Semi-automated quantification of left ventricular volumes and ejection fraction by real-time three-dimensional echocardiography
Semi-automated quantification of left ventricular volumes and ejection fraction by real-time three-dimensional echocardiography
Jger Hansegrd 2
Stig Urheim 1
Ketil Lunde 1
Siri Malm 0
Stein Inge Rabben 2
0 Harstad University Hospital , Harstad , Norway
1 Dept. of Cardiology, Rikshospitalet University Hospital , Oslo , Norway
2 GE Vingmed Ultrasound , Horten , Norway
Background: Recent studies have shown that real-time three-dimensional (3D) echocardiography (RT3DE) gives more accurate and reproducible left ventricular (LV) volume and ejection fraction (EF) measurements than traditional two-dimensional methods. A new semi-automated tool (4DLVQ) for volume measurements in RT3DE has been developed. We sought to evaluate the accuracy and repeatability of this method compared to a 3D echo standard. Methods: LV end-diastolic volumes (EDV), end-systolic volumes (ESV), and EF measured using 4DLVQ were compared with a commercially available semi-automated analysis tool (TomTec 4D LV-Analysis ver. 2.2) in 35 patients. Repeated measurements were performed to investigate interand intra-observer variability. Results: Average analysis time of the new tool was 141s, significantly shorter than 261s using TomTec (p < 0.001). Bland Altman analysis revealed high agreement of measured EDV, ESV, and EF compared to TomTec (p = NS), with bias and 95% limits of agreement of 2.1 21 ml, -0.88 17 ml, and 1.6 11% for EDV, ESV, and EF respectively. Intra-observer variability of 4DLVQ vs. TomTec was 7.5 6.2 ml vs. 7.7 7.3 ml for EDV, 5.5 5.6 ml vs. 5.0 5.9 ml for ESV, and 3.0 2.7% vs. 2.1 2.0% for EF (p = NS). The inter-observer variability of 4DLVQ vs. TomTec was 9.0 5.9 ml vs. 17 6.3 ml for EDV (p < 0.05), 5.0 3.6 ml vs. 12 7.7 ml for ESV (p < 0.05), and 2.7 2.8% vs. 3.0 2.1% for EF (p = NS). Conclusion: In conclusion, the new analysis tool gives rapid and reproducible measurements of LV volumes and EF, with good agreement compared to another RT3DE volume quantification tool.
Left ventricular (LV) volumes and ejection fraction (EF)
are important parameters for diagnosis and prognosis of
patients with heart disease [1-3]. Traditionally, LV
volumes are measured by manual tracing in two sequentially
acquired two-dimensional (2D) echocardiograms, using
the biplane method of disks (MOD) [4,5]. The spatial
under-sampling of the ventricle, inherent with such 2D
techniques, requires geometric assumptions about the LV
shape. Foreshortening, occurring when the image plane is
oblique to the ventricular main axis, also introduces errors
in MOD measurements in 2D echocardiography [6,7].
Real-time three-dimensional (3D) echocardiography
(RT3DE) (also known as four-dimensional (4D)
echocardiography) is gaining popularity as a routine clinical tool
, and has a significant potential of improving clinical
decision-making . Of particular interest is the
improved accuracy and repeatability of volume and EF
measurements, compared to conventional 2D techniques
[6,10-13]. However, manual analysis of 3D data is
timeconsuming and impractical. Thus, clinical use of volume
measurements from RT3DE requires simple and efficient
automated analysis tools.
Currently, two commercially available volume
measurement tools for RT3DE exist on the market; QLAB (Philips,
Andover, Massachussetts, USA), and TomTec 4D
LV-Analysis (TomTec Imaging Systems, Unterschleissheim,
Germany). Different versions of the TomTec tool have been
verified against cardiac magnetic resonance imaging
(cMRI) in several studies [7,14-16], showing excellent
agreement of measured LV volumes and EF. One of the
challenges with the TomTec analysis tool is that it requires
manual tracing of the endocardial border in three apical
planes for initialization and manual correction of the
detected surface . Manual tracing of the endocardial
boundary is a difficult and time-consuming procedure,
especially for non-expert users, and the accuracy is
experience dependent .
