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Transesophageal echocardiography (TEE) uses the esophagus as an imaging window to the heart. This enables cardiac imaging without interference from the ribs or lungs and allows for higher frequency ultrasound to be used compared with transthoracic echocardiography (TTE). TEE facilitates the successful imaging of obese or elderly patients, where TTE may be unable to produce images of satisfactory quality. Recently, three-dimensional (3-D) TEE has been introduced, which greatly improves the image quality and diagnostic value of TEE by adding an extra dimension. Further improvement could be achieved by optimizing 3-D TEE for harmonic imaging. This article describes the optimal geometry and element configuration for a matrix probe for 3-D second harmonic TEE. The array concept features separated transmit and receive subarrays. The element geometry was studied using finite element modeling and a transmit subarray prototype was examined both acoustically and with laser interferometry. The transmit subarray is suitable for its role, with a 3 MHz resonance frequency, a 40%-50% -3 dB bandwidth and crosstalk levels <-27 dB. The proposed concept for the receive subarray has a 5.6 MHz center frequency and a 50% -3 dB bandwidth., (Copyright © 2012 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)

There is a clear clinical need for creating 3-D images of the heart. One promising technique is the use of transesophageal echocardiography (TEE). To enable 3-D TEE, we are developing a miniature ultrasound probe containing a matrix piezoelectric transducer with more than 2000 elements. Because a gastroscopic tube cannot accommodate the cables needed to connect all transducer elements directly to an imaging system, a major challenge is to locally reduce the number of channels, while maintaining a sufficient signal-to-noise ratio. This can be achieved by using front-end receiver electronics bonded to the transducers to provide appropriate signal conditioning in the tip of the probe. This paper presents the design of such electronics, realizing time-gain compensation (TGC) and micro-beamforming using simple, low-power circuits. Prototypes of TGC amplifiers and micro-beamforming cells have been fabricated in 0.35-μm CMOS technology. These prototype chips have been combined on a printed circuit board (PCB) to form an ultrasound-receiver system capable of reading and combining the signals of three transducer elements. Experimental results show that this design is a suitable candidate for 3-D TEE.

For quantification of the left ventricular volume from 3-dimensional echocardiograms a number of cross-sectional images are used. The goal of this study was to determine the minimum number of long-axis images necessary for accurate quantification of the left ventricular volume. A strong correlation was observed between volumes obtained from magnetic resonance imaging and 3-dimensional echocardiography using 16 equiangular images (r = 0.99; y = 0.95x + 3.3 mL; standard error of the estimate = 7.0 mL; N = 30). Comparison of these results with random subsets showed a significant difference for volumes obtained with 4 and 2 equiangular images (P < .005). However, when the subsets were selected to target the eccentric region of the endocardial border this was only the case for subsets of two images (P < .001). This study demonstrates that accurate left ventricular volume quantification can be performed with as little as 8 equiangular long-axis images. By selecting the correctly oriented image set, this number can even be brought down to 4, which will further reduce the analysis time.

Catheterization remains the "gold standard" for bladder volume assessment, but it is invasive and introduces the risk of infections and traumas. Therefore, noninvasive bladder volume measurement methods have gained interest. In a preceding study a new technique to measure the bladder volume on the basis of nonlinear ultrasound wave propagation was validated. This paper describes a first prototype of a dedicated multilayer transducer to implement this approach. It is composed of a PZT transducer for transmission and a PVDF layer for reception. Acoustical measurements in a water tank and phantom measurements showed that there is a relation between bladder volume and the harmonic contents of the echo obtained from a region of interest behind the bladder. Simulations with an equivalent transducer model on the basis of KLM-circuit modeling closely matched with the results from the acoustical measurements. The results demonstrated the feasibility of the multilayer transducer design for bladder volume assessment on the basis of nonlinear wave propagation.

Although the advantages of three-dimensional (3-D) echocardiography have been acknowledged, its application for routine diagnosis is still very limited. This is mainly due to the relatively long acquisition time. Only recently has this problem been addressed with the introduction of new real-time 3-D echo systems. This paper describes the design, characteristics, and capabilities of an alternative concept for rapid 3-D echocardiographic recordings. The presented fast-rotating ultrasound (FRU)-transducer is based on a 64-element phased array that rotates with a maximum speed of 8 Hz (480 rpm). The large bandwidth of the FRU-transducer makes it highly suitable for tissue and contrast harmonic imaging. The transducer presents itself as a conventional phased-array transducer; therefore, it is easily implemented on existing 2-D echo systems, without additional interfacing. The capabilities of the FRU-transducer are illustrated with in-vitro volume measurements, harmonic imaging in combination with a contrast agent, and a preliminary clinical study.

