Email updates

Keep up to date with the latest news and content from Cardiovascular Ultrasound and BioMed Central.

Open Access Technical notes

Quantification of echodensities in tuberculous pericardial effusion using fractal geometry: a proof of concept study

Mpiko Ntsekhe1, Bongani M Mayosi1* and Tawanda Gumbo23

Author Affiliations

1 Department of Medicine, The Cardiac Clinic, Groote Schuur Hospital and University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa

2 Office of Global Health, University of Texas Southwestern Medical Centre, Dallas, TX, USA

3 Department of Medicine, University of Texas Southwestern Medical Centre, Dallas, TX, USA

For all author emails, please log on.

Cardiovascular Ultrasound 2012, 10:30  doi:10.1186/1476-7120-10-30

Published: 28 July 2012

Abstract

Background

The purpose of this study was to quantify the heterogeneous distribution of echodensities in the pericardial fluid of patients with tuberculous pericarditis using echocardiography and fractal analysis, and to determine whether there were differences in the fractal dimensions of effusive-constrictive and effusive non-constrictive disease.

Methods

We used fractal geometry to quantify the echocardiographic densities in patients who were enrolled in the Investigation of the Management of Pericarditis in Africa (IMPI Africa) Registry. Sub-costal and four chamber images were included in the analysis if a minimum of two clearly identified fibrin strands were present and the quality of the images were of a standard which allowed for accurate measurement of the fractal dimension. The fractal dimension was calculated as follows: Df = limlog N(s)/[log (l/s)], where Df is the box counting fractal dimension of the fibrin strand, s is the side length of the box and N(s) is the smallest number of boxes of side length s to cover the outline of the object being measured. We compared the fractal dimension of echocardiographic findings in patients with effusive constrictive pericarditis to effusive non-constrictive pericardial effusion using the non-parametric Mann–Whitney test.

Results

Of the 14 echocardiographs from 14 participants that were selected for the study, 42.8% (6/14) of images were subcostal views while 57.1% (8/14) were 4-chamber views. Eight of the patients had tuberculous effusive constrictive pericarditis while 6 had tuberculous effusive non-constrictive pericarditis. The mean fractal dimension Df was 1.325 with a standard deviation (SD) of 0.146. The measured fibrin strand dimension exceeded the topological dimension in all the images over the entire range of grid scales with a correlation coefficient (r2) greater than 0.8 in the majority. The fractal dimension of echodensities was 1.359 ± 0.199 in effusive constrictive pericarditis compared to 1.330 ± 0.166 in effusive non-constrictive pericarditis (p = 0.595).

Conclusions

The echocardiographic densities in tuberculous pericardial effusion have a fractal geometrical dimension which is similar in pure effusive and effusive constrictive disease.

Keywords:
Pericardial effusion; Tuberculosis; Fractal dimension; Effusive constrictive pericarditis; Effusive non-constrictive pericarditis