GE has introduced a new semi-automated tool for 4D LV
volume quantification (4DLVQ) in RT3DE (EchoPAC ver.
108.1.0, GE Vingmed Ultrasound, Horten, Norway).
4DLVQ provides a simple user interface and an efficient
workflow by eliminating the need for manual tracing,
making the tool simple to use for non-expert users.
The objective of this study was to evaluate the agreement
of LV volumes and EF measured by 4DLVQ compared to
TomTec, to evaluate the repeatability of these parameters,
and to determine the potential of 4DLVQ as a clinical
Volume quantification tool
4DLVQ is a volume quantification tool for rapid
semiautomated detection of the LV endocardial border in
RT3DE. When entering the tool, the user is presented with
a quad-screen, showing cine loops of three apical views
with 60 inter-plane spacing, and one short axis (SAX)
view. If required, the apical views can be manually
corrected to show the standard apical four-chamber (A4CH),
apical two-chamber (A2CH), and apical long axis (ALAX)
views, thereby eliminating foreshortening. When this
anatomical alignment step is complete, the ED frame is
automatically detected from the EGG, but can be manually
corrected if necessary.
While displaying the ED frame, surface detection is
initialized by manually selecting two points identifying the
mitral annulus and one point identifying the LV apex in
sFAhingouwexrnaemin1p(lae) of LV surface detection at ED using 4DLVQ is
An example of LV surface detection at ED using
4DLVQ is shown in (a). The standard apical views (top
left, top middle, bottom left) were obtained by manual
alignment. Each small circle in the apical views indicates a
manually defined landmark used for initialization of surface
detection. One SAX view (middle, bottom) was dynamically
updated to reflect the trackball position, in order to facilitate
precise landmark positioning and verification of the 3D
surface detection. If necessary, additional landmarks could be
added to leave papillary muscles within measured cavity
volume. Three extra SAX views distributed between apex and
base (right) were used to further verify the detected surface.
The complete 4D surface detection at ES with time-volume
curve is shown in (b).
each of the three apical views shown in figure 1(a). After
the total of nine landmarks are defined at ED,
non-temporal 3D surface detection is immediately performed to
extract the endocardial border and to compute the EDV.
The time required for a full 3D surface detection is less
than one second. Cross-sections of the detected 3D
surface are displayed in three apical views and three SAX
views distributed between the LV apex and base, as shown
in figure 1(a), to allow visual verification of the detected
surface. A fourth user controlled SAX plane is used to
further inspect the surface detection result. If necessary, the
displayed LV surface can, at this time, be edited manually
by adding or removing landmark points. An interactive
workflow is achieved by automatically repeating 3D
surface detection after each new landmark until a satisfactory
result is obtained. An overview of the tool workflow is
given in figure 2(a).
The above procedure is repeated for ES. The frame
corresponding best to end systole is estimated automatically
from the R-R interval of the EGG [18,19] and can be
When surface detection is complete for both ED and ES,
preliminary measurements of EDV, ESV, and EF are
presented to the user. However, better measurements can be
achieved by manually triggering temporal 4D surface
detection to detect LV surfaces for each frame in the entire
cardiac cycle. This typically requires less than 10 seconds,
depending on the frame- and heart rate, and gives a full
time-volume curve (see additional file 1 and additional
file 2). Once completed, the maximum and minimum
volumes are presented on the screen as EDV and ESV
respectively along with the derived EF, as shown in figure
1(b). If required, the LV surfaces computed during this
step can be edited further. In these cases, non-temporal
3D surface detection is performed after each additional
manually defined landmark as for ED and ES. A full 4D
surface detection can then be manually triggered once
again, to update the time-volume curve. Several
segmentation algorithms suitable for 3D echocardiography exist
. Commonly, these algorithms are formulated as
deformable surface models, such as for instance level sets
[21,22], or simplex meshes [23,24].
