Korean J Radiol.  2018 Aug;19(4):704-714. 10.3348/kjr.2018.19.4.704.

Comparison between Three-Dimensional Navigator-Gated Whole-Heart MRI and Two-Dimensional Cine MRI in Quantifying Ventricular Volumes

Affiliations
  • 1Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea. ghw68@hanmail.net

Abstract


OBJECTIVE
To test whether the method utilizing three-dimensional (3D) whole-heart MRI has an additional benefit over that utilizing conventional two-dimensional (2D) cine MRI in quantifying ventricular volumes.
MATERIALS AND METHODS
In 110 patients with congenital heart disease, a navigator-gated, 3D whole-heart MRI during end-systole (ES) and end-diastole (ED), 2D short-axis cine MRI, and phase contrast MRI of the great arteries were acquired. Ventricular volumes were measured by using a 3D threshold-based segmentation for 3D whole-heart MRI and by using a simplified contouring for 2D cine MRI. The cardiac trigger delays of 3D whole-heart MRI were compared with those of a 2D cine MRI. The stroke volumes calculated from the ventricular volumes were compared with the arterial flow volumes, measured by phase contrast MRI.
RESULTS
The ES and ED trigger delays of whole-heart MRI were significantly less than cine MRI for both the left ventricle (−16.8 ± 35.9 ms for ES, −59.0 ± 90.4 ms for ED; p < 0.001) and the right ventricle (−58.8 ± 30.6 ms for ES, −104.9 ± 92.7 ms for ED; p < 0.001). Compared with the arterial flow volumes, 2D cine MRI significantly overestimated the left ventricular stroke volumes (8.7 ± 8.9 mL, p < 0.001) and the 3D whole-heart MRI significantly underestimated the right ventricular stroke volumes (−22.7 ± 22.9 mL, p < 0.001).
CONCLUSION
Three-dimensional whole-heart MRI is often subject to early timing of the ED phase, potentially leading to the underestimation of the right ventricular stroke volumes.

Keyword

Cardiac MR; CMR; Cardiac volumetric quantification; Congenital heart disease; Simplified contouring; Threshold-based segmentation

MeSH Terms

Arteries
Heart Defects, Congenital
Heart Ventricles
Humans
Magnetic Resonance Imaging*
Magnetic Resonance Imaging, Cine*
Methods
Stroke Volume

Figure

  • Fig. 1 18-year-old male with repaired tetralogy of Fallot.Short-axis reformatted ES 3D whole-heart MR images show LV cavity (A) and RV cavity (C) segmented by 3D threshold-based method in pink. Notably, papillary muscles (arrows, A) and trabeculations are excluded from ventricular cavity in method. In contrast, ES 2D short-axis cine MR images show manually traced LV cavity (green line, B) and RV cavity (yellow line, D) based on simplified contouring method. In method, papillary muscles (arrows, B) and trabeculations are included in ventricular cavity, which increases measured ventricular volumes. Slight differences between retrospectively reformatted short-axis imaging plane of 3D whole-heart MRI and short-axis cine imaging plane are present. ES = end-systolic, LV = left ventricular, MR = magnetic resonance, RV = right ventricular, 2D = two-dimensional, 3D = three-dimensional

  • Fig. 2 10-year-old female with repaired tetralogy of Fallot.A. Histogram shows threshold of 497 (white line) located between two different distribution curves of M and ventricular B. Threshold is close to myocardium curve to exclude tissues consisting of 100% ventricular myocardium and it was used for 3D threshold-based segmentation method. B. LV long-axis reformatted image using ES 3D whole-heart MRI demonstrates segmented LV cavity in pink. Even after exclusion of papillary muscles and trabeculations from ventricular cavity by using 3D threshold-based segmentation, small fraction of pixels partially including myocardial tissue are present along LV endocardium (white arrows). AV and MV were manually segmented (black arrows). C. LV ESV segmented by using 3D threshold-based method and 3D whole-heart MRI data was 31.8 mL. Three commissures (arrows) of aortic valve are clearly noted. D. RV long-axis reformatted image using ES 3D whole-heart MRI displays segmented RV cavity in pink. Although papillary muscles and trabeculations are excluded from ventricular cavity by using 3D threshold-based segmentation, small fraction of pixels partially including myocardial tissue are present along RV endocardium. PV and TV were manually segmented (arrows). E. RV ESV segmented by using 3D threshold-based method and 3D whole-heart MRI data was 66.1 mL. AV = aortic valve, B = blood, ESV = end-systolic volume, M = myocardium, MV = mitral valve, PV = pulmonary valve, TV = tricuspid valve

  • Fig. 3 Diagram illustrating ES and ED trigger delays for 2D short-axis cine MRI and 3D whole-heart MRI.Compared with corresponded trigger delays of 2D short-axis cine MRI, shorter trigger delays of 3D whole-heart MRI are pronounced for ED phase and for right ventricle. RR intervals were calculated based on mean heart rates during examination. Temporal resolutions are different between 2D short-axis cine MRI (30–50 ms) and 3D whole-heart MRI (30–100 ms). ED = end-diastolic

