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Alkassar M, Engelhardt S, Abu-Tair T, Ojeda E, Treffer PC, Weyand M, Rompel O. Comparative Study of 2D-Cine and 3D-wh Volumetry: Revealing Systemic Error of 2D-Cine Volumetry. Diagnostics (Basel) 2023; 13:3162. [PMID: 37891983 PMCID: PMC10605840 DOI: 10.3390/diagnostics13203162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/28/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
This study investigates the crucial factors influencing the end-systolic and end-diastolic volumes in MRI volumetry and their direct effects on the derived functional parameters. Through the simultaneous acquisition of 2D-cine and 3D whole-heart slices in end-diastole and end-systole, we present a novel direct comparison of the volumetric measurements from both methods. A prospective study was conducted with 18 healthy participants. Both 2D-cine and 3D whole-heart sequences were obtained. Despite the differences in the creation of 3D volumes and trigger points, the impact on the LV volume was minimal (134.9 mL ± 16.9 mL vs. 136.6 mL ± 16.6 mL, p < 0.01 for end-diastole; 50.6 mL ± 11.0 mL vs. 51.6 mL ± 11.2 mL, p = 0.03 for end-systole). In our healthy patient cohort, a systematic underestimation of the end-systolic volume resulted in a significant overestimation of the SV (5.6 mL ± 2.6 mL, p < 0.01). The functional calculations from the 3D whole-heart method proved to be highly accurate and correlated well with function measurements from the phase-contrast sequences. Our study is the first to demonstrate the superiority of 3D whole-heart volumetry over 2D-cine volumetry and sheds light on the systematic error inherent in 2D-cine measurements.
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Affiliation(s)
- Muhnnad Alkassar
- Department of Cardiac Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (S.E.); (M.W.)
- Department of Pediatrics, Paracelsus Medical School, General Hospital of Nuremberg, 90419 Nuremberg, Germany
| | - Sophia Engelhardt
- Department of Cardiac Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (S.E.); (M.W.)
| | - Tariq Abu-Tair
- Department of Congenital Heart Disease, Centre for Diseases in Childhood and Adolescence, University Medicine Mainz, 55131 Mainz, Germany;
| | - Efren Ojeda
- Siemens Healtineers, 91052 Erlangen, Germany; (E.O.); (P.C.T.)
| | | | - Michael Weyand
- Department of Cardiac Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (S.E.); (M.W.)
| | - Oliver Rompel
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany;
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2
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van der Ven JPG, van Genuchten W, Sadighy Z, Valsangiacomo Buechel ER, Sarikouch S, Boersma E, Helbing WA. Multivendor Evaluation of Automated MRI Postprocessing of Biventricular Size and Function for Children With and Without Congenital Heart Defects. J Magn Reson Imaging 2023; 58:794-804. [PMID: 36573004 DOI: 10.1002/jmri.28568] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/05/2022] [Accepted: 12/05/2022] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Manually segmenting cardiac structures is time-consuming and produces variability in MRI assessments. Automated segmentation could solve this. However, current software is developed for adults without congenital heart defects (CHD). PURPOSE To evaluate automated segmentation of left ventricle (LV) and right ventricle (RV) for pediatric MRI studies. STUDY TYPE Retrospective comparative study. POPULATION Twenty children per group of: healthy children, LV-CHD, tetralogy of Fallot (ToF), and univentricular CHD, aged 11.7 [8.9-16.0], 14.2 [10.6-15.7], 14.6 [11.6-16.4], and 12.2 [10.2-14.9] years, respectively. SEQUENCE/FIELD STRENGTH Balanced steady-state free precession at 1.5 T. ASSESSMENT Biventricular volumes and masses were calculated from a short-axis stack of images, which were segmented manually and using two fully automated software suites (Medis Suite 3.2, Medis, Leiden, the Netherlands and SuiteHeart 5.0, Neosoft LLC, Pewaukee, USA). Fully automated segmentations were manually adjusted to provide two further sets of segmentations. Fully automated and adjusted automated segmentation were compared to manual segmentation. Segmentation times and reproducibility for each method were assessed. STATISTICAL TESTS Bland Altman analysis and intraclass correlation coefficients (ICC) were used to compare volumes and masses between methods. Postprocessing times were compared by paired t-tests. RESULTS Fully automated methods provided good segmentation (ICC > 0.90 compared to manual segmentation) for the LV in the healthy and left-sided CHD groups (eg LV-EDV difference for healthy children 1.4 ± 11.5 mL, ICC: 0.97, for Medis and 3.0 ± 12.2 mL, ICC: 0.96 for SuiteHeart). Both automated methods gave larger errors (ICC: 0.62-0.94) for the RV in these populations, and for all structures in the ToF and univentricular CHD groups. Adjusted automated segmentation agreed well with manual segmentation (ICC: 0.71-1.00), improved reproducibility and reduced segmentation time in all patient groups, compared to manual segmentation. DATA CONCLUSION Fully automated segmentation eliminates observer variability but may produce large errors compared to manual segmentation. Manual adjustments reduce these errors, improve reproducibility, and reduce postprocessing times compared to manual segmentation. Adjusted automated segmentation is reasonable in children with and without CHD. EVIDENCE LEVEL 3. TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Jelle P G van der Ven
- Department of Pediatrics, Division of Cardiology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
- Netherlands Heart Institute, Utrecht, the Netherlands
| | - Wouter van Genuchten
- Department of Pediatrics, Division of Cardiology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
- Netherlands Heart Institute, Utrecht, the Netherlands
| | - Zaheda Sadighy
- Department of Pediatrics, Division of Cardiology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
| | | | - Samir Sarikouch
- Department of Heart, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Eric Boersma
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Willem A Helbing
- Department of Pediatrics, Division of Cardiology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
- Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
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3
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Geerdink LM, van Everdingen WM, Kuipers IM, Fejzic Z, du Marchie Sarvaas GJ, Frerich S, Ter Heide H, Helbing WA, de Korte CL, Habets J, Kapusta L. Comprehensive Evaluation of Pediatric Patients with Ebstein Anomaly Requires Both Echocardiography and Cardiac Magnetic Resonance Imaging. Pediatr Cardiol 2023; 44:75-85. [PMID: 35727332 PMCID: PMC9852135 DOI: 10.1007/s00246-022-02948-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/31/2022] [Indexed: 01/26/2023]
Abstract
With the trend towards childhood surgery in patients with Ebstein anomaly (EA), thorough imaging is crucial for patient selection. This study aimed to assess biventricular function by echocardiography and cardiac magnetic resonance (CMR) and compare EA severity classifications. Twenty-three patients (8-17 years) underwent echocardiography and CMR. Echocardiographic parameters included tricuspid annular plane systolic excursions (TAPSE), fractional area change of the functional right ventricle (fRV-FAC), fRV free wall peak systolic myocardial velocity (fRVs'), and tricuspid regurgitation (TR). End-diastolic and end-systolic volume (EDV resp. ESV), fRV- and LV ejection fraction (EF) and TR were obtained by CMR. EA severity classifications included displacement index, Celermajer index and the total-right/left-volume index. Median fRV-FAC was 38% (IQR 33-42). TAPSE and fRVs' were reduced in 39% and 75% of the patients, respectively. Echocardiographic TR was visually graded as mild, moderate, or severe in nine, six and eight patients, respectively. By CMR, median fRVEF was 49% (IQR 36-58) and TR was graded as mild, moderate, or severe in nine, twelve and two patients, respectively. In 70% of cases, fRV-EDV was higher than LV-EDV. LVEF was decreased in 17 cases (74%). There was excellent correlation between echocardiography-derived fRV-FAC and CMR-derived fRVEF (rho = 0.812, p < 0.001). While echocardiography is a versatile tool in the complex geometry of the Ebstein heart, it has limitations. CMR offers a total overview and has the advantage of reliable volume assessment of both ventricles. Comprehensive evaluation of pediatric patients with EA may therefore require a synergistic implementation of echocardiography and CMR.
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Affiliation(s)
- Lianne M Geerdink
- Department of Pediatric Cardiology, Amalia Children's Hospital, University Medical Center Nijmegen, Nijmegen, 6525GA, The Netherlands
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, 3584EA, The Netherlands
| | - Wouter M van Everdingen
- Department of Medical Imaging, University Medical Center Nijmegen, Geert Grooteplein Zuid 10, Nijmegen, 6525GA, The Netherlands.
| | - Irene M Kuipers
- Department of Pediatric Cardiology, Amsterdam University Medical Center, Amsterdam, 1105AZ, The Netherlands
| | - Zina Fejzic
- Department of Pediatric Cardiology, Amalia Children's Hospital, University Medical Center Nijmegen, Nijmegen, 6525GA, The Netherlands
| | - Gideon J du Marchie Sarvaas
- Center for Congenital Heart Diseases, University Medical Center Groningen, Groningen, 9713GZ, The Netherlands
| | - Stefan Frerich
- Department of Pediatric Cardiology, Maastricht University Medical Center, Maastricht, 6229HX, The Netherlands
| | - Henriëtte Ter Heide
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, 3584EA, The Netherlands
| | - Willem A Helbing
- Department of Pediatric Cardiology, Amalia Children's Hospital, University Medical Center Nijmegen, Nijmegen, 6525GA, The Netherlands
- Department of Pediatric Cardiology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, 3015GD, The Netherlands
| | - Chris L de Korte
- Department of Medical Imaging, University Medical Center Nijmegen, Geert Grooteplein Zuid 10, Nijmegen, 6525GA, The Netherlands
- Medical Ultrasound Imaging Center, Department of Medical Imaging, University Medical Center Nijmegen, Nijmegen, 6525GA, The Netherlands
| | - Jesse Habets
- Department of Medical Imaging, University Medical Center Nijmegen, Geert Grooteplein Zuid 10, Nijmegen, 6525GA, The Netherlands
| | - Livia Kapusta
- Department of Pediatric Cardiology, Amalia Children's Hospital, University Medical Center Nijmegen, Nijmegen, 6525GA, The Netherlands
- Pediatric Cardiology Unit, Department of Pediatrics, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University, 6423906, Tel Aviv, Israel
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4
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Schwaiger JP, Reinstadler SJ, Holzknecht M, Tiller C, Reindl M, Begle J, Lechner I, Lamina C, Mayr A, Graziadei I, Bauer A, Metzler B, Klug G. Prognostic value of depressed cardiac index after STEMI: a phase-contrast magnetic resonance study. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2021; 11:53-61. [PMID: 34750623 DOI: 10.1093/ehjacc/zuab098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/14/2021] [Accepted: 10/18/2021] [Indexed: 11/15/2022]
Abstract
AIMS An invasively measured cardiac index (CI) of ≤2.2 L/min/m2 is one of the strongest prognostic indicators after ST-elevation myocardial infarction (STEMI), however, knowledge is mainly based on invasive evaluations performed in the pre-stent era. Velocity-encoded phase-contrast cardiac magnetic resonance (PC-CMR) allows non-invasive determination of CI. METHODS AND RESULTS In this prospective study, CMR was performed in 406 stable and contemporarily revascularized patients a median of 3 days after STEMI. Forward stroke volume was assessed at the level of the ascending aorta by PC-CMR. Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) were determined by cine CMR. Major adverse cardiac events (MACE) were defined as the composite of death, myocardial infarction, or hospitalization for heart failure. Median CI was 2.52 L/min/m2 and 27% of patients had ≤2.2 L/min/m2. Median LVEF was 53% and median GLS was -12.2%. During a median follow-up of 14.2 [95% confidence interval (95% CI) 13.6-14.7] months, 41 patients (10.1%) experienced a MACE. A depressed CI was significantly associated with MACE after adjustment for LVEF, GLS, Thrombolysis in Myocardial Infarction (TIMI) risk score, and infarct size [hazard ratio = 3.15 (95% CI 1.53-6.47); P = 0.002] and led to significant discrimination improvement [net reclassification improvement 0.61 (95% CI 0.25-0.97); P < 0.001]. CONCLUSIONS A CI of 2.2 L/min/m2 or less as measured by PC-CMR was present in 27% of clinically stable patients after STEMI and strongly and independently predicted medium-term MACE. The prognostic value of a depressed CI was superior and incremental to LVEF, GLS, TIMI risk score, and infarct size.
