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

• Goo HW

• KMID: 2413699
• DOI: http://doi.org/10.3348/kjr.2018.19.4.704

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

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  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

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  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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