  • Fig. 4 Bland-Altman plots illustrating mean differences and 95% limits of agreement between arterial flow volumes measured by phase-contrast MRI and stroke volumes calculated from ventricular volumes, with arterial flow volumes as gold standard.A. Bland-Altman plot between aortic flow volumes and LV stroke volume from 2D short-axis cine MRI. B. Bland-Altman plot between aortic flow volumes and LV stroke volume from 3D whole-heart MRI. C. Bland-Altman plot between pulmonary arterial flow volumes and RV stroke volume from 2D short-axis cine MRI. D. Bland-Altman plot between pulmonary arterial flow volumes and RV stroke volume from 3D whole-heart MRI. SD = standard deviation

  • Fig. 5 Bland-Altman plots illustrating mean differences and 95% limits of agreement between ventricular volumes measured by 2D short-axis MRI and those measured by 3D whole-heart MRI.A. Bland-Altman plot demonstrating differences in LV ESVs between two methods. B. Bland-Altman plot demonstrating differences in LV EDVs between two methods. C. Bland-Altman plot demonstrating differences in RV ESVs between two methods. D. Bland-Altman plot demonstrating differences in RV EDVs between two methods. EDV = end-diastolic volume


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Reference

1. Pattynama PM, Lamb HJ, van der Velde EA, van der Wall EE, de Roos A. Left ventricular measurements with cine and spin-echo MR imaging: a study of reproducibility with variance component analysis. Radiology. 1993; 187:261–268. PMID: 8451425.
Article
2. Gnanappa GK, Rashid I, Celermajer D, Ayer J, Puranik R. Reproducibility of cardiac magnetic resonance imaging (CMRI)-derived right ventricular parameters in repaired tetralogy of Fallot (ToF). Heart Lung Circ. 2018; 27:381–385. PMID: 28662918.
Article
3. van Ooijen PM, de Jonge GJ, Oudkerk M. Informatics in radiology: postprocessing pitfalls in using CT for automatic and semiautomatic determination of global left ventricular function. Radiographics. 2012; 32:589–599. PMID: 22323618.
Article
4. Petitjean C, Dacher JN. A review of segmentation methods in short axis cardiac MR images. Med Image Anal. 2011; 15:169–184. PMID: 21216179.
Article
5. Greil GF, Boettger T, Germann S, Klumpp B, Baltes C, Kozerke S, et al. Quantitative assessment of ventricular function using three-dimensional SSFP magnetic resonance angiography. J Magn Reson Imaging. 2007; 26:288–295. PMID: 17654727.
Article
6. Uribe S, Tangchaoren T, Parish V, Wolf I, Razavi R, Greil G, et al. Volumetric cardiac quantification by using 3D dual-phase whole-heart MR imaging. Radiology. 2008; 248:606–614. PMID: 18574137.
Article
7. Delgado JA, Abad P, Rascovsky S, Calvo V, Castrillon G, Greil G, et al. Assessment of cardiac volumes using an isotropic whole-heart dual cardiac phase sequence in pediatric patients. J Magn Reson Imaging. 2014; 39:708–716. PMID: 23723135.
Article
8. Codella NC, Weinsaft JW, Cham MD, Janik M, Prince MR, Wang Y. Left ventricle: automated segmentation by using myocardial effusion threshold reduction and intravoxel computation at MR imaging. Radiology. 2008; 248:1004–1012. PMID: 18710989.
Article
9. Nassenstein K, de Greiff A, Hunold P. MR evaluation of left ventricular volumes and function: threshold-based 3D segmentation versus short-axis planimetry. Invest Radiol. 2009; 44:635–640. PMID: 19724238.
10. Sheehan FH, Kilner PJ, Sahn DJ, Vick GW 3rd, Stout KK, Ge S, et al. Accuracy of knowledge-based reconstruction for measurement of right ventricular volume and function in patients with tetralogy of Fallot. Am J Cardiol. 2010; 105:993–999. PMID: 20346319.
Article
11. Chuang ML, Gona P, Hautvast GL, Salton CJ, Blease SJ, Yeon SB, et al. Correlation of trabeculae and papillary muscles with clinical and cardiac characteristics and impact on CMR measures of LV anatomy and function. JACC Cardiovasc Imaging. 2012; 5:1115–1123. PMID: 23153911.
Article
12. Jaspers K, Freling HG, van Wijk K, Romijn EI, Greuter MJ, Willems TP. Improving the reproducibility of MR-derived left ventricular volume and function measurements with a semi-automatic threshold-based segmentation algorithm. Int J Cardiovasc Imaging. 2013; 29:617–623. PMID: 23053857.
Article
