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Cardiac trauma: Two-dimensional echocardiographic findings
ABSTRACTS
TUESDAY, APRIL 27, 1982 AM DOPPLER AND TISSUE CHARAClERlZATIoN ULTRASOUND SRJDIES I AND II 8:30- 1O:OO TWO DIMENSIONAL MYOCARDIAL ECHO PATTERNS: IN VIVO AND IN VITRO CORRELATION. Anil K. Bhandari, MD; Navin C. Nanda, MD, FACC, University of Rochester Medical Center, Rochester, NY. We report our findings on 26 autopsied patients with various cardiac lesions who had both in viva (W) and in vitro (VT) two-dimensional echocardiographic studies (2DE). The latter were performed by suspending heart specimens in a water bath at 22°C and placing transducer at the water surface. Long and short axis views of suspended hearts A thin metallic probe were obtained simulating those W. (ultrasonically visible) was guided under direct vision to penetrate areas of myocardium producing altered myocardial echo patterns (MEP) and tissue biopsies were taken along the probe for histopathological (HP) correlation. VT MEP were similar to W MEP in all patients. Two normal hearts, 15/15 hearts with LV/RV hypertrophy due to hypertension/ valvular disease and 3/3 hearts with idiopathic congestive cardiomyopathy (ICC) had homogeneously appearing myocardiums on both VV and VT 2DE. In 3/3 amyloid hearts, both W and VT studies demonstrated diffusely distributed small (2-5mm) discrete and very bright echoes. VT 2DE with HP correlation confirmed the close relationship of distribution of these bright echoes with amyloid deposits. In 2 patients (coronary artery disease 1, congenital heart lesion l), both VT and W studies revealed very bright echoes in papillary muscles and in a patient with ICC, bright linear streaky echoes were observed confined to the inner half of the myocardium in the ventricular septum and posterior wall of the LV. The origin of these localized and bright echoes was demonstrated to be due to fibrosis in the papillary muscles and myocardium by VT technique and HP correlation. Thus, our results indicate that VT MEP duplicate W MEP and VT enhance our understanding of the origins of altered MEP produced by myocardial disease processes.
RATIONAL GAIN COMPENSATION FOR ATTENUATION: A STEP TOWARD QUANTITATIVE TWO-DIMENSIONAL ECHOCARDIOGRAPHY Hewlett E. Melton, Jr., PhD; David J. Skorton, MD, FACC. Division of Information Eng and CV Center, IJof Iowa and Iowa City VA Med Center, Iowa City, Iowa Current methods of compensating for attenuation of ultrasound by chest wall, myocardium and blood do not provide a basis for comparison of backscattered signals from different regions of myocardium for purposes of identifying changes which may be of clinical value. These methods of compensation are dependent only on range; they do not compensate for attenuation along different lines-of-sight of the scan. A new method of compensation has been developed which does account for differential attenuation along different lines-of-sight. This method (rational gain compensation, RGC) was tested by incorporating RGC controls into a commercial two-dimensional, 3 MHz scanner (ATL, Inc.), then by imaging short-axis slices of human and canine hearts in vitro. These slices were imaged using both standard, depth gain compensation (DGC) and RGC. Mean backscatter gray levels (GL) from near and far wall regions were measured from digitized data with an image processing system. Eight such images were analyzed quantitatively and qualitatively. RESULTS:
Ratios of mean GL (far/near wall regions): DGC: 1,61+.58(SD).
RGC: 1.282.38. p<.O25
The appearances of the selected regions within each image were more disparate with DGC than with RGC. CONCLUSIONS: Images produced using DGC exhibit regional differences in backscatter which are artificially large due solely to the method of compensation. The new method, RGC, provides a rational basis for quantitative regional analyses of backscatter in two-dimensional echocardiography.
QUANTITATIVE TEXTURE ANALYSIS OF TWO-DIMENSIONAL ECHOCARDIOGRAMS: APPLICATION TO THE DIAGNOSIS OF ACUTE MYOCARDIAL CONTUSION David J. Skorton, MD, FACC; Steve Collins, PhD; Jim Nichols; Natesa G. Pandian, MD; Richard E. Kerber, MD, FACC, CV Div., Div. of Information Eng and CV Center, U of Iowa and Iowa City VA, Iowa City, Iowa Regional differences in echo intensity and spatial pattern in two-dimensional echocardiograms (2DE) may provide valuable diagnostic information. We applied a quantitative image processing approach to the analysis of echo intensity and spatial pattern, and tested this approach in a model of myocardial contusion (C). We performed 2DE, 2.4MHz, in six dogs before and after closed-chest, blunt trauma. Pathological examination revealed focal hemorrhage in C regions of the LV in all dogs. We digitized short-axis 2DE images at papillary muscle level and used measures of texture to study regions in normal and C segments, preand post-trauma. The parameters which differentiated normal from C regions were: mean gray level (GL), edge count (a measure of regional heterogeneity of GL), and two measures of the size and uniformity of individual echo reflections: run length nonuniformity and long run emphasis. Pre-trauma, the study regions (normal and C) showed no differences. Data for the post-trauma images were (mean+ SD in arbitrarv units): Parameter _ Normal Contused P 156+18 c.001 Gray Level 98525 275+68 Edge Count 382*95 c.02 7.1t1.5 Long Run Emphasis 5.7k1.4 c.01 Run Length Nonuniformity 1.32.12 1.5t.13 c.02 CONCLUSION: Quantitative texture analysis identifies alterations in regional 2D echo intensity and spatial patterns due to acute myocardial contusion. This approach may be of use in characterizing abnormal myocardial tissue structure in other conditions.
