Quantification of Flow Rates and Flow Volumes in Valve Regurgitation Using 3-D High Frame-Rate Ultrasound

Abstract

Valve regurgitation is a cardiac condition caused by the incomplete closure of a cardiac valve. Untreated, this condition may result in cardiac failure. Regular monitoring of this condition is essential in guiding the decision process for surgical intervention. Current guidelines recommend a multiparametric assessment of valve regurgitation using echocardiography, which is both time consuming and heavily dependent on the experience of the examiner. Several methods have been proposed to provide quantitative markers to facilitate the assessment of valve regurgitation, most notably the Proximal Isovelocity Surface Area (PISA) method and methods based on the quantification of the total Regurgitant Volume (RVol) from the power of backscattered blood signal. In this work, we propose a framework based on trans-thoracic 3-D high frame-rate acquisitions for the simultaneous estimation of the jet cross-sectional area and jet velocity directly at the jet core, which are then combined to estimate the instantaneous flow rate and RVol patients with aortic or mitral insufficiency. We compare two methods for the segmentation of the jet cross-sectional area from the power Doppler signal. Validation on simulated data indicates good segmentation accuracy for the best method (β = 0.97, <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">R</i> <sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sup> = 0.91). Validation on recordings from a flow phantom shows good agreement (β = 1.2, <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">R</i> <sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sup> = 0.88) with an external flow rate meter. Clinical feasibility of the method is also shown in a patient with mitral regurgitation.