Ultrasound Visualization and Recording of Transient Myocardial Vibrations.

OBJECTIVE: A new visualization and recording method used to assess and quantitate autogenic high-velocity motions in myocardial walls to provide a new description of cardiac function is described. METHODS: The regional motion display (RMD) is based on high-speed difference ultrasound B-mode images and spatiotemporal processing to record propagating events (PEs). Sixteen normal participants and one patient with cardiac amyloidosis were imaged at rates of 500-1000/s using the Duke Phased Array Scanner, T5. RMDs were generated using difference images and spatially integrating these to display velocity as function of time along a cardiac wall. RESULTS: In normal participants, RMDs revealed four discrete PEs with average onset timing with respect to the QRS complex of -31.7, +46, +365 and +536 ms. The late diastolic PE propagated apex to base in all participants at an average velocity of 3.4 m/s by the RMD. The RMD of the amyloidosis patient revealed significant changes in the appearance of PEs compared with normal participants. The late diastolic PE propagated at 5.3 m/s from apex to base. All four PEs lagged the average timing of normal participants. CONCLUSION: The RMD method reliably reveals PEs as discrete events and successfully allows reproducible measurement of PE timing and the velocity of at least one PE. The RMD method is applicable to live, clinical high-speed studies and may offer a new approach to characterization of cardiac function.

Contractile Fronts In The Interventricular Septum: A Case For High Frame Rate Echocardiographic Imaging.

The real time high frame rate (HFR) 2-dimensional ultrasound system, T5, at Duke University is capable of imaging at up to 1000 images per second for adult cardiac imaging. A method for detecting and visualizing the mechanical contraction fronts using HFR echocardioagraphy-derived Strain Rate Image (SRI) was described in 26 patients. The Tissue Shortening Onset front durations for echocardiographic normal patients were significantly shorter than conduction disorder patients with left bundle branch block (LBBB) with intrinsic conduction and conduction disorder patients without LBBB (non-LBBB) with simulated LBBB (sLBBB). Echocardiographic normal patients had significantly higher correlation coefficients between their SRIs and spatially inverted versions of themselves compared to non-LBBB patients with intrinsic conduction and sLBBB. In conclusion, SRIs could spatially resolve contractile event fronts in patients.

Quantitative Parameters of High-Frame-Rate Strain in Patients with Echocardiographically Normal Function.

Recently, we developed a high-frame-rate echocardiographic imaging system capable of acquiring images at rates up to 2500 per second. High imaging rates were used to quantify longitudinal strain parameters in patients with echocardiographically normal function. These data can serve as a baseline for comparing strain parameters in disease states. The derived timing data also reveal the propagation of mechanical events in the left ventricle throughout the cardiac cycle. High-frame-rate echocardiographic images were acquired from 17 patients in the apical four-chamber view using Duke University's phased array ultrasound system, T5. B-Mode images were acquired at 500-1000 images per second by employing 16:1 or 32:1 parallel processing in receive, a scan depth ≤14 cm and an 80° field of view with a 3.5-MegaHertZ (MHz), 96-element linear array. The images were analyzed using a speckle tracking algorithm tailored for high-frame-rate echocardiographic images developed at Aalborg and Duke University. Four specific mechanical events were defined using strain curves from six regions along the myocardial contour of the left ventricle. The strain curves measure the local deformation events of the myocardium and are independent of the overall cardiac motion. We observed statistically significant differences in the temporal sequence among different myocardial segments for the first mechanical event described, myocardial tissue shortening onset (p < 0.01). We found that the spatial origin of tissue shortening was located near the middle of the interventricular septum in patients with echocardiographically normal function. The quantitative parameters defined here, based on high-speed strain measurements in patients with echocardiographically normal function, can serve as a means of assessing degree of contractile abnormality in the myocardium and enable the identification of contraction propagation. The relative timing pattern among specific events with respect to the Q wave may become an important new metric in assessing cardiac function and may, in turn, improve diagnosis and prognosis.

High-Frame-Rate Deformation Imaging in Two Dimensions Using Continuous Speckle-Feature Tracking.

The study describes a novel algorithm for deriving myocardial strain from an entire cardiac cycle using high-frame-rate ultrasound images. Validation of the tracking algorithm was conducted in vitro prior to the application to patient images. High-frame-rate ultrasound images were acquired in vivo from 10 patients, and strain curves were derived in six myocardial regions around the left ventricle from the apical four-chamber view. Strain curves derived from high-frame-rate images had a higher frequency content than those derived using conventional methods, reflecting improved temporal sampling.

Live high-frame-rate echocardiography.

We describe an advanced real-time high-speed echocardiographic system with live display while scanning. Images are acquired at rates up to 1000 per second for adult cardiac applications and are stored in computer memory. Images may be played back in slow motion or frame by frame to analyze cardiac motion at the millisecond time scale. Images are acquired using the T5 Duke University Phased Array Scanner that allows 32:1 hardware parallel processing in receive and uses a defocused transmit beam. Clinical scans of 70 patients at rates of 240 to 1000 fps showed adequate image quality for diagnostic purpose. We anticipate that high temporal resolution cardiac images will enable the realization of more accurate and new quantitative descriptors of cardiac function in disease and health.