Measurement of left ventricular (LV) volume and function are the most common clinical referral questions to the echocardiography laboratory. A fast, practical, and accurate method would offer important advantages to obtain this important information. To validate a new practical method for rapid measurement of LV volume and function. We developed a continuous fast-rotating transducer, with second-harmonic capabilities, for three-dimensional echocardiography (3DE). Fifteen cardiac patients underwent both 3DE and magnetic resonance imaging (reference method) on the same day. 3DE image acquisition was performed during a 10-second breath-hold with a frame rate of 100 frames/sec and a rotational speed of 6 rotations/sec. The individual images were postprocessed with Matlab software using multibeat data fusion. Subsequently, with these images, 12 datasets per cardiac cycle were reconstructed, each comprising seven equidistant cross-sectional images for analysis in the new TomTec 4DLV analysis software, which uses a semi-automated border detection (ABD) algorithm. The ABD requires an average analysis time of 15 minutes per patient. A strong correlation was found between LV end-diastolic volume (r = 0.99; y = 0.95x - 1.14 ml; SEE = 6.5 ml), LV end-systolic volume (r = 0.96; y = 0.89x + 7.91 ml; SEE = 7.0 ml), and LV ejection fraction (r = 0.93; y = 0.69x + 13.36; SEE = 2.4%). Inter- and intraobserver agreement for all measurements was good. The fast-rotating transducer with new ABD software is a dedicated tool for rapid and accurate analysis of LV volume and function.

Rationale and Objectives: We propose a semiautomatic endocardial border detection method for three-dimensional (3D) time series of cardiac ultrasound (US) data based on pattern matching and dynamic programming, operating on two-dimensional (2D) slices of the 3D plus time data, for the estimation of full cycle left ventricular volume, with minimal user interaction., Materials and Methods: The presented method is generally applicable to 3D US data and evaluated on data acquired with the Fast Rotating Ultrasound (FRU-) Transducer, developed by Erasmus Medical Center (Rotterdam, the Netherlands), a conventional phased-array transducer, rotating at very high speed around its image axis. The detection is based on endocardial edge pattern matching using dynamic programming, which is constrained by a 3D plus time shape model. It is applied to an automatically selected subset of 2D images of the original data set, for typically 10 equidistant rotation angles and 16 cardiac phases (160 images). Initialization requires the drawing of four contours per patient manually. We evaluated this method on 14 patients against MRI end-diastole and end-systole volumes. Initialization requires the drawing of four contours per patient manually. We evaluated this method on 14 patients against MRI end-diastolic (ED) and end-systolic (ES) volumes., Results: The semiautomatic border detection approach shows good correlations with MRI ED/ES volumes (r = 0.938) and low interobserver variability (y = 1.005x - 16.7, r = 0.943) over full-cycle volume estimations. It shows a high consistency in tracking the user-defined initial borders over space and time., Conclusions: We show that the ease of the acquisition using the FRU-transducer and the semiautomatic endocardial border detection method together can provide a way to quickly estimate the left ventricular volume over the full cardiac cycle using little user interaction.

We studied the interaction of ultrasound contrast agent bubbles coated with a layer of lipids, driven by 0.5 MHz ultrasound. High-speed photography on the submicrosecond timescale reveals that some bubbles bounce off each other, while others show very fast coalescence during bubble expansion. This fast coalescence cannot be explained by dissipation-limited film drainage rates. We conclude that the lipid shell ruptures upon expansion, exposing clean free bubble interfaces that support plug flow profiles in the film and inertia-limited drainage whose time scales match those of the observed coalescence.

Objective: To assess a new approach for guiding and hemodynamic optimization of resynchronization therapy, using three-dimensional (3D) transthoracic echocardiography., Background: Resynchronization therapy for heart failure provides the greatest hemodynamic benefit when applied to the most delayed left ventricular (LV) site. Currently, the ideal LV pacing site is selected according to acute invasive hemodynamic assessment and/or tissue Doppler imaging., Methods: A total of 16 patients with advanced heart failure and an implanted biventricular pacemaker were included in this study. Transthoracic apical LV images at equidistant intervals were obtained using a prototype, fast-rotating second harmonic transducer to reconstruct 3D LV datasets during sinus rhythm (SR), right ventricular (RV) apical and biventricular pacing mode. A semi-automated contour analysis system (4D LV analysis, TomTec, Germany) was used for segmental wall motion analysis and identification of the most delayed contracting segment and calculation of global LV function., Results: Data acquisition duration was 10 s and analyzable 3D images were obtained in 12 patients. Of these patients, data during SR were available in 9 and during biventricular pacing in 11. The greatest contraction delay during SR was found in the anterior and antero-septal segments in five of nine patients. Biventricular pacing resulted in reduction of the contraction delay in seven of eight patients. The global LV function did not change significantly., Conclusion: 3D echocardiography with appropriate analytic software allows detection of the most delayed LV contracting segment and can be used to select the optimal pacing site during resynchronization therapy.

When encapsulated microbubbles are subjected to high-amplitude ultrasound, the following phenomena have been reported: oscillation, translation, coalescence, fragmentation, sonic cracking and jetting. In this paper, we explain these phenomena, based on theories that were validated for relatively big, free (not encapsulated) gas bubbles. These theories are compared with high-speed optical observations of insonified contrast agent microbubbles. Furthermore, the potential clinical applications of the bubble-ultrasound interaction are explored. We conclude that most of the results obtained are consistent with free gas bubble theory. Similar to cavitation theory, the number of fragments after bubble fission is in agreement with the dominant spherical harmonic oscillation mode. Remarkable are our observations of jetting through contrast agent microbubbles. The pressure at the tip of a jet is high enough to penetrate any human cell. Hence, liquid jets may act as remote-controlled microsyringes, delivering a drug to a region-of-interest. Encapsulated microbubbles have (potential) clinical applications in both diagnostics and therapeutics.

