超音波検査技術

ISSN: 1881-4506
一般社団法人日本超音波検査学会
〒162-0801 東京都新宿区山吹町358-5
Japanese Journal of Medical Ultrasound Technology 43(2): 133-146 (2018)
doi:10.11272/jss.43.133

原著Original Article

右房容積計測における2次元心エコー法の最適条件の検討—3次元心エコー法との比較—The Optimal Right Atrial Volume Measurement Technique by 2-Dimensional Echocardiography—A Comparative Study to 3-Dimensional Echocardiography—

齊藤 央1，加藤 真吾2，田中 亜由美1，石川 貴子1，中込 こず恵1，斉藤 紀隆1，中村 満美子1，仲地 達哉2，福井 和樹2Naka Saito1, Shingo Kato2, Ayumi Tanaka1, Takako Ishikawa1, Kozue Nakagomi1, Noritaka Saito1, Mamiko Nakamura1, Tatsuya Nakachi2, Kazuki Fukui2

1 神奈川県立循環器呼吸器病センター検査科Department of Clinical Laboratory, Kanagawa Cardiovascular and Respiratory Center

2 神奈川県立循環器呼吸器病センター循環器内科Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center

受付日：2017年8月15日Received: August 15, 2017
受理日：2017年12月5日Accepted: December 5, 2017
発行日：2018年4月1日Published: April 1, 2018
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目的：心エコーを用いた右房容積（RAV）計測は3次元心エコー法（3DE）が最も正確とされるが，容積解析の簡便さは現時点では2次元心エコー法（2DE）に劣り日常検査には不向きである．本研究では3DEによるRAV（3D-RAV）をリファレンスとして，2DEでのRAV（2D-RAV）計測における最適計測断面および最適計測法を検討することを目的とした．

対象と方法：3DEにて右房を撮像し得た57例を対象とし，全例において3D-RAVを計測した．2D-RAVは，まず右房短径が最大となる断面（RA-Max）と右房短径が最小となる断面（RA-Min）の2断面を定義し，計測条件として1）2断面を用いたarea-length法（Bi-AL），2）2断面を用いたdisk summation法（Bi-DS），3）RA-Maxでのsingle-plane area-length法（Max-Si-AL），4）RA-Maxでのsingle-plane disk summation法（Max-Si-DS），5）RA-Minでのsingle-plane area-length法（Min-Si-AL），6）RA-Minでのsingle-plane disk summation法（Min-Si-DS）を用いて各2D-RAVを計測した．3D-RAVと各計測法による2D-RAVを比較し，Bland-Altman plotにて一致性を検討した．

結果と考察：3D-RAVと各2D-RAVはいずれも良好な相関を示した（Bi-AL, r＝0.99; Bi-DS, r＝0.99; Max-Si-AL, r＝0.88; Max-Si-DS, r＝0.87; Min-Si-AL, r＝0.95; Min-Si-DS, r＝0.93．いずれもp＜0.01）．Bland-Altman plotでのbiasおよびlimits of agreement（LOA）は，それぞれBi-AL, 0.8 ml（LOA: −6.5～8.0 ml）; Bi-DS, 2.9 ml（LOA: −12.8～7.0 ml）; Max-Si-AL, 20.2 ml（LOA: −7.7～48.1 ml）; Max-Si-DS, 15.1 ml（LOA: −14.2～44.4 ml）; Min-Si-AL, −13.6 ml（LOA: −31.5～4.3 ml）; Min-Si-DS, −14.8 ml（LOA: −35.6～6.1 ml）であった．

結論：2D-RAVの計測において，RA-MaxとRA-Minを用いたBi-ALが最も3D-RAVに近似する可能性が示唆された．

Purpose: Accurate right atrial volume (RAV) assessment can be achieved by 3-dimensional echocardiography (3DE). However, 3DE has the disadvantage of requiring a complicated and time consuming post-processing analysis. The aims of this study were to compare the 3DE and 2-dimensional (2DE) RAV measurements and to explore the possible applications of the optimal 2DE derived RAV (2D-RAV) measurement technique.

Subjects and Methods: We studied 57 patients who underwent both 2DE and 3DE. The RA maximum view (RA-Max) was defined as the section with the maximum RA short diameter. The RA minimum view (RA-Min) was defined as the section with the minimum RA short diameter. 2D-RAVs were obtained by the following techniques: 1) the biplane area-length technique using the above two sections (Bi-AL); 2) the biplane disk summation technique using the above two sections (Bi-DS); 3) the single-plane area-length technique using RA-Max (Max-Si-AL); 4) the single-plane disk summation technique using RA-Max (Max-Si-DS); 5) the single-plane area-length technique using RA-Min (Min-Si-AL); and 6) the single-plane disk summation technique using RA-Min (Min-Si-DS). We compared each 2D-RAV with the 3D-derived RAV (3D-RAV), and assessed agreement between the 2D-RAV and 3D-RAV by a Bland-Altman plot.

Results: We found a good correlation between each 2D-RAV and 3D-RAV (Bi-AL, r＝0.99; Bi-DS, r＝0.99; Max-Si-AL, r＝0.88; Max-Si-DS, r＝0.87; Min-SI-AL, r＝0.95; Min-Si-DS, r＝0.93. p＜0.01 for all). The Bland-Altman plot showed that the biplane technique closely correlated with 3D-RAV, but the single-plane technique using RA-Max resulted in an overestimation, and the RA-Min resulted in an underestimation (bias (limits of agreement, LOA): Bi-AL, 0.8 ml (LOA: −6.5 to 8.0 ml); Bi-DS, 2.9 ml (LOA: −12.8 to 7.0 ml); Max-Si-AL, 20.2 ml (LOA: −7.7 to 48.1 ml); Max-Si-DS, 15.1 ml (LOA: −14.2 to 4.4 ml); Min-Si-AL, −13.6 ml (LOA: −31.5 to 4.3 ml); Min-Si-DS, −14.8 ml (LOA: −35.6 to 6.1 ml)).

Conclusion: The results we obtained by the Bi-AL using RA-Max and RA-Min were closely correlated with the results by the 3D-RAV; this suggests that the Bi-AL RAV assessment is the optimal 2D-RAV measurement technique.

Key words: right atrial volume; two-dimensional echocardiography; three-dimensional echocardiography; measurement technique; right atrial structure

© 2018 一般社団法人日本超音波検査学会© 2018 Japanese Society of Sonographers

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