Department of Pediatric Cardiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
Int J Cardiovasc Imaging. 2010 Dec;26(8):851-9. doi: 10.1007/s10554-010-9649-5. Epub 2010 Jun 10.
Virtual endoscopy (VE) is a new post-processing method that uses volumetric data sets to simulate the tracks of a "conventional" flexible endoscope. However, almost all studies of this method have involved virtual visualizations of the cardiovascular structures applied to computed tomography (CT) and magnetic resonance (MR) datasets. This paper introduces a novel visualization method called the "three-dimensional echocardiographic intracardiac endoscopic simulation system (3DE IESS)", which uses 3D echocardiographic images in a virtual reality (VR) environment to diagnose congenital heart disease. The aim of this study was to analyze the feasibility of VE in the evaluation of congenital heart disease in children and its accuracy compared with 2DE. Three experienced pediatric cardiologists blinded to the patients' diagnoses separately reviewed 40 two-dimensional echocardiographic (2DE) datasets and 40 corresponding VE datasets and judged whether abnormal intracardiac anatomy was present in terms of a five-point scale (1 = definitely absent; 2 = probably absent; 3 = cannot be determined; 4 = probably present; and 5 = definitely present). Compared with clinical diagnosis, the diagnostic accuracy of VE was 98.7% for ASD, 92.4% for VSD, 92.6% for TOF, and 94% for DORV, respectively. Diagnostic accuracy of VE was significantly higher than that of 2DE for TOF and DORV except for ASD and VSD. The receiver operating characteristic (ROC) curve for VE was closer to the optimal performance point than was the ROC curve for 2DE. The area under the ROC curve was 0.96 for VE and 0.93 for 2DE. Kappa values (range, 0.73-0.79) for VE and 2DE indicated substantial agreement. 3D echocardiographic VE can enhance our understanding of intracardiac structures and facilitate the evaluation of congenital heart disease.
虚拟内窥镜（VE）是一种新的后处理方法，它使用体积数据集来模拟“传统”柔性内窥镜的轨迹。然而，几乎所有关于这种方法的研究都涉及到心血管结构的虚拟可视化，应用于计算机断层扫描（CT）和磁共振（MR）数据集。本文介绍了一种新的可视化方法，称为“三维超声心动图腔内内窥镜模拟系统（3DE IESS）”，它使用虚拟现实（VR）环境中的 3D 超声心动图图像来诊断先天性心脏病。本研究的目的是分析 VE 在儿童先天性心脏病评估中的可行性及其与 2DE 的准确性。三名经验丰富的儿科心脏病专家在不知道患者诊断的情况下，分别对 40 个二维超声心动图（2DE）数据集和 40 个相应的 VE 数据集进行了审查，并根据五分制（1=绝对不存在；2=可能不存在；3=无法确定；4=可能存在；5=绝对存在）判断异常心内解剖是否存在。与临床诊断相比，VE 对 ASD 的诊断准确率为 98.7%，对 VSD 的诊断准确率为 92.4%，对 TOF 的诊断准确率为 92.6%，对 DORV 的诊断准确率为 94%。VE 的诊断准确率明显高于 2DE 对 TOF 和 DORV 的诊断准确率，除了 ASD 和 VSD。VE 的 ROC 曲线比 2DE 的 ROC 曲线更接近最佳性能点。VE 的 ROC 曲线下面积为 0.96，2DE 的 ROC 曲线下面积为 0.93。VE 和 2DE 的 Kappa 值（范围为 0.73-0.79）表示高度一致。3D 超声心动图 VE 可以增强我们对心内结构的理解，并有助于评估先天性心脏病。