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Affiliation(s)
- Johannes P Schwaiger
- Department of Internal Medicine, Academic Teaching Hospital Hall in Tirol, Milser Strasse 10, 6060 Hall in Tirol, Austria
| | - Sebastian J Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Magdalena Holzknecht
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Christina Tiller
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Jana Begle
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Ivan Lechner
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Claudia Lamina
- Department of Genetics and Pharmacology, Institute of Genetic Epidemiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Agnes Mayr
- Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Ivo Graziadei
- Department of Internal Medicine, Academic Teaching Hospital Hall in Tirol, Milser Strasse 10, 6060 Hall in Tirol, Austria
| | - Axel Bauer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Gert Klug
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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5
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van der Ven JPG, Sadighy Z, Valsangiacomo Buechel ER, Sarikouch S, Robbers-Visser D, Kellenberger CJ, Kaiser T, Beerbaum P, Boersma E, Helbing WA. Multicentre reference values for cardiac magnetic resonance imaging derived ventricular size and function for children aged 0-18 years. Eur Heart J Cardiovasc Imaging 2021; 21:102-113. [PMID: 31280290 PMCID: PMC6923680 DOI: 10.1093/ehjci/jez164] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/25/2019] [Accepted: 06/03/2019] [Indexed: 11/17/2022] Open
Abstract
Aims Cardiovascular magnetic resonance (CMR) imaging is an important tool in the assessment of paediatric cardiac disease. Reported reference values of ventricular volumes and masses in the paediatric population are based on small cohorts and several methodologic differences between studies exist. We sought to create steady-state free precession (SSFP) CMR reference values for biventricular volumes and mass by combining data of previously published studies and re-analysing these data in a standardized manner. Methods and results A total of 141 healthy children (68 boys) from three European centres underwent cine-SSFP CMR imaging. Cardiac structures were manually contoured for end-diastolic and end-systolic phases in the short-axis orientation according to current standardized CMR post-processing guidelines. Volumes and masses were derived from these contours. Age-related reference curves were constructed using the lambda mu sigma method. Median age was 12.7 years (range 0.6–18.5). We report biventricular volumes and masses, unindexed and indexed for body surface area, stratified by age groups. In general, boys had approximately 15% higher biventricular volumes and masses compared with girls. Only in children aged <6 years old no gender differences could be observed. Left ventricle ejection fraction was slightly higher in boys in this study population (median 67% vs. 65%, P = 0.016). Age-related reference curves showed non-linear relations between age and cardiac parameters. Conclusion We report volumetric SSFP CMR imaging reference values for children aged 0–18 years old in a relatively large multi-centre cohort. These references can be used in the follow-up of paediatric cardiac disease and for research purposes.
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Affiliation(s)
- J P G van der Ven
- Department of Pediatrics, Division of Cardiology, Erasmus University Medical Center-Sophia Children's Hospital, Doctor Molewaterplein 40, GD, Rotterdam, The Netherlands.,Netherlands Heart Institute, Moreelsepark 1, EP, Utrecht, The Netherlands
| | - Z Sadighy
- Department of Pediatrics, Division of Cardiology, Erasmus University Medical Center-Sophia Children's Hospital, Doctor Molewaterplein 40, GD, Rotterdam, The Netherlands
| | | | - S Sarikouch
- Department of Heart, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl Neuberg-Strasse 1, Hannover, Germany
| | - D Robbers-Visser
- Department of Cardiology, Amsterdam Medical Center, Postbus 22660, 1100 DD, Amsterdam, The Netherlands
| | - C J Kellenberger
- Department of Diagnostic Imaging, University Children's Hospital, Steinwiesstrasse 75, Zurich, Switzerland
| | - T Kaiser
- Pediatric Heart Centre, University Children's Hospital, Steinwiesstrasse 75, Zurich, Switzerland
| | - P Beerbaum
- Department of Pediatric Cardiology and Intensive Care, Hannover Medical School, Carl Neuberg-Strasse 1, Hannover, Germany
| | - E Boersma
- Department of Cardiology, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - W A Helbing
- Department of Pediatrics, Division of Cardiology, Erasmus University Medical Center-Sophia Children's Hospital, Doctor Molewaterplein 40, GD, Rotterdam, The Netherlands.,Department of Radiology, Erasmus University Medical Center, Sophia Children's Hospital, Doctor Molewaterplein 40, GD, Rotterdam, The Netherlands
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6
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Backhaus SJ, Schuster A, Lange T, Stehning C, Billing M, Lotz J, Pieske B, Hasenfuß G, Kelle S, Kowallick JT. Impact of fully automated assessment on interstudy reproducibility of biventricular volumes and function in cardiac magnetic resonance imaging. Sci Rep 2021; 11:11648. [PMID: 34078942 PMCID: PMC8172876 DOI: 10.1038/s41598-021-90702-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/17/2021] [Indexed: 11/10/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) imaging provides reliable assessments of biventricular morphology and function. Since manual post-processing is time-consuming and prone to observer variability, efforts have been directed towards novel artificial intelligence-based fully automated analyses. Hence, we sought to investigate the impact of artificial intelligence-based fully automated assessments on the inter-study variability of biventricular volumes and function. Eighteen participants (11 with normal, 3 with heart failure and preserved and 4 with reduced ejection fraction (EF)) underwent serial CMR imaging at in median 63 days (range 49–87) interval. Short axis cine stacks were acquired for the evaluation of left ventricular (LV) mass, LV and right ventricular (RV) end-diastolic, end-systolic and stroke volumes as well as EF. Assessments were performed manually (QMass, Medis Medical Imaging Systems, Leiden, Netherlands) by an experienced (3 years) and inexperienced reader (no active reporting, 45 min of training with five cases from the SCMR consensus data) as well as fully automated (suiteHEART, Neosoft, Pewaukee, WI, USA) without any manual corrections. Inter-study reproducibility was overall excellent with respect to LV volumetric indices, best for the experienced observer (intraclass correlation coefficient (ICC) > 0.98, coefficient of variation (CoV, < 9.6%) closely followed by automated analyses (ICC > 0.93, CoV < 12.4%) and lowest for the inexperienced observer (ICC > 0.86, CoV < 18.8%). Inter-study reproducibility of RV volumes was excellent for the experienced observer (ICC > 0.88, CoV < 10.7%) but considerably lower for automated and inexperienced manual analyses (ICC > 0.69 and > 0.46, CoV < 22.8% and < 28.7% respectively). In this cohort, fully automated analyses allowed reliable serial investigations of LV volumes with comparable inter-study reproducibility to manual analyses performed by an experienced CMR observer. In contrast, RV automated quantification with current algorithms still relied on manual post-processing for reliability.
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Affiliation(s)
- Sören J Backhaus
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Andreas Schuster
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Torben Lange
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | | | - Marcus Billing
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Joachim Lotz
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.,University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Burkert Pieske
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.,Department of Internal Medicine and Cardiology, Charité University Medicine, Campus Virchow Klinikum, Berlin, Germany.,German Heart Center Berlin, Berlin, Germany
| | - Gerd Hasenfuß
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Sebastian Kelle
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.,Department of Internal Medicine and Cardiology, Charité University Medicine, Campus Virchow Klinikum, Berlin, Germany.,German Heart Center Berlin, Berlin, Germany
| | - Johannes T Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany. .,University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
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7
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Impact of bi-planar localization of the tricuspid valve on the evaluation of right ventricular functional parameters in the short axis plane. Int J Cardiovasc Imaging 2020; 36:2255-2263. [DOI: 10.1007/s10554-020-01941-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
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8
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Diller GP, Vahle J, Radke R, Vidal MLB, Fischer AJ, Bauer UMM, Sarikouch S, Berger F, Beerbaum P, Baumgartner H, Orwat S. Utility of deep learning networks for the generation of artificial cardiac magnetic resonance images in congenital heart disease. BMC Med Imaging 2020; 20:113. [PMID: 33032536 PMCID: PMC7542728 DOI: 10.1186/s12880-020-00511-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/16/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Deep learning algorithms are increasingly used for automatic medical imaging analysis and cardiac chamber segmentation. Especially in congenital heart disease, obtaining a sufficient number of training images and data anonymity issues remain of concern. METHODS Progressive generative adversarial networks (PG-GAN) were trained on cardiac magnetic resonance imaging (MRI) frames from a nationwide prospective study to generate synthetic MRI frames. These synthetic frames were subsequently used to train segmentation networks (U-Net) and the quality of the synthetic training images, as well as the performance of the segmentation network was compared to U-Net-based solutions trained entirely on patient data. RESULTS Cardiac MRI data from 303 patients with Tetralogy of Fallot were used for PG-GAN training. Using this model, we generated 100,000 synthetic images with a resolution of 256 × 256 pixels in 4-chamber and 2-chamber views. All synthetic samples were classified as anatomically plausible by human observers. The segmentation performance of the U-Net trained on data from 42 separate patients was statistically significantly better compared to the PG-GAN based training in an external dataset of 50 patients, however, the actual difference in segmentation quality was negligible (< 1% in absolute terms for all models). CONCLUSION We demonstrate the utility of PG-GANs for generating large amounts of realistically looking cardiac MRI images even in rare cardiac conditions. The generated images are not subject to data anonymity and privacy concerns and can be shared freely between institutions. Training supervised deep learning segmentation networks on this synthetic data yielded similar results compared to direct training on original patient data.
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Affiliation(s)
- Gerhard-Paul Diller
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer Campus 1, Muenster, Germany.
- Competence Network for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), Berlin, Germany.
| | - Julius Vahle
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer Campus 1, Muenster, Germany
| | - Robert Radke
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer Campus 1, Muenster, Germany
| | - Maria Luisa Benesch Vidal
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer Campus 1, Muenster, Germany
| | - Alicia Jeanette Fischer
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer Campus 1, Muenster, Germany
| | - Ulrike M M Bauer
- Competence Network for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), Berlin, Germany
- National Register for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Samir Sarikouch
- Department of Heart-, Thoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Felix Berger
- Department of Congenital Heart Disease-Pediatric Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Philipp Beerbaum
- Department of Pediatric Cardiology and Pediatric Intensive Care, Hannover Medical School, Hannover, Germany
| | - Helmut Baumgartner
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer Campus 1, Muenster, Germany
| | - Stefan Orwat
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer Campus 1, Muenster, Germany
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Retson TA, Masutani EM, Golden D, Hsiao A. Clinical Performance and Role of Expert Supervision of Deep Learning for Cardiac Ventricular Volumetry: A Validation Study. Radiol Artif Intell 2020; 2:e190064. [PMID: 32797119 DOI: 10.1148/ryai.2020190064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 02/21/2020] [Accepted: 03/27/2020] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate the performance of a deep learning (DL) algorithm for clinical measurement of right and left ventricular volume and function across cardiac MR images obtained for a range of clinical indications and pathologies. Materials and Methods A retrospective, Health Insurance Portability and Accountability Act-compliant study was conducted using the first 200 noncongenital clinical cardiac MRI examinations from June 2015 to June 2017 for which volumetry was available. Images were analyzed using commercially available software for automated DL-based and manual contouring of biventricular volumes. Fully automated measurements were compared using Pearson correlations, relative volume errors, and Bland-Altman analyses. Manual, automated, and expert revised contours for 50 MR images were examined by comparing regional Dice coefficients at the base, midventricle, and apex to further analyze the contour quality. Results Fully automated and manual left ventricular volumes were strongly correlated for end-systolic volume (ESV: Pearson r = 0.99, P < .001), end-diastolic volume (EDV: r = 0.97, P < .001), and ejection fraction (EF: r = 0.94, P < .001). Right ventricular measurements were also correlated for ESV (r = 0.93, P < .001), EDV (r = 0.92, P < .001), and EF (r = 0.73, P < .001). Visual inspection of segmentation quality showed most errors (73%) occurred at the cardiac base. Mean Dice coefficients between manual, automated, and expert revised contours ranged from 0.92 to 0.95, with greatest variance at the base and apex. Conclusion Fully automated ventricular segmentation by the tested algorithm provides contours and ventricular volumes that could be used to aid expert segmentation, but can benefit from expert supervision, particularly to resolve errors at the basal and apical slices. Supplemental material is available for this article. © RSNA, 2020.
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Affiliation(s)
- Tara A Retson
- Department of Radiology, Altman Clinical and Translational Research Institute, University of California, San Diego, 9452 Medical Center Dr, 4th Floor, La Jolla, CA 92037 (T.A.R., A.H.); Department of Bioengineering, University of California San Diego School of Medicine, La Jolla, Calif (E.M.M.); and Arterys, San Francisco, Calif (D.G.)
| | - Evan M Masutani
- Department of Radiology, Altman Clinical and Translational Research Institute, University of California, San Diego, 9452 Medical Center Dr, 4th Floor, La Jolla, CA 92037 (T.A.R., A.H.); Department of Bioengineering, University of California San Diego School of Medicine, La Jolla, Calif (E.M.M.); and Arterys, San Francisco, Calif (D.G.)
| | - Daniel Golden
- Department of Radiology, Altman Clinical and Translational Research Institute, University of California, San Diego, 9452 Medical Center Dr, 4th Floor, La Jolla, CA 92037 (T.A.R., A.H.); Department of Bioengineering, University of California San Diego School of Medicine, La Jolla, Calif (E.M.M.); and Arterys, San Francisco, Calif (D.G.)
| | - Albert Hsiao
- Department of Radiology, Altman Clinical and Translational Research Institute, University of California, San Diego, 9452 Medical Center Dr, 4th Floor, La Jolla, CA 92037 (T.A.R., A.H.); Department of Bioengineering, University of California San Diego School of Medicine, La Jolla, Calif (E.M.M.); and Arterys, San Francisco, Calif (D.G.)
