Automated interpretation of regional left ventricular wall motion from cardiac magnetic resonance images.

Magnetic resonance (MR) diagnosis of regional left ventricular (LV) dysfunction relies on visual interpretation of cine images that suffers from wide inter-observer variability, especially when performed by readers not specifically trained in the assessment of LV wall motion. Quantitative analysis tools, though widely available, are rarely used because they provide large amounts of detailed information, the interpretation of which requires additional time-consuming processing. We tested the feasibility of fast automated interpretation of regional LV function using computer analysis of this wall motion information. METHODS: Dynamic, ECG-gated, steady-state free precession short-axis images were obtained in 6-10 slices in 28 subjects (10 normal volunteers; 18 patients). Images were reviewed by an expert cardiologist who provided "gold standard" grades (normal, abnormal) for regional wall motion and, independently, by four radiologists. Same images were then analyzed using custom software. Regional fractional area changes computed in normal volunteers were used to obtain the optimal segment- and slice-specific threshold values for automated classification of regional wall motion for each patient. The levels of agreement with the "gold standard" grades were compared between the radiologists and the automated interpretation. RESULTS: While the visual interpretation required 2-5 minute per patient, the automated interpretation required < 1 sec, after endocardial border detection was complete. The automated interpretation resulted in higher sensitivity, specificity, and accuracy (84%, 77%, 79%, respectively) than the radiologists' grades (80%, 76%, 77%, respectively) and eliminated the high interobserver variability. CONCLUSION: Once the endocardial boundaries are defined, computer analysis of the regional wall motion information allows accurate, fully automated, immediate, objective and experience-independent interpretation of regional LV function.     

Improvement in echocardiographic evaluation of left ventricular wall motion using still-frame parametric imaging.

BACKGROUND: Conventional echocardiographic assessment of left ventricular wall motion is based on visual interpretation of dynamic images, which depends on readers' experience. We tested the feasibility of evaluating endocardial motion using still-frame parametric images. METHODS AND RESULTS: In protocol 1, integrated backscatter images were obtained in 8 anesthetized pigs at baseline, 5, and 60 seconds after left anterior descending coronary occlusion and during reperfusion. Images from 1 cardiac cycle were analyzed offline to create a parametric image of local video intensity oscillations. Ischemia-induced changes were quantified by segmenting the parametric images and calculating regional pixel-intensity profiles. In protocol 2, parametric images were obtained from contrast-enhanced echocardiograms in 30 patients (18 with wall-motion abnormalities; 12 control subjects). "Gold standard" for wall motion was determined from independent interpretations of dynamic images made by 3 experienced reviewers. Dynamic images were independently classified by 3 inexperienced and 3 intermediate-level readers. Interpretation was then repeated in combination with parametric images. Parametric images showed a bright band in the area spanned by endocardial motion, which gradually decreased in brightness and thickness in the left anterior descending territory during coronary occlusion in all animals. In patients, the agreement with the gold standard correlated with the readers' experience (68% inexperienced, 87% intermediate) and significantly improved by adding parametric images (83% and 91%, respectively). CONCLUSION: Parametric imaging provides a still-frame display of regional endocardial motion, sensitive to track ischemia-induced abnormalities. When combined with dynamic images, this technique improves the accuracy of the interpretation of wall motion, especially by less experienced echocardiographers.     

Automated quantitative assessment of wall motion in patients with poor acoustic windows.

BACKGROUND: No technique exists for objective evaluation of left ventricular wall motion in contrast-enhanced images. We tested a new technique for quantification of regional fractional area change using contrast-enhanced power modulation imaging with color kinesis. METHODS: The feasibility of this technique for detecting acute ischemia was first tested in 11 pigs. Next, the accuracy for detecting resting wall-motion abnormalities was determined in 52 patients requiring contrast and compared with conventional interpretation of 2-dimensional images by inexperienced readers. Expert interpretation of 2-dimensional images served as the gold standard. RESULTS: In pigs, coronary occlusion resulted in reversible hypokinesis and reduced regional fractional area change. In patients with poor acoustic windows, this technique's accuracy for quantitative detection of resting wall-motion abnormalities was 86% compared with 81% for conventional interpretation by inexperienced readers (P <.01). CONCLUSIONS: Regional wall motion can be accurately assessed using color-encoded power modulation imaging for patients requiring contrast. This technique may prove a useful diagnostic aid to echocardiographers of varying levels of experience.     

