Is magnetic resonance imaging the 'reference standard' for cardiac functional assessment? Factors influencing measurement of left ventricular mass and volumes

Henning Steen, Khurram Nasir, Ellen Flynn, Iman El-Shehaby, Shenghan Lai, Hugo A. Katus, David Bluemcke, Joao Lima

Research output: Contribution to journalArticle

Abstract

Purpose: MRI is considered reference standard for the assessment of left ventricular (LV) volume and mass measurements. There are few accepted guidelines for uniform assessment of cardiac function with MRI. We sought to investigate different confounding factors influencing LV measurement results. Material and Methods: In 60 diabetic type-II patients (group A) we compared intra-/inter-reader variability of MRI for cardiac function measured twice at a 3 month interval by one MRI trained reader and one untrained. In 20 patients (group B) two different techniques were compared for determining the epicardial and endocardial LV-borders. Results: Bland Altman analysis showed excellent intra-observer measurement agreement for the trained reader 1 for EDM (mean=-2.3 (-23.6-19)), EDV (2.9(-9.2-15.0)), ESV (3.3(-5.8-12.4)) and EF (1.2(-3.3-5.7)). Untrained reader 2 measurement agreement was considerably less appropriate for EDM (mean=-8.2 (-25.8-9.5)), EDV (7.8(-5.1-20.7)), ESV (5.3(-8.0-18.6)). Only for EF (0.8 (-6.5-8.1)) results were comparable to reader 1. Inter-observer measurement in the beginning was poor for EDM (-13.5(-55.6-28.6)) and EDV (7.3(-61.9-76.6)), whereas agreement for ESV (2.1(-29.9-34.2)) and EF (-0.9(-11.6-9.9)) was good. After 3 months, measurement agreement for EDM (-5.3 (-46.4-35.8)) was considerably improved, for EDV (0.4(-67.0-66.2)) was excellent, whereas agreement for ESV (3.1(-34.4-28.1)) and EF (-1.7(-13.0-9.6)) was similar. Using different techniques for determining the epicardial and endocardial borders, only end-diastolic volume was unchanged whereas all other parameters were significantly different using the two methods (p ≤ 0.03). Conclusion: Intra- and inter-reader variability, analyst experience as well as different techniques for determining the boundaries of the left ventricle significantly affect MRI parameters for cardiac function. These results suggest a need for developing commonly accepted standards for cardiac MRI evaluation.

Original languageEnglish (US)
Pages (from-to)743-751
Number of pages9
JournalClinical research in cardiology : official journal of the German Cardiac Society
Volume96
Issue number10
DOIs
StatePublished - Oct 2007

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Functional assessment
Magnetic resonance
Magnetic resonance imaging
Magnetic Resonance Imaging
Imaging techniques
Heart Ventricles
Guidelines

Keywords

  • Analyst experience
  • Cardiac mass and volume measurement
  • Inter- and intra observer variability

ASJC Scopus subject areas

  • Mechanics of Materials
  • Computational Mechanics

Cite this

Is magnetic resonance imaging the 'reference standard' for cardiac functional assessment? Factors influencing measurement of left ventricular mass and volumes. / Steen, Henning; Nasir, Khurram; Flynn, Ellen; El-Shehaby, Iman; Lai, Shenghan; Katus, Hugo A.; Bluemcke, David; Lima, Joao.

In: Clinical research in cardiology : official journal of the German Cardiac Society, Vol. 96, No. 10, 10.2007, p. 743-751.

Research output: Contribution to journalArticle

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AU - Steen, Henning

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AU - Lai, Shenghan

AU - Katus, Hugo A.

AU - Bluemcke, David

AU - Lima, Joao

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N2 - Purpose: MRI is considered reference standard for the assessment of left ventricular (LV) volume and mass measurements. There are few accepted guidelines for uniform assessment of cardiac function with MRI. We sought to investigate different confounding factors influencing LV measurement results. Material and Methods: In 60 diabetic type-II patients (group A) we compared intra-/inter-reader variability of MRI for cardiac function measured twice at a 3 month interval by one MRI trained reader and one untrained. In 20 patients (group B) two different techniques were compared for determining the epicardial and endocardial LV-borders. Results: Bland Altman analysis showed excellent intra-observer measurement agreement for the trained reader 1 for EDM (mean=-2.3 (-23.6-19)), EDV (2.9(-9.2-15.0)), ESV (3.3(-5.8-12.4)) and EF (1.2(-3.3-5.7)). Untrained reader 2 measurement agreement was considerably less appropriate for EDM (mean=-8.2 (-25.8-9.5)), EDV (7.8(-5.1-20.7)), ESV (5.3(-8.0-18.6)). Only for EF (0.8 (-6.5-8.1)) results were comparable to reader 1. Inter-observer measurement in the beginning was poor for EDM (-13.5(-55.6-28.6)) and EDV (7.3(-61.9-76.6)), whereas agreement for ESV (2.1(-29.9-34.2)) and EF (-0.9(-11.6-9.9)) was good. After 3 months, measurement agreement for EDM (-5.3 (-46.4-35.8)) was considerably improved, for EDV (0.4(-67.0-66.2)) was excellent, whereas agreement for ESV (3.1(-34.4-28.1)) and EF (-1.7(-13.0-9.6)) was similar. Using different techniques for determining the epicardial and endocardial borders, only end-diastolic volume was unchanged whereas all other parameters were significantly different using the two methods (p ≤ 0.03). Conclusion: Intra- and inter-reader variability, analyst experience as well as different techniques for determining the boundaries of the left ventricle significantly affect MRI parameters for cardiac function. These results suggest a need for developing commonly accepted standards for cardiac MRI evaluation.

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