Improved endocardial border delineation with the application of contrast agents should allow for less complex and faster tracing algorithms for left ventricular volume analysis. We developed a fast rotating phased array transducer for 3D imaging of the heart with harmonic capabilities making it suitable for contrast imaging. In this study the feasibility of 3D harmonic contrast imaging is evaluated in vitro. A commercially available tissue mimicking flow phantom was used in combination with Sonovue. Backscatter power spectra from a tissue and contrast region of interest were calculated from recorded radio frequency data. The spectra and the extracted contrast to tissue ratio from these spectra were used to optimize the excitation frequency, the pulse length and the receive filter settings of the transducer. Frequencies ranging from 1.66 to 2.35 MHz and pulse lengths of 1.5, 2 and 2.5 cycles were explored. An increase of more than 15 dB in the contrast to tissue ratio was found around the second harmonic compared with the fundamental level at an optimal excitation frequency of 1.74 MHz and a pulse length of 2.5 cycles. Using the optimal settings for 3D harmonic contrast recordings volume measurements of a left ventricular shaped agar phantom were performed. Without contrast the extracted volume data resulted in a volume error of 1.5%, with contrast an accuracy of 3.8% was achieved. The results show the feasibility of accurate volume measurements from 3D harmonic contrast images. Further investigations will include the clinical evaluation of the presented technique for improved assessment of the heart.

The beam shape of a circular array transducer that is commonly used in intravascular ultrasound catheters was investigated in linear mode of operation. For this use, a simulation program which can simulate the radio frequency (rf)-response of a number of scatterers has been developed. The program is based on the impulse response method, which is implemented in the frequency domain. Due to the unusual geometry of the transducer, the far field gets peculiarly shaped for large apertures. Instead of having a far field with its maximum intensity in a single lobe on the acoustical axis, the far field splits up into a dual-lobe far field with maximum intensity in two lobes off the acoustical axis. A formula is derived that predicts the occurrence of these beam shapes.

Most three-dimensional (3-D) echocardiography (3-DE) systems today are based on off-line methods where a large number of cross-sectional 2-D scans have to be acquired sequentially before a 3-D image can be reconstructed. Because acquisition is done step-by-step based on ECG triggering plus respiratory gating, this introduces motion artefacts and takes significant acquisition time. Another 3-D approach is based on 2-D transducers and parallel beam-forming. Such a system is very complex. In this manuscript, a fast continuously-rotating scanning unit, based on a 64-element phased-array transducer, is described. Typical rotation speed of the 3-D unit is 8 rotations per s. Therefore, 16 3-D volume datasets can be acquired per s in real-time. The first clinical examples as acquired with this probe are presented.

Based on three-dimensional (3D) information, quantitative data such as plaque volume can be calculated. The procedure includes automatic contour detection based in image segmentation methods and greatly speeds up clinical evaluation. With the use of additional X-ray information, the true tortuous vessel geometry can be reconstructed in 3D. This allows, by numerical modelling techniques, to calculate endothelial shear stress values which in turn may indicate sites prone to stenosis. With a decorrelation technique for radio frequency (RF) echo information from sequential data in the same beam direction and integration method over the entire cross section, blood velocity can be shown colour-coded during the cardiac cycle, while even blood flow quantification seems to be possible. In vitro as well as animal experiments have shown the feasibility of the method. Intravascular imaging can be used to study the biomechanical properties of atheroma components. Local radial strain as a measure of local tissue hardness can be estimated in principle. Hard or soft plaques can be identified from the strain images independently of the echogenic contrast between plaque and vessel wall.

IntraVascular Ultrasound Imaging (IVUS) has already been proposed in the early days of diagnostic ultrasound. Today, it has come under further full attention as a result of minimal invasive techniques. Not only excellent intravascular two-dimensional (2D) images are presently obtained, also three-dimensional (3D) reconstructed images show their diagnostic value. Based on 3D information, quantitative data such as plaque volume can be calculated. The procedure includes automatic contour detection based on image segmentation methods and greatly speeds up clinical evaluation. With the use of additional X-ray information, the true tortuous vessel geometry can be reconstructed in 3D. This allows, by numerical modelling techniques, to calculate endothelial shear stress values, which in turn may indicate sites prone to stenosis. With a decorrelation technique for radiofrequency (RF) echo information from sequential data in the same beam direction and integration method over the entire cross section, blood velocity can be shown colour-coded during the cardiac cycle, while even blood flow quantification seems to be possible. In vitro as well as in vivo experiments have shown the feasibility of the method. Intravascular imaging can be used to study the biomechanical properties of atheroma components. Local radial strain, used as a measure of local tissue hardness, can be estimated to identify hard or soft plaques independently of the echogenicity contrast between plaque and vessel wall., (Copyright 1998 Elsevier Science Ireland Ltd.)

