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Trodimenzionalna ehokardiografija

С Википедије, слободне енциклопедије
Trodimenzionalna ehokardiografija
Trodimenzionalni ehokardiogram vrha srca
ICD-9-CM88.72
MeSHD004452
OPS-301 code3-052
MedlinePlus003869

Trodimenzionalna ehokardiografija ili 3D ehokardiografijaje prikaz srčanih struktura u realnom vremenu u tri dimenzije upotrebom različitih tehnika računarske grafike.[1] Kako je konvencionalna ehokardiografija (koja je značajno doprinela razumevanju morfologije i funkcije srca) limitirana prikazom u dve dimenzije, ona zahteva mentalnu rekonstrukciju treće dimenzije od strane ehokardiografera. Zato je koncept trodimenzijskog prikaza (3D) prihvaćen kao prirodna evolucija ove tehnologije, koja je značajno smanjila subjektivnost tumačenja dobijenih rezultata. [2] Iako 3D ehokardiografija predstavlja značajan korak u tehnologiji digitalnih slika, njihova procena i interpretacija je kompleksna, jer zahteva razumevanje prostorne anatomije i hemodinamike, poznavanje ograničenja ove metode i interpretaciju nalaza uz pažljiv klinički pregled.[3]

Posledih 50 godina ehokardiografija je, pored elektrokardiografije, postala osnovna dijagnostička metoda u kardiologiji. Ehokardiografija je vremenom postala glavni neinvazivni dijagnostički alat za snimanje srčane strukture i funkcije srca u realnom vremenu.[3] Sa napretkom tehnologije mikroprocesora i računara dijagnostičke mogućnosti ehokardiografije su se stalni uvećavale. Iako je konvencionalna ehokardiografija značajno doprinela razumevanju morfologije i funkcije srca, ona je ograničena prikazom u dve dimenzije, što zahteva mentalnu rekonstrukciju treće dimenzije od strane ehokardiografera. Zato je koncept trodimenzijskog prikaza (3D) koji je doveo do značajnog napretka u ovoj oblasti (nakon razvoj i usavršavanje trodimenzionalnog (3D) snimanja) prihvaćen kao prirodna evolucija ove tehnologije.[4]

Lakoća prikupljanja podataka matričnom sondom, mogućnost da se slika gotovo celo srce u realnom vremenu, kao i mogućnost da se fokusira na određene strukture u jednom otkucaju, dovele su 3D ehokardiografiju bliže rutinskoj kliničkoj upotrebi.

Tehnički principi

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Trodimenzionalna ehokardiografija (poznata i kao četvorodimenzionalna ehokardiografija kada se slika kreće) koristi ultrazvučnu sondu sa matričnim nizom i odgovarajući sistem za obradu podataka. Ovo omogućava detaljnu anatomsku procenu srčane patologije, posebno valvularnih defekata,[5] i kardiomiopatija.[6]

Sposobnost presecanja virtuelnog srca u beskonačnim ravninama na anatomski odgovarajući način i rekonstrukcije trodimenzionalnih slika anatomskih struktura čine je jedinstvenom za razumevanje urođenih mana srca.[7]

Trodimenzionalna ehokardiografija u realnom vremenu može se koristiti za usmeravanje lokacije bioptoma tokom endomiokardijalne biopsije desne komore, postavljanja valvularnih uređaja isporučenih kateterom i u mnogim drugim intraoperativnim procenama.[8]

Trodimenzionalna ehokardiografska tehnologija može sadržati anatomsku inteligenciju ili upotrebu tehnologije modeliranja organa za automatsku identifikaciju anatomije na osnovu generičkih modela. Svi generički modeli odnose se na skup anatomskih podataka koji se jedinstveno prilagođava varijabilnosti anatomije pacijenta za obavljanje specifičnih zadataka.

Prikupljanje podataka u tri dimenzije je moguće upotrebom različitih tehnika kao što su:

  • 3DE u realnom vremenu, (Real- time 3D, live 3D) sa specijalnim sistemom matričnih (matrix-array) pretvarača. 3DE prikaz u realnom vremenu (RT3DE) odnosi se na prikupljanje više piramidalnih grupa podataka u sekundi u jednom srčanom otkucaju.
  • 3DE rekonstrukcija u više srčanih ciklusa, bazirana na brojnim u nizu dobijenim, 2D presecima (slično multi-plane TEE), koji se kasnije prikazuju zajedno.

Zasnovana na algoritmima za prepoznavanje funkcija i segmentaciju, ova tehnologija može pružiti dijagnostičaru specifično trodimenzionalno modeliranje srca i drugih aspekata anatomije, uključujući mozak, pluća, jetru, bubrege, grudni koš i kičmeni stub.

Transezofagealna trodimenzionalna ehokardiografija

Klinička primena

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Klinička korist 3D ehokardiografije dokazana je u brojnim oblastima:

  • Direktna i automatizovana procena volumena srčane komore bez potrebe za geometrijskim modelovanjem i bez štetnih efekata skraćenih apikalnih pogleda, što rezultiuje preciznijom i reproduktivnijom zapreminom leve (LV) i desne komore (RV) i izbacivanjem (EF) merenja kod 2D ehokardiografija u poređenju sa referentnim vrednostima snimanja magnetnom rezonancom srca.[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]
  • Takođe, pokazalo se da 3D merenja funkcije i naprezanja miokarda imaju dodatnu prognostičku vrednost.[28]
  • interventne kardiologije kao vodič u brojnim perkutanim procedurama kao „hirurški” pogledi na mitralne, trikuspidalne i aortne srčane zaliske, susedne strukture i intrakardijalne mase.[29][30][31][32][33][34][35][36][37][38][39][40]

Osnovna ograničenja trodimenzionalne ehokardiografije odnose se na suboptimalne prikaze koji su uzrokovani:[3]

  • pomeranjem ultrazvučne sonde tokom akvizicije
  • varijacija tokom respiratornih faza i/ili RR intervala.
  • ćinjenicom da je rekonstrukcija prikaza zavisna od operatera,
  • da se originalne sive vrednosti delimično gube u 3D prikazu, zbog čega se ne mogu dobiti karakteristike tkiva.
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