FCiogmurpear2ison of workflow for 4DLVQ (a) and TomTec (b)
Comparison of workflow for 4DLVQ (a) and TomTec (b). With 4DLVQ, each view is aligned to the standard apical
view. Initialization is done at ED using 3 clicks in each apical view. 3D surface detection is automatically triggered, and if
necessary the detected 3D surface is edited manually by adding landmarks. This is an interactive procedure where the 3D surface
detection is repeated after each new landmark. Once completed with ED, the same procedure is repeated for ES. When both
ED and ES are finished, a full 4D surface detection is performed to obtain EDV, ESV, and EF along with a time-volume curve. At
this stage it is possible to edit the surfaces if improvements are required. With TomTec, initialization is done by accurate
tracing at both ED and ES in each view after alignment to the standard apical views. 4D surface detection is done directly after
initialization, and correction is done to the resulting surfaces if required.
4DLVQ is based upon a 3D energy minimizing
deformable model . The deformable model is evolved using an
iterative deformation scheme, under the influence of
internal and image derived forces, temporal forces, and
user defined landmark forces.
The model's internal forces ensure second order shape
continuity of the detected object by counteracting
stretching and bending of the surface. In order to be able to adapt
the deformable model to clinical data, where a large
variation of LV shapes is expected due to different pathologies
and individual variations between patients, the
deformable model is allowed to evolve freely, and is not
constrained by any explicit a priori shape model.
The segmentation algorithm is initialized at ED and ES by
manually selecting nine initial points in three different
image planes rotated about the LV long axis. These
manually defined initial points are used to position a simplified
geometric LV model within the LV cavity. The radius and
height of the initial model are determined from the
position of the manually defined initial points.
Image forces are derived from the volumetric data using a
local edge detector, utilizing a combination of gradient
and transition information . These image forces pull
the surface towards image edges within a region around
the deformable model. To ensure consistent surface
detection from frame to frame, and to give a smooth
time-volume curve, temporal forces constrain the model to
second-order temporal continuity.
By disabling temporal forces, the deformable model can
be used for surface detection in single frames. This mode
was used for initial surface detection at end-diastole (ED)
and end-systole (ES).
User input is facilitated by generating spring-like forces
that pull the deformable model towards the spatial
location of user-defined landmarks .
The relative weights of the image and model forces were
tuned on more than 100 training data sets to obtain a
good trade-off between accuracy and robustness in
different imaging situations and for various pathologies.
After completed surface detection, LV volumes were
derived from the triangulated surfaces by summation of
all triangular patches using the divergence theorem .
Evaluation was done in 3D echocardiograms recorded in
conjunction with two previous studies, giving data from a
total of 56 patients (77% men, age 2376) referred for
echocardiography at St. Olavs Hospital, Trondheim,
Norway, (, n = 20, exclusion criteria: atrial fibrillation,
severe non-cardiac diseases), and Rikshospitalet
University Hospital, Oslo, Norway, (, n = 36, exclusion
criterion: arrhythmia). Of note is that the original studies did
not use 3D data. 3D echocardiograms were therefore only
recorded in randomized sub-groups of the total study
populations, as an addition to the primary protocols.
Participants were not pre-selected from 2D or 3D image
quality for the primary protocol, nor for the sub-group
subject to 3D echocardiography. All patients gave
informed written consent to participation, and the studies
conformed to the declaration of Helsinki, with approval
from the regional committees of medical ethics.
Apical volumetric imaging was performed by experienced
operators using a Vivid 7 scanner (GE Vingmed
Ultrasound, Horten, Norway) and a 3D transducer (3V).
Electrocardiogram (EGG) gated sub-volumes were acquired at
2030 frames per second from four consecutive cardiac
cycles during breath-hold, with the participants in the left
lateral recumbent position. The sub-volumes were
automatically stitched to a sequence of full 3D volumes
covering the entire LV, and stored digitally for analysis.
In 20 (36%) of the 56 patients, less than 70% of the
myocardium was visualized, caused by a too narrow imaging
sector, shadows, or dropouts. Stitching artefacts were
found in one additional patient (2%). These factors
would prohibit reliable volume measurements , and
the total of 21 patients (38%), were therefore excluded
from further analysis.
