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The impact of simplified endocardial contouring on left ventricular volumetric assessment
Journal of Cardiovascular Magnetic Resonance volume 12, Article number: P250 (2010)
Study objective
To assess the impact of simplified endocardial contouring, performed manually and using semi-automated software, on left ventricular (LV) volumetric assessment.
Background
Cardiovascular magnetic resonance (CMR) is the gold standard for LV volumetric assessment. Detailed tracing of the endocardial border, including papillary muscles and trabeculations, can be time consuming. In many centres it is clinical practice to simplify this and trace the general outline of the endocardial border instead. Such analysis means that all non-wall adherent trabeculations are included in the LV cavity rather than within the myocardium. We aimed to assess the impact of manual and semi-automated simplified endocardial contouring on the accuracy and reproducibility of LV volumetric assessment.
Methods
20 consecutive patients undergoing clinically indicated CMR imaging were included. SSFP cine images were obtained using a 1.5 T scanner (Siemens Avanto, Germany) and a 32-channel coil system. Images were independently analysed by 2 observers using 3 software packages; 1. CMRtools (UK) which includes a thresholding tool allowing detailed endocardial border tracing, used as the reference standard in this study; 2. Siemens Argus ("Argus")-simplified manual endocardial contouring; 3. Siemens Argus 4DVF ("4DVF")-semi-automated simplified endocardial contouring. 25% of scans were reanalysed to assess intra-observer reproducibility. Time taken for each analysis was recorded.
Results
Mean EF measured by Argus (58 + 15%) and 4DVF (53 + 10%) were both significantly lower than EF measured by CMRtools (50 + 12%, p < 0.001 for Argus, p = 0.04 for 4DVF). End-diastolic- and end-systolic volumes measured with Argus (EDV 181 + 52 mls, ESV 92 + 36 mls, p < 0.001 for both) and 4DVF (175 + 48 mls, p = 0.008, 84 + 31 mls p = 0.015) were significantly lower than measured with CMRtools (159 + 50 mls, 67 + 32 mls). Inter- and intra-observer reproducibility were extremely high for CMRtools. Reproducibility for Argus was slightly lower, but still high (EF data presented in Table 1, 2, 3). Time taken for analysis using Argus was significantly shorter than for CMRtools (5 + 1 mins v 8 + 1 mins, p < 0.001), however CMRtools analysis time included measurement of LV mass. The reproducibility of 4DVF was low and analysis took significantly longer than with other methods.
Conclusion
Simplified manual endocardial contouring is time saving and reproducible, however it significantly overestimates LV volumes and underestimates EF, which could have significant implications for clinical decision making. In our hands, the semi-automated simplified endocardial contouring software did not provide any advantages.
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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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Miller, C.A., Pearce, K., Clark, D. et al. The impact of simplified endocardial contouring on left ventricular volumetric assessment. J Cardiovasc Magn Reson 12, P250 (2010). https://doi.org/10.1186/1532-429X-12-S1-P250
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Keywords
- Cardiovascular Magnetic Resonance
- Analysis Time
- Left Ventricular Mass
- Papillary Muscle
- Significant Implication
