3D/4D in Radiology

Rodney L. Fernan MD,FPCR,FUSP

Section Chief Ultrasound Imaging
Cardinal Santos Medical Center
Manila , Philippines
 3D/4D Timeline
VOCAL
Static 3D Multi-planar 3D/4D Institute RealTime 4D
1990 imaging 1995 Live 3D 4 vol / sec 2000

Acquisition time: 20 min 2-3 sec 16 vol / sec

XBeamCRI & VCI in 3D

STIC PD & CFM Contrast Imaging
VCI-A Micro 4D Transducers B-Flow in 3D SRI II
VCI-C 4D View with STIC Inversion Mode TUI HD Flow
STIC 2003 2004 2005 New Magic cut

25 vol / sec 33 vol / sec 40 vol / sec

Obstetrics
 Clinical Advantages Obstetrics
• Fetal biopsy (4D): Ex: umbilical blood sampling
punction with precision, amniocentesis, kidney
dilatation, uropathy
• Fetal well being (4D): Ex: What are the normal
fetal gestures, to understand what are the abnormal
ones. Evaluation of fetal sleepiness vs awakening.
Motion of all sorts: deglutition, respiratory motion,
eyelid, limbs and mouth motion, fetal digestive
peristaltic motion = the ultrasound manning score.
• Fetal Neuro-Myopathy Genetic Disease (4D):
Ex: fetal reactivity / Tonicity
In fetal evaluation
• Morphology, malformation, agenesis (3D,
easier in 4D)
• Bone shape abnormalities: Ex: spina bifida,
hemivertebra, dwarfism, hypoplasia
• Skeletal dysplasia, joint abnormalities in
dynamic (4D): Ex: investigation of spine
• Fetal heart (4D): Ex: valve motion, big vessel crossing,
heart cavities volume evaluation, atrial and ventricular
communication, septal defect
• Fetal volume evaluation of all sorts: Ex: urinary
bladder, stomach, cyst
Gynecology
Clinical Advantages of
3D/4D in Gynecology
• Endometrial hyperplasia exact volume
measurement (3D/4D):
• More accurate hysterosonography
realization(3D/4D):
• Exact measurement of cysts (post-
menopausal) / polyps / myoma:
• Ovarian and endometrial tumors exact
location and measurement:
• Gynecological tumor monitoring after
treatment (chemotherapy) - effectiveness.
• IUD exact positioning
General Radiology Imaging
Breast Imaging
Clinical Advantages of
3D/4D in Medicine or Radiology
• Precise evaluation of acute abdomen (3D, C-
plane): gallbladder disease,
ascites/hemoperitoneum, appendicitis,
Crohn‘s disease, endometriosis.
• Accurate 4D biopsy (liver, kidney etc.)
• Perfect evaluation of parenchymal tumor
volumes
• Colonic polyps (>to 11 mm) localization in
the recto-sigmoidal section (3D, C-plane),
colonic tumor infiltration within the wall.
Applications in Radiology
• Urolithiasis localization during renal colic (3D, C-
plan)
• Contrast media use in hepatic or liver tumors
• Perfect evaluation in 3D of the cholecystitis (wall
thickness evaluation, cholelithiasis well seen in 3D
• Abdominal tumor volume, follow-up and monitoring
in 3D
• 3D/4D tumor characterization and vascularization
before chemoembolization/ablation
• 3D/4D biliary duct obstruction
Clinical Advantages of
RealTime 4D
• Accurate 4D biopsy

• Breast Tumor Volume Evaluation

• Breast Tumor Treatment Monitoring
(Chemotherapy)
• Skin tumoral infiltration evaluation

• Contrast Media use on breast tumors (4D)

Prostate BetaView
Speckle Reduction Imaging
Enhancement of
object boundaries and
small physiological
features

Reduction of noise
and speckle in
homogenous regions
Speckle Reduction Imaging
Enhancement of
object boundaries and
small physiological
features

Reduction of noise
and speckle in
homogenous regions
Compound Resolution Imaging

• Application in
• Radiology: thyroid , lymph nodes ,breast
lesion ( early detection)
• Musculoskeletal: shoulder , knee , tendons
• Urology: kidney , ureters, urinary bladder,
prostate, seminal vesicles, testes
• Peripheral vascular: vessel , vessel walls
 CrossXBeam CRI
Spatial compounding acquisition technique
for enhancing tissue and
border differentiation

CRI acquires images up to 11 different

beam steering directions
Enhanced contrast resolution with better
tissue differentiation and clear organ
borders.
• Speckle averages
• Borders enhance

+ + =

Left Steer Right Steer No Steer Compounded

 CRI

off on
 CRI

off on
3D Breast with CRI & SRI II
CRI

Improved
appearance of
physiological
structures

Enhanced contrast
through reduction
of speckle and noise
3D Breast with CRI & SRI
SRI II & CRI
Enhancement of object
boundaries and small
physiological features

Reduction of noise and

speckle in homogenous
regions
Extended field of view
XTD View
Real-Time operation
Integrated measurement capability in B-Mode
XTD View Arm
 VOlumeCALculation
• Vocal is a program for automated volume
measurement and quantitative evaluation
of blood supply.
• Important task in tumor therapy. Evaluate
the exact volume of lesion for therapy
planning. Follow up examination to
improve the desired success.
• Application: Any volume measurements of
organs and tissue structures.
• Therapy planning and follow-up control in cancer
treatment.
• Faster, more accurate volume calculations
– Quick fingertip tracing of ROI
– Contour detection
– Computer-aided volume analysis
– Broad range of applications
• Obstetrics
• Gynecology
• Pediatrics
• Oncology
VOCAL II
VOCAL II
 3D Power Doppler

• By combining information received from

power Doppler and tissue you can
perfectly analyze the vascularization of the
region of interest.

