Active vegetations can be differentiated from chronic vegetations by visual inspection of standardized two-dimensional echocardiograms

The ability to differentiate active from chronic valvular vegetations (VEGs ) by digital image processing and by visual observation. was evaluated in 1 8 patients with a clinical diagnosis of infective endocarditis (IE). Two-di mensional echocardiographic (2-DE) examinations were performed on all patie nts at diagnosis and after a mean. period of 52 days. Two comparable images (active and chronic) from the same patient and in the same phase of the ca rdiac cycle were digitized, magnified, and displayed on a high resolution m onitor. The mean, pixel intensity (MPI) was 72 +/- 14 in the active stage a nd 143 +/- 23 in the chronic stage (P < 0.0001). The VEG size teas 0.64 +/- 0.15 cm(2) in, the active stage and decreased to 0.46 +/- 0.17 cm(2) in th e chronic stage (P < 0.001). Two experienced echocardiographers, who were b linded to the age of the VEGs, identified each echocardiographic image as a ctive or chronic based on visual observation of density of the VEGs. The VE Gs were correctly identified as active or chronic in 17 out of the 18 patie nts. In summary, although digital image processing of 2-DE may be useful, t he density of VEGs assessed by visual inspection will help differentiate be tween active and chronic VEGs of IE. The standardization procedure at the t ime of the initial study and use of identical gain settings in subsequent s tudies are hey factors in making this distinction.