Diagnostic Capability of Comprehensive Handheld vs Transthoracic Echocardiography

ObjectiveTo assess the diagnostic capability of handheld echocardiography (HHE) compared with transthoracic echocardiography (TTE) performed and evaluated by experienced sonographers and expert echocardiographers.Patients and MethodsWe conducted a prospective study of adult outpatients undergoing comprehensive TTE between July 9, 2012, and April 3, 2013. Experienced sonographers performed a detailed, standardized examination using a handheld ultrasound device that included 2-dimensional and color Doppler images from standard imaging windows. Images from TTE and HHE were independently interpreted by expert echocardiographers to whom the other study was masked. Agreement between the standard TTE and the HHE reports was analyzed.ResultsThe study group contained 190 patients (mean ± SD age, 62±17 years; 49% male [n=93]). The κ values were 0.52 for left ventricular (LV) enlargement, 0.52 for right ventricular enlargement, 0.62 for regional wall motion abnormalities, 0.73 for aortic stenosis, and 0.61 for mitral regurgitation. Lin concordance correlation coefficients ranged from 0.89 for LV end-systolic diameter to 0.78 for LV end-diastolic diameter. In 51 patients (27%), echocardiographic findings were discordant between HHE and standard TTE. The most common discordant finding was the presence vs absence of any regional wall motion abnormalities. In discordant cases, HHE tended to underestimate, rather than overestimate, the severity of abnormal findings.ConclusionIn experienced hands, HHE shows moderate correlation with standard TTE, but discordant findings were present in 27% of patients. Even when performed and interpreted by experienced operators, HHE should not be used as a surrogate for standard TTE.Trial Registrationclinicaltrials.gov Identifier: NCT01558518     

Assessment of Regional Wall Motion Abnormalities with Real-Time 3-Dimensional Echocardiography

Accurate characterization of regional wall motion abnormalities requires a thorough evaluation of the entire left ventricle (LV). Although 2-dimensional echocardiography is frequently used for this purpose, the inability of tomographic techniques to record the complete endocardial surface is a limitation. Three-dimensional echocardiography, with real-time volumetric imaging, has the potential to overcome this limitation by capturing the entire volume of the LV and displaying it in a cineloop mode. The purpose of this study was to assess the feasibility of using real-time 3-dimensional (RT3D) echocardiography to detect regional wall motion abnormalities in patients with abnormal LV function and to develop a scheme for the systematic evaluation of wall motion by using the 3-dimensional data set. Twenty-six patients with high-quality 2-dimensional echo images and at least 1 regional wall motion abnormality were examined with RT3D echocardiography. For 2-dimensional echocardiography, wall motion was analyzed with a 16-segment model and graded on a 4-point scale from normal (1) to dyskinetic (4), from which a wall motion score index was calculated. Individual segments were then grouped into regions (anterior, inferoposterior, lateral, and apical) and the number of regional wall motion abnormalities was determined. The RT3D echocardiogram was recorded as a volumetric, pyramid-shaped data set that contained the entire LV. Digital images, consisting of a single cardiac cycle cineloop, were analyzed off-line with a computerized display of the apical projection. Two intersecting orthogonal apical projections were simultaneously displayed in cineloop mode, each independently tilted to optimize orientation and endocardial definition. The 2 planes were then slowly rotated about the major axis to visualize the entire LV endocardium. Wall motion was then graded in 6 equally spaced views, separated by 30 degrees, yielding 36 segments per patient. A higher percentage of segments were visualized with 2-dimensional versus RT3D echocardiography (97% vs 83%, respectively, P < .001). With the use of the 2-dimensional echocardiographic results as the standard, RT3D echocardiography detected 55 (96%) of 57 regional wall motion abnormalities. Analysis of the RT3D echocardiograms resulted in 3 false-negative and 5 false-positive findings. The total number of regional wall motion abnormalities was correctly classified by RT3D echocardiography in 19 (73%) of 26 patients. RT3D echocardiography detected 11 of 13 anterior, 19 of 20 inferoposterior, 9 of 9 lateral, and 15 of 15 apical wall motion abnormalities. An excellent correlation was found between the 2 techniques for assessment of the regional wall motion score index (r = 0.89, P < .001). This initial clinical study demonstrates the feasibility and potential advantages of RT3D echocardiography for the assessment of regional LV function. Compared with 2-dimensional echocardiography, this new method permits recording of the entire LV in a single beat, allowing the extent and location of the regional wall motion abnormalities to be determined. (J Am Soc Echocardiogr 1999;12:7-14.)     

