Clinical Investigation
Imaging and Diagnostic Testing
Multi–detector row cardiac computed tomography accurately quantifies right and left ventricular size and function compared with cardiac magnetic resonance

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Background

Cardiac magnetic resonance (CMR) accurately quantifies right ventricular (RV) and left ventricular (LV) volumes and function. Limited availability of CMR and increasing use of MR-incompatible cardiovascular devices underscore the potential utility of cardiac computed tomography (CT) for ventricular quantification. This study quantified biventricular size and systolic function with multi–detector row CT compared with CMR imaging.

Methods

Twenty-six subjects prospectively underwent CT and CMR examinations on a 16-detector CT and 1.5 T MR scanner, respectively; claustrophobia in one and nongated CT imaging in another precluded complete imaging in 2 subjects. Contiguous multiphase short-axis images were generated from axial CT data, and steady-state free precession cine MR produced contiguous short-axis cines. Semiautomated software generated ventricular borders to calculate volume, mass, and ejection fraction (EF) from both sets of images. Blinded observers completed quantification and wall motion analyses of 23 CMR and CT data sets independently.

Results

All measures of LV size and function by cardiac CT correlated well with CMR over a wide range of LV function (LVEF 30%-72% by CMR), including end-diastolic volume (r = 0.97), end-systolic volume (r = 0.97), EF (r = 0.97), and mass (r = 0.95). Of 24 cases, 6 had inadequate contrast opacification of the RV precluding RV segmentation. In the remaining 18 CMR-CT data pairs, RVEF showed moderate agreement (r = 0.86), and RV volumes correlated well (r = 0.97 and 0.94 for RV end-diastolic volume and RV end-systolic volume, respectively). Ten percent of LV segments visualized by CT were inadequate for wall motion assessment due to motion artifact or inadequate contrast between myocardium and endocardium. For segments adequately visualized by both techniques, the mean κ statistic was 0.88 (range 0.78-1.0), consistent with good agreement.

Conclusion

Cardiac CT accurately quantifies LV size and function; RV quantification with cardiac CT requires optimized contrast opacification of the RV.

Section snippets

Patient enrollment

Individuals with known or suspected coronary disease were prospectively recruited as part of a multimodality investigation of atherosclerosis. Written informed consent was obtained for participation in this institutional review board–approved protocol. Exclusion criteria included age <18 years, allergy to iodinated contrast, renal insufficiency (serum creatinine >1.5 mg/dL), pregnancy, presence of ferrous metal in the body or other MR-incompatible implant, and severe claustrophobia. Cardiac CT

Results

Twenty-six subjects were sequentially enrolled; unanticipated claustrophobia precluded MR examination in one subject and CT image reconstruction could not be completed in another subject because of nongated acquisition. Thus, 24 subjects successfully underwent both cardiac CT and CMR examinations; clinical characteristics of the study population are summarized in Table I. The mean HR during helical CT acquisition ranged from 47 to 72 beat/min, whereas HR during CMR short-axis cine imaging

Discussion

In this work, we found excellent agreement between multi–detector row cardiac CT and CMR measurements of both RV and LV size and function. Semiautomated analysis software facilitated detection of endocardial and epicardial borders and calculations of ventricular measurements. Such measurements help guide individual patient management and are usually derived from other diagnostic procedures such as echocardiography or ventriculography, although with less precision and accuracy compared with CMR.

References (21)

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This study was supported by a grant from the State of Ohio (BRTT02-0022).

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