Echocardiographic Texture Analysis Research Articles

Cardiac microstructural alterations in immune-inflammatory myocardial disease: a retrospective case-control study

BackgroundImmune-inflammatory myocardial disease contributes to multiple chronic cardiac processes, but access to non-invasive screening is limited. We have previously developed a method of echocardiographic texture analysis, called the high-spectrum signal intensity coefficient (HS-SIC) which assesses myocardial microstructure and previously associated with myocardial fibrosis. We aimed to determine whether this echocardiographic texture analysis of cardiac microstructure can identify inflammatory cardiac disease in the clinical setting.MethodsWe conducted a retrospective case-control study of 318 patients with distinct clinical myocardial pathologies and 20 healthy controls. Populations included myocarditis, atypical chest pain/palpitations, STEMI, severe aortic stenosis, acute COVID infection, amyloidosis, and cardiac transplantation with acute rejection, without current rejection but with prior rejection, and with no history of rejection. We assessed the HS-SIC’s ability to differentiate between a broader diversity of clinical groups and healthy controls. We used Kruskal-Wallis tests to compare HS-SIC values measured in each of the clinical populations with those in the healthy control group and compared HS-SIC values between the subgroups of cardiac transplantation rejection status.ResultsFor the total sample of N = 338, the mean age was 49.6 ± 20.9 years and 50% were women. The mean ± standard error of the mean of HS-SIC were: 0.668 ± 0.074 for controls, 0.552 ± 0.049 for atypical chest pain/palpitations, 0.425 ± 0.058 for myocarditis, 0.881 ± 0.129 for STEMI, 1.116 ± 0.196 for severe aortic stenosis, 0.904 ± 0.116 for acute COVID, and 0.698 ± 0.103 for amyloidosis. Among cardiac transplant recipients, HS-SIC values were 0.478 ± 0.999 for active rejection, 0.594 ± 0.091 for prior rejection, and 1.191 ± 0.442 for never rejection. We observed significant differences in HS-SIC between controls and myocarditis (P = 0.0014), active rejection (P = 0.0076), and atypical chest pain or palpitations (P = 0.0014); as well as between transplant patients with active rejection and those without current or prior rejection (P = 0.031).ConclusionsAn echocardiographic method can be used to characterize tissue signatures of microstructural changes across a spectrum of cardiac disease including immune-inflammatory conditions.

Echocardiographic texture analysis using the wavelet transform: differentiation of early heart muscle disease

Echocardiographic quantitation of myocardial texture for diagnosis of early cardiomyopathy (CMP) remains problematic. Conventional statistical methods are limited, contributed by a small image region-of-interest (ROI) and difficulty in discrimination from noise. This study was performed to evaluate the 2-D Haar wavelet decomposition method as a tool to identify textural changes in a rat model of early CMP, focusing on changes that occur before development of M-mode structural abnormalities. Early diabetic CMP, ethanol CMP and diabetic-ethanol CMP rat models were evaluated. Echocardiography was performed on two groups of rats. Group I (5 week cohort, n = 4 per subgroup) included controls, rats on 12% ethanol, a diabetic subgroup, and diabetic rats on 4% ethanol. Group II (10 week cohort, n = 5 per subgroup) included the same categories as group I with an additional subgroup taking 4% ethanol was also studied. M-mode left ventricular measurements were comparable in all subgroups of group I. However, diabetic rats in group II had an increased left ventricular dimension (LVD) compared to all others and an increased septal dimension (IVSD) and posterior wall dimension (PWD) were noted in the 4% and 12% ethanol groups. End-diastolic digital images of all rats in the parasternal short axis view, at the papillary muscle level, were downloaded to a computer. A 16 × 16 (ROI) was selected from the anterior interventricular septum. Although standard statistical methods could not differentiate any of the groups, calculation of textural energy and normalized textural energy with the 2-D Haar wavelet decomposition method found at 5 weeks increased normalized texture energy in diabetics compared to all others. At 10 weeks increased texture energy was noted in diabetics. Diabetic-ethanol rats at both 5 and 10 weeks revealed a blunted textural energy compared to diabetic rats. In a rat model of diabetic cardiomyopathy, the 2-D wavelet decomposition method identified textural energy changes before development of echocardiographic structural changes. Ethanol-associated blunting of textural changes in diabetic rats was also noted. This method for quantitation of ventricular texture may be relevant for diagnosis of early cardiomyopathy.