13. Freling HG, van Wijk K, Jaspers K, Pieper PG, Vermeulen KM, van Swieten JM, et al. Impact of right ventricular endocardial trabeculae on volumes and function assessed by CMR in patients with tetralogy of Fallot. Int J Cardiovasc Imaging. 2013; 29:625–631. PMID: 22945368.
Article
14. Miller CA, Jordan P, Borg A, Argyle R, Clark D, Pearce K, et al. Quantification of left ventricular indices from SSFP cine imaging: impact of real-world variability in analysis methodology and utility of geometric modeling. J Magn Reson Imaging. 2013; 37:1213–1222. PMID: 23124767.
Article
15. Varga-Szemes A, Muscogiuri G, Schoepf UJ, Wichmann JL, Suranyi P, De Cecco CN, et al. Clinical feasibility of a myocardial signal intensity threshold-based semi-automated cardiac magnetic resonance segmentation method. Eur Radiol. 2016; 26:1503–1511. PMID: 26267520.
Article
16. Sugeng L, Mor-Avi V, Weinert L, Niel J, Ebner C, Steringer-Mascherbauer R, et al. Multimodality comparison of quantitative volumetric analysis of the right ventricle. JACC Cardiovasc Imaging. 2010; 3:10–18. PMID: 20129525.
Article
17. Koch K, Oellig F, Oberholzer K, Bender P, Kunz P, Mildenberger P, et al. Assessment of right ventricular function by 16-detector-row CT: comparison with magnetic resonance imaging. Eur Radiol. 2005; 15:312–318. PMID: 15565315.
Article
18. Juergens KU, Seifarth H, Range F, Wienbeck S, Wenker M, Heindel W, et al. Automated threshold-based 3D segmentation versus short-axis planimetry for assessment of global left ventricular function with dual-source MDCT. AJR Am J Roentgenol. 2008; 190:308–314. PMID: 18212214.
Article
19. de Jonge GJ, van der Vleuten PA, Overbosch J, Lubbers DD, Jansen-van der Weide MC, Zijlstra F, et al. Semi-automatic measurement of left ventricular function on dual source computed tomography using five different software tools in comparison with magnetic resonance imaging. Eur J Radiol. 2011; 80:755–766. PMID: 21112169.
Article
20. Goo HW, Park SH. 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):223–232. PMID: 26319216.
Article
21. Goo HW, Yang DH, Hong SJ, Yu J, Kim BJ, Seo JB, et al. Xenon ventilation CT using dual-source and dual-energy technique in children with bronchiolitis obliterans: correlation of xenon and CT density values with pulmonary function test results. Pediatr Radiol. 2010; 40:1490–1497. PMID: 20411254.
Article
22. Lee VS, Spritzer CE, Carroll BA, Pool LG, Bernstein MA, Heinle SK, et al. Flow quantification using fast cine phase-contrast MR imaging, conventional cine phase-contrast MR imaging, and Doppler sonography: in vitro and in vivo validation. AJR Am J Roentgenol. 1997; 169:1125–1131. PMID: 9308476.
Article
23. Goo HW, Al-Otay A, Grosse-Wortmann L, Wu S, Macgowan CK, Yoo SJ. Phase-contrast magnetic resonance quantification of normal pulmonary venous return. J Magn Reson Imaging. 2009; 29:588–594. PMID: 19243041.
Article
24. Vincenti G, Monney P, Chaptinel J, Rutz T, Coppo S, Zenge MO, et al. Compressed sensing single-breath-hold CMR for fast quantification of LV function, volumes, and mass. JACC Cardiovasc Imaging. 2014; 7:882–892. PMID: 25129517.
25. Codella NC, Lee HY, Fieno DS, Chen DW, Hurtado-Rua S, Kochar M, et al. Improved left ventricular mass quantification with partial voxel interpolation: in vivo and necropsy validation of a novel cardiac MRI segmentation algorithm. Circ Cardiovasc Imaging. 2012; 5:137–146. PMID: 22104165.
26. Kido T, Kido T, Nakamura M, Watanabe K, Schmidt M, Forman C, et al. Compressed sensing real-time cine cardiovascular magnetic resonance: accurate assessment of left ventricular function in a single-breath-hold. J Cardiovasc Magn Reson. 2016; 18:50. PMID: 27553656.
Article
27. Krieger EV, Clair M, Opotowsky AR, Landzberg MJ, Rhodes J, Powell AJ, et al. Correlation of exercise response in repaired coarctation of the aorta to left ventricular mass and geometry. Am J Cardiol. 2013; 111:406–411. PMID: 23178052.
Article
28. Lu JC, Christensen JT, Yu S, Donohue JE, Ghadimi Mahani M, Agarwal PP, et al. Relation of right ventricular mass and volume to functional health status in repaired tetralogy of Fallot. Am J Cardiol. 2014; 114:1896–1901. PMID: 25438919.
Article
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