Current intravascular ultrasound techniques produce real-time imaging of a vessel cross-section with a scan plane approximately normal to blood flow. When a cluster of randomly distributed blood particles moves across the ultrasound beam, the received echo signals decorrelate as a function of time. This phenomenon may be used to estimate blood velocities by measuring the decorrelation rate from a sequence of blood scattering signals. A decorrelation-based method for measuring local blood velocity and quantifying volume flow from cross-sectional radio frequency intravascular echo signals was developed. Serial in vitro measurements were performed with a flow phantom to test the principle of the proposed velocity estimation method. An in vivo pig experiment was carried out to study the feasibility of applying this method in clinical settings. Preliminary results of this study indicate that the proposed decorrelation method is able to extract cross-sectional velocity data and volumetric flow both in vitro and in vivo.

When blood particles travel through an intravascular ultrasound imaging plane, the received echo signals decorrelate at a rate that is related to the flow velocity. In this paper, the feasibility of extracting blood velocity from the decorrelation function of radio frequency signals was investigated through theoretical analysis and computer simulation. A computer model based on the impulse response method was developed to generate the ultrasound field of a 30-MHz intravascular transducer. The decorrelation due to the scatterer displacement as well as other nonmotion related decorrelation sources were studied. The computer simulations show that the decorrelation function is linearly related to the lateral displacement. The monotonic relationship between correlation and displacement provides possibilities to estimate flow velocity with decorrelation measurements. Because of the complexity of the beam profile in the near field, assessment of local velocities requires detailed knowledge of the decorrelation at each axial beam position. Sources of signal decorrelation other than the lateral displacement may cause a bias in the decorrelation based velocity measurements. For localized decorrelation estimation, measurement variations in small range windows present a major challenge. An approach based on multiple decorrelation measurements should be adopted in order to reduce the variations. In conclusion, results of this study suggest that it is feasible to measure flow velocity by quantifying the decorrelation of intravascular ultrasound signals from blood.

In this study several time delay estimation (TDE) methods were investigated for estimation of time shifts of less than 10 ns at a frequency of 30 MHz. Using simulated and experimental echosignals we investigated the performance of five methods: two phase related methods (phase shift and phase difference method); two correlation methods (cross-correlation and correlation interpolation method); and a demodulation method. The results showed that the correlation interpolation method is by far the most accurate for all time delays. With this method, estimation errors of about 200 ps are achievable with an signal-to-noise ratio (SNR) of 40 dB (f0 = 30 MHz, bandwidth = 20 MHz) for time shifts of up to 10 ns.

Many intravascular therapeutic techniques for the treatment of significant atherosclerotic lesions are mechanical in nature: angioplasty, stenting and atherectomy. The selection of the most adequate treatment would be advantageously aided by knowledge of the mechanical properties of the lesion. Based on the success of conventional intravascular ultrasound (IVUS) imaging in accurately depicting the morphology of atheromatous lesions, ultrasonic tissue characterization has been proposed to determine the composition of atherosclerotic plaques. Elastography is an ultrasound-based imaging technique capable of producing cross-sectional elasticity images called elastograms. The technique involves analysis of echo signals obtained at two states of incremental intravascular pressure. High resolution, local tissue displacement estimation by cross-correlation is followed by computation of local strain. Strain is utilized as an indicator of the local compliance of tissue under the assumption of constant stress within the scan plane. Using vessel-mimicking phantoms, we demonstrate the feasibility of intravascular elastography experimentally. The elastograms are able to depict lesions of different elasticity independently of the echogenicity contrast, since the information provided by the elastograms is generally independent of that obtained from the conventional IVUS image. Thus, the elastogram can complement the characterization of lesions from the conventional IVUS image. Progress to in vitro and in vivo testing is expected in conjunction with ongoing improvements in the current instrumentation and processing.

Current intravascular ultrasound techniques produce real-time imaging of a vessel cross-section with a scan plane normal to blood flow. When randomly distributed blood particles travel through this ultrasound imaging plane, the received echo signals decorrelate as a function of time. The speed of such a decorrelation procedure is proportional to the flow velocity. This phenomenon provides a potential to estimate blood velocities by means of decorrelation analysis. In this paper, we present a method for measuring local blood velocity and quantifying volume flow directly from cross-sectional intravascular ultrasound data. This method is based on multiple decorrelation assessments with a sequence of radio frequency echo signals. The velocity measurement is obtained by comparing the measured decorrelation value with the prior knowledge of the beam characteristics of an intravascular ultrasound transducer. Volume flow is derived by integrating the cross-sectional area and its corresponding velocity vector over the vessel lumen. The decorrelation-based method was tested in vitro with a flow phantom. Measurements were also carried out in vivo in pig experiments to determine the usefulness of this method in clinical settings. Preliminary results of these experiments indicate that the proposed decorrelation method is able to extract cross-sectional velocity profiles and volumetric flow both in vitro and in vivo.

