Lodge Freya M, Moody William E, McAloon Christopher J, Stoll Victoria M, Mahmoud-Elsayed Hani, Steeds Richard P, Holloway Benjamin, Hudsmith Lucy E
Cardiology Department, University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, UK.
Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom.
Int J Cardiol Congenit Heart Dis. 2022 Aug 6;10:100411. doi: 10.1016/j.ijcchd.2022.100411. eCollection 2022 Dec.
Right ventricular size and function on cardiac MRI provides thresholds for referral for pulmonary valve intervention in repaired Tetralogy of Fallot (RTOF). However, different contouring techniques are available to calculate right ventricular volumes and ejection fraction. It is not known whether these contouring techniques impact on threshold triggers for intervention.
Right ventricular volumes on cardiac MRI for 24 consecutive subjects with RTOF were measured by two independent, experienced observers using three contouring techniques: , detailed and detailed with semi-automated .
End-diastolic and end-systolic volumes were significantly different between contouring techniques: largest for contours, intermediate for and smallest for (EDV: 233 ml, SD 105 ml; 215 ml, SD 95 ml; 206 ml, SD 94 ml; ESV: 122 ml, SD 71 ml; 113 ml, SD 67 ml; 103 ml, SD 64 ml; p < 0.001 for all comparisons). Stroke volume from contours by correlated most strongly with velocity mapping (r = 0.87, p < 0.001). Interobserver agreement was strongest for (end-diastolic volume ICC = 1.0 (confidence interval (CI):0.999-1.0, p < 0.001); end-systolic volume ICC = 0.999 (CI:0.994-1.0, p < 0.001) and weakest for contours ((end-diastolic volume ICC = 0.89 (CI:0.33-0.99, p = 0.01); end-diastolic volume ICC = 0.88 (CI:0.30-0.99, p = 0.01). Intra-observer agreement was uniformly high (ICC≥0.996, p < 0.001 for all). In 4/24 cases, contouring technique altered threshold triggers for pulmonary valve intervention.
Differences in contouring technique for measuring right ventricular volumes in patients with RTOF can affect thresholds triggering referral for pulmonary valve intervention. Standardisation of right ventricular measurement is needed in congenital cardiac MRI practice.
心脏磁共振成像（MRI）测量的右心室大小和功能为法洛四联症修复术后（RTOF）肺动脉瓣介入治疗的转诊提供了阈值。然而，有多种不同的轮廓描绘技术可用于计算右心室容积和射血分数。目前尚不清楚这些轮廓描绘技术是否会影响干预的阈值触发因素。
24例连续的RTOF患者的心脏MRI右心室容积由两名独立且经验丰富的观察者使用三种轮廓描绘技术进行测量：详细手动描绘、详细手动描绘并结合半自动描绘。
不同轮廓描绘技术之间的舒张末期和收缩末期容积存在显著差异：详细手动描绘轮廓的容积最大，详细手动描绘并结合半自动描绘的容积居中，详细手动描绘的容积最小（舒张末期容积：详细手动描绘为233ml，标准差105ml；详细手动描绘并结合半自动描绘为215ml，标准差95ml；详细手动描绘为206ml，标准差94ml；收缩末期容积：详细手动描绘为122ml，标准差71ml；详细手动描绘并结合半自动描绘为113ml，标准差67ml；详细手动描绘为103ml，标准差64ml；所有比较的p值均<0.001）。详细手动描绘轮廓得出的每搏输出量与速度映射的相关性最强（r = 0.87，p < 0.001）。观察者间一致性在详细手动描绘并结合半自动描绘时最强（舒张末期容积组内相关系数（ICC）= 1.0（置信区间（CI）：0.999 - 1.0，p < 0.001）；收缩末期容积ICC = 0.999（CI：0.994 - 1.0，p < 0.001），在详细手动描绘轮廓时最弱（舒张末期容积ICC = 0.89（CI：0.33 - 0.99，p = 0.01）；舒张末期容积ICC = 0.88（CI：0.30 - 0.99，p = 0.01）。观察者内一致性均较高（ICC≥0.996，所有p值均<0.001）。在24例中的4例中，轮廓描绘技术改变了肺动脉瓣介入治疗的阈值触发因素。
RTOF患者测量右心室容积的轮廓描绘技术差异会影响肺动脉瓣介入治疗转诊的阈值触发因素。先天性心脏MRI实践中需要对右心室测量进行标准化。
