A multi-vendor, multi-center study on reproducibility and comparability of fast strain-encoded cardiovascular magnetic resonance imaging

Abstract

Myocardial strain is a convenient parameter to quantify left ventricular (LV) function. Fast strain-encoding (fSENC) enables the acquisition of cardiovascular magnetic resonance images for strain-measurement within a few heartbeats during free-breathing. It is necessary to analyze inter-vendor agreement of techniques to determine strain, such as fSENC, in order to compare existing studies and plan multi-center studies. Therefore, the aim of this study was to investigate inter-vendor agreement and test-retest reproducibility of fSENC for three major MRI-vendors. fSENC-images were acquired three times in the same group of 15 healthy volunteers using 3 Tesla scanners from three different vendors: at the German Heart Institute Berlin, the Charité University Medicine Berlin-Campus Buch and the Theresien-Hospital Mannheim. Volunteers were scanned using the same imaging protocol composed of two fSENC-acquisitions, a 15-min break and another two fSENCacquisitions. LV global longitudinal and circumferential strain (GLS, GCS) were analyzed by a trained observer (Myostrain 5.0, Myocardial Solutions) and for nine volunteers repeatedly by another observer. Inter-vendor agreement was determined using Bland-Altman analysis. Test-retest reproducibility and intra-and inter-observer reproducibility were analyzed using intraclass correlation coefficient (ICC) and coefficients of variation (CoV). Inter-vendor agreement between all three sites was good for GLS and GCS, with biases of 0.01-1.88%. Test-retest reproducibility of scans before and after the break was high, shown by ICC-and CoV values of 0.63-0.97 and 3-9% for GLS and 0.69-0.82 and 4-7% for GCS, respectively. Intra-and inter-observer reproducibility were excellent for both parameters (ICC of 0.77-0.99, CoV of 2-5%). This trial demonstrates good inter-vendor agreement and test-retest reproducibility of GLS and GCS measurements, acquired at three different scanners from three different vendors using fSENC. The results indicate that it is necessary to account for a possible bias (< 2%) when comparing strain measurements of different scanners. Technical differences between scanners, which impact inter-vendor agreement, should be further analyzed and minimized.

Feasibility of fast cardiovascular magnetic resonance strain imaging in patients presenting with acute chest pain

“…Cardiovascular Magnetic Resonance (CMR) is the accepted reference standard for assessment of ventricular function [10,11]. Recently, fast Strain-ENCoded (fSENC) CMR imaging was introduced as a single heartbeat acquisition technique for assessing myocardial strain, with demonstrated clinical utility [12,13].…”

A Pilot Study of Cardiac MRI in Breast Cancer Survivors After Cardiotoxic Chemotherapy and Three-Dimensional Conformal Radiotherapy

“…Especially relevant, recent studies illustrated the capabilities of fSENC for robust and detailed analysis of cardiac function and myocardial contractility pattern as fast as one slice per heartbeat. Such an approach would allow for evaluating cardiac function based on whole-heart strain analysis in a few seconds without the need for breath-holding or a contrast agent, which is of particular importance in cancer patients who may have difficulties with longer exams (56)(57)(58)(59). Previous studies have found trastuzumab to be cardiotoxic with 5% prevalence of cardiomyopathy when used as monotherapy and 10-15% prevalence when used with anthracyclines (51,61).…”

“…However, the reproducibility of feature tracking can also be variable ( 52 , 53 ). In addition, feature tracking is not as robust or sensitive as other standard strain measuring techniques, such as tagging, strain-encoding [SENC or fast-SENC (fSENC)] ( 54 – 59 ), or displacement-encoding with stimulated echoes (DENSE) ( 60 ). Future studies examining strain using CMR would ideally make use of these more advanced techniques.…”

“…Indeed, the use of standardized cardiac heart substructure contours may allow more refined analysis of risk of cardiac disease based upon dose localization within the heart ( 75 ). For future studies, including advanced CMR techniques for studying regional heart mechanics ( 76 ) [e.g., MRI tagging ( 77 ), fSENC ( 54 – 59 ), or DENSE ( 60 )] could reveal important information about myocardial regional contractility patterns that are expected to be affected at earlier timepoints after radiation, before reduction of global heart function and heart failure development. For global LV geometric measurements (LVEDV, LVEDVI, LVESV, LVESVI, LVEF and LVMI), only short-axis data was used.…”

Cardiovascular imaging 2020 in the international journal of cardiovascular imaging: the 10 most downloaded papers in the year 2020

“…“A multi-vendor, multi-center study on reproducibility and comparability of fast strain-encoded cardiovascular magnetic resonance imaging” by Erley et al [ 7 ] was downloaded 892 times. These authors studied the inter-vender agreement and test-retest reproducibility of fast strain-encoding acquisitions at 3T on 15 volunteers and found good inter-vendor agreement and test-retest reproducibility providing the basis for conducting studies to validate strain techniques in large patient cohorts.…”