A technique is described for measuring the local hardness of the vessel wall and atheroma using intravascular ultrasound. Strain images were constructed using the relative local displacements, which are estimated from the time shifts between gated echo signals acquired at two levels of intravascular pressure. Time shifts were estimated using one-dimensional correlation with bandlimited interpolation around the peak. Tissue-mimicking phantoms with typical morphology and hardness topology of some atherosclerotic vessels were constructed. Hard and soft regions could be distinguished on the strain image, independently of their contrast in echogenicity. Thus, the potential of ultrasonic hardness imaging to provide information that may be unavailable from the echogram alone was demonstrated. The strain images of the homogeneous and layered phantoms showed some artifacts that need to be corrected for, to obtain images of the modulus of elasticity. For in vitro and in vivo experiments, the spatial resolution of the technique needs to be improved. Furthermore, two-dimensional correlation techniques may be necessary in case of nonradial expansion and an off-centre catheter position.

This in vitro study was executed to evaluate the double line pattern generated at both near and far walls of human carotid arteries using B-mode ultrasound. Therefore, extravascular (7.5 MHz) and intravascular (30 MHz) ultrasound imaging were performed at the same locations of the carotid artery. The thickness of the double line pattern of the extravascular image (7.5 MHz) was compared to the thickness of the intima-media complex seen on the corresponding intravascular image (30 MHz) and on the histologic section. At the far wall of the extravascular image, the measurements were executed at the leading edge of the echo. The data showed high correlation and agreement with the intravascular (r = 0.91, p < 0.001; mean(diff) = -0.01 and SDdiff = 0.12) and the histologic measurements (r = 0.87, p < 0.001; mean(diff) = -0.12 and SDdiff = 0.13). In addition, the results of the measurements of the intravascular image showed high correlations and agreement with the histologic data (r(near) = 0.86, p < 0.001; mean(diff) = -0.08 and SDdiff = 0.15, respectively, r(far) = 0.92, p < 0.001; mean(diff) = -0.12 and SDdiff = 0.12). For comparison with other studies, near wall measurements were also included. These had to be performed at the trailing edge of the echoes to be compatible with these studies. The results of the measurements of the extravascular image showed poor correlations and lack of agreement with those of the intravascular (r = 0.49, p = 0.03; mean(diff) = 0.09 and SDdiff = 0.25) and of the histologic (r = 0.37, p = 0.03; mean(diff) = 0.04 and SDdiff = 0.23) measurements. These results can easily be explained from the physical limitations of measuring at the trailing edges. We conclude that the double line pattern seen at the far wall of the extravascular image is representative of the intima-media complex.

To investigate the independent effect of myocardial wall thickness and myocardial perfusion pressure on integrated backscatter, experiments were designed in which integrated backscatter of normally perfused myocardial tissue was measured while changes in wall thickness during the cardiac cycle were reduced to a minimum. In nine blood-perfused isolated pig hearts, perfusion pressure was uncoupled from left ventricular pressure generation (Langendorff method) and isovolumic contraction and relaxation were realized by inserting a noncompressible water-filled balloon into the left ventricle. In a first experiment, at constant perfusion pressure (85 mmHg), the integrated backscatter (3-7 MHz), the myocardial wall thickness and the left ventricular pressure were determined simultaneously at various balloon volumes (5-25 mL). A quasistatic increase of balloon volume by 50% resulted in an average decrease of wall thickness of 6.5% (p < 0.01) and a mean increase in the integrated backscatter level of 1.1 dB (p < 0.01). Integrated backscatter levels increased statistically significant by 0.14 +/- 0.014 dB per percent decrease of wall thickness. Measurements of percentage end-systolic myocardial wall thickening ranged from -10% to +10%, mean 0.15 +/- 4.5% (NS from zero); whereas cyclic variation of integrated backscatter ranged from -3.9 to +3.9 dB, mean 0.19 +/- 1.5 dB (NS from zero). In a second experiment, at a constant midrange balloon volume, the same parameters were determined simultaneously at various perfusion pressures (20-120 mmHg). An increase in perfusion pressure by 50% resulted in a small but statistically significant increase of 1.5% in myocardial wall thickness, which could be explained by an increase of intravascular volume. The integrated backscatter levels did not change statistically significantly. Measurements of percentage end-systolic myocardial wall thickening ranged from -8.9 to +7.8%, mean 0.13 +/- 4.0% (NS from zero); whereas cyclic variation of integrated backscatter ranged from -1.8 to +4.2 dB, mean 0.37 +/- 1.3 dB (NS from zero). The magnitude of cyclic variation of integrated backscatter of myocardial tissue in a contractile state is reduced if myocardial muscle is prevented from normal thickening. In addition, changes in intravascular volume during the cardiac cycle have a negligible influence on the absolute backscatter level or its cyclic variation. We conclude, if only wall thickness and perfusion pressure are involved, that integrated backscatter is mainly determined by myocardial wall thickness.