• This feature gives you the possibility to

improve the ultrasound evaluation of the
vascularization of any lesion.
3D Rendering
3D GlassBody Rendering
4D Testicular
 Acquisition
Render Mode
 Acquisition
Render Mode
Application on Liver
2D Gallbladder
Application in Gallbladder
Abscess
RealTime 4D Biopsy
4D Breast
Breast Biopsy
4D Abd biopsy
 4D Prostate
Multi planer view
 STIC
(Spatial Temporal Image Correlation)
 Inversion Mode

• Visualization of hypoechoic structures which are

difficult or impossible to display with conventional
Ultrasound techniques.

• Intelligent rendering algorithms analyze the target

3D Volume, displaying hypoechoic structures in a
clear inverted surface rendered display, while
simultanously removing information from the
surrounding tissue.
 Application
• OB/Gyn :
• Fetal heart, brain, lung, stomach, bladder, kidneys,
follicles, Gest. Sac, cysts, Uterine cavity during
Sonohysterography
• Pediatrics:
• Brain, heart, stomach, bladder, kidney
• Breast/Oncology:
• Cystic or hypoechoic structures
• Clinical Value:
• Volume Calculation, Visualization and qualitative
assessment of anatomy
 Inversion Mode

Visualization of hypoechoic
structures which are difficult or
Fetal brain - Hydrocephalus
impossible to display with
conventional Ultrasound techniques.

Intelligent rendering algorithms

analyze the target 3D Volume,
displaying hypoechoic structures in
a clear inverted surface rendered
display, while simultanously
removing information from the
surrounding tissue.
Inversion Mode
 High Definition Flow
A newly developed way of
displaying flow information
enhancing display quality in
sensitive vascular studies.
Combines the advantages of
conventional technologies.
Available on all transducers
Can combine with other
features like Static 3D,
HD Zoom and CrossXBeamCRI

Fetal liver, pulmonary veins and placental

vascularization
HD Flow with MagiCut
RealTime 4D Biopsy
Either free-hand or guided biopsies can be
performed in real-time 4D mode. The system
displays multi-planar slices
and a rendered view of the lesion and
the needle.
Thus a perfect control of the needle in all directions
is guaranteed.
Tomographic Ultrasound Imaging

• Makes analysis and documenting of dynamic

studies easier by providing a simultaneous view
of multiple slices of a volume data set.
– Top left held as reference image
– Adjustable slice thickness
 TUI
(Tomographic Ultrasound Imaging)
 TUI
Tomographic Ultrasound Imaging
Combination Modes STIC w/ TUI
4D View
 Utilization of Four
Dimensional Ultrasound in
the Detection of
Neoplastic Liver Mass
IA Lapus, DA Payawal, RL Fernan, RR Reyes, JP Gonzales
Cardinal Santos Medical Center
Metro Manila, Philippines
 Significant advances have been recently
introduced into various fields of
medical technology
Could 4D-US be utilized as a diagnostic
tool in the detection of liver mass?
 OBJECTIVE

To determine the sensitivity and specificity as well the

likelihood ratio of 4D-Ultrasound in comparison to 2-D
Ultrasound and MRI in the detection of neoplastic liver
mass

2D ultrasound ?

4D ultrasound ?

MRI ?
 METHODOLOGY

2D-US
2D-US
Liver
LiverMass/Suspicious
Mass/SuspiciousLiver
LiverMass
Mass
Prospective 1 year study

Blinded

4D-US
4D-US MRI
MRI
GE
GEVoluson
Voluson730
730Expert
Expert High
HighField
FieldTesla
Teslawith
with
Diamond
Diamond Gadolinium
Gadoliniumenhancement
enhancement

Ultrasound
UltrasoundGuided
GuidedLiver
Liver Biopsy
Biopsy

Analysis
Analysis
 METHODOLOGY

Descriptions for Neoplastic Tumor of the Liver

2D-US 4D-US MRI

• Focal solid lesions • Solid lesion • Homogenous,

• Homogenous or • Irregular Heterogeneous or ring
heterogeneous heterogeneous mass enhancement on
hypoechoic lesion • Intralesional hepatic arterial
• Heterogeneous vascular involvement phase
hyperechoic lesion • Hyperintensity on T2
• Target lesion weighted images
• Lesion with internal • Bulls-eye lesion
color Doppler flow
RESULTS

4-D US finding of Hepatocellular carcinoma with

vascular involvement
4-D US finding of HCC with 2-D US and MRI correlation
 CONCLUSION

4D-ultrasound is superior to 2D-ultrasound in

the detection of neoplastic liver mass

4D-ultrasound is comparable with MRI in the

detection of neoplastic liver mass