1. Bruce A Bollen, MD Stan Shernan, MD
Introduction to Philips 3D Matrix Multiplanar Reconstruction (MPR) Views
Bruce A Bollen, MD
Stan Shernan, MD

2. Advanced Echo Workshop March 23-27, 2015 SCA Echo Week – Atlanta, GA

3. Philips 3D Matrix
Philips 3D Matrix data sets are obtained by obtaining multiple “voxel” echo sets stored as one 3D matrix image. (3D Full Volume, 3D Zoom, 3D live) . Frame rate and resolution of these images vary and will not be covered here.

6. Philips developed a way to “look inside” and study the data within these 3D Matrix “cubes “ of data.
Crop Box: slicing into the matrix cube yet still seeing 3D image remaining
MPR (multiplanar reconstruction) views. The MPR view provides a screen divided into 4 quadrants, each with a different “view “ of the data in the 3D Matrix cube. Usually 3 different 2D slices and 4th frame for orientation.
This tutorial will focus on the MPR format
Dr. Bollen/Dr.Shernan 2012

7. Familiarity with the MPR format is helpful to utilize the Philips 3DQ, 3DQ Advance and MVQ Analysis package. They all use the MPR format and controls to manipulate the images to begin doing measurements.

8. What are the MPR Screens?

9. The MPR Screen
The MPR Screen gives the examiner access to four (4) individual sections from the matrix data set.
The four screens in the view have been set up similar to how the 3DQ Advanced and MVQ programs want the image arranged to do their analysis.
We will focus on this orientation for now.

10. MPR has 4 screen (quadrants):
Three 2D Multiplane Reconstruction Views: Blue, Green and Red
One Screen (lower right hand corner screen) that can show
Basic
3D Volume View
Slice Plane View
Advanced
The i Slice view
Yellow MPR View

12. The next MPR screen has been set up in 4 screen quadrants:
3D Volume Screen (lower right hand screen): In this example this screen has been set up to show the 3D Volume view showing how the Blue, Green and Red Slice Planes slice through the 3D Matrix Data set.
Blue Slice Plane (lower left hand screen): shows 2D view of blue slice plane slicing through the 3D Volume Screen ( lower right hand screen) as setup.
Blue Slice Plane is set up to move along “apical/basal vertical axis” through the mitral annulus.
Green Slice Plane (upper left hand screen): Shows 2D view of Green Slice Plane slicing through the 3D Volume Screen (lower right hand screen)
Green Slice Plane is set up to move along the “transverse mitral annular plane” axis.
Red Slice Plane (upper right hand screen): Shows 2D view of the red slice plane going through the 3D Volume Screen (lower right hand screen).
Red Slice Plane is setup to be moved along the “anterior posterior axis” of the mitral valve annulus.

14. Orientate to the MPR screen
Start with the 3D Volume View in the lower right hand quadrant of the MPR.
This view shows the 3D Volume cube image with the Blue, Green and Red Planes transecting (slicing) the 3D Volume. 3D Volume view has been set up to show the enfosse view of mitral valve, looking down from left atrium.
Note: The 2D images in the Blue, Green and Red Screens correspond to the region the corresponding planes are transecting (slicing) the 3D Volume!

16. MPR Plane orientation slant lines

17. Before proceeding, orientate yourself to each Colored Plane orientation slant lines.
This “slant line” is present at one of the four corners of each colored plane.
It orientates the viewer via the 3D Volume Screen and the Colored Slice screens as to the plane slice orientation.

18. Note the Blue slant line circled in each quadrant of the MPR screen.

20. Note the Green slant line circled in each quadrant of the MPR screen.

22. Note the Red slant line circled in each quadrant of the MPR screen.

24. Blue MPR Screen

25. The Blue MPR Plane (lower left quadrant) gives the 2D Blue Slice plane going through the 3D Volume . Here it is set just above the mitral annulus level.
Note:
In Red MPR see Blue Plane line orientation at mitral annulus.
In Green MPR see blue plane at Mitral annulus.

28. Note in the Blue plane MPR we see the region just above the mitral annulus.
Blue plane slant positioned anterolaterally
Red plane line crossing anterior to posterior.
Red slant line positioned anteriorly
Green plane line crossing laterally to medially .
Green slant positioned laterally

29. Using the MPR plane controls we can adjust the level at which the blue plane “slices” the 3D Volume set.
Here the blue plane slice has been adjusted to being at the level of the LVOT.

31. Here the blue plane slice has been adjusted to the mid-papillary level.

33. After focusing on the Blue MPR Screen now look at :
Green MPR screen: examine level of blue plane line in this screen
Red MPR screen: examine level of blue plane line in this screen.
3D Volume screen: examine level of blue plane line in this screen.

35. Important Caveat!
When determining position of red or green plane crossing mitral annulus, best to look at blue MPR screen at mitral annular level.
3D Volume MPR screen enfosse view of planes is misleading as see top of red or green planes (in left atrium), not where they transect mitral annulus.

36. Green MPR Screen

37. Focusing on the Green plane MPR

40. The Green MPR Plane (upper left quadrant) gives the 2D Green Slice plane going through the 3D Volume.

41. It is important to note, that as we have oriented this image, the Green plane looks like a ASE/SCA 2D Midcomm image. It is not. Screen left is antero-lateral. Screen right is postero-medial .

43. Compare these two images:
Green plane MPR m orientation
ASE/SCA 2D mid comm view.

45. PM AL
Dr. Bollen/Dr.Shernan 2012

47. Returning to the Green MPR mode screen.
Note:
Blue plane line crossing the screen.
Red plane line crossing the screen.

48. Look at both the MPR green and blue screens.
You get the feel of where the green plane is transversing the mitral annulus.

50. Red MPR Screen

51. Now to the red MPR screen.
Notice the anteriorly oriented Red MPR slant line.

54. In the Red MPR plane , orientate yourself to the Blue plane line and green plane line.
Then orientate yourself to the red plane line in the Blue, Green and 3D Volume MPR screen.