Yonsei Med J.  2018 Jan;59(1):63-71. 10.3349/ymj.2018.59.1.63.

Supplementary Diagnostic Landmarks of Left Ventricular Non-Compaction on Magnetic Resonance Imaging

• Boban M
• Pesa V
• Beck N
• Manola S
• Zulj M
• Rotim A
• Vcev A

• KMID: 2418850
• DOI: http://doi.org/10.3349/ymj.2018.59.1.63

Abstract

PURPOSE
Diagnostic criteria for left ventricular non-compaction (LVNC) are still a matter of dispute. The aim of our present study was to test the diagnostic value of two novel diagnostic cardiac magnetic resonance (CMR) parameters: proof of non-compact (NC) myocardium blood flow using T2 sequences and changes in geometry of the left ventricle.
MATERIALS AND METHODS
The study included cases with LVNC and controls, from a data base formed in a period of 3.5 years (n=1890 exams), in which CMR protocol included T2 sequences. Measurement of perpendicular maximal and minimal end diastolic dimensions in the region with NC myocardium from short axis plane was recorded, and calculated as a ratio (MaxMinEDDR), while flow through trabecula was proven by intracavital T2-weighted hyperintensity (ICT2HI). LVNC diagnosis met the following three criteria: thickening of compact (C) layer, NC:C>2.3:1 and NC>20%LV.
RESULTS
The study included 200 patients; 71 with LVNC (35.5%; i.e., 3.76% of CMRs) and 129 (64.5%) controls. MaxMinEDDR in patients with LVNC was significantly different from that in controls (1.17±0.08 vs. 1.06±0.04, respectively; p < 0.001). MaxMinEDDR >1.10 had sensitivity of 91.6% [95% confidence intervals (CI) 82.5-96.8], specificity of 85.3% (95% CI 78.0-90.0), and area under curve (AUC) 0.919 (95% CI 0.872-0.953; p < 0.001) for LVNC. Existence of ICT2HI had sensitivity of 100.0% (95% CI 94.9-100.0), specificity of 91.5% (95% CI 85.3-95.7), and AUC 0.957 (95% CI 0.919-0.981; p < 0.001) for LVNC.
CONCLUSION
Two additional diagnostic parameters for LVNC were identified in this study. ICT2HI and geometric eccentricity of the ventricle both had relatively high sensitivity and specificity for diagnosing LVNC.

Keyword

Left ventricle non-compaction; cardiac magnetic resonance imaging; diagnostic criteria; T2-sequences; maximal to minimal end diastolic diameters ratio

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Area Under Curve
Case-Control Studies
Female
Gadolinium/chemistry
Heart Ventricles/diagnostic imaging/pathology
Humans
Isolated Noncompaction of the Ventricular Myocardium/*diagnosis
*Magnetic Resonance Imaging
Male
Middle Aged
ROC Curve
Young Adult
Gadolinium

Figure

• 

  Fig. 1 Case of patient with LVNC. Case of LVNC with trabeculations existing on 23.5% of the left ventricle, left ventricle EDD of 6.29 cm, ejection fraction of 40% and confirmed non-compaction. (A) 2-chamber view, cine SSFP. (B) Short axis cine at end diastolic, marked white line showing: 3) Minimal EDD 5.83 cm, 4) Maximal EDD 6.64 cm, giving MaxMinEDDR=1.14; 5) NC-layer thickness 1.63 cm, and 6) C-layer thickness 0.42 cm, with NC:C=3.9; 4-chamber, cine SSFP. (C) 4-chamber, cine SSFP; showing trabeculations in apical region and lateral wall. (D) 4-chamber, turbo spin echo dark blood T2 fat saturation. Blood flow through non-compact layer is shown as hyperintense T2 signal, or the intracavital T-2 weighted hyperintensity, which is of high spontaneous contrast to the compact part of the myocardium and to endocavital space. LVNC, left ventricular non-compaction; EDD, end diastolic dimension; SSFP, steady state free precession.

• 

  Fig. 2 Case two of LVNC. Case of LVNC with trabeculations existing on 23.5% of the left ventricle, ejection fraction of 50% and confirmed non-compaction. (A) short axis cine at end diastole, marked white line showing: 1) Maximal EDD 5.33 cm, 2) Minimal EDD 4.79 cm, giving MaxMinEDDR=1.11; 3) NC-layer thickness 1.63 cm, and 4) C-layer thickness 0.42 cm, with NC:C=3.9. (B) 4-chamber, cine steady state free precession, showing non-compact myocardium in apical and lateral wall. (C) 4-chamber turbo spin echo dark blood T2, showing intracavital hyperintense T2 signal. (D) 4-chamber, inversion recovery dark blood T2, showing intracavital hyperintense T2 signal. Blood flow through non-compact myocardium is shown as hyperintense T2 signal, i.e. ICT2HI, which is of high spontaneous contrast to the compact part of the myocardium and to endocavital space. ICT2HI, intracavital T2-weighted hyperintensity; MaxMinEDDR, maximal to minimal (perpendicular) end diastolic dimension ratio acquired in mid to apical short axis slices; NC:C, non-compact to compact myocardial layer thickness; NC>20%LV, percentage of trabeculations over 20% of total mass of the left ventricle. LVNC, left ventricular non-compaction; EDD, end diastolic dimension.

• 

  Fig. 3 Multiple receiver operating characteristic curve analysis for studied left ventricular non-compaction diagnostic parameters. ICT2HI, intracavital T-2 weighted hyperintensity; MaxMinEDDR, maximal to minimal end diastolic dimension ratio; NC/C, non-compact to compact myocardial layer thickness; NC<20%LV, percentage of trabeculations over 20% in total left ventricle mass. ◯ - ROC curve values with the highest Youden's Index.

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