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Is Magnetic Resonance Imaging the 'Reference Standard' for Cardiac Functional Assessment? Factors Influencing Measurement of Left Ventricular Mass and Volumes

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Abstract

Purpose

MRI is considered reference standard for the assessment of left ventricular (LV) volume and mass measurements. There are few accepted guidelines for uniform assessment of cardiac function with MRI. We sought to investigate different confounding factors influencing LV measurement results.

Material and Methods

In 60 diabetic type-II patients (group A) we compared intra-/inter-reader variability of MRI for cardiac function measured twice at a 3 month interval by one MRI trained reader and one untrained. In 20 patients (group B) two different techniques were compared for determining the epicardial and endocardial LV-borders.

Results

Bland Altman analysis showed excellent intra-observer measurement agreement for the trained reader 1 for EDM (mean=–2.3 (–23.6–19)), EDV (2.9(–9.2–15.0)), ESV (3.3(–5.8–12.4)) and EF (1.2(–3.3–5.7)). Untrained reader 2 measurement agreement was considerably less appropriate for EDM (mean=–8.2 (–25.8–9.5)), EDV (7.8(–5.1–20.7)), ESV (5.3(–8.0–18.6)). Only for EF (0.8 (–6.5–8.1)) results were comparable to reader 1. Inter-observer measurement in the beginning was poor for EDM (–13.5(–55.6–28.6)) and EDV (7.3(–61.9–76.6)), whereas agreement for ESV (2.1(–29.9–34.2)) and EF (–0.9(–11.6–9.9)) was good. After 3 months, measurement agreement for EDM (–5.3 (–46.4–35.8)) was considerably improved, for EDV (0.4(–67.0–66.2)) was excellent, whereas agreement for ESV (3.1(–34.4–28.1)) and EF (–1.7(–13.0–9.6)) was similar. Using different techniques for determining the epicardial and endocardial borders, only end-diastolic volume was unchanged whereas all other parameters were significantly different using the two methods (p ≤ 0.03).

Conclusion

Intra- and inter-reader variability, analyst experience as well as different techniques for determining the boundaries of the left ventricle significantly affect MRI parameters for cardiac function. These results suggest a need for developing commonly accepted standards for cardiac MRI evaluation.

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Authors and Affiliations

  1. Cardiology Division, Blalock 524, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287, USA

    João A. C. Lima MD

  2. Cardiology Division of the Department of Medicine, of the Johns Hopkins Hospital, Baltimore, USA

    Henning Steen, Khurram Nasir, Ellen Flynn & Iman El-Shehaby

  3. Bloomberg School of Public Health, of the Johns Hopkins University, Baltimore, USA

    Shenghan Lai

  4. Cardiology Division of the Department of Internal Medicine III, of the University of Heidelberg, Germany

    Henning Steen & Hugo A. Katus

  5. Radiology Division, University of Heidelberg, Germany

    David Bluemcke

Authors
  1. Henning Steen
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  2. Khurram Nasir
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  3. Ellen Flynn
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  4. Iman El-Shehaby
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  5. Shenghan Lai
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  6. Hugo A. Katus
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  7. David Bluemcke
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  8. João A. C. Lima MD
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Correspondence to João A. C. Lima MD.

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Steen, H., Nasir, K., Flynn, E. et al. Is Magnetic Resonance Imaging the 'Reference Standard' for Cardiac Functional Assessment? Factors Influencing Measurement of Left Ventricular Mass and Volumes. Clin Res Cardiol 96, 743–751 (2007). https://doi.org/10.1007/s00392-007-0556-2

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  • DOI: https://doi.org/10.1007/s00392-007-0556-2

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