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Evaluation of semi-automated threshold-based CMR post-processing of ventricular size and function in a large healthy pediatric cohort

Session Poster session 2

Speaker Jelle van der Ven

Event : EuroCMR 2019

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

Authors : JPG Van Der Ven (Rotterdam,NL), ER Valsangiacomo Buechel (Zurich,CH), S Sarikouch (Hannover,DE), D Robbers-Visser (Amsterdam,NL), Z Sadighy (Rotterdam,NL), CJ Kellenberger (Zurich,CH), T Kaiser (Zurich,CH), P Beerbaum (Hannover,DE), WA Helbing (Rotterdam,NL)

Authors:
JPG Van Der Ven1 , ER Valsangiacomo Buechel2 , S Sarikouch3 , D Robbers-Visser4 , Z Sadighy1 , CJ Kellenberger5 , T Kaiser2 , P Beerbaum6 , WA Helbing7 , 1Erasmus Medical Center, Paediatrics - Rotterdam - Netherlands (The) , 2University Hospital Zurich, Pediatric Heart Centre - Zurich - Switzerland , 3Hannover Medical School, Department of Heart, Thoracic, Transplantation and Vascular Surgery - Hannover - Germany , 4Academic Medical Center of Amsterdam, Cardiology - Amsterdam - Netherlands (The) , 5University Hospital Zurich, Diagnostic Imaging - Zurich - Switzerland , 6Hannover Medical School, Paediatric Cardiology and Intensive Care - Hannover - Germany , 7Erasmus Medical Center, Paediatrics and Radiology - Rotterdam - Netherlands (The) ,

Citation:
European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii333

Background/Introduction 
Cardiac magnetic resonance imaging (CMR) is an important imaging modality in congenital heart disease. CMR-derived images require post-processing to acquire parameters of cardiac function. Post-processing can be time-consuming and can be a source of variability in measurements. Semi- or fully automated CMR post-processing by software algorithms could aid to reduce post-processing time and reduce variability. 

Purpose 
To assess differences in measurements and variability of a commercially available semi-automated threshold-based method of CMR post-processing, compared to manual contouring in a multicenter healthy pediatric population. 

Methods 
141 healthy children, aged 0-18 years, underwent SSFP CMR imaging using a 1.5 T whole-body scanner (TR 14-45ms, slice thickness 5-10mm, interslice gap 0-2mm, pixel size 1.1x1.1 to 2.3x2.9mm). Post-processing was performed using QMass 8.1 software (Medis, the Netherlands). Images were manually contoured (MC) and analyzed using the threshold-based MassK option (MK) with the same biventricular epicardial contours. Trabecula and papillary muscles were included in the wall mass using both methods. Variability was determined in a subset of 18 subjects, which were re-analyzed by a different observer and the previous first observer, at least 3 months after analysis. Observers were blinded to previous measurements.

Results 
Compared to MC, MK measured lower volumes and higher masses (p <.001 for all parameters). Differences ranged from 3% to 19% and were higher for right ventricular (RV) parameters.
MK derived ejection fraction (EF) was lower for the left ventricle (LV) (difference: 0.9±2.4%, p < .001) and RV (difference: 1.5±4.6%, p <.001). MK derived RV mass differed between end-diastole and end-systole (31.5±17.4%, p <.001). 

Intra-observer variability was excellent (intra-class correlation co-efficient (ICC) >.90) for left ventricular (LV) parameters and RV volumes for both MC and MK. Variability of biventricular EF was similar for MC (LV: 3±5%, ICC .70; RV: 0±5%, ICC .67) and MK (LV: 2±5%, ICC .69; RV: 0±5%, ICC .68). Intraobserver variability of RV mass measurements was 1.5 ± 9.4g (ICC .82) for MC and 2.2 ± 7.2g (ICC .93) for MK.

Interobserver variability was excellent for LV parameters and RV volumes for both MC and MK. Interobserver variability of MC derived EF (LV: 5±5%, ICC .59; RV: 2±6%, ICC .51) was similar to that of MK derived EF (LV: 2±5%, ICC .57; RV: 1±6%, ICC .63)  Interobserver variability for RV mass improved from 8.8 ± 19.2g (ICC .50) using MC to 1.6 ± 7.0 g (ICC .93) using MK.  

Conclusions 
MK threshold-based semi-automated analysis in pediatric CMR measures lower biventricular volumes and higher masses, up to 19%, compared to MC. Differences for biventricular EF are small.
MK analysis decreases variability, most notably for RV mass measurements. Caution is warranted regarding the accuracy of these measurements, as MK measured RV wall mass differs between phases.

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