title: Insights from echocardiography, magnetic resonance imaging, and microcomputed tomography relative to the mid-myocardial left ventricular echogenic zone.
abstract: BACKGROUND
  The anatomical substrate for the mid-mural ventricular hyperechogenic zone remains uncertain, but it may represent no more than ultrasound reflected from cardiomyocytes orientated orthogonally to the ultrasonic beam. We sought to ascertain the relationship between the echogenic zone and the orientation of the cardiomyocytes.
  
  
  METHODS
  We used 3D echocardiography, diffusion tensor imaging, and microcomputed tomography to analyze the location and orientation of cardiomyocytes within the echogenic zone.
  
  
  RESULTS
  We demonstrated that visualization of the echogenic zone is dependent on the position of the transducer and is most clearly seen from the apical window. Diffusion tensor imaging and microcomputed tomography show that the echogenic zone seen from the apical window corresponds to the position of the circumferentially orientated cardiomyocytes. An oblique band seen in the parasternal view relates to cardiomyocytes orientated orthogonally to the ultrasonic beam.
  
  
  CONCLUSIONS
  The mid-mural ventricular hyperechogenic zone represents reflected ultrasound from cardiomyocytes aligned orthogonal to the ultrasonic beam. The echogenic zone does not represent a space, a connective tissue sheet, a boundary between ascending and descending limbs of a hypothetical helical ventricular myocardial band, nor an abrupt change in cardiomyocyte orientation.
authors: Department of Cardiothoracic and Vascular Surgery, Deptartment of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
authors: Peter
authors: http://orcid.org/0000-0002-7338-6624
authors: P
authors: Agger
authors: Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom.|School of Dentistry, The University of Central Lancashire, Preston, United Kingdom.
authors: Robert S
authors: RS
authors: Stephenson
authors: School of Medicine, University of Manchester, Manchester, United Kingdom.
authors: Halina
authors: H
authors: Dobrzynski
authors: School of Medicine, University of Manchester, Manchester, United Kingdom.
authors: Andrew
authors: A
authors: Atkinson
authors: Institute for Engineering in Medicine, Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
authors: Paul A
authors: PA
authors: Iaizzo
authors: Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, United Kingdom.|Division of Biomedical Sciences, University College London, London, United Kingdom.
authors: Robert H
authors: RH
authors: Anderson
authors: Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom.
authors: Jonathan C
authors: JC
authors: Jarvis
authors: Department of Cardiology, Taunton & Somerset Hospital, Taunton, United Kingdom.
authors: Sarah L
authors: SL
authors: Allan
authors: Eurobodalla Unit, Rural Clinical School of the ANU College of Medicine, Biology & Environment, Batemans Bay, NSW, Australia.
authors: John B
authors: JB
authors: Partridge
authors: Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.
authors: Jichao
authors: J
authors: Zhao
authors: Biological Physics Group, School of Astronomy and Physics, University of Manchester, Manchester, United Kingdom.
authors: Henggui
authors: H
authors: Zhang
authors: Department of Cardiology, Taunton & Somerset Hospital, Taunton, United Kingdom. david.maciver@tst.nhs.uk.|Biological Physics Group, School of Astronomy and Physics, University of Manchester, Manchester, United Kingdom. david.maciver@tst.nhs.uk.
authors: David H
authors: DH
authors: MacIver
mesh_terms: D000368:Aged; D057791:Cardiac Imaging Techniques / Q000379:methods; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006352:Heart Ventricles / Q000166:cytology* / Q000000981:diagnostic imaging*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D032383:Myocytes, Cardiac / Q000166:cytology*; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: cardiomyocyte orientation; computed tomography; diffusion tensor magnetic resonance imaging; echocardiography; helical ventricular myocardial band