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10
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Buddhe S, Jani V, Sarikouch S, Gaur L, Schuster A, Beerbaum P, Lewin M, Kutty S. Differences in right ventricular-pulmonary vascular coupling and clinical indices between repaired standard tetralogy of Fallot and repaired tetralogy of Fallot with pulmonary atresia. Diagn Interv Imaging 2020; 102:85-91. [PMID: 32513548 DOI: 10.1016/j.diii.2020.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/20/2020] [Accepted: 05/23/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this study was to compare ventricular vascular coupling ratio (VVCR) between patients with repaired standard tetralogy of Fallot (TOF) and those with repaired TOF-pulmonary atresia (TOF-PA) using cardiovascular magnetic resonance (CMR). MATERIALS AND METHODS Patients with repaired TOF aged>6 years were prospectively enrolled for same day CMR, echocardiography, and exercise stress test following a standardized protocol. Sanz's method was used to calculate VVCR as right ventricle (RV) end-systolic volume/pulmonary artery stroke volume. Regression analysis was used to examine associations with exercise test parameters, New York Heart Association (NYHA) class, RV size and biventricular systolic function. RESULTS A total of 248 subjects were included; of these 222 had repaired TOF (group I, 129 males; mean age, 15.9±4.7 [SD] years [range: 8-29 years]) and 26 had repaired TOF-PA (group II, 14 males; mean age, 17.0±6.3 [SD] years [range: 8-29 years]). Mean VVCR for all subjects was 1.54±0.64 [SD] (range: 0.43-3.80). Mean VVCR was significantly greater in the TOF-PA group (1.81±0.75 [SD]; range: 0.78-3.20) than in the standard TOF group (1.51±0.72 [SD]; range: 0.43-3.80) (P=0.03). VVCR was greater in the 68 NYHA class II subjects (1.79±0.66 [SD]; range: 0.75-3.26) compared to the 179 NYHA class I subjects (1.46±0.61 [SD]; range: 0.43-3.80) (P<0.001). CONCLUSION Non-invasive determination of VVCR using CMR is feasible in children and adolescents. VVCR showed association with NYHA class, and was worse in subjects with repaired TOF-PA compared to those with repaired standard TOF. VVCR shows promise as an indicator of pulmonary artery compliance and cardiovascular performance in this cohort.
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Affiliation(s)
- S Buddhe
- Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, 91805 Seattle, WA, USA
| | - V Jani
- Blalock Taussig Thomas Heart Center, The Johns Hopkins Hospital and School of Medicine, 1800 Orleans St, 21287 Baltimore, MD, USA
| | - S Sarikouch
- Department of Heart- Thoracic- Transplantation- and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - L Gaur
- Blalock Taussig Thomas Heart Center, The Johns Hopkins Hospital and School of Medicine, 1800 Orleans St, 21287 Baltimore, MD, USA
| | - A Schuster
- Department of Cardiology and Pneumology, University of Goettingen School of Medicine, 37075 Göttingen, Germany
| | - P Beerbaum
- Department of Pediatric Cardiology and Pediatric Intensive Care, Hannover Medical School, Hannover Medical School, Hannover, Germany
| | - M Lewin
- Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, 91805 Seattle, WA, USA
| | - S Kutty
- Blalock Taussig Thomas Heart Center, The Johns Hopkins Hospital and School of Medicine, 1800 Orleans St, 21287 Baltimore, MD, USA.
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11
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Tran CT, Halicek M, Dormer JD, Tandon A, Hussain T, Fei B. Fully automated segmentation of the right ventricle in patients with repaired Tetralogy of Fallot using U-Net. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2020; 11317. [PMID: 32476706 DOI: 10.1117/12.2549052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Cardiac magnetic resonance (CMR) imaging is considered the standard imaging modality for volumetric analysis of the right ventricle (RV), an especially important practice in the evaluation of heart structure and function in patients with repaired Tetralogy of Fallot (rTOF). In clinical practice, however, this requires time-consuming manual delineation of the RV endocardium in multiple 2-dimensional (2D) slices at multiple phases of the cardiac cycle. In this work, we employed a U-Net based 2D convolutional neural network (CNN) classifier in the fully automatic segmentation of the RV blood pool. Our dataset was comprised of 5,729 short-axis cine CMR slices taken from 100 individuals with rTOF. Training of our CNN model was performed on images from 50 individuals while validation was performed on images from 10 individuals. Segmentation results were evaluated by Dice similarity coefficient (DSC) and Hausdorff distance (HD). Use of the CNN model on our testing group of 40 individuals yielded a median DSC of 90% and a median 95th percentile HD of 5.1 mm, demonstrating good performance in these metrics when compared to literature results. Our preliminary results suggest that our deep learning-based method can be effective in automating RV segmentation.
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Affiliation(s)
- Christopher T Tran
- University of Texas at Dallas, Department of Bioengineering, Richardson, TX, USA
| | - Martin Halicek
- University of Texas at Dallas, Department of Bioengineering, Richardson, TX, USA.,Georgia Inst. of Tech. and Emory Univ., Dept. of Biomedical Engineering, Atlanta, GA
| | - James D Dormer
- Georgia Inst. of Tech. and Emory Univ., Dept. of Biomedical Engineering, Atlanta, GA
| | - Animesh Tandon
- Dept. of Radiology, Univ. of Texas Southwestern Medical Center, Dallas, TX.,Department of Pediatrics, Univ. of Texas Southwestern Medical Center, Dallas, TX
| | - Tarique Hussain
- Dept. of Radiology, Univ. of Texas Southwestern Medical Center, Dallas, TX.,Department of Pediatrics, Univ. of Texas Southwestern Medical Center, Dallas, TX
| | - Baowei Fei
- University of Texas at Dallas, Department of Bioengineering, Richardson, TX, USA.,Advanced Imaging Research Center, Univ. of Texas Southwestern Medical Center, Dallas, TX.,Dept. of Radiology, Univ. of Texas Southwestern Medical Center, Dallas, TX
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Diller GP, Orwat S, Vahle J, Bauer UMM, Urban A, Sarikouch S, Berger F, Beerbaum P, Baumgartner H. Prediction of prognosis in patients with tetralogy of Fallot based on deep learning imaging analysis. Heart 2020; 106:1007-1014. [DOI: 10.1136/heartjnl-2019-315962] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/24/2020] [Accepted: 02/03/2020] [Indexed: 12/19/2022] Open
Abstract
ObjectiveTo assess the utility of machine learning algorithms for automatically estimating prognosis in patients with repaired tetralogy of Fallot (ToF) using cardiac magnetic resonance (CMR).MethodsWe included 372 patients with ToF who had undergone CMR imaging as part of a nationwide prospective study. Cine loops were retrieved and subjected to automatic deep learning (DL)-based image analysis, trained on independent, local CMR data, to derive measures of cardiac dimensions and function. This information was combined with established clinical parameters and ECG markers of prognosis.ResultsOver a median follow-up period of 10 years, 23 patients experienced an endpoint of death/aborted cardiac arrest or documented ventricular tachycardia (defined as >3 documented consecutive ventricular beats). On univariate Cox analysis, various DL parameters, including right atrial median area (HR 1.11/cm², p=0.003) and right ventricular long-axis strain (HR 0.80/%, p=0.009) emerged as significant predictors of outcome. DL parameters were related to adverse outcome independently of left and right ventricular ejection fraction and peak oxygen uptake (p<0.05 for all). A composite score of enlarged right atrial area and depressed right ventricular longitudinal function identified a ToF subgroup at significantly increased risk of adverse outcome (HR 2.1/unit, p=0.007).ConclusionsWe present data on the utility of machine learning algorithms trained on external imaging datasets to automatically estimate prognosis in patients with ToF. Due to the automated analysis process these two-dimensional-based algorithms may serve as surrogates for labour-intensive manually attained imaging parameters in patients with ToF.
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Effect of comprehensive initial training on the variability of left ventricular measures using fast-SENC cardiac magnetic resonance imaging. Sci Rep 2019; 9:12223. [PMID: 31434950 PMCID: PMC6704124 DOI: 10.1038/s41598-019-48685-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 08/09/2019] [Indexed: 12/31/2022] Open
Abstract
Cardiac magnetic resonance (CMR) is becoming the imaging modality of choice in multicenter studies where highly reproducible measurements are necessary. The purpose of this study was to assess the effect of comprehensive initial training on reproducibility of quantitative left ventricular (LV) parameters estimated using strain-encoded (SENC) imaging. Thirty participants (10 patients with heart failure (HF) and preserved LV ejection fraction (HFpEF), 10 patients with HF and reduced LV ejection fraction (HFrEF) and 10 healthy volunteers) were examined using fast-SENC imaging. Four observers with different experience in non-invasive cardiac imaging completed comprehensive initial training course and were invited to perform CMR data analysis. To assess agreement between observers, LV volumes, mass, ejection fraction (LVEF), global longitudinal strain (GLS) and global circumferential strain (GCS) were estimated using dedicated software (MyoStrain, USA). To test intraobserver agreement data analysis was repeated after 4 weeks. SENC imaging and analysis were fast and were completed in less than 5 minutes. LV end-diastolic volume index (LVEDVi), LVEF and strain were significantly lower in HFpEF patients than in healthy volunteers (p = 0.019 for LVEDVi; p = 0.023 for LVEF; p = 0.004 for GLS and p < 0.001 for GCS). All LV functional parameters were further reduced in HFrEF. Excellent interobserver agreement was found for all LV parameters independently of the level of experience. The reproducibility of LV mass was lower, especially at the intraobserver level (ICC 0.91; 95% CI 0.74–0.96). LV volumetric and functional parameters derived using fast-SENC imaging, are highly reproducible. The appropriate initial training is relevant and allows to achieve highest concordance in fast-SENC measurements.
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Michel M, Shabanah W, Körperich H, Kelter-Klöpping A, Entenmann A, Racolta A, Laser KT. Left ventricular mass estimation by real-time 3D echocardiography favourably competes with CMR in congenital left ventricular disease. Sci Rep 2019; 9:11888. [PMID: 31417137 PMCID: PMC6695417 DOI: 10.1038/s41598-019-48375-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 08/01/2019] [Indexed: 11/18/2022] Open
Abstract
Assessment of left ventricular mass (LVM) is important in the evaluation of patients with congenital heart disease (CHD) and cardiac magnetic resonance imaging (CMR) is the gold standard. Recent software allows LVM calculation by real-time 3-dimensional echocardiography (RT3DE). We investigated the impact of different software analysis tools on LVM determination by CMR or RT3DE in a cohort of patients with heterogeneous left ventricular (LV) disease. 37 subjects (17 patients, mean age 18.7 y; 20 controls, mean age 13.2 y) underwent CMR and RT3DE. CMR LVM and RT3DE calculations were done using two different LV-analysis software packages for each modality: CMR i) customized software “CMR HDZ”, CMR ii) “CMR ISP”; RT3DE i) “Toshiba”, RT3DE ii) “Tomtec”, 4D LV-Analysis Version 3.1 (built 3.1.0.258661). Intra- and interobserver variabilities were calculated. Only RT3DE-derived LVM showed significant software-dependent differences. RT3DE-derived LVM (both softwares) was significantly higher than CMR-derived LVM (both softwares). The two different methods and four evaluation software packages for LVM assessment were well correlated with each other. Intra- and interobserver variability of LVM as assessed by each single modality or software was low. Despite software dependency and overestimation of RT3DE-assessed LVM by 5 to 10%, RT3DE still competes with the gold standard, CMR, even in patients with various forms of LV disease. The use of optimized software, especially for RT3DE, should improve the accuracy of LVM assessment, overcoming LVM overestimation.
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Affiliation(s)
- Miriam Michel
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria. .,Center for Congenital Heart Defects, Heart and Diabetes Center North-Rhine Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany.
| | - Wael Shabanah
- Center for Congenital Heart Defects, Heart and Diabetes Center North-Rhine Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Hermann Körperich
- Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center Northrhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Andrea Kelter-Klöpping
- Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center Northrhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Andreas Entenmann
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Anca Racolta
- Center for Congenital Heart Defects, Heart and Diabetes Center North-Rhine Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Kai Thorsten Laser
- Center for Congenital Heart Defects, Heart and Diabetes Center North-Rhine Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
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15
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A novel evaluation of two related and two independent algorithms for eye movement classification during reading. Behav Res Methods 2019; 50:1374-1397. [PMID: 29766396 DOI: 10.3758/s13428-018-1050-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Nystrӧm and Holmqvist have published a method for the classification of eye movements during reading (ONH) (Nyström & Holmqvist, 2010). When we applied this algorithm to our data, the results were not satisfactory, so we modified the algorithm (now the MNH) to better classify our data. The changes included: (1) reducing the amount of signal filtering, (2) excluding a new type of noise, (3) removing several adaptive thresholds and replacing them with fixed thresholds, (4) changing the way that the start and end of each saccade was determined, (5) employing a new algorithm for detecting PSOs, and (6) allowing a fixation period to either begin or end with noise. A new method for the evaluation of classification algorithms is presented. It was designed to provide comprehensive feedback to an algorithm developer, in a time-efficient manner, about the types and numbers of classification errors that an algorithm produces. This evaluation was conducted by three expert raters independently, across 20 randomly chosen recordings, each classified by both algorithms. The MNH made many fewer errors in determining when saccades start and end, and it also detected some fixations and saccades that the ONH did not. The MNH fails to detect very small saccades. We also evaluated two additional algorithms: the EyeLink Parser and a more current, machine-learning-based algorithm. The EyeLink Parser tended to find more saccades that ended too early than did the other methods, and we found numerous problems with the output of the machine-learning-based algorithm.
