Elsevier

Academic Radiology

Volume 19, Issue 8, August 2012, Pages 991-1002
Academic Radiology

Original investigation
Cardiac MRI Assessment of Right Ventricular Function in Acquired Heart Disease: Factors of Variability

https://doi.org/10.1016/j.acra.2012.03.022Get rights and content

Rationale and Objectives

To evaluate intra- and inter-observer variability of right ventricular (RV) functional parameters as evaluated by cardiac magnetic resonance imaging (MRI) in patients with acquired heart disease (AHD), and to identify factors associated with an increased variability.

Materials and Methods

Sixty consecutive patients were enrolled. Right and left ventricular (LV) volumes, ejection fraction, and mass were determined from short-axis cine sequences. All analyzes were performed twice by three observers with various training-degree in cardiac MRI. Intra- and inter-observer variability was evaluated. The impact on variability of each of the following parameters was assessed: observer's experience, basal and apical slices selection, end-systolic phase selection, and delineation.

Results

Mean segmentation time ranged 9.8–19.0 minutes for RV and 6.4–9.2 minutes for LV. Variability of RV functional parameters measurement was strongly influenced by previous observer's experience: it was two to three times superior to that of LV, even for the most experienced observer. High variability in the measurement of RV mass was observed. For both ventricles, selection of the basal slice and delineation were major determinants of variability.

Conclusion

As compared to LV, RV function assessment with cardiac MRI in AHD patients is much more variable and time-consuming. Observer's experience, selection of basal slice, and delineation are determinant.

Introduction

The assessment of right ventricular (RV) function is essential in cardiac diseases and its prognostic value was reported in both ischemic and nonischemic cardiomyopathies 1, 2, 3, 4. Contrary to the left ventricle, the right ventricle is often considered difficult to evaluate with current imaging techniques, mainly because of its complex motion and geometry (5). Cardiac magnetic resonance imaging (MRI) is the reference method of RV functional evaluation, for both clinical and research purposes 6, 7. Previous studies stated that variability of RV function as estimated by cardiac MRI was comparable to that of the left ventricle 8, 9. However, some of these results were obtained with long processing times (up to 45 minutes) incompatible with routine practice (9). Moreover, most published studies have evaluated the RV function variability either in healthy volunteers 10, 11, 12, 13 or in patients with congenital heart disease 9, 14, 15. On contrary, few studies have evaluated variability in patients with acquired heart disease (AHD). Most of them comprised limited sample size and were limited to a specific disorder 8, 16, 17, 18, 19, 20. Consequently, the extension of those published results to clinical practice is questionable. Furthermore, to our knowledge, previous reports did not evaluate the factors associated with an increased variability, particularly the effect of cardiac MRI experience and processing steps 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20.

The aim of this study was to evaluate intra- and inter-observer variability of RV functional parameters as evaluated by cardiac MRI in patients with AHD, and to identify factors associated with an increased variability.

Section snippets

Materials and methods

This study is the second part of a previously published study that evaluated the diagnostic accuracy of three semiquantitative methods for assessing right ventricular systolic function in patients with acquired heart disease (21). Study design is presented in Figure 1.

Processing Time

Processing times of each observer for the right and left ventricles are reported in Table 1. The mean segmentation time ranged 9.8–19.0 minutes and 6.4–9.2 minutes, respectively, for right and left ventricles. Processing time was significantly shorter for the left ventricle as compared to the right ventricle for all observers, and for their two measurements (P < .001). A significant decrease of processing time was noted between first versus second measurement, for both ventricles and for all

Effect of observer's experience

We found that previous experience was a major determinant of intra- and inter-observer variability. Most of previously reported studies evaluated RV and LV function variability without mentioning the observers' level of experience 14, 15, 19 or involved observers of identical experience: inexperienced (9) or experienced 11, 13, 17, 20. Nevertheless, in a clinical practice perspective, the evaluation of the effect of experience on variability is essential to determine which level of experience

Conclusion

Assessing the RV function from cardiac MRI in patients with AHD is much more variable and time-consuming than evaluating the left ventricle. Particularly, the measurement of the mass of the RV is highly variable even for a trained observer. Previous experience, basal short-axis slice, and delineation are the major determinants of variability. Thus, for an accurate RV functional evaluation, a significant training and a precise definition of the basal short-axis slice selection is required.

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