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    Application News: Vividclub

    Uploaded by

    Roberta Kalasauskaite

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    Application News: Vividclub

    Uploaded by

    Roberta Kalasauskaite
    38 views9 pages

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    38 views9 pages

    Application News: Vividclub

    Uploaded by

    Roberta Kalasauskaite

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 9

    GE Healthcare No 12-2010

    VividClub

    Application
    News
    GE Healthcare
    VividClub

    From EF- to Mass –to 4D Strain

    Tips and Tricks

    -2-
    GE Healthcare
    VividClub

    Content

    FROM EF- TO MASS –TO 4D STRAIN .......................................................................................................... 2 

    TIPS AND TRICKS ......................................................................................................................................... 2 

    GENERAL INFORMATION ............................................................................................................................. 4 


    ECG ................................................................................................................................................................................................... 4 
    Volume rate ................................................................................................................................................................................. 4 
    Myocardium................................................................................................................................................................................. 4 

    IMAGE ACQUISITION .................................................................................................................................... 4 


    4D acquisition ............................................................................................................................................................................. 4 
    Important ...................................................................................................................................................................................... 4 

    THE MEASUREMENT ..................................................................................................................................... 5 


    Alignment ..................................................................................................................................................................................... 5 
    Define endocardial border ................................................................................................................................................... 6 
    Volume and ejection fraction.............................................................................................................................................. 7 
    4D LV Mass ................................................................................................................................................................................... 8 
    4D Strain ........................................................................................................................................................................................ 8 

    NOTE
    This hand out is additional training material.
    For more information please refer to the user manual and/or reference manual.

    -3-
    GE Healthcare
    VividClub

    General information
    This application note describes the workflow on Vivid E9 BT 11 software.
    ECG
    As always it is mandatory to have a proper ECG applied!

    Volume rate
    For Ejection Fraction it is recommended to have at least 12 volumes per second.
    For 4D Strain the limit is higher and the recommendation is having more than 25 fps at a heart
    rate around 60.
    Note: for 4D Strain the volume rate should be around 40% of the heart rate.
    If using Lower frame rates for analysis, results may not be accurate.

    Myocardium
    As in 2D Strain, make sure the entire myocardium is visible throughout the whole heart cycle.
    Check especially in end-diastole if you still have the epicardium visible.

    Image acquisition
    4D acquisition
    Enter the 4D acquisition by using the 4D button on
    the keyboard or the assigned keys (medium, large)
    on the touch panel.
    Enter the multislice mode in order to get a
    comprehensive overview on how the LV fits into
    your chosen 4D sector size. Try to align the image
    as good as possible.
    The result has to be that the entire myocardium
    including the epicardium is visible in all views
    during the entire heart cycle.

    Tip
    You may change to different Layouts of the multislice mode by using the buttons (5-slice, 7slice…)
    on the touch panel.

    To adjust the size of the 4D volume use the most left rotational knob for Volume size.

    Important
    Volume rate needs to be checked accurately. See recommendations above.

    -4-
    GE Healthcare
    VividClub

    If volume rate is too low, use the multibeat acquisition.


    Select number of heart cycles until you are satisfied with the volume rate (fps).
    You may ask the patient for a breath hold in order help to avoid stitching artefacts.
    Increasing temporal resolution by simply using the frame rate button will decrease the spatial
    resolution; therefore the data analysis will lose in quality.
    You need to find a good trade-off between temporal and spatial resolution.

    The measurement
    Recall a 4D dataset with appropriate volume rate.
    Open the measurement package
    Select the Volume folder
    Start by clicking on 4D Auto LVQ

    Alignment
    The system will automatically align the image, but there is still the possibility to align the image
    manually by using the rotation knobs or trackball.

    Note
    The apex has to be centred in all apical images.
    The dataset needs to be aligned in a way that the ventricle is centred around the lines on the
    screen.
    The blue line has to be positioned at the mitral valve annulus.

    Once the image is aligned properly press the EDV button on the touch panel

    -5-
    GE Healthcare
    VividClub

    Define endocardial border


    The system will automatically start with an end-diastolic frame, selected by using the ECG.
    The tracking algorithm works best when the MV is closed. If the MV is slightly open the algorithm
    may track too far into the LA since there is not clear border.
    Make sure the MV is closed in the ED frame (otherwise change manually by using the most left
    rotational knob).
    Initiate the tracking by using the two- point’s method.
    Choose one of the apical views and place one point at the apex and one point at mid-basal area.
    The system will now track the endocardial border automatically.

    Note
    Alternative you may choose the auto or manual (set two basal and one apical point in all apical
    images) from the soft keys.

    Review the border detection carefully!


    You may adjust the tracking by clicking with the cursor at the correct endocardial position. The
    system will then readjust the region of interest. Adjust until you are satisfied with the endocardial
    tracking.

    -6-
    GE Healthcare
    VividClub

    Select ESV from the touch panel and redo the same procedure for the end-systolic frame.
    Check that MV is closed (same principle as for ED)!
    In this frame you should use the same method (2-point, manual or auto) for endocardial tracking
    in as you have used in end-diastole.

    Volume and ejection fraction


    When satisfied with the contours press the Volume waveform button on the touch panel.
    The system will start the analysis of the entire LV and you will get the results for end-diastolic and
    end-systolic, ejection fraction, cardiac output, stroke volume and sphericity index.
    Be aware: The end-diastolic frame is now selected by the frame with the biggest volume; the end-
    systolic frame is now selected by the frame with the smallest volume. You may want to adjust by
    using the rotational knobs on the touch panel.
    Press image store in order to store the loop with the tracking and the volume curve.

    Press the Layout button on the keyboard to get the


    red mesh model in big together with the volume
    curve.

    If you want to finish your measurements here press Approve and Exit.
    Or move ahead with the analysis.

    -7-
    GE Healthcare
    VividClub

    4D LV Mass
    Select 4D LV Mass from the touch panel.
    In the end-diastolic image the epicardial contour will appear automatically.
    Review it carefully and adjust if needed.

    Note
    You may switch between endo- or epicardial border or
    both by using the according rotational knob. The contour
    in green is the active one.

    The mass and the mass index (Mass/BSA) are displayed


    immediately on the screen.

    Press image store in order to store the loop.


    If you want to finish your measurements here press
    Approve and Exit.

    4D Strain
    Select the 4D ROI button on the touch panel.
    The system now displays the end-systolic image.
    You may adjust the region of interest, if necessary.
    Press the 4D Strain results in order to start the analysis of the entire heart cycle.
    Remember that frame rate is recommended to be higher than 25 fps (or 40% of the heart rate).

    In the result screen the system displays all regional strain curves and the global curve.
    A bull’s eye plot is present for a complete overview.

    First parameter shown on the screen is longitudinal strain.


    Use the buttons on the touch panel in order to change from longitudinal to radial –
    circumferential or area strain.

    -8-
    GE Healthcare
    VividClub

    You may use the rotational knob for selecting single segments.
    If one curve is not appreciated well it can be removed from the analysis by using the reject
    segment control. Rejected segments will be displayed in grey colour on the grey scale image ROI
    and on the bull’s eye.
    If 4 or more segments are rejected the global strain value will not be calculated any longer.

    Use the Layout button in order to get the apical views displayed bigger on the screen.

    Important Note: Colours of the bull’s eye are always reflecting the value of each curve from the
    frame that is displayed at the time. While pressing the Freeze button the system automatically
    shows the ES frame, you can scroll frame by frame if needed.

    -9-

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