An approach to the three-dimensional display of left ventricular function and viability using MRI

Cardiac MRI was performed in human volunteers to determine the magnitude of the misregistration (MSR) of cardiac landmarks due to variability in the diaphragm position for repeated breath-holds. Seven normal volunteers underwent MR imaging of the left ventricle (LV) to evaluate the magnitude of the endocardial centroid MSR. The MSR for a mid-ventricle short-axis image was 3.01 ± 1.68 mm through-plane and 4.16 ± 1.62 mm in-plane. A second order polynomial fit through the LV centroid coordinates minimized the in-plane component of the MSR error. Short-axis cine images, corrected for MSR, provided high-resolution 2D data from which an accurate anatomical model of the LV was generated. Anatomical landmarks were used to register parametric maps of myocardial perfusion and viability to the three-dimensional (3D) model, with the corresponding parameters displayed as color-encoded values on the endo- and epicardial surfaces of the LV. Registration of regional wall motion, perfusion and viability to the 3D model was performed for three patients with a history of cardiovascular disease. The proposed 3D reconstruction technique allows visualization in 3D of the LV anatomy, in combination with parametric mapping of its functional status.     

三维重建超声组织多普勒成像测量左室功能:活体动物实验研究

目的　用三维重建超声组织多普勒成像 ( 3DTDI)方法 ,研究左室壁运动特点及左室不同部分的射血分数(EF)。方法　用重建的 3DTDI的方法 ,对 8只心尖部心肌梗死的活体羊模型在四种不同的血流状态下进行左室壁运动的测定和左室不同部分的EF测量。结果　在四种不同的血流状态下 ,左室梗塞区域的室壁运动振幅明显低于正常部分 (P<0 .0 0 1) ,整个左室、左室正常部分的EF明显高于梗塞部分 (P <0 .0 0 1) ,左室正常部分的EF明显高于整个左室 ( 0 .0 0 0 1

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Objective assessment of left ventricular wall motion from contrast-enhanced power modulation images.

There is no method to objectively evaluate left ventricular (LV) function from contrast-enhanced images. We tested the feasibility of evaluating regional LV function by using power modulation imaging. In protocol 1, 9 anesthetized closed-chest pigs were studied. Images were obtained during contrast infusion at baseline, during LAD occlusion and reperfusion. In protocol 2, images were obtained in 20 patients (14 wall-motion abnormalities; 6 controls) during contrast enhancement. Off-line, frame-by-frame, semiautomated endocardial border detection was followed by color encoding of endocardial motion, followed by segmentation and calculation of regional fractional area changes. In all animals, coronary occlusions resulted in hypokinesis and decreased fractional area changes in LAD-related segments only, which were reversed during reperfusion. In patients, wall-motion analysis was in agreement with an expert reader of dynamic images in 92.5% segments, with interobserver variability of 12.5%. Color encoding of endocardial motion from contrast-enhanced power modulation images allows accurate quantitative assessment of regional LV function.     

