How variable is aortic strain measurement using magnetic resonance imaging?
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1 How variable is aortic strain measurement using magnetic resonance imaging? Poster No.: C-1057 Congress: ECR 2015 Type: Scientific Exhibit Authors: M. Hrabak Paar, J. Bremerich, A. Redheuil, T. Heye ; Basel/ CH, Paris/FR Keywords: Arteries / Aorta, MR, Observer performance, Segmentation, Hypertension, Quality assurance DOI: /ecr2015/C-1057 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 8
2 Aims and objectives Aortic strain is a widely used marker of aortic stiffness, but variability of its measurement is yet unknown. We evaluated scan-rescan and intraobserver variability of aortic strain measurement using magnetic resonance imaging (MRI). Methods and materials Fifteen patients (11 males, age years) with systemic arterial hypertension underwent cardiovascular MRI using a 3.0 Tesla MRI scanner. Sets of two axial gradientecho cine images (TR/TE 50.8/4.2, slice thickness 6mm, 50 cardiac phases) of the chest were repeated three times within an examination: one at the level of the right pulmonary artery ( Fig. 1 on page 2 ), and one at the level of diaphragmatic dome. Largest and smallest cross-sectional area of the aorta was measured by the same reader three times at three different levels: ascending aorta, proximal descending aorta, and distal descending aorta using ArtFun software ( Fig. 2 on page 3, Fig. 3 on page 4 ), and aortic strain was calculated ( Fig. 4 on page 5 ). Coefficient of variation (CV) calculation was used to assess scan-rescan and intraobserver variability of aortic strain measurement. Images for this section: Page 2 of 8
3 Fig. 1: Axial gradient-echo cine image (TR/TE 50.8/4.2, slice thickness 6mm, 50 cardiac phases) of the chest at the level of the right pulmonary artery after segmentation of the proximal descending aorta. Page 3 of 8
4 Fig. 2: Segmentation of the aorta using ArtFun software in 50 different cardiac phases. Page 4 of 8
5 Fig. 3: The graph of aortic area throughout the cardiac cycle used to determine largest and smallest cross-sectional area of the aorta. Fig. 4: Equation used for aortic strain calculation from the largest (Amax) and smallest (Amin) cross-sectional area of the aorta. Page 5 of 8
6 Results CV of aortic strain scan-rescan variability was 22.9% (median 20.9%, 95%CI %) for ascending aorta, 13.7% (median 12.4%, 95%CI %) for proximal descending aorta, and 9.7% (median 9.4%, 95%CI %) for distal descending aorta ( Fig. 5 on page 6 ). CV of aortic strain intraobserver variability was 9.6% (median 3.4%, 95% CI %) for ascending aorta, 3.0% (median 1.5%, 95%CI %) for proximal descending aorta, and 2.1% (median 1.2%, 95%CI %) for distal descending aorta. Images for this section: Fig. 5: Mean scan-rescan and intraobserver coefficient of variation for aortic strain measurement in the ascending (AA), proximal descending (PDA) and distal descending aorta (DDA). Page 6 of 8
7 Conclusion Aortic strain variability is larger at the level of the ascending than descending aorta, possibly as a result of through-plane motion of the ascending aorta. Aortic strain measurement using MRI has acceptable scan-rescan variability and low intraobserver variability, with all parameters smaller than 20% except scan-rescan variability for ascending aorta. However, caution must be exerted in the interpretation of strain changes in longitudinal studies, particularly in the ascending aorta. Personal information Dr. Maja Hrabak Paar Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland (on the leave from Department of Radiology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia) maja.hrabak@usb.ch Maja Hrabak Paar acknowledges support from the Marie Curie FP7-PEOPLE-2011COFUND program NEWFELPRO. Prof. Dr. Jens Bremerich Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland jens.bremerich@usb.ch Dr. Alban Redheuil Cardiovascular Imaging Department, European Hospital, Georges Pompidou, University of Paris, René Descartes School of Medicine, Paris Cedex 15, France alban.redheuil@gmail.com Dr. Tobias Heye Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland Page 7 of 8
8 References Voges I, Jerosch-Herold M, Hedderich J, et al. Normal values of aortic dimensions, distensibility, and pulse wave velocity in children and young adults: a cross-sectional study. J Cardiovasc Magn Reson 2012; 14:77. Dogui A, Kachenoura N, Frouin F, et al. Consistency of aortic distensibility and pulse wave velocity estimates with respect to the Bramwell-Hill theoretical model: a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2011; 13:11. Shan Y, Lin J, Xu P, Zhou J, Zeng M. Comprehensive assessment of aortic compliance and brachial endothelial function using 3.0-T high-resolution MRI: A feasibility study. J Comput Assist Tomogr 2012; 36: Nelson AJ, Worthley SG, Cameron JD, et al. Cardiovascular magnetic resonance-derived aortic distensibility: validation and observed regional differences in the elderly. J Hypertens 2009; 27: O'Rourke MF, Staessen JA, Vlachopoulos C, Duprez D, Plante GE. Clinical applications of arterial stiffness; Definitions and reference values. Am J Hypertens 2002; 15: Liu CY, Chen D, Teixido-Tura G, et al. Aortic size, distensibility, and pulse wave velocity changes with aging: longitudinal analysis from Multi-Ethnic Study of Atherosclerosis (MESA). J Cardiovasc Magn Reson 2012; 14(Suppl 1):P126. Herment A, Lefort M, Kachenoura N, et al. Automated estimation of aortic strain from steady-state free-precession and phase contrast MR images. Magn Reson Med 2011; 65: Boutouyrie P, Fliser D, Goldsmith D, et al. Assessment of arterial stiffness for clinical and epidemiological studies: methodological considerations for validation and entry into the European Renal and Cardiovascular Medicine registry. Nephrol Dial Transplant 2014; 29: Page 8 of 8
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