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16
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Backhaus SJ, Staab W, Steinmetz M, Ritter CO, Lotz J, Hasenfuß G, Schuster A, Kowallick JT. Fully automated quantification of biventricular volumes and function in cardiovascular magnetic resonance: applicability to clinical routine settings. J Cardiovasc Magn Reson 2019; 21:24. [PMID: 31023305 PMCID: PMC8059518 DOI: 10.1186/s12968-019-0532-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 03/12/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) represents the clinical gold standard for the assessment of biventricular morphology and function. Since manual post-processing is time-consuming and prone to observer variability, efforts have been directed towards automated volumetric quantification. In this study, we sought to validate the accuracy of a novel approach providing fully automated quantification of biventricular volumes and function in a "real-world" clinical setting. METHODS Three-hundred CMR examinations were randomly selected from the local data base. Fully automated quantification of left ventricular (LV) mass, LV and right ventricular (RV) end-diastolic and end-systolic volumes (EDV/ESV), stroke volume (SV) and ejection fraction (EF) were performed overnight using commercially available software (suiteHEART®, Neosoft, Pewaukee, Wisconsin, USA). Parameters were compared to manual assessments (QMass®, Medis Medical Imaging Systems, Leiden, Netherlands). Sub-group analyses were further performed according to image quality, scanner field strength, the presence of implanted aortic valves and repaired Tetralogy of Fallot (ToF). RESULTS Biventricular automated segmentation was feasible in all 300 cases. Overall agreement between fully automated and manually derived LV parameters was good (LV-EF: intra-class correlation coefficient [ICC] 0.95; bias - 2.5% [SD 5.9%]), whilst RV agreement was lower (RV-EF: ICC 0.72; bias 5.8% [SD 9.6%]). Lowest agreement was observed in case of severely altered anatomy, e.g. marked RV dilation but normal LV dimensions in repaired ToF (LV parameters ICC 0.73-0.91; RV parameters ICC 0.41-0.94) and/or reduced image quality (LV parameters ICC 0.86-0.95; RV parameters ICC 0.56-0.91), which was more common on 3.0 T than on 1.5 T. CONCLUSIONS Fully automated assessments of biventricular morphology and function is robust and accurate in a clinical routine setting with good image quality and can be performed without any user interaction. However, in case of demanding anatomy (e.g. repaired ToF, severe LV hypertrophy) or reduced image quality, quality check and manual re-contouring are still required.
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Affiliation(s)
- Sören J. Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Wieland Staab
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Centre Göttingen, Georg-August University, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Michael Steinmetz
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Christian O. Ritter
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Centre Göttingen, Georg-August University, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Joachim Lotz
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Centre Göttingen, Georg-August University, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Department of Cardiology, Royal North Shore Hospital, The Kolling Institute, Nothern Clinical School, University of Sydney, Sydney, Australia
| | - Johannes T. Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Centre Göttingen, Georg-August University, Robert-Koch-Str. 40, 37075 Göttingen, Germany
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Backhaus SJ, Metschies G, Billing M, Kowallick JT, Gertz RJ, Lapinskas T, Pieske B, Lotz J, Bigalke B, Kutty S, Hasenfuß G, Beerbaum P, Kelle S, Schuster A. Cardiovascular magnetic resonance imaging feature tracking: Impact of training on observer performance and reproducibility. PLoS One 2019; 14:e0210127. [PMID: 30682045 PMCID: PMC6347155 DOI: 10.1371/journal.pone.0210127] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 12/16/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance feature tracking (CMR-FT) is increasingly used for myocardial deformation assessment including ventricular strain, showing prognostic value beyond established risk markers if used in experienced centres. Little is known about the impact of appropriate training on CMR-FT performance. Consequently, this study aimed to evaluate the impact of training on observer variance using different commercially available CMR-FT software. METHODS Intra- and inter-observer reproducibility was assessed prior to and after dedicated one-hour observer training. Employed FT software included 3 different commercially available platforms (TomTec, Medis, Circle). Left (LV) and right (RV) ventricular global longitudinal as well as LV circumferential and radial strains (GLS, GCS and GRS) were studied in 12 heart failure patients and 12 healthy volunteers. RESULTS Training improved intra- and inter-observer reproducibility. GCS and LV GLS showed the highest reproducibility before (ICC >0.86 and >0.81) and after training (ICC >0.91 and >0.92). RV GLS and GRS were more susceptible to tracking inaccuracies and reproducibility was lower. Inter-observer reproducibility was lower than intra-observer reproducibility prior to training with more pronounced improvements after training. Before training, LV strain reproducibility was lower in healthy volunteers as compared to patients with no differences after training. Whilst LV strain reproducibility was sufficient within individual software solutions inter-software comparisons revealed considerable software related variance. CONCLUSION Observer experience is an important source of variance in CMR-FT derived strain assessment. Dedicated observer training significantly improves reproducibility with most profound benefits in states of high myocardial contractility and potential to facilitate widespread clinical implementation due to optimized robustness and diagnostic performance.
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Affiliation(s)
- Sören J. Backhaus
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Georg Metschies
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Marcus Billing
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Johannes T. Kowallick
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen, Germany
| | - Roman J. Gertz
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Tomas Lapinskas
- German Heart Center Berlin (DHZB), University of Berlin, Department of Internal Medicine / Cardiology, Charité Campus Virchow Clinic, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
| | - Burkert Pieske
- German Heart Center Berlin (DHZB), University of Berlin, Department of Internal Medicine / Cardiology, Charité Campus Virchow Clinic, Berlin, Germany
| | - Joachim Lotz
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen, Germany
| | - Boris Bigalke
- Charité Campus Benjamin Franklin, University Medical Center Berlin, Department of Cardiology and Pneumology, Berlin, Germany
| | - Shelby Kutty
- Children's Hospital and Medical Center, University of Nebraska College of Medicine, Omaha, United States of America
| | - Gerd Hasenfuß
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Philipp Beerbaum
- Hanover Medical School, Department of Pediatric Cardiology and Intensive Care, Hanover, Germany
| | - Sebastian Kelle
- German Heart Center Berlin (DHZB), University of Berlin, Department of Internal Medicine / Cardiology, Charité Campus Virchow Clinic, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
| | - Andreas Schuster
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
- Department of Cardiology, Royal North Shore Hospital, The Kolling Institute, Nothern Clinical School, University of Sydney, Sydney, Australia
- * E-mail:
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Kalaitzidis P, Orwat S, Kempny A, Robert R, Peters B, Sarikouch S, Beerbaum P, Baumgartner H, Diller GP. Biventricular dyssynchrony on cardiac magnetic resonance imaging and its correlation with myocardial deformation, ventricular function and objective exercise capacity in patients with repaired tetralogy of Fallot. Int J Cardiol 2018; 264:53-57. [PMID: 29673853 DOI: 10.1016/j.ijcard.2018.04.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 03/09/2018] [Accepted: 04/02/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Electrical dyssynchrony and prolonged QRS duration are common in patients with repaired tetralogy of Fallot (ToF). It has been linked to increased risk of sudden cardiac death and right ventricular (RV) dysfunction. We investigated myocardial dyssynchrony using cardiac magnetic resonance imaging (CMR) and feature tracking analysis (FT) in this setting and compared it to myocardial deformation, conventional parameters of ventricular dysfunction and clinical parameters. METHODS AND RESULTS Patients underwent standardized CMR investigations as part of a nationwide study. We prospectively assessed myocardial deformation and analysed regional wall motion abnormalities of the RV and the left ventricle (LV) using CMR-FT. The main measure of dyssynchrony was the maximal time difference (wall motion delay) of the regional strain as a parameter of mechanical biventricular dyssynchrony. In addition, clinical parameters and measures of cardiopulmonary exercise capacity were available. Overall 345 patients were included. Parameters of biventricular wall motion delay correlated significantly with global FT-strain parameters (p < 0.0001 for all imaging planes assessed). Furthermore, we found a significant correlation between circumferential RV motion delay and QRS duration (p = 0.006). Higher LV and RV wall motion delay parameters were also associated with lower peak oxygen consumption (p < 0.05) and a worse LV and RV ejection fraction (p < 0.02). CONCLUSIONS Assessment of mechanical dyssynchrony is feasible using CMR-FT in ToF patients. Parameters of mechanical dyssynchrony correlate with electrical dyssynchrony, biventricular function and objective exercise capacity in this setting. Due to the weak degree of correlation, however, the clinical significance of these findings remains to be clarified by further studies.
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Affiliation(s)
- Pantelis Kalaitzidis
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Stefan Orwat
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Aleksander Kempny
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | - Radke Robert
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Brigitte Peters
- Institute for Biometry and Medical Informatics, University of Magdeburg, Germany
| | - Samir Sarikouch
- Department of Heart-, Thoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Germany
| | - Philipp Beerbaum
- Department of Pediatric Cardiology and Pediatric Intensive Care, Hannover Medical School, Germany
| | - Helmut Baumgartner
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Gerhard-Paul Diller
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
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Cross-sectional Areas of the Thoracic Aorta in Children and Adolescents With Repaired Tetralogy of Fallot Obtained by Cardiac Magnetic Resonance Angiography. J Thorac Imaging 2017; 33:105-111. [PMID: 29232281 DOI: 10.1097/rti.0000000000000316] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE Dilatation of the thoracic aorta is a well-known finding in corrected Tetralogy of Fallot. Complications are rare but can be life-threatening. Standard 1-dimensional (1D) measurements have several limitations. We sought to establish contrast-enhanced magnetic resonance angiography cross-sectional areas of the aorta that could serve as reference values and to identify parameters that are associated with aortic dilatation. MATERIALS AND METHODS We enrolled 101 children and adolescents. The aortic areas were measured at the level of the aortic sinus (AS), the sinotubular junction (STJ), the ascending aorta (AA), the brachiocephalic trunk (TBC), and the descending aorta (DA). Sex-specific aortic dimensions were presented as percentile curves as well as regression equations. Furthermore volumetric and functional parameters as well as clinical data were analyzed to identify parameters that are associated with aortic dilatation. RESULTS Aortic areas (mm) for female subjects were 139+366×body surface area (BSA) for the AS, 134+255×BSA for the STJ, 113+239×BSA for the AA, 88+185×BSA proximal to the TBC, and 2.9+88×BSA for the DA. Aortic areas (mm) for male subjects were 162+403×BSA for the AS, 171+258×BSA for the STJ, 151+233×BSA for the AA, 73+206×BSA proximal to the TBC, and 21+80×BSA for the DA. The postoperative interval and age at examination were parameters associated with aortic size. CONCLUSIONS We provide aortic areas in children and adolescents after correction of Tetralogy of Fallot measured by contrast-enhanced magnetic resonance angiography. Our 2D data may better depict the geometry of enlarged aortae than standard 1D diameters and serve as reference values for evaluating aortic disease in these patients.
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20
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Lücke C, Oppolzer B, Werner P, Foldyna B, Lurz P, Jochimsen T, Brenneis B, Lehmkuhl L, Sattler B, Grothoff M, Barthel H, Sabri O, Gutberlet M. Comparison of volumetric and functional parameters in simultaneous cardiac PET/MR: feasibility of volumetric assessment with residual activity from prior PET/CT. Eur Radiol 2017; 27:5146-5157. [PMID: 28631080 PMCID: PMC5674117 DOI: 10.1007/s00330-017-4896-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 04/24/2017] [Accepted: 05/12/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare cardiac left ventricular (LV) parameters in simultaneously acquired hybrid fluorine-18-fluorodeoxyglucose ([18F] FDG) positron emission tomography/magnetic resonance imaging (PET/MRI) in patients with residual tracer activity of upstream PET/CT. METHODS Twenty-nine patients (23 men, age 58±17 years) underwent cardiac PET/MRI either directly after a non-cardiac PET/CT with homogenous cardiac [18F] FDG uptake (n=20) or for viability assessment (n=9). Gated cardiac [18F] FDG PET and cine MR sequences were acquired simultaneously and evaluated blinded to the cross-imaging results. Image quality (IQ), end-diastolic (LVEDV), end-systolic volume (LVESV), ejection fraction (LVEF) and myocardial mass (LVMM) were measured. Pearson correlation and intraclass correlation coefficient (ICC), regression and a Bland-Altman analysis were assessed. RESULTS Except LVMM, volumetric and functional LV parameters demonstrated high correlations (LVESV: r=0.97, LVEDV: r=0.95, LVEF: r=0.91, LVMM: r=0.87, each p<0.05), but wide limits of agreement (LOA) for LVEDV (-25.3-82.5ml); LVESV (-33.1-72.7ml); LVEF (-18.9-14.8%) and LVMM (-78.2-43.2g). Intra- and interobserver reliability were very high (ICC≥0.95) for all parameters, except for MR-LVEF (ICC=0.87). PET-IQ (0-3) was high (mean: 2.2±0.9) with significant influence on LVMM calculations only. CONCLUSION In simultaneously acquired cardiac PET/MRI data, LVEDV, LVESV and LVEF show good agreement. However, the agreement seems to be limited if cardiac PET/MRI follows PET/CT and only the residual activity is used. KEY POINTS • [ 18 F] FDG PET-MRI is feasible with residual [ 18 F] FDG activity in patients with homogenous cardiac uptake. • Cardiac volumes and function assessed by PET/MRI show good agreement. • LVEDV and LVESV are underestimated; PET overestimates LVMM and LVEF. • Cardiac PET and MRI data correlate better when acquired simultaneously than sequentially. • PET and MRI should not assess LV parameters interchangeably.
