Tondi Lara, Figliozzi Stefano, Boveri Sara, Sturla Francesco, Pasqualin Giulia, Camporeale Antonia, Disabato Giandomenico, Attanasio Andrea, Carrafiello Gianpaolo, Spagnolo Pietro, Lombardi Massimo
Multimodality Cardiac Imaging Section, I.R.C.C.S., Policlinico San Donato, Via Morandi, 30, 20097, San Donato, Milan, Italy.
Postgraduate School in Radiodiagnostics, Università Degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy.
Radiol Med. 2024 Dec;129(12):1830-1839. doi: 10.1007/s11547-024-01908-6. Epub 2024 Oct 30.
Cardiovascular magnetic resonance (CMR) is the gold-standard to estimate right ventricular (RV) volumes, which are key for clinical management of patients with repaired tetralogy of Fallot (rTOF). Semi-automated threshold-based methods (SAT) have been proposed for CMR post-processing as alternatives to fully manual standard tracing. We investigated the impact of SAT on RV analysis using different thresholds in rTOF patients.
RV volumes and mass were estimated using SAT and standard fully manual tracing methods in rTOF patients. Two threshold levels were set for SAT, i.e., default 50 (SAT-50) and 30 (SAT-30). RV stroke volumes (SV) were compared to main pulmonary artery forward flow (MPA-FF). Post-processing time, intra- and interobserver variabilities were compared across methods.
Sixty-two CMRs of rTOF patients were analyzed. Compared to the standard fully manual tracing, no significant differences in RV mass, volumes and ejection fraction were observed using SAT-30, whereas SAT-50 significantly underestimated RV end-diastolic-volume index (EDVi) by 10.4% (mean difference of - 11.8 ± 6.2 ml/m, p 0.03) and overestimated RV mass index by 21.8% (mean difference of 14.2 ± 11.9 g/m, p 0.002). Compared to MPA-FF, RVSV by standard fully manual method and SAT-30 showed minor biases, respectively, 0.03 ml/m and 0.7 ml/m, while SAT-50 underestimated RVSV by 6.86 ml/m (p < 0.001). In six patients, the degree of RV EDVi underestimation by SAT-50 determined a change of category from dilated to non-dilated RV. Intra- and interobserver variabilities were good to excellent for all methods. Post-processing duration was shorter for SAT compared to standard manual segmentation (5.5 ± 1.7 min vs. 19.5 ± 4.4 min, p < 0.001).
CMR SAT-30 post-processing is a precise, accurate and time-saving method for biventricular assessment of volumes, ejection fraction and mass in rTOF.
心血管磁共振成像（CMR）是评估右心室（RV）容积的金标准，而RV容积对于法洛四联症修复术后（rTOF）患者的临床管理至关重要。基于阈值的半自动方法（SAT）已被提出用于CMR后处理，作为完全手动标准追踪的替代方法。我们研究了在rTOF患者中使用不同阈值的SAT对RV分析的影响。
在rTOF患者中使用SAT和标准的完全手动追踪方法评估RV容积和质量。为SAT设置了两个阈值水平，即默认的50（SAT-50）和30（SAT-30）。将RV每搏输出量（SV）与主肺动脉前向血流（MPA-FF）进行比较。比较各方法的后处理时间、观察者内和观察者间变异性。
分析了62例rTOF患者的CMR。与标准的完全手动追踪相比，使用SAT-30时，RV质量、容积和射血分数无显著差异，而SAT-50显著低估RV舒张末期容积指数（EDVi）10.4%（平均差异为-11.8±6.2ml/m，p=0.03），并高估RV质量指数21.8%（平均差异为14.2±11.9g/m，p=0.002）。与MPA-FF相比，标准完全手动方法和SAT-30的RVSV分别显示出较小的偏差，分别为0.03ml/m和0.7ml/m，而SAT-50低估RVSV 6.86ml/m（p<0.001）。在6例患者中，SAT-50对RV EDVi的低估程度导致RV类别从扩张型变为非扩张型。所有方法的观察者内和观察者间变异性均良好至优秀。与标准手动分割相比，SAT的后处理持续时间更短（5.5±1.7分钟对19.5±4.4分钟，p<0.001）。
CMR SAT-30后处理是一种精确、准确且省时的方法，用于对rTOF患者的双心室容积、射血分数和质量进行评估。
