Comparison of single-source cardiac CT and CMR quantified ventricular volumes and function in congenital heart disease.

Nikhil Patel, Jennifer Cohen, Hari G Rajagopal, David M Barris, Kenan W D Stern, Nadine F Choueiter, Kali A Hopkins, Gina LaRocca, Adam Jacobi, Barry Love, Robert H Pass, Ali N Zaidi, Son Q Duong
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Abstract

Background: Cardiac CT (CCT) is important for anatomic evaluation of congenital heart disease (CHD) prior to pulmonary valve replacement (PVR). However, volumetric and functional criteria for PVR are derived from cardiac MRI (CMR). Systematic differences between CCT and CMR volumes are underexplored in patients with CHD.

Methods: Retrospective review of CHD patients with CMR and single-source CCT<180 days apart. Ventricular volumes were recontoured by blinded experts and global agreement was compared. Right ventricular regional differences in contours were assessed. Agreement of CCT with CMR-defined criteria for PVR was reported.

Results: Twenty-nine patients (mean age 33 years, 48 ​% tetralogy of Fallot, 24 ​% congenital pulmonary stenosis, 83 ​% evaluated for PVR) had average CMR RVEDVi 152 ​mL/m2, RVESVi 80 ​mL/m2, RVEF 49 ​%, and RVEDV:LVEDV 1.9:1. CCT measured significantly higher RVEDVi (mean difference (MD) +17 ​mL/m2), RVESVi (MD +17 ​mL/m2), and RVEDV:LVEDV (MD +0.1) with no difference in stroke volume. There was a lower RVEF (MD -5 ​%). CCT had 90-100 ​% sensitivity/NPV to identify CMR-defined RV PVR thresholds, but had lower specificity and PPV. Faster heart rates had higher RVESVi CCT-CMR difference. The basal and mid-inferior RV contours contributed the most to CCT-CMR differences.

Conclusions: Single-source CCT measures higher RV volumes and lower EF compared to CMR (i.e. more adversely-remodeled). Mechanisms include inferior stretch due to differences in breathing-instruction, and misidentification of end-systole. CMR-derived PVR thresholds applied to CCT would lead to more proactive intervention. "Adjusting" single-source CCT volumes by the observed difference between modalities is a reasonable approach. Single-source CCT-specific volumetric recommendations for PVR are needed.

单源心脏CT与CMR量化先天性心脏病心室容量和功能的比较。
背景:心脏CT (CCT)对先天性心脏病(CHD)在肺瓣膜置换术(PVR)前的解剖评估很重要。然而,PVR的体积和功能标准来自心脏MRI (CMR)。冠心病患者CCT和CMR体积的系统性差异尚未得到充分探讨。方法:回顾性分析合并CMR和单源ccd的冠心病患者。结果:29例患者(平均年龄33岁,48%为法洛四联症,24%为先天性肺狭窄,83%为PVR)的平均CMR RVEDVi为152 mL/m2, RVESVi为80 mL/m2, RVEF为49%,RVEDV:LVEDV为1.9:1。CCT测量的RVEDVi(平均差值(MD) +17 mL/m2)、RVESVi (MD +17 mL/m2)和RVEDV:LVEDV (MD +0.1)显著升高,但卒中容积无差异。RVEF较低(MD - 5%)。CCT识别cmr定义的RV PVR阈值的灵敏度/NPV为90- 100%,但特异性和PPV较低。心率越快,RVESVi CCT-CMR差异越大。基底和中下RV轮廓对CCT-CMR差异贡献最大。结论:与CMR相比,单源CCT测量更高的RV体积和更低的EF(即更多的不良重构)。机制包括由于呼吸指令的差异而导致的低度拉伸,以及对收缩期末期的错误识别。将cmr衍生的PVR阈值应用于CCT将导致更积极的干预。通过观察到的模式之间的差异“调整”单源CCT体积是一种合理的方法。需要针对PVR的单一来源cct特异性容积建议。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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