Safarkhanlo Yasaman, Berto Martina Boscolo, Spano Giancarlo, Bernhard Benedikt, Schütze Jonathan, Stark Anselm W, Praz Fabien, Shiri Isaac, Peters Alan A, Schaub Christof, Peper Eva S, Garefa Chrysoula, Wahl Andreas, Bastiaansen Jessica A M, Gräni Christoph
Department of Cardiology, Inselspital, University Hospital Bern, Bern, CH-3010, Switzerland.
Graduate School for Cellular and Biomedical Sciences (GCB), University of Bern, Bern, Switzerland.
Int J Cardiovasc Imaging. 2025 May 16. doi: 10.1007/s10554-025-03421-x.
Accurate quantification of mitral valve regurgitation (MVR) is crucial for patient management. While different MVR quantification methods based on cardiac magnetic resonance imaging (CMR) exist, their reproducibility and reliability remain uncertain. This study aims to evaluate the reproducibility of different CMR 2D-phase contrast (PC) and 4D-flow MVR quantification methods. The inter-reader and intra-reader reproducibility were assessed using intraclass correlation coefficients (ICC). Seven methods were evaluated: 2D-PC standard (LVSV minus aortic flow), 2D-PC mitral-aortic (mitral inflow minus aortic flow), 2D-PC direct (quantifying mitral backflow), 4D-flow standard, 4D-flow mitral-aortic, 4D-flow direct, and volumetric method (LVSV minus RVSV) in 32 patients (74.8 ± 9.8 years, 28% females) with secondary MVR, analyzed independently by two experienced readers. A total of 26 patients were included in the analysis for 2D-PC and 15 for 4D-flow methods. Among all techniques, 2D-PC standard was the most reliable method with both good inter-reader (ICC = 0.85, p < 0.001) and intra-reader agreement (ICC = 0.87, p < 0.001). The 4D-flow standard (ICC = 0.97, p < 0.001) and the volumetric method (ICC = 0.81, p < 0.001) showed excellent and good intra-reader agreements, respectively, but only moderate inter-reader reproducibility (ICC = 0.52, p = 0.027 and ICC = 0.71, p < 0.001). In patients with secondary MVR, 2D-PC standard method demonstrated the highest reproducibility, while 4D-flow methods showed excellent intra-reader reliability but more variable inter-reader agreement. Standardized post-processing protocols and training would likely enhance the clinical application of these techniques. Future studies should investigate these methods in larger, diverse cohorts and correlate findings with clinical outcomes.
准确量化二尖瓣反流（MVR）对患者管理至关重要。虽然存在基于心脏磁共振成像（CMR）的不同MVR量化方法，但其可重复性和可靠性仍不确定。本研究旨在评估不同CMR二维相位对比（PC）和四维血流MVR量化方法的可重复性。使用组内相关系数（ICC）评估阅片者间和阅片者内的可重复性。评估了七种方法：二维PC标准法（左心室射血分数减去主动脉血流）、二维PC二尖瓣 - 主动脉法（二尖瓣流入量减去主动脉血流）、二维PC直接法（量化二尖瓣反流）、四维血流标准法、四维血流二尖瓣 - 主动脉法、四维血流直接法和容积法（左心室射血分数减去右心室射血分数），对32例继发MVR患者（74.8±9.8岁，28%为女性）进行分析，由两名经验丰富的阅片者独立进行。二维PC分析纳入26例患者，四维血流方法纳入15例患者。在所有技术中，二维PC标准法是最可靠的方法，阅片者间（ICC = 0.85，p < 0.001）和阅片者内一致性（ICC = 0.87，p < 0.001）均良好。四维血流标准法（ICC = 0.97，p < 0.001）和容积法（ICC = 0.81，p < 0.001）分别显示出优异和良好的阅片者内一致性，但阅片者间可重复性仅为中等（ICC = 0.52，p = 0.027和ICC = 0.71，p < 0.001）。在继发MVR患者中，二维PC标准法显示出最高的可重复性，而四维血流方法显示出优异的阅片者内可靠性，但阅片者间一致性变化更大。标准化的后处理方案和培训可能会增强这些技术在临床中的应用。未来的研究应在更大、更多样化的队列中研究这些方法，并将结果与临床结局相关联。