After its introduction about two decades ago, transesophageal echocardiography (TEE) has rapidly evolved into an important diagnostic feature for the cardiologist, since it offers anatomic and hemodynamic information which cannot be obtained precordially. Part of this success was due to the developments in transducer technology which resulted in smaller probes with progressively better imaging qualities. A short review of past, recent and future developments of TEE phased array probes, in particular those at the Erasmus University in Rotterdam, will be given. Furthermore, this article discusses basic parameters of the transducer dictating image quality such as centre frequency, array aperture and focusing illustrated with several simulations. The simulations show that a poor design of the transducer will limit the resolution and will give artefacts in the two-dimensional image.

Early developments and basic principles in the field of Transesophageal Echocardiography (TEE) probe technology are summarized. Mechanical and electronical sector scanners are compared, and several probe characteristics and image parameters are discussed. A short review of recent developments in TEE is given.

In the literature, different forms of measuring the ultrasound power returned by myocardial tissue are reported. Frequency domain methods will give the maximum frequency information, whereas time domain methods are limited in bandwidth, but more practical to realize. It was the purpose of this study to compare the various methods of signal processing. High frequency ultrasound signals from a pig's myocardium, digitally recorded during normal contractile performance, were analyzed by six different methods of signal processing to obtain estimates of backscatter power. The myocardial tissue characterization parameters studied were the integrated power as well as its cyclic variation during the cardiac cycle. A total number of 8109 ultrasound traces obtained in 16 pigs were processed. The study included three signal processing methods in the frequency domain: frequency compensated integrated backscatter calculated over both a large (4 MHz, method 1) as well as a small frequency bandwidth (2 MHz, method 2) and uncompensated integrated backscatter (method 3), and three methods in the time domain: high frequency signal squared and integrated (method 4), mean rectified signal level (method 5) and mean signal level after logarithmic compression and envelope detection (method 6). The random measurement variation (including beat-to-beat variation) was analyzed as well as the paired differences of the backscatter parameters obtained by the respective methods as compared with the only theoretically correct method in the time domain (method 4). The magnitudes of the random measurement variation expressed as a standard deviation (SD) were comparable (range 0.93-1.2 dB) except for method 6 (0.61 dB), where the measurement variation is decreased by the logarithmic compression.(ABSTRACT TRUNCATED AT 250 WORDS)

This study investigated the in vitro (40 MHz) and in vivo (30 MHz) feasibility of intravascular ultrasound to document the influence of atherosclerotic lesions on the typical 3-layered appearance of muscular arteries. The in vitro images of 39 arteries were compared with the corresponding histologic sections. Media and lesion thickness were measured at the areas of minimal and maximal lesion thickness. The median media thickness was 0.8 mm in the absence of a lesion, decreasing to 0.3 mm in the area of maximal atherosclerosis. The ultrasonic data correlated closely with histologic measurements (0.6 and 0.3 mm, respectively). The in vivo study was performed in 29 patients undergoing coronary or peripheral vascular procedures. A total of 150 still-frames were selected for quantitative analysis. The median media thickness was 0.6 mm in the absence of a lesion, decreasing to 0.1 mm in the area with maximal atherosclerosis. This study revealed that intravascular ultrasound imaging accurately determines that media thickness of muscular arteries is inversely related to lesion thickness. In vitro data, verified with histology, can be translated to humans in vivo.

The behaviour of gas bubbles and gas encapsulated spheres as echographic contrast agents is reviewed. Compared with rigid spheres, gas bubbles are superior scattering agents and they offer a number of useful properties which can be exploited in a variety of ways. The analysis of their velocity of sound, back-scatter intensity, second harmonic emission and resonant frequency opens up new perspectives in the development of contrast agents for echocardiographic research with potential clinical applications.

The purpose of this study was to assess the empirical relationship between myocardial integrated backscatter (IB) and myocardial wall thickness (WT) in normal myocardium. A second object was to estimate the additional contribution to acute ischemic integrated backscatter levels given this relationship. Myocardial IB measurements and simultaneous myocardial WT measurements were made in 16 open-chested pigs with intact coronary circulation (normal myocardium) and 10 min after the flow in the left anterior descending coronary artery had been reduced to 20% of its baseline value (ischemic myocardium). Measurements were made 50 times during one cardiac cycle and averaged over 10 cardiac cycles. IB and WT measurements were normalized with respect to the nonischemic end-diastolic values. The relationship between IB and WT in normal myocardium was estimated in every individual pig by simple linear regression. Estimates of IB during ischemia were calculated on the basis of this relationship and the ischemic WT measurements. Differences of the estimator and the actual measurement made during ischemia depict the actual contribution of the state of acute ischemia, without the influence of WT. The slope of the relationship between IB and WT during normal myocardial contraction ranged from -0.16 to 0.03 dB/% (mean = -0.036 dB/%, SD = 0.06 dB/%). The additional contribution of ischemia ranged from -3.84 to 5.56 dB (mean = 0.31 dB, SD = 2.72 dB). It was concluded that the average contribution of ischemia to IB measurements is insignificant if the IB dependency on WT is removed from the data and that the higher level of ischemic IB measurements can be explained by the decrease in wall thickness during ischemia and not by the ischemia itself.

