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Comparison of left ventricular volumetric assessment by standard steady-state free precession and real time cine imaging

Session Poster session 2

Speaker Kelly Parke

Event : EuroCMR 2019

  • Topic : imaging
  • Sub-topic : Cardiac Magnetic Resonance: Dimensions, Volumes and Mass
  • Session type : Poster Session

Authors : K Parke (Leicester,GB), J Wormmeighton (Leicester,GB), G Mccann (Leicester,GB), H Xue (Bethesda,US), P Kellman (Bethesda,US), R Arnold (Leicester,GB)

K Parke1 , J Wormmeighton1 , G Mccann1 , H Xue2 , P Kellman2 , R Arnold1 , 1University of Leicester, NIHR Leicester Biomedical Research centre, Department of Cardiovascular sciences - Leicester - United Kingdom of Great Britain & Northern Ireland , 2National Institutes of Health - Bethesda - United States of America ,

European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii332

Background: Cardiovascular magnetic resonance (CMR) has become the gold standard for the assessment of cardiac volumetry and function. Currently, the technique of choice is cine imaging with steady-state free precession (SSFP), involving the acquisition of a multi-breath-hold stack of short-axis images (acquisition time up to 10 minutes). Hence, accelerated image acquisition may be desirable in order to improve the time efficiency of the CMR examination and also to reduce the occurrence of motion artefact in subjects experiencing difficulty breath-holding. 

Purpose: To compare a novel non-breath-hold SSFP multi-slice real-time Cine sequence with the standard multi-breath-hold SSFP technique for the assessment of left ventricular (LV) volumes and systolic function. 

Methods: We prospectively studied 20 patients with known or suspected cardiac disease referred for routine clinical CMR assessment. Functional assessment was performed with a standard SSFP sequence (approximate acquisition matrix 256 X 166, acquisition voxel size 1.66 X 1.33 X 8mm, 30 phases, TR 48.16, IPAT 3, retrospective or prospective triggering depending on R-R regularity). Functional assessment was also carried out using a novel real time Cine sequence (approximate acquisition matrix 160 x 92, acquisition voxel size 3.26 X 2.5 X 8mm, number of phases determined according to R-R interval, TR 42.84, IPAT 4). Quantification of end-diastolic volume index [EDVi], end-systolic volume index [ESVi] and ejection fraction [EF] was performed by single observer in a blinded fashion. Image quality for both scans was graded on a 4-point scale. 

Results: Scans from 20 patients (age 63.0±11.7 years, 13 male) were analysed. All images for both techniques were analysable and image quality was rated as excellent/good in 85% of real-time images and 90% of standard cine images. The duration of imaging was 15±7 seconds for the real-time sequence and 383±139 seconds for the standard sequence (p<0.0001). LVEF was quantified as similar for both methods (49.6±9.1% for real-time vs. 48.6±8.5% for standard, p=0.27, intraclass correlation (ICC) 0.90, 95% confidence interval [CI] 0.77-0.96). There was also excellent agreement for EDVi (ICC 0.96, 95% CI 0.89-0.98, p=0.47 for difference) and for ESVi (ICC 0.95, 95% CI 0.88-0.98, p=0.22 for difference). 

Conclusion: For assessment of LV volumes and function, a non-breath-hold multi-slice real-time cine sequence is feasible in the clinical setting and achieves similar values to segmented breath-held cine acquisitions. This technique may prove useful in patients with breath-holding difficulty, in patients with arrhythmias, or to accelerate exam times to enhance patient flow. 

Figure: Bland-Altman plots of ejection fraction (EF), end-diastolic volume index (EDVi) and end-systolic volume index (ESVi)

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