CARDIAC TRAUMA: TWO-DIMENSIONAL ECHOCARDIOGRAPHIC FINDINGS Fletcher A. Miller, Jr., MD; James B. Seward, MD, FACC; Bernard J. Gersh, MD, FACC; Peter Mucha, Jr., MD; Abdul J. Tajik, MD, FACC, Mayo Clinic, Rochester, MN. Cardiac contusion (CC) is a potentially serious complication of blunt chest trauma. The diagnosis of CC is obscured in the milieu of multisystem trauma and nonspecific physical and laboratory findings. CC may be the most frequently unrecognized serious cardiac disease. The role of echocardiography in the diagnosis of CC has not been established. We present our initial experience in 7 patients (pts) with major blunt chest trauma in whom twodimensional echocardiography (2DE) showed significant abnormalities. In this group of pts, additional findings, suggestive of CC, included abnormal physical examination 217 pts, ECG change 517 pts, cardiomegaly on chest x-ray 2/7 pts, and elevated creatine phosphokinase MB (cardiac) fraction 416 pts. In 2 pts, all the above examinations were normal, and diagnosis of CC was based solely on the 2DE examination. 2DE abnormalities included (1) ventricular thrombi (4 RV,l LV), (2) fibrinous pericardial effusion (1 pt), (3) flail tricuspid valve (1 pt), (4) sinus of Valsalva aneurysm (1 pt), (5) LV wall thinning (1 pt), and (6) RV dilatation, wall thinning, and motion abnormalities (5 pts). Myocardial involvement was predominantly RV in 5 pts and LV in 1 pt. One pt with tricuspid valve rupture and sinus of Valsalva aneurysm required subsequent cardiac surgery. This initial experience suggests that 2DE is a reliable means of detecting CC complications. It appears to be a superior means of detecting structural complications of CC, including wall motion abnormalities, thrombi, effusion, and valve injury. Since RV trauma may clinically simulate tamponade, ZDE is of particular value in distinguishing these two conditions.
March 1982
The American Journal of CARDIOLOGY
Volume 49
931
TUESDAY, APRIL 27, 1982 AM DOPPLER AND TISSUE CHARAClERlZATIoN ULTRASOUND SRJDIES I AND II 8:30- 1O:OO TWO DIMENSIONAL MYOCARDIAL ECHO PATTERNS: IN VIVO AND IN VITRO CORRELATION. Anil K. Bhandari, MD; Navin C. Nanda, MD, FACC, University of Rochester Medical Center, Rochester, NY. We report our findings on 26 autopsied patients with various cardiac lesions who had both in viva (W) and in vitro (VT) two-dimensional echocardiographic studies (2DE). The latter were performed by suspending heart specimens in a water bath at 22°C and placing transducer at the water surface. Long and short axis views of suspended hearts A thin metallic probe were obtained simulating those W. (ultrasonically visible) was guided under direct vision to penetrate areas of myocardium producing altered myocardial echo patterns (MEP) and tissue biopsies were taken along the probe for histopathological (HP) correlation. VT MEP were similar to W MEP in all patients. Two normal hearts, 15/15 hearts with LV/RV hypertrophy due to hypertension/ valvular disease and 3/3 hearts with idiopathic congestive cardiomyopathy (ICC) had homogeneously appearing myocardiums on both VV and VT 2DE. In 3/3 amyloid hearts, both W and VT studies demonstrated diffusely distributed small (2-5mm) discrete and very bright echoes. VT 2DE with HP correlation confirmed the close relationship of distribution of these bright echoes with amyloid deposits. In 2 patients (coronary artery disease 1, congenital heart lesion l), both VT and W studies revealed very bright echoes in papillary muscles and in a patient with ICC, bright linear streaky echoes were observed confined to the inner half of the myocardium in the ventricular septum and posterior wall of the LV. The origin of these localized and bright echoes was demonstrated to be due to fibrosis in the papillary muscles and myocardium by VT technique and HP correlation. Thus, our results indicate that VT MEP duplicate W MEP and VT enhance our understanding of the origins of altered MEP produced by myocardial disease processes.