Clinical application of intravascular ultrasound to assess arterial atherosclerotic disease was introduced in humans after extensive in vitro and in vivo animal studies. Real-time images, obtained with a 30 MHz element mounted on a 5 F catheter, consistently confirmed angiographic images, up till now considered to be the gold standard. In addition to these data, ultrasonic cross-sectional imaging provided information on the composition of atheroselectic lesions and the size and shape of the lumen. Based on the experimentally derived criteria for tissue characterization, a better insight into arterial morphology could be obtained, allowing improved planning of interventional or reconstructional procedures. Moreover intravascular ultrasound has proved valuable as a post-interventional procedure to monitor and assess the quality of interventional results. The ultrasound images are clearly superior to angiographic studies, albeit the ultrasonic information is an adjunct to angiography and, as yet, not a substitute. We present our initial experience with intravascular ultrasound obtained in patients with substantial peripheral arterial disease.

The purpose of this study was to investigate the dependence of ultrasonic integrated backscatter (IB) and attenuation in myocardium on wall thickness in a state of acute ischemia. Therefore, an in vitro experiment was set up in which attenuation, IB and wall thickness of a piece of freshly excised myocardium could be measured almost simultaneously. The myocardium was taken from 11 Yorkshire pigs (25-30 kg) that were killed less than 45 min before the experiment. The myocardium was placed in the far field of an ultrasound transducer (3.2-7.2 MHz) and then compressed by a stainless steel sphere. Data were processed off-line. Backscatter and attenuation were also measured as a function of frequency at 100% and 75% wall thickness, respectively. Both attenuation and IB varied during compression. Attenuation had an initial value of 2.19 +/- 0.76 dB/cm and a slope of 0.015 +/- 0.017 dB/cm% wall thickness. IB had an initial value of -76.9 +/- 2.7 dB and a slope of -0.12 +/- 0.07 dB/% wall thickness. After subtracting the influence of the attenuation from the IB the initial value of IB was -74.0 +/- 2.7 dB and the slope -0.08 +/- 0.07 dB/% wall thickness. Attenuation appeared to have a linear dependency on frequency. Backscatter appeared not to increase with increasing frequency without correction of the spectrum for the frequency dependent insonified volume.

The purpose of this study was to distinguish between normal and ischemic myocardium using ultrasonic integrated backscatter (IB) measurements and to relate IB with myocardial wall thickness. IB was measured in 9 open-chested Yorkshire pigs (24-30 kg) before, after 30 minutes of partial occlusion of the proximal left anterior descending coronary artery (LADCA), and after 60 minutes of subsequent reperfusion. The ultrasound transducer (4 MHz) was sutured onto the epicardial surface perfused by the LADCA. IB measurements were made with a repetition rate of 50 times per heart rate simultaneously with a left ventricular pressure signal. Myocardial wall thickness was measured off-line. The measurements of integrated backscatter, left ventricular pressure and wall thickness were based on mean values of ten subsequent cardiac cycles. End-systolic IB measurements were 5.3 dB higher during occlusion as compared to the reference measurements (7.1 +/- 3.2 dB versus 1.8 +/- 2.6 dB; p = 0.002). No statistically significant differences were found in end-systolic IB measurements. End-systolic wall thickness was 5 mm smaller during occlusion as compared to the reference measurements (7.2 +/- 1.4 mm versus 12.2 +/- 1.2 mm; p less than 0.001). Simple linear regression analysis showed a statistically significant inverse relationship between IB measurements and wall thickness in 21 out of the 23 sequences in which wall thickness could be measured. End-systolic IB measurements are favourable to distinguish acute ischemic myocardium from normal myocardium. There is a distinct inverse relationship between IB and myocardial wall thickness.

The history of intraluminal echography dates back to the very beginning of diagnostic ultrasound. Over the years many fascinating ideas and applications of catheter tip or gastroscopic tube tip mounted transducers have been described. This chapter surveys these methods, subdividing them into a) measurements; b) Doppler and c) imaging. The survey ranges from early work of Cieszynski on the feasibility of echocardiography to more recent intra-arterial catheter tip Doppler with guidewire and balloon as described by Serruys. Examples of ultrasound catheter tip echography in combination with other techniques such as angioscopy, laser ablation and spark erosion are also described. Today practical approaches are limited to imaging only. The three major approaches for catheter tip echo imaging are described and compared. This paper concludes with the results of automatic contour analysis of the inner arterial boundaries.

The ability of transoesophageal echocardiography to visualize the left coronary artery was retrospectively analysed in 60 consecutive patients without clinical evidence of coronary artery disease. The left main coronary artery was visualized in 56 patients, the proximal circumflex in 34 patients and the proximal anterior descending artery in nine patients. Patency of these arteries was established in all these patients. Subsequently, a prospective study was undertaken in 23 patients with angiographically proven left coronary artery disease. Both the left main coronary artery and the circumflex artery were adequately visualized with transoesophageal echocardiography in all 23 patients, whereas the anterior descending artery was identified in three patients. The extent of stenosis in the left main coronary artery and the circumflex artery was correctly diagnosed in 18 patients. In five patients the degree of stenosis was overestimated. These findings indicate the potential of transoesophageal echocardiography to detect or exclude stenosis of both the left main coronary artery and circumflex artery.

