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Accuracy of 3-Dimensional Color Doppler-Derived Flow Volumes With Increasing Image Depth

Oregon Health & Science University, Portland, Oregon, USA (J.P., L.H., M.Y., X.L., D.J.S.); and Department of Cardiology, The Freeman Hospital, Newcastle Upon Tyne, England (A.K.).

Address correspondence to David J. Sahn, MD, L608, Pediatric Cardiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239-3098 USA. E-mail: sahnd{at}ohsu.edu

Objectives. We and others have reported on the use of digital color Doppler sonography from real-time 3-dimensional (3D) echocardiography and its use in accurately calculating cardiac flow volumes, namely stroke volume (SV) and, hence, cardiac output. However, in some patients, image depth is higher than average, and this may affect the accuracy of volume calculation. We sought to investigate the impact of image depth and the accompanying change in signal strength, spatial resolution, and pulse repetition frequency on the accuracy of SV calculation from 3D color Doppler data in an in vitro model. Methods. A tube model of the left ventricular outflow tract was constructed from plastic tubing and connected to a pulsatile pump. The volume flowing through the tube was imaged using a 3D echocardiography system. Stroke volumes from the pump were computed from the DICOM data using commercially available software and compared with a reference standard of timed volumes with the use of a graduated measuring cylinder over a range of depth settings and SVs. Results. There was good correlation between the 3D-derived SVs and the reference cylinder measures over all depths from 4 to 16 cm at 1-cm increments with a tube diameter of 17 mm, a pump rate of 60 beats/min, and SVs ranging from 20 to 70 mL. The average r² value for the 13 different depths was 0.976. However, the accuracy of the 3D method of volume calculation appeared to fall at depths greater than 13 cm, especially at higher SVs. Conclusions. Stroke volume calculation from real-time 3D color Doppler data in this in vitro study shows that at depths greater than approximately 13 cm, accuracy decreases, especially at higher SVs. This may be due to decreased resolution and the reduced frame rate at these depths. At shallower depths, volume calculation form the 3D Doppler data appears very accurate.

Key Words: Doppler sonography • echocardiography • 3-dimensional

Abbreviations: ANOVA, analysis of variance • ECG, electrocardiogram • LVOT, left ventricular outflow tract • SV, stroke volume • 3DE, 3-dimensional echocardiography • 2DE, 2-dimensional echocardiography

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