RATIONAL GAIN COMPENSATION FOR ATTENUATION: A STEP TOWARD QUANTITATIVE TWO-DIMENSIONAL ECHOCARDIOGRAPHY Hewlett E. Melton, Jr., PhD; David J. Skorton, MD, FACC. Division of Information Eng and CV Center, IJof Iowa and Iowa City VA Med Center, Iowa City, Iowa Current methods of compensating for attenuation of ultrasound by chest wall, myocardium and blood do not provide a basis for comparison of backscattered signals from different regions of myocardium for purposes of identifying changes which may be of clinical value. These methods of compensation are dependent only on range; they do not compensate for attenuation along different lines-of-sight of the scan. A new method of compensation has been developed which does account for differential attenuation along different lines-of-sight. This method (rational gain compensation, RGC) was tested by incorporating RGC controls into a commercial two-dimensional, 3 MHz scanner (ATL, Inc.), then by imaging short-axis slices of human and canine hearts in vitro. These slices were imaged using both standard, depth gain compensation (DGC) and RGC. Mean backscatter gray levels (GL) from near and far wall regions were measured from digitized data with an image processing system. Eight such images were analyzed quantitatively and qualitatively. RESULTS:
Ratios of mean GL (far/near wall regions): DGC: 1,61+.58(SD).
RGC: 1.282.38. p<.O25
The appearances of the selected regions within each image were more disparate with DGC than with RGC. CONCLUSIONS: Images produced using DGC exhibit regional differences in backscatter which are artificially large due solely to the method of compensation. The new method, RGC, provides a rational basis for quantitative regional analyses of backscatter in two-dimensional echocardiography.
QUANTITATIVE TEXTURE ANALYSIS OF TWO-DIMENSIONAL ECHOCARDIOGRAMS: APPLICATION TO THE DIAGNOSIS OF ACUTE MYOCARDIAL CONTUSION David J. Skorton, MD, FACC; Steve Collins, PhD; Jim Nichols; Natesa G. Pandian, MD; Richard E. Kerber, MD, FACC, CV Div., Div. of Information Eng and CV Center, U of Iowa and Iowa City VA, Iowa City, Iowa Regional differences in echo intensity and spatial pattern in two-dimensional echocardiograms (2DE) may provide valuable diagnostic information. We applied a quantitative image processing approach to the analysis of echo intensity and spatial pattern, and tested this approach in a model of myocardial contusion (C). We performed 2DE, 2.4MHz, in six dogs before and after closed-chest, blunt trauma. Pathological examination revealed focal hemorrhage in C regions of the LV in all dogs. We digitized short-axis 2DE images at papillary muscle level and used measures of texture to study regions in normal and C segments, preand post-trauma. The parameters which differentiated normal from C regions were: mean gray level (GL), edge count (a measure of regional heterogeneity of GL), and two measures of the size and uniformity of individual echo reflections: run length nonuniformity and long run emphasis. Pre-trauma, the study regions (normal and C) showed no differences. Data for the post-trauma images were (mean+ SD in arbitrarv units): Parameter _ Normal Contused P 156+18 c.001 Gray Level 98525 275+68 Edge Count 382*95 c.02 7.1t1.5 Long Run Emphasis 5.7k1.4 c.01 Run Length Nonuniformity 1.32.12 1.5t.13 c.02 CONCLUSION: Quantitative texture analysis identifies alterations in regional 2D echo intensity and spatial patterns due to acute myocardial contusion. This approach may be of use in characterizing abnormal myocardial tissue structure in other conditions.
CARDIAC TRAUMA: TWO-DIMENSIONAL ECHOCARDIOGRAPHIC FINDINGS Fletcher A. Miller, Jr., MD; James B. Seward, MD, FACC; Bernard J. Gersh, MD, FACC; Peter Mucha, Jr., MD; Abdul J. Tajik, MD, FACC, Mayo Clinic, Rochester, MN. Cardiac contusion (CC) is a potentially serious complication of blunt chest trauma. The diagnosis of CC is obscured in the milieu of multisystem trauma and nonspecific physical and laboratory findings. CC may be the most frequently unrecognized serious cardiac disease. The role of echocardiography in the diagnosis of CC has not been established. We present our initial experience in 7 patients (pts) with major blunt chest trauma in whom twodimensional echocardiography (2DE) showed significant abnormalities. In this group of pts, additional findings, suggestive of CC, included abnormal physical examination 217 pts, ECG change 517 pts, cardiomegaly on chest x-ray 2/7 pts, and elevated creatine phosphokinase MB (cardiac) fraction 416 pts. In 2 pts, all the above examinations were normal, and diagnosis of CC was based solely on the 2DE examination. 2DE abnormalities included (1) ventricular thrombi (4 RV,l LV), (2) fibrinous pericardial effusion (1 pt), (3) flail tricuspid valve (1 pt), (4) sinus of Valsalva aneurysm (1 pt), (5) LV wall thinning (1 pt), and (6) RV dilatation, wall thinning, and motion abnormalities (5 pts). Myocardial involvement was predominantly RV in 5 pts and LV in 1 pt. One pt with tricuspid valve rupture and sinus of Valsalva aneurysm required subsequent cardiac surgery. This initial experience suggests that 2DE is a reliable means of detecting CC complications. It appears to be a superior means of detecting structural complications of CC, including wall motion abnormalities, thrombi, effusion, and valve injury. Since RV trauma may clinically simulate tamponade, ZDE is of particular value in distinguishing these two conditions.
March 1982
The American Journal of CARDIOLOGY
Volume 49
931