Department of Medicine, Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong, China.
Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia.
Heart Lung Circ. 2019 Sep;28(9):1400-1410. doi: 10.1016/j.hlc.2019.04.003. Epub 2019 Apr 19.
Three-dimensional (3D) echo has been around for almost five decades. Recent advances in ultrasound, electronic and computing technologies have moved 3D echo from the research environment to everyday clinical practice. Real time 3D echo and full volume acquisition are now possible with transthoracic as well as transoesophageal probes. The main advantages of 3D echo are the infinite cut planes possible, allowing direct, en face, and anatomical views of cardiac structures, avoiding foreshortening and circumventing the geometric assumptions of the cardiac chambers inherent in any 2D echo techniques. Three-dimensional echo is still dependent on image quality, subjected to ultrasound artifacts and faces the compromise between spatial and temporal resolution. In routine clinical practice in 2019, we recommend a focussed 3D examination after a full 2D echo study. The area where 3D echo has been consistently shown to have superior accuracy and reproducibility over 2D echo is in the assessment of left ventricular (LV) volumes and ejection fraction. We recommend obtaining a full volume 3D echo data set from the apical window, from which LV volumes and LV global longitudinal strain can be measured. Further 3D examination can be performed depending on the pathologies identified on 2D examination. Three-dimensional echo is superior to 2D echo in the assessment of mitral valve pathologies and atrial septal defects. Furthermore, real time 3D transoesophageal echo is a very useful technique in guiding structural cardiac intervention, both before, during and after the procedure. While 3D echo is not the holy grail of echocardiography, it does represent a useful technique in selected areas of cardiac imaging.
三维（3D）超声已经存在了将近五十年。超声、电子和计算技术的最新进展使得 3D 超声从研究环境进入了日常临床实践。实时 3D 超声和全容积采集现在可以通过经胸和经食管探头实现。3D 超声的主要优势在于可以获得无限的切面，从而可以直接、正面和解剖地观察心脏结构，避免缩短和规避任何 2D 超声技术固有的心脏腔室的几何假设。3D 超声仍然依赖于图像质量，容易受到超声伪影的影响，并且在空间和时间分辨率之间存在折衷。在 2019 年的常规临床实践中，我们建议在进行全面的 2D 超声研究后进行有针对性的 3D 检查。在评估左心室（LV）容积和射血分数方面，3D 超声一直被证明比 2D 超声具有更高的准确性和可重复性。我们建议从心尖窗获取完整的 3D 全容积数据集，从中可以测量 LV 容积和 LV 整体纵向应变。根据 2D 检查中发现的病变，可以进一步进行 3D 检查。3D 超声在评估二尖瓣病变和房间隔缺损方面优于 2D 超声。此外，实时 3D 经食管超声在结构性心脏介入的术前、术中和术后指导中是一种非常有用的技术。虽然 3D 超声不是超声心动图的圣杯，但它确实代表了心脏成像的特定领域中的一种有用技术。