Biomedical engineering: yesterday, today, and tomorrow.

Today, biomedical engineering (BME) in tertiary medical care involves functions such as: medical monitoring (e.g., PET visualization of brain receptors to identify neuronal dysfunction); medical diagnosis (e.g., computer-aided echocardiographic texture analysis to detect myocardial infarcts); radiation therapy (for cancer treatment); organ-support (e.g., peritoneal dialysis); therapeutic function (e.g., encapsulation of insulin-producing pancreatic islet cells for treatment of diabetes). However, is biomedical engineering a relatively new field? Not really, although one may have opened up new vistas of it. In the past, science was not so compartmentalized into material science, engineering science, and life science. Hermann von Helmholtz (1821-1894), who determined the velocity of pulse-propagation in nerves, was professor of both physiology and physics. On the German 10 DM note is depicted (along with the familiar bell-shaped probability distribution curve) the portrait of Carl Friedrich Gauss (1777-1855). Ranking as one of the greatest mathematicians of all times, he also made important contributions to astronomy, geodesy, and electromagnetism. It is this spirit, to explore and bring to bear physical and engineering sciences as well as psychology to medical and clinical sciences, that constitutes the future of biomedical engineering. A modern and intrinsic concept is that of internal biomedical engineering or organ systems engineering, entailing analyses of organ functional mechanisms and processes. Biomedical engineering development of both macro and micro body processes can eventually lead to more intrinsic and reliable diagnostic methodologies. However, the author first visits a hitherto relatively unexplored phenomenon associated with vital (life) engineering, namely the role of consciousness in health and disease. This approach has in fact been a long-standing tradition in Eastern systems of medicine.

Noninvasive diagnosis of cardiac rejection through echocardiographic tissue characterization

Ultrasonic tissue characterization is based on the assumption that microscopic tissue structures are identifiable by their acoustic properties. Our study group consisted of 23 cardiac recipients. Two-dimensional images were obtained within 2 hours of endomyocardial biopsy. The end-diastolic echo frames were digitized into the matrix of an image-processing system. A region of interest was placed into the anteroseptal segment of the left ventricle. The texture within the region of interest was analyzed using four major groups of texture analysis (first-order histogram, co-occurrence matrix, run-length statistic, and power spectrum). A total of 408 echocardiographic examinations were compared with histologic findings. The 117 initially calculated texture parameters were reduced incrementally using a series of discriminant analyses. A set of three texture parameters (inverse difference moment undirected, run-length nonuniformity vertical, and sector sum) was able to describe changed echocardiographic texture when rejection occurred. Using these three parameters, echocardiographic sensitivity was 89.0% and specificity was 83.6% for moderate rejection. We conclude that cardiac rejection is associated with echocardiographic texture alterations and that serial echocardiographic texture analysis can reliably identify rejection.

The clinical value of ultrasonic tissue characterization in the management of heart transplant patients.

The purpose of this study was to evaluate the rejection process by ultrasonic tissue characterization. Serial 2D echocardiographic images were obtained within 24 h prior to an endomyocardial biopsy. The end-diastolic echoframes were digitized into a computer matrix. A region of interest was placed into the anteroseptal segment of each scan. Image texture was analysed by four major groups of texture analysis (first-order histogram, co-occurrence matrix, run-length statistic, power spectrum). In 23 patients, 408 biopsies were taken after each examination, so that correlation between the ultrasonic tissue measurements and the histological state of the tissue could be determined. When rejection occurred, heterogeneity, brightness and contrast of texture increased. Of 117 texture parameters originally claculated, three parameters (inverse difference moment, run-length non-uniformity, ring sums of power spectrum) that characterized rejection were determined by means of discriminance analysis. Compared with biopsy findings, echocardiographic sensitivity for moderate rejection was 93.3% and specifity 83.6%. Our study indicates that acute rejection is associated with changes in echocardiographic texture. Serial echocardiographic texture analysis can reliably identify heart transplant rejection.

