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Guide-point modeling for the assessment of left ventricular function: comparison with the standard summation of slices method

Introduction

Left ventricular (LV) function parameters play an important role in diagnosis, therapy monitoring and risk stratification in a variety of cardiovascular diseases; therefore, their analysis is part of daily clinical practice. The standard SoS-approach, however, is relatively time-consuming, thus, faster alternatives are desirable.

Purpose

We aimed to prospectively evaluate the accuracy of a new guide-point modeling post-processing technique (GPM-approach) in the assessment of LV function with both the standard steady-state free-precession (SSFP)-sequence and a highly accelerated cine MRI in multi-orientations compared to the standard summation of slices-method based on a stack of short-axis views (SoS-approach).

Methods

52 consecutive patients were examined on a 1.5 T scanner with the standard SSFP- ("trueFISP", TR, 3.0 ms; TE, 1.5 ms; temporal resolution, 36 ms) and a highly accelerated, single breath-hold temporal parallel acquisition SSFP-sequence (TR, 4.6 ms; TE, 1.1 ms; temporal resolution, 40 ms). The standard SSFP-sequence was post-processed both with the standard SoS-approach and the new GPM-approach, which relies on a 4-dimensional model of the LV and requires long- and short-axis views for analysis. The highly accelerated sequence was solely evaluated with the GPM-approach. Thus, in each patient ejection fraction (EF), end-diastolic volume (EDV), and end-systolic volume (ESV) was calculated using three different approaches and results were compared by applying various statistical tests.

Results

Post-processing was considerably faster with the two GPM-approaches when compared to the SoS-approach (standard SSFP-sequence/SoS-approach, 6 ± 3 min; standard SSFP-sequence/GPM-approach, 4 ± 1.5 min; accelerated SSFP sequence/GPM-approach, 3 ± 1.5 min).

EF: The approaches did not significantly vary in calculations of EF and in their variances (p > 0.539), mirrored by high Pearson's (r > 0.977) and intraclass correlation coefficients (ICC > 0.977).

EDV: Post-processing with the GPM-approaches yielded higher volumes compared to the SoS-approach (Table 1) due to an improved definition of the mitral valve by including long-axis views in the analysis. Consequently, Bland-Altman-Plots showed higher degrees of statistical spread (Figure 1) and significant differences in the variances (p < 0.00) when the SoS-approach was compared with either of the GPM-approaches. Pearson's and intraclass coefficients demonstrated high correlation between the two GPM-approaches (r = 0.968; ICC = 0.967).

Figure 1
figure1

Bland-Altman-Plots for calculation of the end-diastolic volume.

Table 1 LV function parameters as measured with the three different approaches

ESV: As with EDV, ESV measurements were higher when the GPM-approaches were used. The SoS-approach and GPM-approaches had significant differences in their variances and showed considerably more statistical spread in the Bland-Altman-Plots when compared than was evident between the two GPM-approaches, which demonstrated high correlation (r = 0.992; ICC = 0.990).

Conclusion

The GPM-approach can be fast and reliably used with standard and highly accelerated SSFP-sequences and is well-suited for assessment of LV parameters in daily clinical practice.

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Correspondence to Christina Heilmaier.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Heilmaier, C., Hunold, P., Barkhausen, J. et al. Guide-point modeling for the assessment of left ventricular function: comparison with the standard summation of slices method. J Cardiovasc Magn Reson 12, O42 (2010). https://doi.org/10.1186/1532-429X-12-S1-O42

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Keywords

  • Ejection Fraction
  • Mitral Valve
  • Temporal Resolution
  • Daily Clinical Practice
  • Statistical Spread