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Reproducibility and variability in the assessment of color-coded tissue velocity imaging of the fetal myocardium
KTH, School of Technology and Health (STH), Medical Engineering.
KTH, School of Technology and Health (STH).
CFM, Karolinska Universitetssjukhuset.
CFM, Karolinska Universitetssjukhuset.
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2013 (English)In: Journal of biomedical graphics and computing, ISSN 1925-4008, Vol. 3, no 2Article in journal (Refereed) Published
Abstract [en]

Objective: The introduction of color-coded tissue velocity imaging (TVI) in fetal medicine is quite recent, and as this method is presently evaluated and developed in regard to diagnostic precision it is of outmost importance to evaluate the reproducibility for adequate clinical use. In this study, reproducibility and intra- and inter-observer variability was assessed for offline analysis as well as echocardiography investigations. Also, we evaluated the importance of exact placement of the region of interest (ROI).

Methods: TVI recordings from 21 fetuses, at a gestational age of 27 to 41 weeks, were acquired at 208-239 frames/s for subsequent offline analysis. All recordings were performed with the transducer positioned to provide an apical four-chamber view and the myocardial velocity data was obtained from basal inferoseptum. The data set was analyzed according to Bland-Altman and reproducibility was expressed as the standard error of a single determination, estimated from duplicate determinations in percentage of the total.

Results: The variation of reproducibility for the echocardiography investigation ranged from 2.0% to 9.8%. The duration of left ventricular ejection, and the peak velocities of early diastolic filling and atrial contraction being the most robust events measured. The variation of inter-observer variability for the echocardiography investigation ranged from 1.5% to 8.4%, and the variation of intra- and inter-observer variability for the offline analysis ranged from 1.2% to 10.4%. Least robust were the events of shortest duration, including isovolumetric contraction and relaxation.

Conclusion: We believe that TVI measurements of the fetal myocardium could be performed in the clinical routine with acceptable reproducibility.

Place, publisher, year, edition, pages
2013. Vol. 3, no 2
National Category
Medical Image Processing
Identifiers
URN: urn:nbn:se:kth:diva-120776DOI: 10.5430/jbgc.v3n2p16OAI: oai:DiVA.org:kth-120776DiVA: diva2:616320
Note

QC 20130419

Available from: 2013-04-16 Created: 2013-04-16 Last updated: 2017-01-12Bibliographically approved
In thesis
1. Prenatal Tisse Velocity Imaging of the Heart: A new approach to assess fetal myocardial function
Open this publication in new window or tab >>Prenatal Tisse Velocity Imaging of the Heart: A new approach to assess fetal myocardial function
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The general aim of this thesis has been to evaluate color‐coded tissue velocity imaging (TVI) as an approach to developing a new, non‐invasive assessment method for fetal myocardial function. Such a method could hypothetically give early indications of fetal pathology, as myocardial dysfunction is often the consequence when the circulation tries to adapt to deteriorating situations. This would be beneficial in clinical decision making when evaluating fetal well‐being in a wide range of pregnancy associated conditions, to facilitate risk assessment and to monitor the benefit of therapeutic interventions.

TVI is an ultrasound technique that enables quantification of longitudinal myocardial motion with high temporal resolution, which is essential in the identification of fetal myocardial movements of short duration. Furthermore, the longitudinal motion is mainly determined by subendocardial fibers that usually become abnormal in the very early stages of cardiac dysfunction as they are sensitive to milder degrees of hypoxia. Thus, TVI has the potential to give early indications of impaired fetal myocardial function and hypothetically facilitate the detection of intrauterine hypoxia. Hypoxia is a common phenomenon of many pathological conditions in pregnancy, from which a substantial number of children either die or acquire permanent brain injury during delivery every year.

After having established optimal sampling requirements and ensured an acceptable reproducibility for TVI measurements of the fetal myocardium, normal reference values were determined feasible and sensitive enough to provide insight into maturational changes in myocardial function. This provided a foundation that should enable further investigations and was partly accomplished using the cardiac state diagram (CSD) to accurately time the myocardial events during a cardiac cycle according to the motion shifts of the atrioventricular plane.

The demonstrated results are promising and the general conclusion of this thesis is that TVI contributes to increasing the knowledge and understanding of fetal myocardial function and dysfunction. Used together with CSD this technique has great potential as an assessment method. However, further testing of the clinical potential is needed in larger study populations concerning the pathological or physiological questions at issue, and additional development of the method is required to render the method simple enough to be of potential aid in clinical practice.

Place, publisher, year, edition, pages
Stockholm: KTH Royal Institute of Technology, 2013. xiv, 29 p.
Series
Trita-STH : report, ISSN 1653-3836 ; 2013:3
National Category
Medical Image Processing
Identifiers
urn:nbn:se:kth:diva-120982 (URN)
Public defence
2013-05-07, Sal 4-221, Alfred Nobels allé 12, Huddinge, 13:00 (Swedish)
Opponent
Supervisors
Note

QC 20130419

Available from: 2013-04-19 Created: 2013-04-16 Last updated: 2013-04-19Bibliographically approved

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