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Near-field (NF) clutter in echocardiography is depicted as a diffuse haze hindering the visualization of the myocardium and the blood-pool, thereby degrading its diagnostic value. Several clutter filters have been developed, which are limited in patients with contraction motion and rhythm anomalies, and in 3-D ultrasound (US). This study introduces a new NF clutter reduction method, which preserves US speckles required for strain imaging. The filter developed detects the NF clutter region in the spatial frequency domain. The filter employs an oriented, multiscale approach, and assumes the NF clutter to be predominantly present in the highest and lowest bandpass images. These bandpass images were filtered, whilst sparing features in the myocardium and NF clutter-free regions. The performance of the filter was assessed in a volunteer study, in ten 3-D apical and parasternal view acquisitions, and in a retrospective clinical study composed of 20 cardiac patients with different indications for echocardiography. The filter reduced NF clutter in all data sets, whilst preserving all or most of the myocardium. Additionally, it demonstrated a consistent enhancement of image quality, with an increase in contrast of 4.3 dB on average, and generated a clearer myocardial boundary distinction. Furthermore, the speckles were preserved according to the quality index based on local variance, the structural similarity index method, and normalized cross correlation values, being 0.82, 0.92, and 0.95 on average, respectively. Global longitudinal strain measurements on NF clutter reduced images were improved or equivalent compared to the original acquisitions, with an average increase in strain signal-to-noise ratio of 34%.

A Spatial Near-Field Clutter Reduction Filter Preserving Tissue Speckle in Echocardiography