The clinical value of ultrasonic tissue characterization in the management of heart transplant patients

The purpose of this study was to evaluate the rejection process by ultrasonic tissue characterization. Serial 2D echocardiographic images were obtained within 24 h prior to an endomyocardial biopsy. The end-diastolic echoframes were digitized into a computer matrix. A region of interest was placed into the anteroseptal segment of each scan. Image texture was analysed by four major groups of texture analysis (first-order histogram, co-occurrence matrix, run-length statistic, power spectrum). In 23 patients, 408 biopsies were taken after each examination, so that correlation between the ultrasonic tissue measurements and the histological state of the tissue could be determined. When rejection occurred, heterogeneity, brightness and contrast of texture increased. Of 117 texture parameters originally claculated, three parameters (inverse difference moment, run-length non-uniformity, ring sums of power spectrum) that characterized rejection were determined by means of discriminance analysis. Compared with biopsy findings, echocardiographic sensitivity for moderate rejection was 93.3% and specifity 83.6%. Our study indicates that acute rejection is associated with changes in echocardiographic texture. Serial echocardiographic texture analysis can reliably identify heart transplant rejection.

Identification of exudative pericardial effusion from transudate by quantitative echocardiographic texture analysis

Identification of exudative pericardial effusion from transudate by quantitative echocardiographic texture analysis

Feasibility of identifying amyloid and hypertrophic cardiomyopathy with the use of computerized quantitative texture analysis of clinical echocardiographic data

Ultrasound tissue characterization, the evaluation of certain physical properties of a tissue based on its acoustic properties, is an evolving application in echocardiography. The ability to identify acutely and chronically injured tissue has been demonstrated in a number of animal studies, but data in humans are limited. The present study tested the hypothesis that quantitative echocardiographic texture analysis, a method of evaluating the spatial pattern of echoes in echocardiographic images, would differentiate amyloid and hypertrophic cardiomyopathy from normal myocardium. Routine clinical echocardiographic data were obtained on 34 subjects at the Mayo Clinic (10 normal subjects, 10 patients with amyloid heart disease, 8 patients with hypertrophic cardiomyopathy and 6 patients with left ventricular hypertrophy due to hypertension). Standard videotape recordings of these echocardiograms were analyzed at the University of Iowa.Echocardiographic data were digitized with use of a calibrated, 256 gray level digitization system. Quantitative texture analysis was performed on data from the ventricular septum and posterior left ventricular wall in end-diastolic and end-systolic, short-axis and long-axis echocardiographic images. The gray level run length texture variables were able to discriminate hypertrophic cardiomyopathy and amyloid heart disease from normal myocardium and from each other (p < 0.0083 for comparisons of the quantitative texture features of amyloid versus hypertrophic cardiomyopathy versus normal by multivariate analysis of variance). The texture of the myocardium in hypertensive left ventricular hypertrophy not associated with amyloid or hypertrophic cardiomyopathy was in general not significantly different from that of normal myocardium.On the basis of these data, it was concluded that quantitative texture analysis of clinical echocardiographic data has the potential to identify amyloid and hypertrophic cardiomyopathy; false positive results occur rarely in left ventricular hypertrophy due to hypertension. Further prospective studies of this technique are needed to establish its utility in identifying the etiology of clinical cardiomyopathies.

Ultrasound characterization of acute myocardial ischemia by quantitative texture analysis

In this study we tested the efficacy of quantitative texture analysis in the identification of acute myocardial ischemia using an ultrasound data acquisition system that digitizes and stores echocardiographic data in polar format. In nine closed-chest dogs, data were acquired before and after coronary occlusion using a 2.4 MHz echocardiographic system. Regions of interest were analyzed at end-diastole and end-systole from the ischemic area and normal area at the same depth of field. Ultrasound data were evaluated using previously reported quantitative gray level texture measures. After occlusion, texture changes indicative of ischemia were found in systolic images. The directional component of the data analysis was important; analysis in the azimuthal direction was more accurate than in the axial direction. Six texture measures exhibited significant changes in the ischemic region from control to occlusion when analyzing data in the azimuthal direction. One false positive result occurred (significant texture change in the normal region from control to occlusion) in the azimuthal direction. Several false positive alterations in the normal regions from control to occlusion were found when the texture was evaluated in the axial direction. For accurate assessment of ischemic changes, preocclusion image data were required. We conclude that quantitative echocardiographic texture analysis using polar format data can identify subtle changes in myocardial texture such as that due to acute ischemia, using data acquired through the chest wall.

