Department of Radiology, Charité-Universitätsmedizin Berlin, Germany.
Jules-Eye-Stein-Institute, University of California Los Angeles, United States.
Rofo. 2020 Aug;192(8):764-775. doi: 10.1055/a-1108-1892. Epub 2020 Feb 27.
To evaluate the diagnostic performance of diastolic function parameters derived from long-axis (LAX) planimetry compared with short-axis (SAX) volumetry in cardiac magnetic resonance imaging.
Cine steady-state free precession (SSFP) datasets of 15 healthy participants (8 young and 7 middle aged) and 25 patients with echocardiographically proven diastolic dysfunction (9 mild, 9 moderate, and 7 severe) were retrospectively included. Volume-time curves for assessing left ventricular (LV) function were obtained by manually contouring the LV endocardial borders in SAX and LAX datasets. The time needed for contouring was recorded for each dataset. The following LV parameters were determined: end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), myocardial mass (MM), time to peak filling rate (TPFR), normalized peak filling rate (nPFR), and the ratio of early to late peak filling rate (E/A ratio). A Wilcoxon signed-rank test was used to compare subgroups based on age and severity of diastolic dysfunction for statistical differences. Intraclass correlation coefficients were used to assess intermethod and interobserver reliability.
Accuracy for the diagnosis of diastolic dysfunction was highest for E/A (mild diastolic dysfunction) and nPFR (any stage of diastolic dysfunction) derived from LAX datasets (E/A: area under the curve (AUC) = 0.97, sensitivity of 68 % and specificity of 100 %; nPFR: AUC = 0.84, sensitivity of 84 % and specificity of 80 %). Diastolic parameters showed a moderate to good intraclass correlation between both methods. The mean differences in EDV, ESV, EF, and MM were 5.3 ml, 1.9 ml, 3.5 %, and 11 g, respectively (each p < 0.001). Significantly less time was needed to derive volume-time curves from LAX images (median 14:45 min, interquartile range 14:15-15:53 min versus median 29:25 min, interquartile range 28:12-32:22 min; p = 0.001). The interobserver reliability was generally good to excellent.
Diastolic function parameters derived from left ventricular LAX planimetry have high diagnostic performance and can be obtained in significantly less time compared with SAX volumetry. These findings may pave the way for routine use of LAX planimetry in the clinical diagnosis of diastolic dysfunction.
· Diastolic function parameters derived from long-axis datasets have high diagnostic performance.. · Generation of volume-time curves using long-axis datasets requires significantly less time.. · This time savings may allow use of cardiac MRI for the diagnosis of diastolic dysfunction in the clinical routine..
· Schaafs LA, Wyschkon S, Elgeti M et al. Diagnosis of Left Ventricular Diastolic Dysfunction Using Cardiac Magnetic Resonance Imaging: Comparison of Volume-Time Curves Derived from Long- and Short-Axis Cine Steady-State Free Precession Datasets. Fortschr Röntgenstr 2020; 192: 764 - 775.
评估心脏磁共振成像中长轴（LAX）平面测量法衍生的舒张功能参数与短轴（SAX）容积测量法的诊断性能。
回顾性纳入 15 名健康志愿者（8 名年轻志愿者和 7 名中年志愿者）和 25 名经超声心动图证实存在舒张功能障碍的患者（轻度 9 例、中度 9 例、重度 7 例）的电影稳态自由进动（cine SSFP）数据集。通过手动描绘 SAX 和 LAX 数据集的左心室（LV）心内膜边界来获取评估 LV 功能的容积-时间曲线。记录每个数据集的描绘时间。确定以下 LV 参数：舒张末期容积（EDV）、收缩末期容积（ESV）、射血分数（EF）、心肌质量（MM）、峰值充盈率（TPFR）、标准化峰值充盈率（nPFR）和早期与晚期峰值充盈率的比值（E/A 比值）。采用 Wilcoxon 符号秩检验对基于年龄和舒张功能障碍严重程度的亚组进行统计学差异比较。采用组内相关系数评估两种方法之间和观察者之间的可靠性。
LAX 数据集衍生的 E/A（轻度舒张功能障碍）和 nPFR（任何阶段的舒张功能障碍）对舒张功能障碍的诊断准确性最高（E/A：曲线下面积（AUC）=0.97，敏感性为 68%，特异性为 100%；nPFR：AUC=0.84，敏感性为 84%，特异性为 80%）。两种方法之间的舒张参数具有中等至良好的组内相关性。EDV、ESV、EF 和 MM 的平均差异分别为 5.3ml、1.9ml、3.5%和 11g（均 p<0.001）。从 LAX 图像中获取容积-时间曲线所需的时间明显更少（中位数 14:45min，四分位距 14:15-15:53min 与中位数 29:25min，四分位距 28:12-32:22min；p=0.001）。观察者之间的可靠性通常为好到极好。
与 SAX 容积测量法相比，从左心室 LAX 平面测量法衍生的舒张功能参数具有较高的诊断性能，且所需时间明显更少。这些发现可能为 LAX 平面测量法在舒张功能障碍的临床诊断中的常规应用铺平道路。
