Comparison of Free Breathing Cardiac MRI Radial Technique to the Standard Multi Breath-Hold Cine SSFP CMR Technique For the Assessment of LV Volumes and Function Shimon Kolker, Giora Weisz, Naama Bogot, Irit Hadas Halpern, Arik Wolak Shaare-Tzedek Medical Center Cardiology, Radiology Departments, Jerusalem, Israel.
Disclosure of Interests No financial relationships to disclose concerning the content of this presentation or session.
Background Cardiac MRI (CMRI) is considered the gold standard for left ventricular (LV) and right ventricular (RV) volumes and function assessment. Standard cine SSFP sequences require prolonged, repeated breath holds. Radial cine (RC) k space acquisition technique can provide a good image quality without the need for breath holding.
Background Continued Cine radial exploits the potential of image compression during acquisition of raw data. For this to occur 3 principles are crucial: 1)Sparsity. 2)Incoherent sampling. 3)Non linear iterative reconstruction
Background Continued Cine Radial (SOA) Cine SSFP (SOA)
Background Continued Cine Radial (SOA) with artifact Cine Radial (SOA) without artifact
Aim The purpose of this study was to compare volume and function results for both LV and RV between the new free breathing cine radial technique and the standard multi breath-hold cine SSFP technique.
Methods 30 patients who underwent clinically indicated cardiac MRI (CMRI) were included.
Methods In all patients both cine SSFP and cine radial sequences were performed. The images were analyzed using CMR 42 semiautomatic tool of the CVI42 software, version 5.0.0. end diastolic volume (EDV), end systolic volume (ESV) and ejection fraction (EF) were calculated for both LV and RV and myocardial mass was calculated for LV only in both techniques.
Methods Continued All tests were done on a 1.5T SIEMENS Aera scanner. Image quality: 49% of images were of excellent or good quality and 51% of images were of adequate quality. The volume and function measurements of the RC vs. the cine SSFP multi breath-hold techniques were compared using Pearson correlation and Bland-Altman analyses. All statistical calculations were done using Analyse-it version 2.26.
Methods Continued Radial cine (SOA) Cine SSFP (SOA) Radial cine (SOA) Cine SSFP (SOA)
Methods Continued Radial cine (SOA)
Baseline Characteristics The average age was 34 (4-75) 33% were female The indication for the test was assessment of iron overload in 7%, assessment for infiltrative disease in 17%, evaluation of congenital conditions in 7%, assessment for a cardiomyopathy in 23%, assessment for myocarditis in 30%, viability assessment in 10% and assessment due to arrhythmias in 6%.
Difference ( - ) Results: LV Volumes and Function EDV 20 LV EDV difference plot Identity 15 Bias (-0.15) 350 LV EDV Correlation 10 300 5 95% Limits of agreement (-10.86 to 10.55) 250 200 0 150 100-5 50-10 0 0 100 200 300 EDV -15 0 100 200 300 Mean of EDV r statistic 1.00 2-tailed p 0.0001< Range 37.40to 304.60 EDV Mean LV EDV RADIAL 163.60 LV EDV CINE 163.45
Difference ( - ) Results: LV Volumes and Function ESV 15 LV ESV difference plot Identity 10 Bias (-1.45) 250 LV ESV Correlation 5 200 0-5 95% Limits of agreement (-11.82 to 8.93) 150 100-10 50-15 -20 0 0 100 200 ESV -25 0 50 100 150 200 250 Mean of ESV r statistic 0.99 2-tailed p 0.0001< Range 15.30to 223.20 ESV Mean LV ESV RADIAL 74.44 LV ESV CINE 73.00
Difference ( - ) Results: LV Volumes and Function EF 15 LV EF difference plot Identity 10 Bias (0.60) 90 80 LV EF Correlation 70 5 0 95% Limits of agreement (-5.34 to 6.53) 60 50 40 30 20-5 10 10 60 EF -10 10 30 50 70 90 Mean of EF r statistic 0.98 2-tailed p 0.0001< Range 18.00to 87.60 EF Mean LV EF RADIAL 57.93 LV EF CINE 58.53
Difference ( - ) Results: LV Volumes and Function MyoMass_diast LV mass difference plot Identity 50 Bias (2.19) 200 LV Mass Correlation 30 180 160 10 95% Limits of agreement (-30.36 to 34.74) 140 120 100-10 80 60 40-30 20 20 70 120 170 220 MyoMass_diast -50 20 70 120 170 220 Mean of MyoMass_diast r statistic 0.93 2-tailed p 0.0001< Range 69.10to 241.00 Mean LV MYOCARDIAL MASS RADIAL 122.07 LV MYOCARDIAL MASS CINE 124.26
Difference (RV EDV cine - RV EDV radial) RV EDV cine Results: RV Volumes and Function 10 RV EDV difference plot Identity 5 Bias (-0.23) 240 RV EDV Correlation 220 0 95% Limits of agreement (-7.89 to 7.43) 200 180 160 140-5 120 100-10 -15 60 110 160 210 260 Mean of All 80 60 60 110 160 210 260 RV EDV radial r statistic 1.00 2-tailed p 0.0001< Range 31.50to 179.30 Mean RV EDV radial 158.51 RV EDV cine 158.28
Difference (RV ESV cine - RV ESC radial) RV ESV cine Results: RV Volumes and Function 10 RV ESV difference plot Identity 8 6 Bias (-0.34) 180 RV ESV Correlation 4 2 0 95% Limits of agreement (-6.99 to 6.31) 160 140 120 100-2 80-4 -6-8 -10 20 70 120 170 Mean of All 60 40 20 20 70 120 170 RV ESV radial r statistic 1.00 2-tailed p 0.0001< Mean RV ESV radial 83.90 RV ESV cine 83.56
Difference (RV EF cine - RV EF rdial) RV EF cine Results: RV Volumes and Function 5 RV EF difference plot Identity 4 3 Bias (0.31) 70 RV EF Correlation 2 95% Limits of agreement (-3.42 to 4.03) 60 1 50 0 40-1 30-2 20-3 -4-5 10 20 30 40 50 60 70 Mean of All 10 10 30 50 70 RV EF rdial r statistic 0.99 2-tailed p 0.0001< Range 14.70to 69.80 Mean RV EF rdial 47.69 RV EF cine 49.00
Conclusions The results demonstrate the feasibility of applying the RC non breath-hold strategy to evaluate LV and RV volume and function with high accuracy in a variety of patients.