A method of semi-automatic contour detection is described using a commercial (Kontron) image analysis instrument. Input data consists of high-quality transesophageal echocardiograms of short-axis left ventricular cross-sections. The purpose of the study is to evaluate the feasibility of such a method for the quantitative monitoring of the dynamic behaviour of the left ventricle during high risk surgery. From the first experience it is authors' impression that the automatically derived contour depends strongly on the selected algorithm parameters. Therefore derivation of absolute measurements from these contours seems problematic. Automatic contour detection seems much better fit for monitoring situations, where the patient acts as his own reference and there is no need to change the algorithm parameters.

This paper studies the influence of parameter estimation on integrated backscatter using a computer model. The study is specifically aimed at applications to the heart muscle; however, the validity of the conclusions drawn from this work should be confirmed by in vivo tests.

This report describes a patient with a Björk-Shiley mitral valve prosthesis in whom transoesophageal cross sectional echocardiography revealed a large vascularised mass within the left atrial appendage with smoke-like opacification of blood flow in the left atrium. Transoesophageal cross sectional echocardiography gave a detailed image of the lesion which was unobtainable with precordial cross sectional echocardiography.

Presently several new methods are being developed to recanalize obstructed arteries during catheterization. Intra-arterial high frequency ultrasonic imaging may be used as a guidance for these new techniques. Spark erosion is a new obstruction removal technology. Experiments have shown that this method can be applied in a selective way. An ultrasonic intra-arterial imaging system allows for the proper indication of the spark erosion catheter relative to the obstruction. The first in vitro results of this study illustrate that integration of catheter tip imaging and spark erosion is possible.

The feasibility of assessing arterial wall configuration with an intravascular 40 MHz ultrasound imaging device was investigated in an in vitro study of 11 autopsy specimens of human arteries. The system consists of a single element transducer, rotated with a motor mounted on an 8F catheter tip. Cross sections obtained with ultrasound were matched with the corresponding histologic sections. The arterial specimens were histologically classified as of the muscular or elastic type. Muscular arteries interrogated with ultrasound presented with a hypoechoic media, coinciding with the smooth muscle cells. In contrast, the media of an elastic artery densely packed with elastin fibers was as echogenic as the intima and the adventitia. On the basis of the cross-sectional image, it was possible to determine the nature of the atherosclerotic plaque. The location and thickness of the lesion measured from the histologic sections correlated well with the data derived from the corresponding ultrasound images. This study indicates that characterization of the type of artery and detection of arterial wall disease are possible with use of an intravascular ultrasound imaging technique.

The clinical urge for echocardiographic data from patients with inadequate image quality at the precordial examination has initiated the development of transesophageal scanning techniques. The orientation of heart structures with respect to the transducer position in the esophagus, the absence of interfering structures in the soundbeam and the constraints imposed by the anatomy of the esophagus result in a different set of parameters for the optimization of the transducer and its assembly. In this article, the design and construction of a miniaturized 5 MHz phased array transducer optimized for transesophageal scanning is described. Relevant parameters and their influence on the design will be discussed, such as: bandwidth, sensitivity, resolution (in three dimensions), focal depth and the production method.

The slope of an individual contrast trajectory on M-mode contrast echocardiography represents a physiological variable similar to that measured by Doppler echocardiography: the projection of the intracardiac velocity vector in the direction of the sound beam. To test the hypothesis that M-mode contrast echocardiography slope measurement can yield information quantitatively similar to Doppler measurements, we performed both simultaneously in 11 normal volunteers. A pulsed Doppler unit capable of simultaneous M-mode and Doppler display was used. Contrast was obtained by intravenous injection of 5% dextrose. Two independent observers measured velocity simultaneously by both techniques at eight to 16 points per subject. One observer repeated the measurements a month later. All subjects had contrast, and 10 had sufficient quality tracings for simultaneous Doppler and contrast slope measurements. The correlation between velocity measurements by both techniques was good, though velocities by Doppler echocardiography were less than by M-mode contrast echocardiography. We conclude that the component of flow velocity towards or away from the transducer can be measured from M-mode contrast trajectory slopes as well as by Doppler echocardiography. M-mode contrast echocardiography may provide a practical method for verifying or calibrating Doppler measurements in vivo.

We developed a computer program to analyze videodensity changes due to contrast appearance within a given operator-designated rectangle using two-dimensional echocardiograms previously recorded on videotape. Videodensity curves have been obtained from two-dimensional echocardiographic recordings in 14 patients after a total of 32 injections of 5% dextrose solution into the left ventricle during cardiac catheterization. The resulting videodensity vs time curves have some characteristics of indicator-dilution curves. The decay phase of these curves is largely mono-exponential. Potential clinical applications of this technique in measurement of ejection fraction, cardiac output and shunt quantification are discussed, as well as some potential limitations.