Mean Myocardial Velocity Mapping in Quantifying Regional Myocardial Contractile Reserve in Patients with Impaired Left Ventricular Systolic Function: Doppler Myocardial Imaging Study

The aim of this study was to use Doppler myocardial imaging–derived mean myocardial velocity (MMV) at baseline and during low-dose dobutamine stress echocardiography (DSE) to quantify regional contractile reserve of the left ventricle (LV). Sixteen patients (mean age 59 ± 7 years) with coronary artery disease and regional left ventricular wall motion abnormalities were studied. During each increment of Dobutamine infusion, 6 2-dimensional transthoracic apical images were acquired in standard gray-scale and Doppler myocardial imaging modes at 30° steps over 180°. For the analysis, the LV was divided into 18 segments. For each segment, both wall motion score and MMV obtained in systole and both early and late diastole were measured at baseline and at each stage of DSE. In viable segments by wall motion score, MMV increased during DSE in systole and in early and late diastole. In contrast, in nonviable segments, MMV did not change during DSE. Mean myocardial velocity mapping is a promising new approach to quantify regional myocardial contractile reserve of the LV. (J Am Soc Echocardiogr 2000;13:96-107.)     

Experience with an ultrasound stethoscope.

BACKGROUND: To test the diagnostic potential of the SonoHeart, a battery-powered hand-held ultrasound imaging device, in an outpatient clinic setting. METHODS: A total of 114 patients with a variety of cardiac diseases were examined by 2 independent cardiologists with the hand-held device using the standard echocardiographic system (SE) as a reference. Global right ventricular (RV) and left ventricular (LV) function (scored as normal, mildly to moderately, or severely reduced) and internal cavity dimensions were assessed. Regional wall motion of 6 segments using a 2-point score (1 = normal wall motion, 2 = abnormal wall motion) was evaluated in 34 patients on-line. RESULTS: There was a good agreement between the 2 imaging devices for evaluation of global LV (93%) and RV function (99%), regional wall motion (90%), dimensions of the LV (99%) and the RV (99%), and the left (96%) and right atria (99%). Furthermore, SonoHeart identified hypertrophic cardiomyopathy, pericardial effusion, and abnormalities of valves. CONCLUSION: The SonoHeart device allows rapid and accurate diagnosis, whenever needed in the outpatient clinic.     

MR应变成像技术在心脏疾病中的应用

心脏MRI是无创性评估心脏结构和功能的"金标准"。相比于标准电影成像,MR应变成像技术可通过定量测量心肌组织位移而早期识别心脏疾病的节段性运动异常,对判断病情、指导治疗及估测预后均有重要价值。心肌应变可定量测量室壁运动,且结果受其他因素影响较少。本文对MR应变成像技术在心脏疾病中的应用进行综述。     

Ability of emergency physicians with advanced echocardiographic experience at a single center to identify complex echocardiographic abnormalities

Objectives

To determine the ability of emergency physicians to detect complex abnormalities on point-of-care (POC) echocardiograms.

Methods

Single-blinded, nonrandomized, cross-sectional study. Twenty-five different emergency medicine clinical scenarios (video clips and digital images) covering a variety of echocardiographic abnormalities were presented to a group of emergency physician sonologists. The echocardiographic abnormalities included right ventricular dysfunction, left ventricular systolic dysfunction, diastolic dysfunction, regional wall motion abnormalities, Doppler abnormalities of pericardial tamponade physiology, left ventricular hypertrophy, hypertrophic cardiomyopathy, and aortic abnormalities. All emergency physician sonologists were blinded to the study hypothesis. They reviewed echocardiography video clips and images individually, and their interpretations were compared with the criterion standard (expert echocardiographer interpretations).

Results

A total of 200 echocardiography studies (video clips and images) were independently reviewed by 8 emergency physician sonologists with varying POC echocardiography experiences. Emergency physicians accurately identified left ventricular systolic dysfunction 94% of the time, diastolic dysfunction (100%), and right ventricular dysfunction 80% of the time. Regional wall motion abnormalities were detected only 50% of the time. Doppler echocardiographic abnormalities of pericardial tamponade physiology were accurately identified 57% of the time. Emergency physicians who performed more than 250 POC echocardiograms were found to be more accurate in identifying complex echocardiographic abnormalities.

