Korean J Radiol.  2020 Apr;21(4):450-461. 10.3348/kjr.2019.0499.

Cardiac CT for Measurement of Right Ventricular Volume and Function in Comparison with Cardiac MRI: A Meta-Analysis

• Kim JY
• Suh YJ
• Han K
• Kim YJ
• Choi BW

• KMID: 2471811
• DOI: http://doi.org/10.3348/kjr.2019.0499

Abstract

OBJECTIVE
We performed a meta-analysis to evaluate the agreement of cardiac computed tomography (CT) with cardiac magnetic resonance imaging (CMRI) in the assessment of right ventricle (RV) volume and functional parameters.
MATERIALS AND METHODS
PubMed, EMBASE, and Cochrane library were systematically searched for studies that compared CT with CMRI as the reference standard for measurement of the following RV parameters: end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), or ejection fraction (EF). Meta-analytic methods were utilized to determine the pooled weighted bias, limits of agreement (LOA), and correlation coefficient (r) between CT and CMRI. Heterogeneity was also assessed. Subgroup analyses were performed based on the probable factors affecting measurement of RV volume: CT contrast protocol, number of CT slices, CT reconstruction interval, CT volumetry, and segmentation methods.
RESULTS
A total of 766 patients from 20 studies were included. Pooled bias and LOA were 3.1 mL (−5.7 to 11.8 mL), 3.6 mL (−4.0 to 11.2 mL), −0.4 mL (5.7 to 5.0 mL), and −1.8% (−5.7 to 2.2%) for EDV, ESV, SV, and EF, respectively. Pooled correlation coefficients were very strong for the RV parameters (r = 0.87-0.93). Heterogeneity was observed in the studies (I2 > 50%, p < 0.1). In the subgroup analysis, an RV-dedicated contrast protocol, ≥ 64 CT slices, CT volumetry with the Simpson's method, and inclusion of the papillary muscle and trabeculation had a lower pooled bias and narrower LOA.
CONCLUSION
Cardiac CT accurately measures RV volume and function, with an acceptable range of bias and LOA and strong correlation with CMRI findings. The RV-dedicated CT contrast protocol, ≥ 64 CT slices, and use of the same CT volumetry method as CMRI can improve agreement with CMRI.

Keyword

Right ventricular function; Volumetry; Computed tomography; Magnetic resonance imaging; Meta-analysis

MeSH Terms

Bias (Epidemiology)
Heart Ventricles
Humans
Loa
Magnetic Resonance Imaging*
Methods
Papillary Muscles
Population Characteristics
Stroke Volume
Ventricular Function, Right

Figure

• 

  Fig. 1 Flowchart of literature review process.Process of identification and selection of studies for inclusion in this meta-analysis based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. CT = computed tomography, MRI = magnetic resonance imaging

• 

  Fig. 2 Modified Blan–Altman plot for agreement between CT and CMRI for RV parameters.A. EDV. B. ESV. C. SV. D. EF. CMRI = cardiac MRI, EDV = end-diastolic volume, EF = ejection fraction, ESV = end-systolic volume, LOA = limits of agreement, RV = right ventricle, SV = stroke volume

• 

  Fig. 3 Quality assessment of included studies.Risk of bias and applicability of concerns domains are presented as percentages based on modified Quality Assessment of Diagnostic Accuracy Studies-2 tool. Each bar shows percentage of studies with high (red), unclear (yellow), and low (green) risks of bias and applicability of concerns.

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