Ultrasound characterization of acute myocardial ischemia by quantitative texture analysis.

In this study we tested the efficacy of quantitative texture analysis in the identification of acute myocardial ischemia using an ultrasound data acquisition system that digitizes and stores echocardiographic data in polar format. In nine closed-chest dogs, data were acquired before and after coronary occlusion using a 2.4 MHz echocardiographic system. Regions of interest were analyzed at end-diastole and end-systole from the ischemic area and normal area at the same depth of field. Ultrasound data were evaluated using previously reported quantitative gray level texture measures. After occlusion, texture changes indicative of ischemia were found in systolic images. The directional component of the data analysis was important; analysis in the azimuthal direction was more accurate than in the axial direction. Six texture measures exhibited significant changes in the ischemic region from control to occlusion when analyzing data in the azimuthal direction. One false positive result occurred (significant texture change in the normal region from control to occlusion) in the azimuthal direction. Several false positive alterations in the normal regions from control to occlusion were found when the texture was evaluated in the axial direction. For accurate assessment of ischemic changes, preocclusion image data were required. We conclude that quantitative echocardiographic texture analysis using polar format data can identify subtle changes in myocardial texture such as that due to acute ischemia, using data acquired through the chest wall.

Detection of myocardial scars in neonatal infants from computerized echocardiographic texture analysis.

It has been demonstrated that highly reflectile echoes (HREs) on standard echocardiograms may represent foci of myocardial fibrosis, calcification, or infiltration. A pilot study of the echocardiograms of premature infants by our group has indicated the presence of HREs in many stressed infants. We have subsequently shown that these HREs correspond to myocardial scarring or necrosis. By studying normal two-dimensional echocardiograms and those with visually observed highly reflectile echoes (HREs), we have been able to develop echo-intensity ranges for normal neonatal myocardium and suspected foci of necrosis. An amplitude analysis of the intensity levels of these highly reflectile areas (HREs) in the echocardiogram has indicated that their mean intensity was significantly higher than the surrounding healthy myocardial areas. Significant correlation was found between these highly reflectile echo zones and calcified or necrotic tissue based on postmortem pathological examination. An objective method of quantifying the ultrasonic reflection amplitude has thereby been developed by us, based on image analysis of the echograms available from the B-scan system. Algorithms have been developed for evaluating the greylevels (or echo intensities or reflection amplitudes) of the pixels, normalizing them with respect to the reflection amplitude of the pericardium, and then printing out the grey-level distribution over an image. Appropriate software has been developed to designate scarred myocardial segments, based on the mean and standard deviation of the selected region on the echo image in comparison with these values for the pericardium.

Cytotoxicity of lymphocytes in the newborn.

Antibody-dependent, phytohaemagglutinin-induced, and spontaneous cytotoxicity was studied in 44 term and 60 preterm newborn babies, all of whom were healthy and of normal weight for gestational age. Twenty-seven adults were used as controls. Antibody-dependent cytotoxicity was low in term babies particularly in the preterm ones during the first 4 days of life, but soon rose to adult levels. Phytohaemagglutinin-induced cytotoxicity was low both in term and preterm babies compared with adult levels, and remained lower throughout the neonatal period although it began to rise. Spontaneous cytotoxicity was lower in preterm babies than in term ones during the first 2 weeks of life, and lower too than in adults. These findings indicate decreased cytotoxic ability of neonatal leucocytes especially during the first 4 days of postnatal life particularly in preterm babies, suggesting either lack of effector cells or that the cells are functionally immature.