Conclusions

Our study results suggest that with increased experience, emergency physicians can accurately identify most of complex echocardiographic abnormalities.     

Left ventricular dysfunction in lethal severe brain injury: impact of transesophageal echocardiography on patient management

OBJECTIVE: To evaluate the impact of transesophageal echocardiographic (TEE) studies on further patient management and incidence and degree of left ventricular (LV) dysfunction in patients with lethal severe brain injury. DESIGN AND SETTING: Retrospective, clinical study in two surgical intensive care units in a university hospital. PATIENTS: In 51 patients with severe brain injury ultimately leading to brain death, the results of TEE studies were reviewed for evidence of newly developed LV dysfunction (i.e., regional wall motion abnormalities) and its impact on patient management. MEASUREMENTS AND RESULTS: Seven patients (13.7%) had a diminished LV function global (fractional area change <50%). Four of these patients (7.8%) exhibited a severely reduced LV function (fractional area change <35%). Regional wall motion abnormalities and preserved global function were found in eight patients (15.7%). Patient management was altered in all patients with diminished LV function: implementation of advanced hemodynamic monitoring (n=5), institution or adjustment of inotropes and adjustment of fluid management (n=7). In patients exhibiting a severely reduced LV function and deteriorating cardiovascular status, brain death diagnosis was established by one clinical examination in conjunction with laboratory tests, thus shortening the interval required for brain death diagnosis by about 12 h. CONCLUSIONS: Severe LV dysfunction occurred in about 8% of our patients with severe brain injury ultimately leading to brain death. TEE may be helpful in guiding cardiovascular resuscitation ultimately leading to improved organ procurement rates.     

Impact of presence of abnormal wall motion on echocardiographic determination of left ventricular function with automated boundary detection technique: re-evaluation

It is still unclear whether echocardiography with an automated boundary detection technique (ABD) can accurately determine the left ventricular (LV) volume and function particularly in the presence of LV wall asynergy. We intended to re-evaluate the reliability and application of the ABD, which was based on the acoustic quantification technique (Sonos 2500, Hewlett Packard) for the LV volume measurement in patients without or with LV wall asynergy. A total of 80 patients (mean age 56 years) who underwent left ventriculography (LVG) were divided into two groups. The group A consisted of 29 patients with normal LV wall motion and the group B consisted of 51 patients with generalized or regional LV wall motion abnormality. In group A patients, the LV end-diastolic volume (LVEDV) was 96 ± 25 ml by ABD and 112 ± 33 ml by LVG and those of LV end-systolic volume (LVESV) were 44 ± 14 ml by ABD and 48 ± 17 ml by LVG, thus resulting in the underestimation of LV volume by 12% in average. Under these conditions, the LV ejection fraction (LVEF) by ABD, 54 ± 8%, correlated well with that by LVG, 58 ± 7%. Although underestimation of LV volume by 17% in average also occurred in groups B (N.S.), LVEF was found to correlate well with that by LVG; 27 ± 8% vs 30 ± 11% (r=0.87, SEE=3.1%) for 21 patients with the generalized LV asynergy; 39 ± 10% vs 39 ± 12% (r=0.86. SEE=3.3%) for 30 patients with the regional LV asynergy. These results demonstrate the feasibility of the ABD in determining the LVEF, although underestimation can occur in measuring the absolute LV volume in patients with or without LV asynergy.     