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Affiliation(s)
- C Lücke
- Department of Diagnostic and Interventional Radiology, University Leipzig - Heart Center, Strümpellstr. 39, 04289, Leipzig, Germany.
| | - B Oppolzer
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - P Werner
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - B Foldyna
- Department of Diagnostic and Interventional Radiology, University Leipzig - Heart Center, Strümpellstr. 39, 04289, Leipzig, Germany
- Cardiac MR PET CT Program, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
| | - P Lurz
- Clinic for Internal Medicine/Cardiology, University Leipzig - Heart Center, Leipzig, Germany
| | - T Jochimsen
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - B Brenneis
- Department of Diagnostic and Interventional Radiology, University Leipzig - Heart Center, Strümpellstr. 39, 04289, Leipzig, Germany
| | - L Lehmkuhl
- Radiologische Klinik, Herz- und Gefäß-Klinik GmbH, Bad Neustadt, Germany
| | - B Sattler
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - M Grothoff
- Department of Diagnostic and Interventional Radiology, University Leipzig - Heart Center, Strümpellstr. 39, 04289, Leipzig, Germany
| | - H Barthel
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - O Sabri
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - M Gutberlet
- Department of Diagnostic and Interventional Radiology, University Leipzig - Heart Center, Strümpellstr. 39, 04289, Leipzig, Germany
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Pieterman ED, Budde RPJ, Robbers-Visser D, van Domburg RT, Helbing WA. Knowledge-based reconstruction for measurement of right ventricular volumes on cardiovascular magnetic resonance images in a mixed population. CONGENIT HEART DIS 2017; 12:561-569. [DOI: 10.1111/chd.12484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/27/2017] [Accepted: 04/30/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Elise D. Pieterman
- Department of Pediatrics, Division of Cardiology; Erasmus Medical Center, Sophia Children's Hospital; Rotterdam The Netherlands
- Department of Radiology; Erasmus Medical Center; Rotterdam The Netherlands
| | | | - Daniëlle Robbers-Visser
- Department of Pediatrics, Division of Cardiology; Erasmus Medical Center, Sophia Children's Hospital; Rotterdam The Netherlands
- Department of Radiology; Erasmus Medical Center; Rotterdam The Netherlands
| | - Ron T. van Domburg
- Department of Cardiology-Thorax Center; Erasmus Medical Center; Rotterdam The Netherlands
| | - Willem A. Helbing
- Department of Pediatrics, Division of Cardiology; Erasmus Medical Center, Sophia Children's Hospital; Rotterdam The Netherlands
- Department of Radiology; Erasmus Medical Center; Rotterdam The Netherlands
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Orwat S, Diller GP, Kempny A, Radke R, Peters B, Kühne T, Boethig D, Gutberlet M, Dubowy KO, Beerbaum P, Sarikouch S, Baumgartner H. Myocardial deformation parameters predict outcome in patients with repaired tetralogy of Fallot. Heart 2015; 102:209-15. [PMID: 26715570 DOI: 10.1136/heartjnl-2015-308569] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 11/19/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Parameters of myocardial deformation have been suggested to be superior to conventional measures of ventricular function and to predict outcome in repaired tetralogy of Fallot (ToF). We aimed to test the hypothesis that parameters of myocardial deformation on cardiac MRI (CMR) relate to symptoms and provide prognostic information in patients with repaired ToF. METHODS AND RESULTS We included 372 patients with ToF (median age 16 years; 55% male), recruited within a nationwide, prospective study. Longitudinal (LS), circumferential (CS) and radial global strain (RS) were analysed by CMR-based feature tracking (FT). A combined endpoint of death, successful resuscitation or documented ventricular tachycardia was employed. Parameters of global strain were associated with New York Heart Association (NYHA) class and symptomatic deterioration. During a median follow-up of 7.4 years, 20 events occurred. Left ventricular (LV) CS and right ventricular (RV) LS emerged as predictors of outcome, independent of QRS duration, LV/RV ejection fraction and volumes, NYHA class and peak oxygen uptake. In combination, these parameters also identified a subgroup of patients at significantly increased risk of adverse of outcomes (HR 3.3, p=0.002). Furthermore, LV LS, RS, CS and RV LS were related to the risk of death and nearly missed death (p<0.05 for all). CONCLUSIONS FT-CMR provides myocardial deformation parameters, easily derived from standard CMR studies. They relate to symptoms and clinical deterioration in patients with ToF. More importantly, they predict adverse outcome independent of established risk markers, and should be considered as a useful adjunct to established outcome predictors, especially in younger patients with ToF. CLINICAL TRIAL REGISTRATION NUMBER http://www.clinicaltrials.gov: NCT00266188; Results.
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Affiliation(s)
- Stefan Orwat
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Gerhard-Paul Diller
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Aleksander Kempny
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Robert Radke
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Brigitte Peters
- Institute for Biometry and Medical Informatics, University of Magdeburg, Magdeburg, Germany
| | - Titus Kühne
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Germany
| | - Dietmar Boethig
- Department of Pediatric Cardiology and Pediatric Intensive Care, Hannover Medical School, Hannover, Germany
| | - Matthias Gutberlet
- Department of Diagnostic and Interventional Radiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Karl-Otto Dubowy
- Department of Paediatric Cardiology, Heartcenter of North Rhine-Westphalia, University of Bochum, Bad Oeynhausen, Germany
| | - Philipp Beerbaum
- Department of Pediatric Cardiology and Pediatric Intensive Care, Hannover Medical School, Hannover, Germany
| | - Samir Sarikouch
- Department of Heart-, Thoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Germany
| | - Helmut Baumgartner
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
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Abman SH, Hansmann G, Archer SL, Ivy DD, Adatia I, Chung WK, Hanna BD, Rosenzweig EB, Raj JU, Cornfield D, Stenmark KR, Steinhorn R, Thébaud B, Fineman JR, Kuehne T, Feinstein JA, Friedberg MK, Earing M, Barst RJ, Keller RL, Kinsella JP, Mullen M, Deterding R, Kulik T, Mallory G, Humpl T, Wessel DL. Pediatric Pulmonary Hypertension: Guidelines From the American Heart Association and American Thoracic Society. Circulation 2015; 132:2037-99. [PMID: 26534956 DOI: 10.1161/cir.0000000000000329] [Citation(s) in RCA: 686] [Impact Index Per Article: 76.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Pulmonary hypertension is associated with diverse cardiac, pulmonary, and systemic diseases in neonates, infants, and older children and contributes to significant morbidity and mortality. However, current approaches to caring for pediatric patients with pulmonary hypertension have been limited by the lack of consensus guidelines from experts in the field. In a joint effort from the American Heart Association and American Thoracic Society, a panel of experienced clinicians and clinician-scientists was assembled to review the current literature and to make recommendations on the diagnosis, evaluation, and treatment of pediatric pulmonary hypertension. This publication presents the results of extensive literature reviews, discussions, and formal scoring of recommendations for the care of children with pulmonary hypertension.
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MESH Headings
- Cardiovascular Agents/therapeutic use
- Child
- Child, Preschool
- Combined Modality Therapy
- Diagnostic Imaging/methods
- Disease Management
- Extracorporeal Membrane Oxygenation
- Genetic Counseling
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/therapy
- Hernias, Diaphragmatic, Congenital/complications
- Hernias, Diaphragmatic, Congenital/therapy
- Humans
- Hypertension, Pulmonary/diagnosis
- Hypertension, Pulmonary/etiology
- Hypertension, Pulmonary/genetics
- Hypertension, Pulmonary/therapy
- Infant
- Infant, Newborn
- Lung/embryology
- Lung Transplantation
- Nitric Oxide/administration & dosage
- Nitric Oxide/therapeutic use
- Oxygen Inhalation Therapy
- Persistent Fetal Circulation Syndrome/diagnosis
- Persistent Fetal Circulation Syndrome/therapy
- Postoperative Complications/therapy
- Respiration, Artificial/adverse effects
- Respiration, Artificial/methods
- Ventilator-Induced Lung Injury/prevention & control
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24
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Schelhorn J, Neudorf U, Schemuth H, Nensa F, Nassenstein K, Schlosser TW. Volumetric measurements in patients with corrected tetralogy of Fallot: comparison of short-axis versus axial cardiac MRI and echocardiography. Acta Radiol 2015; 56:1315-22. [PMID: 25348475 DOI: 10.1177/0284185114556017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 09/25/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with corrected tetralogy of Fallot (cToF) are prone to develop pulmonary regurgitation and right ventricular enlargement resulting in long-term complications, thus correct right ventricular volumetric monitoring is crucial. However, it remains controversial which cardiovascular magnetic resonance imaging (CMRI) slice orientation is most appropriate in cToF for the analysis of the right ventricular volume. PURPOSE To investigate which slice orientation is most suited for right ventricular volumetry in cToF we compared short-axis and axial slices, and furthermore we compared right ventricular data between CMRI and echocardiography. MATERIAL AND METHODS Thirty CMRI examinations of 27 patients with cToF were included retrospectively. Right ventricular end-diastolic (EDV) and end-systolic volume (ESV) were derived from short-axis and axial cine CMRI planes. Furthermore, pulmonary trunk forward flow in phase-contrast CMRI and right ventricular inner diastolic diameter in echocardiography (R VIDdiast) were measured. By Bland-Altman and variance analysis intra- and inter-observer agreement were assessed for cine CMRI data. By Pearson correlation CMRI cine and phase-contrast data and CMRI cine and echocardiographic data were compared. RESULTS Intra- and inter-observer variability for right ventricular EDV were significantly lower in axial slices (P = 0.016, P = 0.010). For right ventricular ESV a trend towards a lower intra- and inter-observer variability in axial slices was found (P = 0.063, P = 0.138). Right ventricular stroke volume in short-axis (r = 0.872, P < 0.001) and in axial (r = 0.914, P < 0.001) planes correlated highly, respectively very highly with pulmonary trunk forward flow in phase-contrast CMRI. R VIDdiast correlated highly with right ventricular EDV assessed by short-axis and axial CMRI (P < 0.001, P < 0.001). CONCLUSION Due to lower intra- and inter-observer variability, axial slices are recommended for right ventricular volumetry in cToF.
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Affiliation(s)
- Juliane Schelhorn
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Ulrich Neudorf
- Clinic for Pediatrics III, University Hospital Essen, Essen, Germany
| | - Haemi Schemuth
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Felix Nensa
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Kai Nassenstein
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Thomas W Schlosser
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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25
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Klug G, Reinstadler SJ, Feistritzer HJ, Kremser C, Schwaiger JP, Reindl M, Mair J, Müller S, Mayr A, Franz WM, Metzler B. Cardiac index after acute ST-segment elevation myocardial infarction measured with phase-contrast cardiac magnetic resonance imaging. Eur Radiol 2015; 26:1999-2008. [PMID: 26385805 DOI: 10.1007/s00330-015-4022-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 09/02/2015] [Accepted: 09/09/2015] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Phase-contrast CMR (PC-CMR) might provide a fast and robust non-invasive determination of left ventricular function in patients after ST-segment elevation myocardial infarction (STEMI). METHODS Cine sequences in the left-ventricular (LV) short-axis and free-breathing, retrospectively gated PC-CMR were performed in 90 patients with first acute STEMI and 15 healthy volunteers. Inter- and intra-observer agreement was determined. The correlations of clinical variables (age, gender, ejection fraction, NT pro-brain natriuretic peptide [NT-proBNP] with cardiac index (CI) were calculated. RESULTS For CI, there was a strong agreement of cine CMR with PC-CMR in healthy volunteers (r: 0.82, mean difference: -0.14 l/min/m(2), error ± 23 %). Agreement was lower in STEMI patients (r: 0.61, mean difference: -0.17 l/min/m(2), error ± 32 %). In STEMI patients, CI measured with PC-CMR showed lower intra-observer (1 % vs. 9 %) and similar inter-observer variability (9 % vs. 12 %) compared to cine CMR. CI was significantly correlated with age, ejection fraction and NT-proBNP values in STEMI patients. DISCUSSION The agreement of PC-CMR and cine CMR for the determination of CI is lower in STEMI patients than in healthy volunteers. After acute STEMI, CI measured with PC-CMR decreases with age, LV ejection fraction and higher NT-proBNP. KEY POINTS • Cine CMR and PC-CMR correlate well in healthy volunteers. • Agreement is lower in STEMI patients. • Cardiac Output should be measured with one method longitudinally. • Cardiac output decreases with age after myocardial infarction.