In vivo real-time 3-D intracardiac echo using PMUT arrays.

Piezoelectric micromachined ultrasound transducer (PMUT) matrix arrays were fabricated containing novel through-silicon interconnects and integrated into intracardiac catheters for in vivo real-time 3-D imaging. PMUT arrays with rectangular apertures containing 256 and 512 active elements were fabricated and operated at 5 MHz. The arrays were bulk micromachined in silicon-on-insulator substrates, and contained flexural unimorph membranes comprising the device silicon, lead zirconate titanate (PZT), and electrode layers. Through-silicon interconnects were fabricated by depositing a thin-film conformal copper layer in the bulk micromachined via under each PMUT membrane and photolithographically patterning this copper layer on the back of the substrate to facilitate contact with the individually addressable matrix array elements. Cable assemblies containing insulated 45-AWG copper wires and a termination silicon substrate were thermocompression bonded to the PMUT substrate for signal wire interconnection to the PMUT array. Side-viewing 14-Fr catheters were fabricated and introduced through the femoral vein in an adult porcine model. Real-time 3-D images were acquired from the right atrium using a prototype ultrasound scanner. Full 60° × 60° volume sectors were obtained with penetration depth of 8 to 10 cm at frame rates of 26 to 31 volumes per second.

Live volumetric imaging (LVI) intracardiac ultrasound catheter.

The Live Volumetric Imaging (LVI) catheter is capable of real-time 3D intracardiac echo (ICE) imaging, uniquely providing full volume sectors with deep penetration depth and high volume frame rate. The key enabling technology in this catheter is an integrated piezoelectric micromachined ultrasound transducer (pMUT), a novel matrix phased array transducer fabricated using semiconductor microelectromechanical systems (MEMS) manufacturing techniques. This technology innovation may enable better image guidance to improve accuracy, reduce risk, and reduce procedure time for transcatheter intracardiac therapies which are currently done with limited direct visualization of the endocardial tissue. Envisioned applications for LVI include intraprocedural image guidance of cardiac ablation therapies as well as transcatheter mitral and aortic valve repair.

Harmonic source wavefront aberration correction for ultrasound imaging.

A method is proposed which uses a lower-frequency transmit to create a known harmonic acoustical source in tissue suitable for wavefront correction without a priori assumptions of the target or requiring a transponder. The measurement and imaging steps of this method were implemented on the Duke phased array system with a two-dimensional (2-D) array. The method was tested with multiple electronic aberrators [0.39π to 1.16π radians root-mean-square (rms) at 4.17 MHz] and with a physical aberrator 0.17π radians rms at 4.17 MHz) in a variety of imaging situations. Corrections were quantified in terms of peak beam amplitude compared to the unaberrated case, with restoration between 0.6 and 36.6 dB of peak amplitude with a single correction. Standard phantom images before and after correction were obtained and showed both visible improvement and 14 dB contrast improvement after correction. This method, when combined with previous phase correction methods, may be an important step that leads to improved clinical images.

Theory and operation of 2-D array piezoelectric micromachined ultrasound transducers.

Piezoelectric micromachined ultrasound transducers (pMUTs) are a new approach for the construction of 2-D arrays for forward-looking 3-D intravascular (IVUS) and intracardiac (ICE) imaging. Two-dimensional pMUT test arrays containing 25 elements (5 x 5 arrays) were bulk micromachined in silicon substrates. The devices consisted of lead zirconate titanate (PZT) thin film membranes formed by deep reactive ion etching of the silicon substrate. Element widths ranged from 50 to 200 microm with pitch from 100 to 300 mum. Acoustic transmit properties were measured in de-ionized water with a calibrated hydrophone placed at a range of 20 mm. Measured transmit frequencies for the pMUT elements ranged from 4 to 13 MHz, and mode of vibration differed for the various element sizes. Element capacitance varied from 30 to over 400 pF depending on element size and PZT thickness. Smaller element sizes generally produced higher acoustic transmit output as well as higher frequency than larger elements. Thicker PZT layers also produced higher transmit output per unit electric field applied. Due to flexure mode operation above the PZT coercive voltage, transmit output increased nonlinearly with increased drive voltage. The pMUT arrays were attached directly to the Duke University T5 Phased Array Scanner to produce real-time pulse-echo B-mode images with the 2-D pMUT arrays.

Three-dimensional motion measurements using feature tracking.

