Adolescent Reference Values for MR‐Derived Biventricular Strain Obtained Using Feature‐Tracking and Myocardial Tagging

Abstract

BackgroundMyocardial strain is a promising marker for the detection of early left or right ventricular (LV or RV) dysfunction in pediatric populations. The reference standard for MR strain measurement is myocardial tagging (MT); however, MT has limited clinical utility because the additional acquisitions needed are time‐consuming. In contrast, MR‐feature tracking (FT) allows strain quantification from routinely acquired cine sequences. Studies providing reference values obtained with both FT and MT for adolescents are lacking.PurposeTo use MR‐FT and MT to define sex‐specific LV and RV strain reference values for adolescents.Study TypeCross‐sectional, prospective.PopulationOne hundred twenty‐three adolescents aged 15–18 years (52% girls) without known cardiovascular disease.Field Strength/SequenceBalanced steady‐state free‐precession sequence for FT analysis and a spatial modulation of magnetization hybrid TFE‐EPI sequence for MT acquisitions at 3.0‐T.AssessmentSegment Medviso software was used to obtain longitudinal (LS) and circumferential (CS) strain for both ventricles, and radial strain (RS) for LV.Statistical TestsThe Student t‐test was used for between‐sex comparisons of continuous variables. Sex‐specific percentiles were calculated using the weighted average method. Intraobserver and interobserver agreement was assessed in 30 randomly selected studies using intraclass correlation coefficients (ICC). A P‐value <0.05 was considered statistically significant.ResultsFT‐derived LVLS and LVCS were significantly higher in girls than in boys (−19.8% vs. −17.8% and −22.2% vs. −21.0%, respectively), as they were with MT (LVLS: −18.1% vs. −16.8%; LVCS: −20.8% vs. −19.7%). FT‐LVRS was higher in girls than in boys (44.8% vs. 35.1%), while MT‐LVRS was the opposite (18.6% vs. 22.7%). FT‐RVLS was higher in girls (−23.4% vs. −21.3%), but there were no between‐sex differences in MT‐derived RVLS or RVCS. ICC values for intraobserver agreement were ≥0.89, whereas for interobserver agreement were <0.80 for MT‐LVRS and ≥0.80 for all remaining parameters.Data ConclusionThis study provides sex‐specific reference biventricular strain values obtained with MR‐MT and MR‐FT for adolescents aged 15–18 years. MR‐FT may be a valid method for obtaining strain values in pediatric populations.Evidence Level1Technical EfficacyStage 3