A customized EchoPAC workstation (GE Vingmed
Ultrasound, Horten, Norway) with the 4DLVQ software
integrated was used by an expert operator according to the
described tool workflow. Accurate anatomical alignment
to the standard A4CH, A2CH, and ALAX views, were
applied in all cases. If necessary, the ED frame was
corrected to agree with the maximum cavity area, while the
ES frame was adjusted primarily to agree with aortic valve
closing, secondarily by visually determining the minimal
cavity area. We always applied 4D segmentation to
compute the full time-volume curve, as our experience was
that this gave the most accurate EDV and ESV estimates.
Manual editing of the detected surfaces was done as
necessary at ED, ES, and after performing 4D segmentation.
When a satisfactory result was obtained, EDV, ESV, and
EF, were recorded for analysis.
Repeated measurements were done in a randomized order
using an EchoPAC workstation with a TomTec 4D
LVAnalysis plug-in ver. 2.2. by the same expert operator after
a minimum of 14 days. The operator was equally
experienced with both 4DLVQ and TomTec, and was blinded to
previous measurements. An overview of the TomTec
workflow is given in figure 2(b). The apical views were
aligned to the standard A4CH, A2CH, and ALAX views,
similarly as for the 4DLVQ tool, to eliminate
Initialization of the TomTec surface detection algorithm
was done by manually tracing the endocardial border
using a spline-based annotation tool in the three apical
views. Contrary to 4DLVQ, manual tracing was completed
at both ED and ES in each apical view before continuing
to the next view. Manual editing of the LV surface after
surface detection could be avoided by tracing the endocardial
border as accurately as possible during initialization .
While tracing, a cine-loop of the corresponding view
displayed the traced endocardial border to ensure temporal
consistency between ED and ES. After tracing in the
A4CH, A2CH, and the ALAX views, 4D LV surface
detection was performed. Two manually adjustable apical
planes were used to validate the automatically detected
surfaces. The tool provided a manual editing feature for
the detected LV surfaces, but since the initialization
procedure required the user to accurately trace the LV according
to his preference, this was not used. EDV, ESV, and EF
measurements were derived from the automatically
detected LV surfaces, and recorded for analysis. These
values were used as reference values for evaluation of
For both methods, the analysis time was measured from
the start of analysis of volumetric data until the volume
and EF measurements were displayed on the screen. The
analysis time was reported as average time standard
Intra-observer variability for 4DLVQ and TomTec was
assessed in all 35 patients by the primary operator in a
randomized order. The second expert operator assessed
inter-observer variability in 10 randomly selected
patients. Both operators were equally experienced with
both 4DLVQ and TomTec, and were blinded to previous
measurements. The minimum time interval between
repeated measurements was 14 days.
To compare repeatability with other studies, we adopted
the method of Jacobs et al.  and Sugeng et al. .
First, the absolute difference between two repeated
measurements was computed for each patient as shown in Eq.
(1). The absolute differences were reported as mean SD
over all patients. Secondly, relative percentage variability
was defined as the absolute difference between two single
measurements, normalized by the average of the two
measurements in the same patient as shown in Eq. (2).
The relative percentage variability was reported as mean
SD over all patients.
Abs. variability = meas. 2 meas. 1
meas. 2meas. 1
avg of meas. 1 and 2
The relationship between 4DLVQ and the TomTec
reference values was analyzed by linear regression and Bland
Altman analysis . The latter was used to evaluate the
agreement between the two methods (two-tailed t-test on
the differences with a null hypothesis of zero difference
and p < 0.05 regarded as significant). The agreement
between the two methods was reported as the mean
difference (bias) and the corresponding 95% limits of
agreement. For comparison with other studies, Pearson's
correlation coefficient between the two methods was also
Agreement between inter- and intra-observer variability of
the two methods was computed from the absolute
differences between repeated measurements (Mann-Whitney U
test with p < 0.05 regarded as a significant).