Feature tracking was developed to efficiently compute motion measurements from volumetric ultrasound images. Prior studies have demonstrated the motion magnitude accuracy and computation speed of feature tracking. However, the previous feature tracking implementations were limited by performance of their calculations in rectilinear coordinates. Also, the previous feature tracking approaches did not fully explore the three dimensional (3- D) nature of volumetric image analysis or utilize the 3-D directional information from the tracking calculations. This study presents an improved feature tracking method which achieves further computation speed gains by performing all calculations in the native spherical coordinates of the 3-D ultrasound image. The novel method utilizes a statistical analysis of tracked directions of motion to achieve better rejection of false tracking matches. Results from in vitro tracking of a speckle target show that the new feature tracking method is significantly faster than correlation search and can accurately determine target motion magnitude and 3-D direction.

Interactive volume rendering of real-time three-dimensional ultrasound images.

Real-time, three-dimensional (RT3D) ultrasound allows video frame rate volumetric imaging. The ability to acquire full three-dimensional (3-D) image data in real-time is particularly helpful for applications such as cardiac imaging, which require visualization of complex and dynamic 3-D anatomy. Volume rendering provides a method for intuitive graphical display of the 3-D image data, but capturing the RT3D echo data and performing the necessary processing to generate a volumetric image in real time poses a significant technical challenge. We present a data capture and rendering implementation that uses off-the-shelf components to real-time volume render RT3D ultrasound images. Our approach allowed live, interactive volume rendering of RT3D ultrasound scans.

Real-time 3-dimensional echocardiography for quantification of the difference in left ventricular versus right ventricular stroke volume in a chronic animal model study: Improved results using C-scans for quantifying aortic regurgitation.

OBJECTIVE: The purpose of our study was to test the applicability of calculating the difference between left ventricular (LV) and right ventricular (RV) stroke volume (SV) for assessing the severity of aortic (Ao) regurgitation (AR) using a real-time 3-dimensional (3D) echocardiographic (RT3DE) imaging system. METHODS: The Ao valve was incised in 5 juvenile sheep, 6 to 10 weeks before the study, to produce AR (mean regurgitant fraction = 0.50). Simultaneous hemodynamic and RT3DE images were obtained on open-chest animals with Ao and pulmonary flows derived by Ao and pulmonary electromagnetic flowmeters balanced against each other. Four stages (baseline, volume loading, sodium nitroprusside, and angiotensin infusion) were used to produce a total of 16 different hemodynamic states. Epicardial scanning was done with a 2.5-MHz probe to sequentially record first the RV and then the LV cavities. Cavity volumes from the 3D echocardiography data were determined from angled sector planes (B-scans) and parallel cutting planes (C-scans, which are planes perpendicular to the direction of the volume interrogation). AR volumes were determined from 3D images by computing and then subtracting RV SVs from LV SVs and then these were compared with electromagnetic flowmeter-derived SV and regurgitant volumes. RESULTS: There was close correlation between RV and LV SVs of the RT3DE and electromagnetic methods (C-scans: LV, r = 0.98, standard error of the estimate [SEE] = 2.62 mL, P =.0001; RV, r = 0.89, SEE = 2.67 mL, P <.0001; and B-scans: LV, r = 0.95, SEE = 3.55 mL, P =.0001; RV, r = 0.77, SEE = 2.78 mL, P =.0003). Because of the small size of the RV in this model, the correlation was closer for C-scans than B-scans for RV SV. AR volume estimation also showed that C-scan (r = 0.93, SEE = 4.23 mL, P <.0001) had closer correlation than B-scan (r = 0.89, SEE = 4.87 mL, P <.0001). However, B-scan-derived AR fraction showed closer correlation than did C-scan (r = 0.82 vs r = 0.85, respectively). CONCLUSION: In this animal model, RT3DE imaging had the ability to reliably quantify both LV (B- and C-scans) and RV SVs and to assess the severity of AR.

Real-time three-dimensional echocardiography to construct clinically ready, load-independent indices of myocardial contractile performance.

BACKGROUND: Real-time 3-dimensional echocardiography (RT3DE) reliably determines intracardiac chamber volumes without left ventricular (LV) geometric assumptions, yet clinical assessment of contractile performance is often on the basis of potentially inaccurate, load-dependent indices such as ejection fraction. METHODS: In 6 chronically instrumented dogs, RT3DE estimated LV volumes at various loading conditions. Preload recruitable stroke work and end-systolic pressure-volume relationships were constructed. RT3DE-derived indices were compared with similar relationships determined by sonomicrometry. RESULTS: Highly linear preload recruitable stroke work and end-systolic pressure-volume relationships were constructed by RT3DE and sonomicrometry. Mean preload recruitable stroke work slopes correlated between methods, but volume intercepts differed as a result of geometric assumptions of sonomicrometry. Conversely, RT3DE-derived end-systolic pressure-volume relationships did not correlate well with sonomicrometry. CONCLUSIONS: These data are unique in reporting load-independent measures of LV performance using RT3DE. These techniques would strengthen evaluation of LV function after myocardial ischemia or cardiac operation, in which frequent changes in ventricular geometry or loading conditions confound functional assessment by more traditional methods.