Velocity tracking, a new and user independent method for detecting regional function of the left ventricle

Background: The use of two‐dimensional echocardiography (2D echo) for detection of ischaemia is limited due to high user dependency. Longitudinal motion is sensitive for ischaemia and usable for quantitative measurement of longitudinal myocardial function but time consuming. Velocity tracking (VeT) is a new method that gives an easy three‐dimensional understanding of both systolic and diastolic regional motion, using colour coded bull’s eye presentation of longitudinal velocity, derived from colour coded tissue Doppler. The aim of this study was to test the accuracy of VeT in detecting ischaemia in non‐ST‐segment elevation myocardial infarction (NSTEMI) patients bedside. Methods: Twenty patients with NSTEMI and 10 controls were included. Echocardiography was performed within 24 h of symptoms and prior to coronary angiography. Bull’s eye plots presenting the peak systolic velocity (PSV) and the sum of PSV and the E‐wave‐velocity (PSV+E) were created using our developed software. VeT was compared to expert wall motion scoring (WMS) and bedside echo. We used the clinical conclusion based on ECG, angiography and clinical picture as ‘gold standard’. Results: Sensitivity for ischaemia with VeT (PSV+E) was 85% and specificity 60%. The corresponding sensitivities for expert WMS were 75% (specificity 40%). For regional analysis VeT and WMS showed comparable results with correct regional outcome in 11/20 of patients both superior to bedside echo. Conclusion: Velocity tracking is a promising technique that provides an easily understandable three‐dimensional bull’s eye plot for assessment of regional left ventricular longitudinal velocity with great potential for detection of regional dysfunction and myocardial ischaemia.     

Regional patterns of left ventricular systolic dysfunction after subarachnoid hemorrhage: evidence for neurally mediated cardiac injury.

Although left ventricular (LV) dysfunction has been described after subarachnoid hemorrhage (SAH), its pathophysiology, regional distribution, and reversibility remain uncertain. To test the hypothesis that regional wall motion patterns in SAH patients do not match the typical patterns observed in coronary artery disease, a segmental wall motion analysis was performed in 30 SAH patients with LV dysfunction. Both regional (n = 21) and global (n = 9) wall motion patterns were observed. Preservation of apical function relative to the base was observed in 17 (57%) of the 30 patients. Many of the wall motion patterns were atypical of coronary artery disease but correlated with the distribution of the myocardial sympathetic nerve terminals. Five subjects had follow-up echocardiograms with resolution of LV dysfunction in all cases. In conclusion, a previously unreported, apex-sparing pattern of LV dysfunction is described, providing indirect evidence for a neurally mediated mechanism of cardiac injury. Limited data indicate that LV dysfunction in SAH patients is potentially reversible.     

Fully automated MR liver volumetry using watershed segmentation coupled with active contouring

Purpose

Our purpose is to develop a fully automated scheme for liver volume measurement in abdominal MR images, without requiring any user input or interaction.

Methods

The proposed scheme is fully automatic for liver volumetry from 3D abdominal MR images, and it consists of three main stages: preprocessing, rough liver shape generation, and liver extraction. The preprocessing stage reduced noise and enhanced the liver boundaries in 3D abdominal MR images. The rough liver shape was revealed fully automatically by using the watershed segmentation, thresholding transform, morphological operations, and statistical properties of the liver. An active contour model was applied to refine the rough liver shape to precisely obtain the liver boundaries. The liver volumes calculated by the proposed scheme were compared to the “gold standard” references which were estimated by an expert abdominal radiologist.

Results

The liver volumes computed by using our developed scheme excellently agreed (Intra-class correlation coefficient was 0.94) with the “gold standard” manual volumes by the radiologist in the evaluation with 27 cases from multiple medical centers. The running time was 8.4 min per case on average.

Conclusions

We developed a fully automated liver volumetry scheme in MR, which does not require any interaction by users. It was evaluated with cases from multiple medical centers. The liver volumetry performance of our developed system was comparable to that of the gold standard manual volumetry, and it saved radiologists’ time for manual liver volumetry of 24.7 min per case.