Analysis times were compared using a Mann-Whitney U
test with p < 0.05 regarded as significant.
Semi-automated analysis was feasible in all 35 data sets. A
full 4D analysis using 4DLVQ required 141 37 s
including image alignment, initialization, and manual
correction of the detected surfaces. This was significantly quicker
than for Tom Tec (p < 0.001), which required 261 63 s.
The maximum time required for the two tools was 266
and 392 seconds respectively. The 4DLVQ tool required
on average three additional manually defined landmarks
to correct the initially detected surfaces.
TomTec and 4DLVQ yielded similar results for population
mean and range for EDV, ESV, and EF (Table 1). Figure
3(ac) shows the agreement between 4DLVQ and
TomTec. The mean differences and 95% limits of
agreement for EDV were 2.1 21 ml, -0.88 17 ml for ESV, and
1.6 11% for EF. The differences between the two tools
were not statistically significant for EDV, ESV, or EF. The
0 70 140 210 280 350
Average EDV (4DLVQ, TomTec) [ml]
0 50 100 150 200 250
Average ESV (4DLVQ, TomTec) [ml]
70 140 210 280 350
EDV TomTec [ml]
BFliagnudreAl3tman analysis of EDV, ESV, and EF measured by 4DLVQ compared to TomTec is shown in (a), (b), and (c) respectively
Bland Altman analysis of EDV, ESV, and EF measured by 4DLVQ compared to TomTec is shown in (a), (b),
and (c) respectively. Average difference (solid) is shown along with 95% limits of agreement (dashed). EDV, ESV, and EF
measured by 4DLVQ are plotted against TomTec in (d), (e), and (f) along with unit line (dashed), regression line (solid), and
Pearson's correlation coefficient r.
small bias and relatively narrow 95% limits of agreements
indicate that 4DLVQ gives results that compare well with
TomTec. Figure 3(df) shows the relationship between
EDV, ESV, and EF measured by 4DLVQ and TomTec.
Linear regression gave slopes that were less than unity for all
parameters (0.87, 0.94, and 0.92 for EDV, ESV, and EF
respectively). The zero intercepts were 20 ml for EDV, 4.1
ml for ESV, and 5.4% for EF. The correlation coefficients
of parameters measured by 4DLVQ and TomTec were
0.98, 0.98, and 0.90 for EDV, ESV, and EF respectively.
The results from the inter- and intra-observer analysis of
4DLVQ and TomTec are shown in Table 2. This analysis
reveals low intra-observer variability for both methods.
An important observation is that the inter-observer
variability was significantly better with 4DLVQ than with
TomTec for both EDV and ESV.
We have evaluated a new semi-automated method for
rapid quantification of LV volumes and EF in volumetric
echocardiograms, and compared this to a reference
volume quantification tool (TomTec) in 35 patients.
3D echocardiography makes it possible to capture the
shape and function of the entire LV in a single data set.
Compared to 2D echocardiography, this is an advantage
for LV quantification, since geometric assumptions of LV
shape can be completely eliminated. Further, 3D
echocardiograms allowed for manually aligning the displayed
views to the true anatomical LV main axis to avoid
foreshortening and to ensure precise identification of the LV
apex. These factors make automated 3D quantification
better suited for accurate and reproducible measurements
of ventricular volumes and EF than manual 2D methods.
Also, an automated method can provide time-volume
* Significantly different from 4DLVQ (p < 0.05). EDV, end-diastolic
volume; ESV, end-systolic volume; EF, ejection fraction. Abs. values
are population mean SD of absolute differences between repeated
measurements. % values are population mean SD of absolute
differences of repeated measurements normalized by the average of
the two repeated measurements.
curves from a full cardiac cycle, giving more accurate EF
estimates. The time-volume curve can potentially also be
used to improve echocardiographic diagnosis, by
providing information about timing of cardiac events, and filling
rates in diastolic function analysis.
