Effects of slice orientation on reproducibility of sequential assessment of right ventricular volumes and ejection fraction: short-axis vs transverse SSFP cine cardiovascular magnetic resonance

Abstract

BackgroundTest-retest reproducibility is of utmost importance in follow-up of right ventricular (RV) volumes and function; optimal slice orientation though is not yet known. We compared test-retest reproducibility and intra-/inter-observer variability of right ventricular (RV) volumes and function assessed with short-axis and transverse cardiovascular magnetic resonance (CMR).MethodsEighteen volunteers underwent cine CMR for RV assessment obtaining ventricular coverage in short-axis and transverse slice orientation. Additional 2D phase contrast flow imaging of the main pulmonary artery (MPA) was performed. After complete repositioning repeat acquisitions were performed. Data sets were contoured by two blinded observers. Statistical analysis included Student’s t-test, Bland-Altman plots, intra-class correlation coefficient (ICC) and 2-way ANOVA, SEM and minimal detectable difference calculations.ResultsHeart rates (65.0 ± 7.4 vs. 67.6 ± 9.9 bpm; P = 0.1) and MPA flow (89.8 ± 16.6 vs. 87.2 ± 14.9 mL; P = 0.1) did not differ between imaging sessions. EDV and ESV demonstrated an inter-study bias of 0.4 %[−9.5 %,10.3 %] and 2.1 %[−12.3 %,16.4 %] for short-axis and 1.1 %[−7.3 %,9.4 %] and 0.8 %[−16.0 %,17.6 %] for transverse orientation, respectively. There was no significant interaction between imaging orientation and interstudy reproducibility (p = 0.395–0.824), intra-observer variability (p = 0.726–0.862) or inter-observer variability (p = 0.447–0.706) by 2-way ANOVA. Inter-observer agreement by ICC was greater for short axis versus transverse orientation for all parameters (0.769–0.986 vs. 0.625–0.983, respectively). Minimal detectable differences for short axis and transverse orientations were 10.1 mL/11.5 mL for EDV, 8.3 mL/8.4 mL for ESV and 4.1 % vs. 4.7 % for EF, respectively.ConclusionShort-axis and transverse orientation both provide reliable and reproducible measures for follow-up of RV volumes and global function. Therefore, additional transverse SSFP cine CMR may not necessarily be required if performed for the sole purpose of quantitative volumetric RV assessment.

Review of Journal of Cardiovascular Magnetic Resonance (JCMR) 2015-2016 and transition of the JCMR office to Boston

“…Reproducibility of right ventricular (RV) volumes and function are of utmost importance, but the optimal slice orientation for RV measurements is unknown. In this study, D’Errico et al [ 151 ] performed cine CMR in the ventricular short axis and transverse slice orientations in addition to phase velocity mapping of the main pulmonary artery in 18 subjects. Both short axis and transverse imaging slices were found to provide similarly reliable and reproducible measures and thus suitable for baseline and follow-up studies.…”

Right and left ventricular function and flow quantification in pediatric patients with repaired tetralogy of Fallot using four-dimensional flow magnetic resonance imaging

“…Cardiac function and flow measurements by cardiac magnetic resonance (CMR) are usually analyzed using conventional two-dimensional (2D) balanced steadystate free precession (b-SSFP) cine and 2D phase contrast (PC) sequences. The accuracy of 2D b-SSFP cine has been validated and the technique is widely used in postoperative functional assessment with CHD [5][6][7][8][9][10]. 2D PC is the primary method used to measure blood flow volume and velocity in CMR [11].…”

Journal of Cardiovascular Magnetic Resonance 2017

“…CMR technical advances continue to advance the field. Advances are in both automated analysis [85–88], contrast agents [89–91], accelerated methods [92, 93], 3T T2* [94], oxygen content [95], native T1 and ECV [96–98], respiratory suppression [99], flow [100, 101], ventricular function [102, 103], dark blood LGE [104], coronary imaging [105] and diffusion tensor imaging [106, 107].…”