Korean J Radiol.  2019 Jan;20(1):114-125. 10.3348/kjr.2018.0243.

Retrospective Electrocardiography-Gated Real-Time Cardiac Cine MRI at 3T: Comparison with Conventional Segmented Cine MRI

• Cui C
• Yin G
• Lu M
• Chen X
• Cheng S
• Li L
• Yan W
• Song Y
• Prasad S
• Zhang Y
• Zhao S

• KMID: 2429925
• DOI: http://doi.org/10.3348/kjr.2018.0243

Abstract

OBJECTIVE
Segmented cardiac cine magnetic resonance imaging (MRI) is the gold standard for cardiac ventricular volumetric assessment. In patients with difficulty in breath-holding or arrhythmia, this technique may generate images with inadequate quality for diagnosis. Real-time cardiac cine MRI has been developed to address this limitation. We aimed to assess the performance of retrospective electrocardiography-gated real-time cine MRI at 3T for left ventricular (LV) volume and mass measurement.
MATERIALS AND METHODS
Fifty-one patients were consecutively enrolled. A series of short-axis cine images covering the entire left ventricle using both segmented and real-time balanced steady-state free precession cardiac cine MRI were obtained. End-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), and LV mass were measured. The agreement and correlation of the parameters were assessed. Additionally, image quality was evaluated using European CMR Registry (Euro-CMR) score and structure visibility rating.
RESULTS
In patients without difficulty in breath-holding or arrhythmia, no significant difference was found in Euro-CMR score between the two techniques (0.3 ± 0.7 vs. 0.3 ± 0.5, p > 0.05). Good agreements and correlations were found between the techniques for measuring EDV, ESV, EF, SV, and LV mass. In patients with difficulty in breath-holding or arrhythmia, segmented cine MRI had a significant higher Euro-CMR score (2.3 ± 1.2 vs. 0.4 ± 0.5, p < 0.001).
CONCLUSION
Real-time cine MRI at 3T allowed the assessment of LV volume with high accuracy and showed a significantly better image quality compared to that of segmented cine MRI in patients with difficulty in breath-holding and arrhythmia.

Keyword

Magnetic resonance imaging; Cardiac cine; Real-time acquisition

MeSH Terms

Arrhythmias, Cardiac
Diagnosis
Heart Ventricles
Humans
Magnetic Resonance Imaging
Magnetic Resonance Imaging, Cine*
Retrospective Studies*
Stroke Volume

Figure

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  Fig. 1 Schematic diagram for data acquisition in retrospective gated real-time cardiac cine.ECG = electrocardiography, EDV = end-diastolic volume, ESV = end-systolic volume

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  Fig. 2 Representative images of patients without difficulty in breath-holding and arrhythmia.Short-axis view images in end-diastole and end-systole phases in hypertrophic cardiomyopathy patient with heart rate of 59 beats/min.

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  Fig. 3 Representative images of patients with difficulty in breath-holding and arrhythmia.Short-axis view images in end-diastole and end-systole phases in patient with atrial fibrillation. In contrast to real-time cardiac cine, endocardial contour was difficult to identify in conventional segmented cine in mid-ventricular and apical slices.

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  Fig. 4 Reviewer rating of endocardial border definition, epicardial border definition, papillary muscle visualization, myocardium visualization, blood pool contrast, and cardiac motion for real-time and segmented cine in patients from both groups.

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  Fig. 5 Bland-Altman analysis shows good agreements in measurements of EDV (A), ESV (B), SV (C), EF (D) and LV mass (E).Blue line indicates mean value and brown dashed line indicates 95% confidence interval. EF = ejection fraction, LV = left ventricular, SD = standard deviation, SV = stroke volume

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  Fig. 6 Scatter plots for LV volumetric and mass measurements in standard segmented cine and real-time cine show good correlation in EDV (A), ESV (B), SV (C), EF (D), and mass (E) assessment.Brown dashed line indicates 95% confidence interval.

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