Three-dimensional echocardiographic assessment of annular shape changes in the normal and regurgitant mitral valve.

OBJECTIVES: To compare mitral annular shape and motion throughout the cardiac cycle in patients with normal hearts versus those with functional mitral regurgitation (FMR). BACKGROUND: The causes of mitral regurgitation without valvular disease are unclear, but the condition is associated with changes in annular shape and dynamics. Three-dimensional (3D) imaging provides a more comprehensive view of annular structure and allows accurate reconstructions at high spatial and temporal resolution. METHODS: Nine normal subjects and 8 patients with FMR undergoing surgery underwent rotationally scanned transesophageal echocardiography. At every video frame of 1 sinus beat, the mitral annulus was manually traced and reconstructed in 3D by Fourier series. Annular projected area, nonplanarity, eccentricity, perimeter length, and interpeak and intervalley spans were determined at 10 time points in systole and 10 points in diastole. RESULTS: The mitral annulus in patients with FMR had a larger area, perimeter, and interpeak span than in normal subjects (P <.001 for all). At mid-systole in normal annuli, area and perimeter reach a minimum, nonplanarity is greatest, and projected shape is least circular. These cyclic variations were not significant in patients with FMR. Annular area change closely paralleled perimeter change in all patients (mean r = 0.96 +/- 0.07). CONCLUSIONS: FMR is associated with annular dilation and reduced cyclic variation in annular shape and area. Normal mitral valve function may depend on normal annular 3D shape and dimensions as well as annular plasticity. These observations may have implications for design and selection of mitral annular prostheses.

Influence of echocardiographic scan plane location and number on the accuracy of three-dimensional left ventricular volume and shape determination.

Quantitative 3-dimensional (3-D) echocardiography provides accurate assessment of left ventricular (LV) volume, shape, and function, but depends on manual endocardial border tracing. This study determined the minimal number of borders that need to be traced to obtain an accurate analysis of not only the volume of the left ventricle but also its shape, using the integrated methods for quantitative 3-D echocardiography developed by our laboratory. Transthoracic 3-D echocardiographic studies were obtained in 9 normal subjects and 6 patients with heart disease by freehand scanning. The LV endocardium was manually traced in 17 +/- 5 imaging planes and reconstructed in 3 dimensions. The volume and shape of each reconstruction were compared with values measured from surfaces reconstructed from 8 subsets containing 2 to 7 borders; each subset was acquired from different combinations of spatially distributed parasternal and apical views. Accurate measurements were obtained from data sets having > or = 5 borders, regardless of whether the image planes were predominantly apical or parasternal views. In conclusion, the LV border should be traced in > or = 5 imaging planes to obtain accurate measurements of volume and shape. The piece-wise smooth reconstruction method and freehand scanning using a magnetic field tracing system allow the borders to be acquired from whatever combination of acoustic windows and views provides optimal image quality.

Skeletal coccidioidomycosis: imaging findings in 19 patients.

OBJECTIVE: The objective of this study was to describe the distribution and radiologic appearance of skeletal coccidioidomycosis in 19 documented cases. DESIGN AND PATIENTS: Medical records of 19 patients (17 men, 2 women; age range 17-62 years, mean age 34 years) with clinically confirmed skeletal coccidioidomycosis were retrospectively reviewed. The patients were studied with plain radiography (n = 19), skeletal scintigraphy (n = 6), computed tomography (CT) (n = 5), and magnetic resonance imaging (MRI) (n = 1). RESULTS: Multiple lesions were seen in 11 of 19 patients (58%). Of a total of 46 lesions, 27 (59%) were described as punched-out lytic, 10 (22%) as permeative/destructive, and 9 (17%) as involving a joint and/or disk space. Lesions were identified in almost every bone (with the exception of the facial bones, ulna, carpus, and fibula) and were most commonly found in the axial skeleton (20 of 46; 43%). CONCLUSION: Skeletal coccidioidomycosis is frequently multicentric and may involve almost any bone. The axial skeleton is the most common site of involvement. Lesions are usually well demarcated but may present with an ill-defined border and permeative type of bone destruction, especially in the spine. Joint involvement is not uncommon. Plain radiographs are effective in the initial evaluation of bones and joints, scintigraphic studies can identify disseminated disease, and CT and MRI are effective in determining soft tissue involvement and spinal abnormalities.