Analysis time was significantly shorter with 4DLVQ than
with TomTec. This difference was mainly due to the
simplified 4DLVQ initialization procedure, requiring only
nine easily located landmarks at ED and ES, instead of
triplane tracing used for the TomTec analysis. Because of this
simplified initialization, a few additional manually
defined landmarks were often required to include
papillary muscles in the LV volume, but since this was done
interactively with immediate visual feedback, the
overhead was minimal. One might argue that the TomTec
analysis time could be reduced by a less accurate
initialization, but it has been shown that accurate initialization
is required to avoid time-consuming manual editing of
the detected LV surface when using TomTec . Soliman
et al.  reported a TomTec analysis time of 360 120
seconds, confirming that our results are representable
with respect to TomTec analysis time.
We have shown that EDV, ESV, and EF assessed by 4DLVQ
compare well to measurements performed by TomTec,
with small bias, narrow 95% limits of agreement, and
high repeatability. A limitation of this study is the lack of
an independent reference, and it is therefore not possible
to determine which of the two methods is more accurate.
However, since the agreement between the two methods
was high for EDV, ESV, and EF, we conclude that 4DLVQ
performs at least as well as TomTec in clinically realistic
data, even with a lower analysis time.
Several studies have presented repeatability assessment
for various versions of TomTec. Soliman et al. 
reported inter-observer variability of 6.4 7.8 ml, 7.8
9.7 ml, and 7.1 6.9%, and intra-observer variability of
4.7 3.2 ml, 6.1 5.8 ml, and 6.6 7.4% for EDV, ESV,
and EF respectively. Our results demonstrated similar
intra-observer variability, but higher inter-observer
variability with TomTec. We speculate if the discrepancy in
inter-observer variability can be explained by the manual
initialization procedure provided by TomTec. Slight
differences in tracing conventions caused a bias between the
observers of approximately 9 ml at ED and ES. This bias
corresponds to a systematic tracing error of less than 1
mm for typical chamber sizes , but the impact on the
variability parameters used in this study is evident.
4DLVQ requires less user input during initialization, and
is therefore less influenced by such differences in tracing
conventions, as confirmed by a lower inter-observer
variability with 4DLVQ than with TomTec.
Differences between the workflows provided by TomTec
and 4DLVQ are illustrated in figure 2. With 4DLVQ,
initialization of all views is completed at ED before
continuing to ES. TomTec uses a different strategy, where manual
initialization is completed at both ED and ES in each view
before proceeding with the next view. The traced contours
are shown in a cine-loop preview display during tracing,
providing additional information to ensure consistent
contours between ED and ES. It has been claimed that
manual editing in TomTec only has local impact on the
detected surfaces . We experienced in several cases
that manually editing the surface caused it to "slip" from
the endocardial border outside of the edited area, even in
cases with strong edge evidence. Also, TomTec does not
provide immediately updated surface detection during
editing, whereas 4DLVQ provided immediate feedback,
giving better control over the detected surface.
The clinical feasibility of RT3DE relies on simple and
efficient analysis tools, ideally integrated as a part of the
scanner software to facilitate on-line analysis during
examinations. This puts strong constraints on the
performance and ease of use of the tool, also with respect to
manual correction of automatically detected surfaces. The
presented volume quantification tool was implemented
as an off-line analysis tool for use on the EchoPAC
workstation. We have shown that a full 4D analysis can be
done in less than 3 minutes, also in patients where
manual correction was needed. This indicates that the tool is
well suited for on-line analysis.
4DLVQ seems to be a reliable clinical tool, which provides
rapid and reproducible measurements of LV volumes and
EF with good agreement compared to TomTec. It has a
simple workflow that makes it easy to use for non-expert
users. Recent development within the field of automated
landmark detection in RT3DE  may be utilized to
completely eliminate the need for manual initialization.
Also, promising results have been presented using fully
automated real-time 4D surface detection methods
[34,35]. In patients with poor acoustic properties,
semiautomated methods are still preferred, since they allow for
manual correction of the automatically determined LV
volumes. But in the future, fully automated methods will
improve efficiency and repeatability of echocardiography
It has been shown that the accuracy of LV volumes and EF
is highly correlated to the amount of myocardium that is
visualized in the RT3DE recording . We defined an
image quality threshold of 70% myocardium visibility,
causing exclusion of 36% of the patients (which were not
pre-selected for image quality). The need for combining
sub-volumes from four cardiac cycles caused exclusion of
one patient due to inability to hold breath throughout the
acquisition. Future improvements to probe design and
front-end processing capabilities are expected to give
increased field of view, and less need for EGG gating,
while improving image contrast and signal to noise ratio.
