniel
authors.initials: D
authors.lastname: Weisenberg
authors.affiliation: The Echocardiography Unit and Valve Clinic, Department of Cardiology, Rabin Medical Center, Beilinson Hospital, Petah-Tikva and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Daniel
authors.initials: D
authors.lastname: Monakier
authors.affiliation: The Echocardiography Unit and Valve Clinic, Department of Cardiology, Rabin Medical Center, Beilinson Hospital, Petah-Tikva and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Roman
authors.initials: R
authors.lastname: Nevzorov
authors.affiliation: The Echocardiography Unit and Valve Clinic, Department of Cardiology, Rabin Medical Center, Beilinson Hospital, Petah-Tikva and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Alexander
authors.initials: A
authors.lastname: Sagie
authors.affiliation: The Echocardiography Unit and Valve Clinic, Department of Cardiology, Rabin Medical Center, Beilinson Hospital, Petah-Tikva and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Mordehay
authors.initials: M
authors.lastname: Vaturi
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging*; D050197:Atherosclerosis / Q000000981:diagnostic imaging*; D004452:Echocardiography / Q000379:methods*; D019560:Echocardiography, Three-Dimensional / Q000379:methods; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity
keywords: aortic atherosclerotic plaque; three-dimensional; transoesophageal echocardiography; two-dimensional