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A systematic evaluation of left ventricular (LV) models for estimating LV volumes in children using cardiac cine (MRI)
Journal of Cardiovascular Magnetic Resonance volume 15, Article number: P234 (2013)
Assumptions about LV shape are often used to estimate LV volumes in ultrasound and x-ray angiography, which are not necessary for CMRI.
Using CMRI as the gold standard, we sought to systematically evaluate the performance of commonly used models, and a linear combination of the models, to estimate LV volumes of children.
198 children (137 male, age: 12.4 ± 1.2 years, range 11~15 years) who provided written informed consent, in the context of a screening study for causes of sudden cardiac death, were enrolled in this IRB approved study.
Breath held CMRI cine images were acquired in standard orientations (4-chamber (4Ch), Left-Ventricular Outflow Tract (LVOT), and Short Axis (Sax)) were acquired using a vendor provided stock SSFP sequence at 1.5 T (Philips Healthcare) with an in-plane resolution < 2 x 2 mm2, and an acquired temporal resolution < 50 ms for all subjects.
An expert observer drew contours in end-diastole (ED) and in end-systole (ES) to estimate LV volumes on CMR images acquired in all orientations (Sax, LVOT, and 4Ch). In 4Ch and LVOT views, longitudinal length (distance from mitral valve annulus to apical endocardium), and the transverse width (at mitral valve annulus) of the LV were recorded.
The performance of six geometric models (described in Figure 1), and 15 weighted models generated (LVVw) using a linear combination of any two of the six geometric models (LVVw = αiLVVi+βjLVVj, where αi, βj were the coefficients estimated in 100 subjects via minimizing the least-square's error compared to volumes estimated from Sax) were evaluated.
Using Sax volumes as the reference, percentage-error of EDV, ESV, and ejection fraction (EF) of all 21 models were calculated.
Commonly used biplane and triplane ellipsoid models have significant mean percentage error (at least 9%) for EDV/ESV/EF (Table 1), and triplane model was more reproducible than bi-plane model. A linear-weighted model of biplane and parabola substantially diminishes percentage error for EDV, ESV and EF to 0.3±6.0%, 0.5±10.7% and 0.0±6.4% (αEDV = 0.4, βEDV=0.7; αESV = 0.9, βESV=0.2) respectively.
In this group of young children, our results show that the estimation of LV volumes of conventional bi-plane and triplane models can be significantly improved by using a linear weighted model of bi-plane and parabolic models. These findings have to be confirmed in a larger study.
The study was partly funded by Texas Heart Institue.
Thiele H et al:. JCMR. 2002, 4 (3): 327-339.
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Zhang, J., Uribe, C., Liu, J. et al. A systematic evaluation of left ventricular (LV) models for estimating LV volumes in children using cardiac cine (MRI). J Cardiovasc Magn Reson 15, P234 (2013). https://doi.org/10.1186/1532-429X-15-S1-P234
- Percentage Error
- Left Ventricular Volume
- Weighted Model
- Parabolic Model
- Longitudinal Length