A joint committee of the European Association for Echocardiography and the American Society of Echocardiography has issued the first joint guidelines for image acquisition using 3D echocardiography.
The recommendations, published in the Journal of the American Society of Echocardiography (JASE, January 2012, Vol. 25:1, pp. 3-46), are a practical guide for acquiring, analyzing, and displaying various cardiac structures using 3D echo. Dr. Roberto Lang from Mount Sinai Medical Center in New York City and colleagues discuss the advantages and limitations of the technique, as well as current and potential uses of the technology, exploring novel image acquisition and display techniques.
The paper details data acquisition modes ranging from simultaneous multiplane mode to real-time 3D mode, as well as narrow to focused wide-sector zoom. The authors also discuss challenges of 3D acquisition, including 3D gating and breath-hold and 3D optimization tips.
In addition, the group discusses the problems associated with low- and high-gain settings, advising that practitioners begin in the midrange (50 units), then optimize settings with slightly higher time-gain compensation to enable the greatest flexibility in postprocessing.
Transthoracic and transesophageal exam techniques also are covered in detail. In transthoracic 3D echo, for example, the authors advise that clinicians acquire images from multiple transthoracic echo transducer positions to overcome the limitations of poor temporal and spatial resolution. For transesophageal exams, gated 3D modes, including 3D color-flow Doppler, also should be used whenever ECG and respiration gating requirements permit, in order to benefit from the improved spatial and temporal resolution of the wide-angled acquisitions, the authors stated.
Foremost among 3D echo's limitations are that spatial and temporal resolution remain poor, but this is expected to improve as the technology advances, they concluded. Live 3D echo color Doppler acquisition is limited to small color Doppler volumes, generally with limited temporal resolution of 10 to 15 voxels/sec.
"Alternatively, multiple-beam full-volume acquisition of color Doppler providing larger color Doppler volumes and volume rates (up to 40 voxels/sec) are limited by stitching artifacts, resulting in significant displacement between different subvolumes," Lang and colleagues wrote.
Although 3D echocardiography has been a research interest for more than three decades, recent improvements in imaging technology have made it suitable for clinical use, they concluded.
In a statement accompanying release of the article, Dr. Alan Pearlman, JASE editor in chief, wrote: "I believe that real-time volumetric imaging using 3D echocardiography now provides a practical way to measure ventricular volumes and ejection fraction without making any assumptions about chamber geometry, and suspect that one day this imaging method will surpass current 2D echo imaging, just as 25 years ago 2D imaging supplanted M-mode echocardiography."
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