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Affiliation(s)
- Gert Klug
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Sebastian Johannes Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Hans-Josef Feistritzer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Christian Kremser
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes P Schwaiger
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Johannes Mair
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Silvana Müller
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Agnes Mayr
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang-Michael Franz
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
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26
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Dimensions of the ascending aorta in children and adolescents with repaired Tetralogy of Fallot obtained by cardiac magnetic resonance angiography. Clin Res Cardiol 2015; 105:239-47. [PMID: 26329586 PMCID: PMC4759232 DOI: 10.1007/s00392-015-0912-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 08/27/2015] [Indexed: 11/06/2022]
Abstract
Introduction Dilatation of the ascending aorta is a common finding in Tetralogy of fallot (TOF). We sought to provide aortic dimensions in children and adolescents after corrected TOF obtained by contrast-enhanced cardiac-magnetic-resonance angiography (CE-CMRA) that could serve as reference values. Materials and methods We enrolled 101 children and adolescents (56 male) with a median age of 10.9 years. All patients underwent CE-CMRA imaging using a 3-dimensional spoiled gradient-echo-sequence. Aortic diameters were measured at the level of the aortic valve (AV), aortic sinus (AS), sino-tubular junction (STJ) and the ascending aorta (AA) and compared with normal values obtained from literature. Sex-specific aortic dimensions are given as percentile curves as well as z scores. Furthermore CMR volumetric and functional parameters as well as clinical and anamnestic data were analyzed to identify parameters that are associated with aortic dilatation. Results Diameters for aortic size for males were 3.6 + 16.6*BSA0.5 at the AV level, 7.0 + 19.5*BSA0.5 at the AS level, 7.0 + 14.4*BSA0.5 at the STJ level and 7.3 + 15.5*BSA0.5 at the AA level. Diameters for females were 5.8 + 14.1*BSA0.5 at the AV level, 7.2 + 17.6*BSA0.5 at the AS level, 5.2 + 15.4*BSA0.5 at the STJ level and 2.0 + 17.8*BSA0.5 at the AA level. All diameters in TOF patients were larger compared with normal values. The postoperative interval and age at examination were the only parameters associated with aortic size at all measured levels. Conclusion We provide CE-CMRA data of aortic dimensions in children and adolescents after correction of TOF. Our data might be useful for an estimation of the “normal” aortic size in this patient cohort and can serve as a basis for future longitudinal studies adding prognostic data.
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27
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Semiautomatic three-dimensional CT ventricular volumetry in patients with congenital heart disease: agreement between two methods with different user interaction. Int J Cardiovasc Imaging 2015; 31 Suppl 2:223-32. [DOI: 10.1007/s10554-015-0751-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 08/20/2015] [Indexed: 01/12/2023]
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28
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Free-Breathing 3D Imaging of Right Ventricular Structure and Function Using Respiratory and Cardiac Self-Gated Cine MRI. BIOMED RESEARCH INTERNATIONAL 2015; 2015:819102. [PMID: 26185764 PMCID: PMC4491385 DOI: 10.1155/2015/819102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 09/26/2014] [Accepted: 10/07/2014] [Indexed: 11/20/2022]
Abstract
Providing a movie of the beating heart in a single prescribed plane, cine MRI has been widely used in clinical cardiac diagnosis, especially in the left ventricle (LV). Right ventricular (RV) morphology and function are also important for the diagnosis of cardiopulmonary diseases and serve as predictors for the long term outcome. The purpose of this study is to develop a self-gated free-breathing 3D imaging method for RV quantification and to evaluate its performance by comparing it with breath-hold 2D cine imaging in 7 healthy volunteers. Compared with 2D, the 3D RV functional measurements show a reduction of RV end-diastole volume (RVEDV) by 10%, increase of RV end-systole volume (RVESV) by 1.8%, reduction of RV systole volume (RVSV) by 21%, and reduction of RV ejection fraction (RVEF) by 12%. High correlations between the two techniques were found (RVEDV: 0.94; RVESV: 0.85; RVSV: 0.95; and RVEF: 0.89). Compared with 2D, the 3D image quality measurements show a small reduction in blood SNR, myocardium-blood CNR, myocardium contrast, and image sharpness. In conclusion, the proposed self-gated free-breathing 3D cardiac cine imaging technique provides comparable image quality and correlated functional measurements to those acquired with the multiple breath-hold 2D technique in RV.
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Indications for cardiovascular magnetic resonance in children with congenital and acquired heart disease: an expert consensus paper of the Imaging Working Group of the AEPC and the Cardiovascular Magnetic Resonance Section of the EACVI. Cardiol Young 2015; 25:819-38. [PMID: 25739865 DOI: 10.1017/s1047951115000025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This article provides expert opinion on the use of cardiovascular magnetic resonance (CMR) in young patients with congenital heart disease (CHD) and in specific clinical situations. As peculiar challenges apply to imaging children, paediatric aspects are repeatedly discussed. The first section of the paper addresses settings and techniques, including the basic sequences used in paediatric CMR, safety, and sedation. In the second section, the indication, application, and clinical relevance of CMR in the most frequent CHD are discussed in detail. In the current era of multimodality imaging, the strengths of CMR are compared with other imaging modalities. At the end of each chapter, a brief summary with expert consensus key points is provided. The recommendations provided are strongly clinically oriented. The paper addresses not only imagers performing CMR, but also clinical cardiologists who want to know which information can be obtained by CMR and how to integrate it in clinical decision-making.
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Lyen S, Mathias H, McAlindon E, Trickey A, Rodrigues J, Bucciarelli-Ducci C, Hamilton M, Manghat N. Optimising the imaging plane for right ventricular magnetic resonance volume analysis in adult patients referred for assessment of right ventricular structure and function. J Med Imaging Radiat Oncol 2015; 59:421-430. [PMID: 25898767 DOI: 10.1111/1754-9485.12303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 02/19/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Our aim was to evaluate the reproducibility and accuracy of using short-axis and axial (transaxial) plane for magnetic resonance imaging analysis in adult patients referred for assessment of right ventricular (RV) structure and function. METHODS Twenty consecutive subjects (10 male, 10 female, mean age 32.2 ± 14.8 years) who were referred for RV assessment and had cardiac magnetic resonance imaging were retrospectively selected. Axial and short-axis manual contouring was performed using cine steady-state free precession sequences by three experienced imaging specialists. The reproducibility of end diastolic volumes, end systolic volumes and ejection fraction was assessed with intraclass correlation coefficients (ICCs) and paired t-tests. Left ventricular stroke volume (LVSV) and RV stroke volumes (RVSV) were compared with concordance correlation coefficients (CCCs) and t-tests to determine accuracy. RESULTS The concordance between the RVSV and LVSV was good using both methods (axial RVSV CCC = 0.93, short-axis RVSV CCC = 0.86). Paired t-test and analysis of variance showed that the LV/RV stroke volume differences were not significant (p = 0.17). There was slight improvement in interobserver reliability with end systolic volume measurements (axial ICC = 0.92, short-axis ICC = 0.81) but this failed to reach statistical significance (p = 0.37). There was excellent intraobserver variability (ICC > 0.9). CONCLUSION This study shows that there is no statistically significant difference in reproducibility or accuracy using the short-axis or axial orientations in RV volume analysis in adult patients being referred for RV assessment.
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Affiliation(s)
- Stephen Lyen
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Bristol, UK
| | - Helen Mathias
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Bristol, UK
| | - Elisa McAlindon
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Bristol, UK
| | - Adam Trickey
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Bristol, UK
| | - Jonathan Rodrigues
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Bristol, UK
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Bristol, UK
| | - Mark Hamilton
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Bristol, UK
| | - Nathan Manghat
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Bristol, UK
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Laser KT, Houben BA, Körperich H, Haas NA, Kelter-Klöpping A, Barth P, Burchert W, DallaPozza R, Kececioglu D, Herberg U. Calculation of Pediatric Left Ventricular Mass: Validation and Reference Values Using Real-Time Three-Dimensional Echocardiography. J Am Soc Echocardiogr 2015; 28:275-83. [DOI: 10.1016/j.echo.2014.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Indexed: 02/08/2023]
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Valsangiacomo Buechel ER, Grosse-Wortmann L, Fratz S, Eichhorn J, Sarikouch S, Greil GF, Beerbaum P, Bucciarelli-Ducci C, Bonello B, Sieverding L, Schwitter J, Helbing WA, Galderisi M, Miller O, Sicari R, Rosa J, Thaulow E, Edvardsen T, Brockmeier K, Qureshi S, Stein J. Indications for cardiovascular magnetic resonance in children with congenital and acquired heart disease: an expert consensus paper of the Imaging Working Group of the AEPC and the Cardiovascular Magnetic Resonance Section of the EACVI. Eur Heart J Cardiovasc Imaging 2015; 16:281-97. [PMID: 25712078 DOI: 10.1093/ehjci/jeu129] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This article provides expert opinion on the use of cardiovascular magnetic resonance (CMR) in young patients with congenital heart disease (CHD) and in specific clinical situations. As peculiar challenges apply to imaging children, paediatric aspects are repeatedly discussed. The first section of the paper addresses settings and techniques, including the basic sequences used in paediatric CMR, safety, and sedation. In the second section, the indication, application, and clinical relevance of CMR in the most frequent CHD are discussed in detail. In the current era of multimodality imaging, the strengths of CMR are compared with other imaging modalities. At the end of each chapter, a brief summary with expert consensus key points is provided. The recommendations provided are strongly clinically oriented. The paper addresses not only imagers performing CMR, but also clinical cardiologists who want to know which information can be obtained by CMR and how to integrate it in clinical decision-making.
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Park EA, Lee W, Kim HK, Chung JW. Effect of papillary muscles and trabeculae on left ventricular measurement using cardiovascular magnetic resonance imaging in patients with hypertrophic cardiomyopathy. Korean J Radiol 2015; 16:4-12. [PMID: 25598670 PMCID: PMC4296277 DOI: 10.3348/kjr.2015.16.1.4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 11/05/2014] [Indexed: 11/20/2022] Open
Abstract
Objective To evaluate the influence of papillary muscles and trabeculae on left ventricular (LV) cardiovascular magnetic resonance (CMR) analysis using three methods of cavity delineation (classic or modified inclusion methods, and the exclusion method) in patients with hypertrophic cardiomyopathy (HCM). Materials and Methods This retrospective study included 20 consecutive HCM patients who underwent 1.5-T CMR imaging with short-axis cine stacks of the entire LV. LV measurements were performed using three different methods of manual cavity delineation of the endocardial and epicardial contours: method A, presumed endocardial boundary as seen on short-axis cine images; method B, including solely the cavity and closely adjacent trabeculae; or method C, excluding papillary muscles and trabeculae. Ascending aorta forward flow was measured as reference for LV-stroke volume (SV). Interobserver reproducibility was assessed using intraclass correlation coefficients. Results Method A showed larger end-diastole and end-systole volumes (largest percentage differences of 25% and 68%, respectively, p < 0.05), compared with method C. The ejection fraction was 55.7 ± 6.9% for method A, 68.6 ± 8.4% for B, and 71.7 ± 7.0% for C (p < 0.001). Mean mass was also significantly different: 164.6 ± 47.4 g for A, 176.5 ± 50.5 g for B, and 199.6 ± 53.2 g for C (p < 0.001). LV-SV error was largest with method B (p < 0.001). No difference in interobserver agreement was observed (p > 0.05). Conclusion In HCM patients, LV measurements are strikingly different dependent on whether papillary muscles and trabeculae are included or excluded. Therefore, a consistent method of LV cavity delineation may be crucial during longitudinal follow-up to avoid misinterpretation and erroneous clinical decision-making.
