4.3 Article

Utility of transillumination and transparency renderings in 3D transthoracic imaging

Journal

INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING
Volume 38, Issue 1, Pages 141-147

Publisher

SPRINGER
DOI: 10.1007/s10554-021-02388-9

Keywords

Three-dimensional echocardiography; Transthoracic echocardiography; Structural heart disease; Valvular heart disease

Funding

  1. NIH T32 Cardiovascular Sciences Training Grant [T32 HL007381]
  2. Brazilian Society of Cardiology, Department of Cardiovascular Imaging

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The addition of transparency in transthoracic echocardiography significantly improves image quality and diagnostic confidence when compared to standard 3D rendering. Experts perceived incremental value of transillumination with transparency in terms of ability to identify anatomy or pathology, depth perception, degree of anatomic detail, and border delineation.
Transillumination (TI) is a new 3D rendering tool that uses a freely movable virtual light source to enhance depth, contours, and image detail. The TI model was recently modified to allow the operator adjust the degree of transparency of both cardiac and extra-cardiac structures. While the addition of transparency was shown to significantly improve quality in 3D transesophageal imaging, this has not yet been shown for transthoracic (TTE) imaging. We prospectively studied 35 patients who underwent clinically indicated TTE with standard 3D acquisition, as well as TI with and without transparency. Six experienced echocardiographers were shown images of all three display types in random order. Each image was scored independently using a Likert Scale while assessing each of the following aspects: ability to identify anatomy or pathology, depth perception, degree of anatomic detail, and border delineation. All experts perceived an incremental value of the transparency mode, compared to TI without transparency and standard 3D rendering, in terms of ability to identify anatomy or pathology (4.15 +/- 0.97 vs. 3.88 +/- 0.99 vs. 2.52 +/- 1.41, p < 0.01), depth perception (4.33 +/- 0.78 vs. 3.88 +/- 0.82 vs. 2.29 +/- 1.07, p < 0.01), degree of anatomic detail (4.08 +/- 1.0 vs. 3.89 +/- 0.79 vs. 2.31 +/- 1.08, p < 0.01), and border delineation (4.44 +/- 0.80 vs. 3.90 +/- 0.78 vs. 2.42 +/- 1.13, p < 0.01). Compared to standard 3D and TI renderings of TTE images, the addition of transparency significantly improves both image quality and diagnostic confidence.

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