     

Difference in the Diastolic Left Ventricular Wall Motion Velocities Between Aortic and Mitral Regurgitation by Pulsed Tissue Doppler Imaging

We evaluated the difference in the diastolic left ventricular (LV) wall motion velocity between chronic isolated aortic and mitral regurgitation (AR and MR, respectively) by recording subendocardial motion velocity patterns at the middle site of the LV posterior wall in the parasternal (along the short axis) and apical (along the long axis) long-axis views of the left ventricle with pulsed tissue Doppler imaging. We studied 33 patients with AR and 35 with MR, showing moderate to severe regurgitation, and 34 healthy controls (C). The end-diastolic LV dimension along the short axis was greater in the AR and MR groups than in the C group, and that along the long axis was greater in the AR group than in the MR and C groups. There were no significant differences in percent LV fractional shortening along the short axis among the 3 groups, whereas that along the long axis was significantly smaller in the AR group than in the MR and C groups. The peak early diastolic wall motion velocity (Ew) and the time to Ew from the aortic component of the second heart sound (S₂ -Ew) along the long axis were significantly lower and longer, respectively, in patients with AR than in the 2 other groups. The Ew and S₂ -Ew along both the short and long axes were significantly higher and shorter, respectively, in patients with MR than in the 2 other groups. The peak early diastolic velocity of the transmitral flow correlated positively with Ew along the short axis in all patients with AR and correlated positively with Ews along the long and short axes in all patients with MR. In conclusion, early diastolic LV filling was associated with expansion of the LV wall along the short axis but with decreased excursion along the long axis in patients with AR, whereas that in patients with MR was associated with expansion of the LV wall along both the long and short axes. Pulsed tissue Doppler imaging was useful for evaluation of diastolic LV function along the long and short axes in patients with diastolic LV volume overload. (J Am Soc Echocardiogr 1999;12:15-21.)     

Variability in frame by frame analysis of left ventricular wall motion from contrast angiograms

Background. Measurement of the timing of left ventricular (LV) wall motion, of asynchrony, and of diastolic function from contrast angiograms requires delineation of the endocardial border frame by frame through the cardiac cycle. This study was performed to determine the magnitude of intraobserver and interobserver variability in manual border tracing, and to measure the impact of this variability on the derived functional parameters. Methods. The contrast ventriculograms of 25 patients with coronary artery disease (CAD) or with normal coronary arteries were analyzed frame by frame, by two observers or twice by the same observer. Motion was measured using the centerline method at each twelfth of systole and of diastole. Variability was calculated as the absolute difference between repeated measurements of: wall motion, asynchrony, and the time at which each region of the LV reached 10%, 50%, and 100% of peak contraction, and 50% of filling. Results. Intraobserver and interobserver variability in wall motion were similar, and varied with time in the cycle, and with location on the LV contour. Variability was highest at end systole, when it averaged 8% of the normal mean for wall motion. Variability in timing was highest at peak contraction; however, the variability in measuring asynchrony averaged only 18 msec. Conclusion. Analysis of the magnitude and synchrony of regional LV wall motion through the cardiac cycle from contrast ventriculograms can be performed with reproducibility comparable to that at end systole.     

放射状重建3.0T MR髋臼唇三维稳态双回波图像诊断髋臼唇损伤

目的 评估放射状重建3.0T MR髋臼唇三维稳态双回波（3D-DESS）图像诊断髋臼唇损伤的价值。方法 收集47例于1个月内接受3.0T MR 3D-DESS检查及关节镜检查的股骨髋臼撞击综合征（FAI）患者,对3D-DESS图像进行放射状重建显示髋臼唇。由2名影像科医师评估髋臼唇的前侧、外上侧及后侧区,观察医师间及医师内评估结果的一致性。以关节镜结果为金标准,评价放射状重建3D-DESS图像诊断髋臼唇撕裂的敏感度、特异度、准确率、阳性预测值和阴性预测值。结果 医师间（Kappa=0.89）及医师内（Kappa=0.93）MRI评估结果的一致性较好（P均<0.05）。2名医师诊断髋臼唇撕裂的敏感度、特异度、准确率、阳性预测值及阴性预测值分别为95.31%、93.50%、94.32%、92.42%及96.00%和98.43%、90.90%、94.32%、90.00%及98.59%,与关节镜结果的一致性均较好（Kappa均=0.89,P均<0.05）。结论 放射状重建3.0T MR髋臼唇3D-DESS图像诊断髋臼唇损伤的效能与关节镜检查相当。