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Affiliation(s)
- Eun-Ah Park
- Department of Radiology, Cardiovascular Division, Seoul National University Hospital, Seoul 110-744, Korea
| | - Whal Lee
- Department of Radiology, Cardiovascular Division, Seoul National University Hospital, Seoul 110-744, Korea
| | - Hyung-Kwan Kim
- Department of Internal Medicine, Cardiovascular Division, Seoul National University Hospital, Seoul 110-744, Korea
| | - Jin Wook Chung
- Department of Radiology, Cardiovascular Division, Seoul National University Hospital, Seoul 110-744, Korea
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Heiberg J, Ringgaard S, Schmidt MR, Redington A, Hjortdal VE. Structural and functional alterations of the right ventricle are common in adults operated for ventricular septal defect as toddlers. Eur Heart J Cardiovasc Imaging 2014; 16:483-9. [DOI: 10.1093/ehjci/jeu292] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 11/03/2014] [Indexed: 11/12/2022] Open
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Nyns ECA, Dragulescu A, Yoo SJ, Grosse-Wortmann L. Evaluation of knowledge-based reconstruction for magnetic resonance volumetry of the right ventricle in tetralogy of Fallot. Pediatr Radiol 2014; 44:1532-40. [PMID: 24986364 DOI: 10.1007/s00247-014-3042-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 03/20/2014] [Accepted: 05/12/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiac magnetic resonance using the Simpson method is the gold standard for right ventricular volumetry. However, this method is time-consuming and not without sources of error. Knowledge-based reconstruction is a novel post-processing approach that reconstructs the right ventricular endocardial shape based on anatomical landmarks and a database of various right ventricular configurations. OBJECTIVE To assess the feasibility, accuracy and labor intensity of knowledge-based reconstruction in repaired tetralogy of Fallot (TOF). MATERIALS AND METHODS The short-axis cine cardiac MR datasets of 35 children and young adults (mean age 14.4 ± 2.5 years) after TOF repair were studied using both knowledge-based reconstruction and the Simpson method. Intraobserver, interobserver and inter-method variability were assessed using Bland-Altman analyses. RESULTS Knowledge-based reconstruction was feasible and highly accurate as compared to the Simpson method. Intra- and inter-method variability for knowledge-based reconstruction measurements showed good agreement. Volumetric assessment using knowledge-based reconstruction was faster when compared with the Simpson method (10.9 ± 2.0 vs. 7.1 ± 2.4 min, P < 0.001). CONCLUSION In patients with repaired tetralogy of Fallot, knowledge-based reconstruction is a feasible, accurate and reproducible method for measuring right ventricular volumes and ejection fraction. The post-processing time of right ventricular volumetry using knowledge-based reconstruction was significantly shorter when compared with the routine Simpson method.
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Affiliation(s)
- Emile Christian Arie Nyns
- The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, M5G 1X8, Canada
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Laser KT, Horst JP, Barth P, Kelter-Klöpping A, Haas NA, Burchert W, Kececioglu D, Körperich H. Knowledge-based reconstruction of right ventricular volumes using real-time three-dimensional echocardiographic as well as cardiac magnetic resonance images: comparison with a cardiac magnetic resonance standard. J Am Soc Echocardiogr 2014; 27:1087-97. [PMID: 24969839 DOI: 10.1016/j.echo.2014.05.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Right ventricular volume quantification using real-time three-dimensional echocardiographic (RT3DE) imaging is limited by technical shortcomings of acquisition and quantification. In this study, a two-step approach was used to overcome these limitations. First, a modified acquisition technique for RT3DE imaging was applied, and second, a software tool using knowledge-based reconstruction (KBR) was used. The approach was validated against the gold standard, cardiac magnetic resonance (CMR) imaging, using CMR and RT3DE data sets from healthy children and from patients with congenital heart disease. METHODS Sixty individuals (20 healthy persons, 40 with congenital heart defects; age range, 2.3-43.9 years; median age, 11.3 years) consecutively underwent investigation by CMR and RT3DE imaging. CMR data sets were first quantified by the method of disks (MOD) as the standard. Then CMR and RT3DE data sets were quantified using KBR software and compared with the MOD. RESULTS CMR was more feasible than echocardiography (100% vs 88%). Compared with the MOD (CMRMOD), there were trivial volume overestimations of KBR for CMR data (CMRKBR), of end-diastolic volume (EDV) (-1.3 ± 8.6%, r = 0.984) and end-systolic volume (ESV) (-3.4 ± 13.3%, r = 0.985), resulting in a 0.7 ± 8.7% difference in ejection fraction (EF) (r = 0.882). Comparing CMRMOD and RT3DE imaging, EDV (1.1 ± 7.4%, r = 0.990) and EF (0.8 ± 9.2%, r = 0.871) were slightly underestimated by RT3DE imaging, with a slight overestimation of ESV (-1.5 ± 13.3%, r = 0.977). Intraobserver variability was excellent for KBR of CMR and RT3DE data, with interclass coefficients of correlation of 0.995 and 0.997 for EDV, 0.995 and 0.994 for ESV, and 0.915 and 0.912 for EF. Interobserver variability provided intraclass correlation coefficients of 0.992 and 0.990 for EDV, 0.997 and 0.992 for ESV, and 0.953 and 0.933 for EF. The KBR analysis required a mean time of 5 min. CONCLUSIONS KBR is an accurate, versatile, and time-saving method for right ventricular three-dimensional volumetry; it shows excellent reproducibility for RT3DE and CMR data sets. These results suggest that this tool is clinically valuable.
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Affiliation(s)
- Kai Thorsten Laser
- Center for Congenital Heart Defects, Heart and Diabetes Center Northrhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany.
| | - Jan-Pit Horst
- Center for Congenital Heart Defects, Heart and Diabetes Center Northrhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Peter Barth
- Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center Northrhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | | | - Nikolaus Alexander Haas
- Center for Congenital Heart Defects, Heart and Diabetes Center Northrhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Wolfgang Burchert
- Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center Northrhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Deniz Kececioglu
- Center for Congenital Heart Defects, Heart and Diabetes Center Northrhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Hermann Körperich
- Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center Northrhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
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Flow-sensitive four-dimensional velocity-encoded magnetic resonance imaging reveals abnormal blood flow patterns in the aorta and pulmonary trunk of patients with transposition. Cardiol Young 2014; 24:47-53. [PMID: 23327710 DOI: 10.1017/s1047951112002193] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES Flow profiles are important determinants of fluid-vessel wall interactions. The aim of this study was to assess blood flow profiles in the aorta and pulmonary trunk in patients with transposition and different ventriculoarterial connection, and hence different mechanics of the coherent pump. METHODS In all, 29 patients with operated transposition--concordant atrioventricular and discordant ventriculoarterial connection, and no other cardiac malformation--and eight healthy volunteers were assessed with cardiac magnetic resonance imaging: n = 17 patients after atrial redirection, with a morphologic right ventricle acting as systemic pump and a morphologic left ventricle connected to the pulmonary trunk, and n = 12 patients after the arterial switch procedure, with physiologic ventriculoarterial connections. Flow-sensitive four-dimensional velocity-encoded magnetic resonance imaging was used to analyse systolic flow patterns in the aorta and pulmonary trunk, relating to helical flow and vortex formation. RESULTS In the aorta, overall helicity was present in healthy volunteers, but it was absent in all patients independent on the operation technique. Partial helices were observed in the ascending aorta of 58% of patients after arterial switch. In the pulmonary trunk, mostly parallel flow was seen in healthy volunteers and in patients after arterial switch, whereas vortex formation was present in 88% of patients after atrial redirection. CONCLUSION Blood flow patterns differ substantially between the groups. In addition to varying mechanics of the coherent pumping ventricles, the absent overall helicity in all patients might be explained by the missing looping of the aorta in transposition.
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Pressure overloaded right ventricles: a multicenter study on the importance of trabeculae in RV function measured by CMR. Int J Cardiovasc Imaging 2014; 30:599-608. [DOI: 10.1007/s10554-014-0367-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 01/12/2014] [Indexed: 10/25/2022]
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[Cardiac magnetic resonance imaging: from imaging to diagnosis]. Radiologe 2013; 53:1033-52. [PMID: 24231826 DOI: 10.1007/s00117-013-2533-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Cardiac magnetic resonance imaging (CMR) has evolved over the past 20 years from a research-based imaging modality to an indispensable routine procedure in cardiac diagnostics. In addition to the morphological representation of cardiac anatomy, whereby only noninvasive multidetector computed tomography (MDCT) is superior, another strength of CMR is the assessment of cardiac function and tissue differentiation. This requires that the radiologist performing the examination and analyzing the results has good knowledge of cardiac and thoracic anatomy and a detailed knowledge of the various cardiovascular diseases, hemodynamics, and pathophysiology. CMR reliably allows determination of a range of easy to determine quantitative parameters such as ventricular ejection fraction and also the valvular regurgitation fraction, which allows objective assessment of cardiac function. Especially the possibility to differentiate inflamed, viable, and ischemic tissue using adenosine stress MRI in the last 10 years has led to routine use of CMR. Even compared to competing nuclear medicine procedures, CMR is important for treatment decision-making and for prognosis estimation, thus, making it an indispensable component of cardiovascular diagnostics.
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Sarikouch S, Boethig D, Peters B, Kropf S, Dubowy KO, Lange P, Kuehne T, Haverich A, Beerbaum P. Poorer right ventricular systolic function and exercise capacity in women after repair of tetralogy of fallot: a sex comparison of standard deviation scores based on sex-specific reference values in healthy control subjects. Circ Cardiovasc Imaging 2013; 6:924-33. [PMID: 24132714 DOI: 10.1161/circimaging.112.000195] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In repaired congenital heart disease, there is increasing evidence of sex differences in cardiac remodeling, but there is a lack of comparable data for specific congenital heart defects such as in repaired tetralogy of Fallot. METHODS AND RESULTS In a prospective multicenter study, a cohort of 272 contemporary patients (158 men; mean age, 14.3±3.3 years [range, 8-20 years]) with repaired tetralogy of Fallot underwent cardiac magnetic resonance for ventricular function and metabolic exercise testing. All data were transformed to standard deviation scores according to the Lambda-Mu-Sigma method by relating individual values to their respective 50th percentile (standard deviation score, 0) in sex-specific healthy control subjects. No sex differences were observed in age at repair, type of repair conducted, or overall hemodynamic results. Relative to sex-specific controls, repaired tetralogy of Fallot in women had larger right ventricular end-systolic volumes (standard deviation scores: women, 4.35; men, 3.25; P=0.001), lower right ventricular ejection fraction (women, -2.83; men, -2.12; P=0.011), lower right ventricular muscle mass (women, 1.58; men 2.45; P=0.001), poorer peak oxygen uptake (women, -1.65; men, -1.14; P<0.001), higher VE/VCO2 (ventilation per unit of carbon dioxide production) slopes (women, 0.88; men 0.58; P=0.012), and reduced peak heart rate (women, -2.16; men -1.74; P=0.017). Left ventricular parameters did not differ between sexes. CONCLUSIONS Relative to their respective sex-specific healthy control subjects, derived standard deviation scores in repaired tetralogy of Fallot suggest that women perform poorer than men in terms of right ventricular systolic function as tested by cardiac magnetic resonance and exercise capacity. This effect cannot be explained by selection bias. Further outcome data are required from longitudinal cohort studies.
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Affiliation(s)
- Samir Sarikouch
- Departments of Cardiothoracic, Transplant, and Vascular Surgery
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Maffessanti F, Muraru D, Esposito R, Gripari P, Ermacora D, Santoro C, Tamborini G, Galderisi M, Pepi M, Badano LP. Age-, Body Size-, and Sex-Specific Reference Values for Right Ventricular Volumes and Ejection Fraction by Three-Dimensional Echocardiography. Circ Cardiovasc Imaging 2013; 6:700-10. [DOI: 10.1161/circimaging.113.000706] [Citation(s) in RCA: 164] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Francesco Maffessanti
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy (F.M., P.G., G.T., M.P.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy (D.M., D.E., L.P.B.); Cardioangiology with CCU, Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy (R.E., C.S., M.G.)
| | - Denisa Muraru
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy (F.M., P.G., G.T., M.P.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy (D.M., D.E., L.P.B.); Cardioangiology with CCU, Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy (R.E., C.S., M.G.)
| | - Roberta Esposito
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy (F.M., P.G., G.T., M.P.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy (D.M., D.E., L.P.B.); Cardioangiology with CCU, Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy (R.E., C.S., M.G.)
| | - Paola Gripari
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy (F.M., P.G., G.T., M.P.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy (D.M., D.E., L.P.B.); Cardioangiology with CCU, Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy (R.E., C.S., M.G.)
| | - Davide Ermacora
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy (F.M., P.G., G.T., M.P.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy (D.M., D.E., L.P.B.); Cardioangiology with CCU, Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy (R.E., C.S., M.G.)
| | - Ciro Santoro
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy (F.M., P.G., G.T., M.P.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy (D.M., D.E., L.P.B.); Cardioangiology with CCU, Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy (R.E., C.S., M.G.)
| | - Gloria Tamborini
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy (F.M., P.G., G.T., M.P.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy (D.M., D.E., L.P.B.); Cardioangiology with CCU, Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy (R.E., C.S., M.G.)
| | - Maurizio Galderisi
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy (F.M., P.G., G.T., M.P.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy (D.M., D.E., L.P.B.); Cardioangiology with CCU, Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy (R.E., C.S., M.G.)
| | - Mauro Pepi
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy (F.M., P.G., G.T., M.P.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy (D.M., D.E., L.P.B.); Cardioangiology with CCU, Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy (R.E., C.S., M.G.)
| | - Luigi P. Badano
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy (F.M., P.G., G.T., M.P.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy (D.M., D.E., L.P.B.); Cardioangiology with CCU, Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy (R.E., C.S., M.G.)