These factors will improve feasibility and accuracy of
automated assessment of LV function.
In this study, both TomTec and 4DLVQ were evaluated on
the same data sets, to rule out differences in measured
volumes and EF caused by differences during acquisition
related to frame rate, probe position, and differences in
image quality. This study design also ruled out
comparison with Philips QLAB, due to file format limitations.
Analysis of inter-examination variability, and comparison
with analysis packages from multiple vendors should be
addressed in a future study.
Cardiac MRI is currently accepted as the gold standard for
LV quantification, and several studies have shown that
TomTec compares well with cMRI, giving good agreement
in measured EF, but with slightly under estimated
volumes [7,12,14-16]. This bias is explained by differences in
how the two modalities visualize trabeculae and valves,
and also partial volume effects in cMRI . Since 4DLVQ
provides volume and EF measurements that agree well
with TomTec, it is reasonable to believe that 4DLVQ will
give similar results in a comparison with cMRI. The next
natural step is therefore to compare 4DLVQ against cMRI.
Accurate EF measurements are of high clinical importance
for diagnosis, prognosis, and treatment planning of
patients with cardiac diseases. 4DLVQ is now fully
integrated as an online measurement tool on the Vivid E9
ultrasound scanners (GE Vingmed Ultrasound, Horten,
Norway). This allows for fast and reliable bedside
measurements of global LV function without limitations
related to foreshortening and geometric modelling of the
We have evaluated a new volume quantification tool for
automated EDV, ESV, and EF measurements in volumetric
echocardiograms. The tool compared well to a
commercially available analysis tool (TomTec 4D LV-Analysis),
with higher repeatability, and a significantly shorter
analysis time. This is an important step towards wide spread
use of RT3DE in clinical routine.
JH worked as consultant for GE Vingmed Ultrasound. SIR
is employed by GE Vingmed Ultrasound. SU, KL, and SM
received research grants from GE Vingmed Ultrasound.
JH contributed to development of the analysis tool, was
the primary observer, drafted the manuscript, and
performed the statistical analysis. SIR designed and
developed the analysis tool, was the secondary observer,
supervised the project, and participated in drafting the
manuscript. SU collected data, supervised the clinical
aspects of the project, and participated in drafting the
manuscript. KL collected parts of the data, and revised the
manuscript critically for important intellectual content.
SM collected parts of the data, and revised the manuscript
critically for important intellectual content. All authors
read and approved the final manuscript.
Additional file 1
Temporal 4D (3D + time) analysis results from a normal left ventricle
with normal function. The movie shows four anatomically aligned cut
planes through a 4D recording of a normal left ventricle, where left
ventricular (LV) surfaces (green contours) have been detected for each frame
in the entire cardiac cycle. Manually added landmark points are shown as
green circles. The time-volume curve (right) shows the volumes computed
from the detected surfaces in each frame of the cardiac cycle, along with
the end diastolic (ED) and end systolic (ES) frames computed from the
maximum and minimum volumes respectively.
Click here for file
Additional file 2
Temporal 4D (3D + time) analysis results from a dilated left ventricle.
The movie shows four anatomically aligned cut planes through a 4D
recording of a dilated left ventricle, where left ventricular (LV) surfaces
(green contours) have been detected for each frame in the entire cardiac
cycle. Manually added landmark points are shown as green circles. The
time-volume curve (right) shows the volumes computed from the detected
surfaces in each frame of the cardiac cycle, along with the end diastolic
(ED) and end systolic (ES) frames computed from the maximum and
minimum volumes respectively.
Click here for file
This work was supported by the Norwegian Research Council under grant
156724 and GE Vingmed Ultrasound.
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