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Fratz S, Chung T, Greil GF, Samyn MM, Taylor AM, Valsangiacomo Buechel ER, Yoo SJ, Powell AJ. Guidelines and protocols for cardiovascular magnetic resonance in children and adults with congenital heart disease: SCMR expert consensus group on congenital heart disease. J Cardiovasc Magn Reson 2013; 15:51. [PMID: 23763839 PMCID: PMC3686659 DOI: 10.1186/1532-429x-15-51] [Citation(s) in RCA: 310] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 05/08/2013] [Indexed: 01/12/2023] Open
Abstract
Cardiovascular magnetic resonance (CMR) has taken on an increasingly important role in the diagnostic evaluation and pre-procedural planning for patients with congenital heart disease. This article provides guidelines for the performance of CMR in children and adults with congenital heart disease. The first portion addresses preparation for the examination and safety issues, the second describes the primary techniques used in an examination, and the third provides disease-specific protocols. Variations in practice are highlighted and expert consensus recommendations are provided. Indications and appropriate use criteria for CMR examination are not specifically addressed.
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Affiliation(s)
- Sohrab Fratz
- Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München (German Heart Center Munich) of the Technical University Munich, Munich, Germany
| | - Taylor Chung
- Department of Diagnostic Imaging, Children’s Hospital & Research Center Oakland, Oakland, California, USA
| | - Gerald F Greil
- Department of Pediatric Cardiology, Evelina Children’s Hospital/Guy’s and St. Thomas’ Hospital NHS Foundation Trust; Division of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
| | - Margaret M Samyn
- The Herma Heart Center, Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrew M Taylor
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, & Great Ormond Street Hospital for Children, London, UK
| | | | - Shi-Joon Yoo
- Department of Diagnostic Imaging and Division of Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Andrew J Powell
- Department of Cardiology, Boston Children’s Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Dobutamine stress MRI in repaired tetralogy of Fallot with chronic pulmonary regurgitation. Int J Cardiol 2013; 166:96-105. [DOI: 10.1016/j.ijcard.2011.10.142] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 09/10/2011] [Accepted: 10/13/2011] [Indexed: 11/24/2022]
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Parish V, Valverde I, Kutty S, Head C, Greil GF, Schaeffter T, Razavi R, Beerbaum P. Higher dose dobutamine stress MR imaging in repaired Tetralogy of Fallot: observer variance of volumetric assessment compared with normal volunteers. J Magn Reson Imaging 2013; 38:1356-61. [PMID: 23704060 DOI: 10.1002/jmri.24103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 02/11/2013] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To investigate changes in image quality and observer variance between rest and higher-dose dobutamine stress MR imaging (DS-MR) in tetralogy of Fallot (TOF) patients and in a group of normal healthy volunteers using both axial and short axis orientation for cardiac volumetric assessment. MATERIALS AND METHODS Eighteen adult patients (age 34 ± 13) with TOF and severe pulmonary regurgitation and 10 healthy volunteers underwent ventricular MR volumetry at baseline and during dobutamine infusion of 10 μg/kg/min and 20 μg/kg/min. Inter-observer and intra-observer agreement was calculated by coefficient of variance (COV). RESULTS Inter-observer comparison showed good agreement for left ventricle (LV) and right ventricle (RV) end-diastolic volumes at rest and both stress levels in TOF patients (axial geometry) and in normal volunteers (short axis). During dobutamine stress, the COV in TOF patients increased for LV end-systolic volume (LV-ESV) with each level, suggesting less agreement between observers. In contrast, RV-ESV was much more comparable with a COV < 10 at each condition. All volumetric measurements in normal volunteers showed good inter-observer agreement. Excellent intra-observer agreement could be seen for all volumetric parameters with COV levels below 7. CONCLUSION Volumetric assessment during DS-MR shows excellent inter-observer agreement, except for LV-ESV in the TOF patients at higher doses of dobutamine. The axial geometry appears to be reproducible for assessment of RV parameters, and could be considered superior to short axis imaging in patients with repaired TOF.
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Affiliation(s)
- Victoria Parish
- King's College London BHF Centre, Division of Imaging Sciences, NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, UK; Adult Congenital Heart Disease Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
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The systemic right ventricle in congenitally corrected transposition of the great arteries is different from the right ventricle in dextro-transposition after atrial switch: a cardiac magnetic resonance study. Cardiol Young 2013; 23:239-47. [PMID: 22694856 DOI: 10.1017/s1047951112000790] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Patients with a congenitally corrected transposition of the great arteries show an increasing incidence of cardiac failure with age. In other systemic right ventricles, such as in dextro-transposition after atrial switch, excessive hypertrophy is a potential risk factor for impaired systolic function. In this trial, we sought to compare systemic function and volumes between patients with congenitally corrected transposition and those with dextro-transposition after atrial switch by using cardiac magnetic resonance imaging. METHODS AND RESULTS A total of 19 patients (nine male) with congenitally corrected transposition and 31 patients (21 male) with dextro-transposition after atrial switch were studied using a 1.5-Tesla scanner. Cine steady-state free-precession sequences in standard orientations were acquired for volumetric and functional imaging. Patient parameters were compared with those of a group of 25 healthy volunteers. Although patients with congenitally corrected transposition were older, they presented with higher right ventricular ejection fractions (p = 0.04) compared with patients with dextro-transposition. Patients with congenitally corrected transposition showed a weak negative correlation between age at examination and systemic ejection fraction (r = −0.18, p = 0.04) but no correlation between right ventricular myocardial mass index and ejection fraction. There was no significant difference in the right ventricular end-diastolic volumes between both patient groups. CONCLUSION Although patients with congenitally corrected transposition had a longer pressure load of the systemic right ventricle, ventricular function was better compared with that in patients with dextro-transposition after atrial switch. The results suggest that the systemic ventricles might have partly different physiologies. One difference could be the post-operative situation after atrial switch, which results in impaired atrial contribution to ventricular filling.
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Gabbert DD, Entenmann A, Jerosch-Herold M, Frettlöh F, Hart C, Voges I, Pham M, Andrade A, Pardun E, Wegner P, Hansen T, Kramer HH, Rickers C. Determination of volume-time curves for the right ventricle and its outflow tract for functional analyses. Magn Reson Med 2013; 70:1718-27. [PMID: 23382056 DOI: 10.1002/mrm.24609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 11/15/2012] [Accepted: 11/30/2012] [Indexed: 11/08/2022]
Abstract
PURPOSE The determination of right ventricular volumes and function is of increasing interest for the postoperative care of patients with congenital heart defects. The presentation of volumetry data in terms of volume-time curves allows a comprehensive functional assessment. By using manual contour tracing, the generation of volume-time curves is exceedingly time-consuming. METHODS This study describes a fast and precise method for determining volume-time curves for the right ventricle and for the right ventricular outflow tract. The method applies contour detection and includes a feature for identifying the right ventricular outflow tract volume. The segregation of the outflow tract is performed by four-dimensional curved smooth boundary surfaces defined by prespecified anatomical landmarks. RESULTS The comparison with manual contour tracing demonstrates that the method is accurate and improves the precision of the measurement. Compared to manual contour tracing the bias is <0.1% ± 4.1% (right ventricle) and -2.6% ± 20.0% (right ventricular outflow tract). The standard deviations of inter- and intraobserver variabilities for determining the volume of the right ventricular outflow tract are reduced to less than half the values of manual contour tracing. The time consumption per patient is reduced from 341 ± 80 min (right ventricle) and 56 ± 11 min (right ventricular outflow tract) using manual contour tracing to 46 ± 9 min for a combined analysis of right ventricle and right ventricular outflow tract. CONCLUSION The analysis of volume-time curves for the right ventricle and its outflow tract discloses new evaluation methods in clinical routine and science.
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Affiliation(s)
- Dominik D Gabbert
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany
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Systemic right ventricles rarely show myocardial scars in cardiac magnetic resonance delayed-enhancement imaging. Clin Res Cardiol 2013; 102:337-44. [DOI: 10.1007/s00392-013-0539-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 01/22/2013] [Indexed: 10/27/2022]
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Grothoff M, Pachowsky M, Hoffmann J, Posch M, Klaassen S, Lehmkuhl L, Gutberlet M. Value of cardiovascular MR in diagnosing left ventricular non-compaction cardiomyopathy and in discriminating between other cardiomyopathies. Eur Radiol 2012; 22:2699-709. [PMID: 22772366 PMCID: PMC3486997 DOI: 10.1007/s00330-012-2554-7] [Citation(s) in RCA: 128] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 05/21/2012] [Accepted: 05/24/2012] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To analyse the value of cardiovascular magnetic resonance (CMR)-derived myocardial parameters to differentiate left ventricular non-compaction cardiomyopathy (LVNC) from other cardiomyopathies and controls. METHODS We retrospectively analysed 12 patients with LVNC, 11 with dilated and 10 with hypertrophic cardiomyopathy and compared them to 24 controls. LVNC patients had to fulfil standard echocardiographic criteria as well as additional clinical and imaging criteria. Cine steady-state free precession and late gadolinium enhancement (LGE) imaging was performed. The total LV myocardial mass index (LV-MMI), compacted (LV-MMI(compacted)), non-compacted (LV-MMI(non-compacted)), percentage LV-MM(non-compacted), ventricular volumes and function were calculated. Data were compared using analysis of variance and Dunnett's test. Additionally, semi-quantitative segmental analyses of the occurrence of increased trabeculation were performed. RESULTS Total LV-MMI(non-compacted) and percentage LV-MM(non-compacted) were discriminators between patients with LVCN, healthy controls and those with other cardiomyopathies with cut-offs of 15 g/m(2) and 25 %, respectively. Furthermore, trabeculation in basal segments and a ratio of non-compacted/compacted myocardium of ≥3:1 were criteria for LVNC. A combination of these criteria provided sensitivities and specificities of up to 100 %. None of the LVNC patients demonstrated LGE. CONCLUSIONS Absolute CMR quantification of the LV-MMI(non-compacted) or the percentage LV-MM(non-compacted) and increased trabeculation in basal segments allows one to reliably diagnose LVNC and to differentiate it from other cardiomyopathies. KEY POINTS Cardiac magnetic resonance imaging can reliably diagnose left ventricular non-compaction cardiomyopathy. Differentiation of LVNC from other cardiomyopathies and normal hearts is possible. The best diagnostic performance can be achieved if combined MRI criteria for the diagnosis are used.
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Affiliation(s)
- Matthias Grothoff
- Department of Diagnostic and Interventional Radiology, University of Leipzig - Heart Center, Strümpellstr. 39, 04289, Leipzig, Germany.
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Nordmeyer S, Riesenkampff E, Messroghli D, Kropf S, Nordmeyer J, Berger F, Kuehne T. Four-dimensional velocity-encoded magnetic resonance imaging improves blood flow quantification in patients with complex accelerated flow. J Magn Reson Imaging 2012; 37:208-16. [PMID: 22976284 DOI: 10.1002/jmri.23793] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 07/27/2012] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To evaluate the use of four-dimensional (4D) velocity-encoded magnetic resonance imaging (VEC MRI) for blood flow quantification in patients with semilunar valve stenosis and complex accelerated flow. MATERIALS AND METHODS Peak velocities (Vmax) and stroke volumes (SV) were quantified by 2D and 4D VEC MRI in volunteers (n = 7) and patients with semilunar valve stenosis (n = 18). Measurements were performed above the aortic and pulmonary valve with both techniques and, additionally, at multiple predefined planes in the ascending aorta and in the pulmonary trunk within the 4D dataset. In patients, 4D VEC MRI streamline analysis identified flow patterns and regions of highest flow velocity (4D(max-targeted)) for further measurements and Vmax was also measured by Doppler-echocardiography. RESULTS In patients, 4D VEC MRI showed higher Vmax than 2D VEC MRI (2.7 ± 0.6 m/s vs. 2.4 ± 0.5 m/s, P < 0.03) and was more comparable to Doppler-echocardiography (2.8 ± 0.7 m/s). 4D(max-targeted) revealed highest Vmax values (3.1 ± 0.6 m/s). SV measurements showed significant differences between different anatomical levels in the ascending aorta in patients with complex accelerated flow, whereas differences in volunteers with laminar flow patterns were negligible (P = 0.004). CONCLUSION 4D VEC MRI improves MRI-derived blood flow quantification in patients with semilunar valve stenosis and complex accelerated flow.
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Affiliation(s)
- Sarah Nordmeyer
- Deutsches Herzzentrum Berlin, Unit of Cardiovascular Imaging, Department of Congenital Heart Disease and Pediatric Cardiology, Berlin, Germany.
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Freling HG, van Wijk K, Jaspers K, Pieper PG, Vermeulen KM, van Swieten JM, Willems TP. Impact of right ventricular endocardial trabeculae on volumes and function assessed by CMR in patients with tetralogy of Fallot. Int J Cardiovasc Imaging 2012; 29:625-31. [DOI: 10.1007/s10554-012-0112-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 08/07/2012] [Indexed: 11/30/2022]
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