TY - JOUR
T1 - Multicenter Consistency Assessment of Valvular Flow Quantification With Automated Valve Tracking in 4D Flow CMR
AU - Juffermans, Joe F.
AU - Minderhoud, Savine C. S.
AU - Wittgren, Johan
AU - Kilburg, Anton
AU - Ese, Amir
AU - Fidock, Benjamin
AU - Zheng, Yu-Cong
AU - Zhang, Jun-Mei
AU - Blanken, Carmen P. S.
AU - Lamb, Hildo J.
AU - Goeman, Jelle J.
AU - Carlsson, Marcus
AU - Zhao, Shihua
AU - Planken, R. Nils
AU - van Ooij, Pim
AU - Zhong, Liang
AU - Chen, Xiuyu
AU - Garg, Pankaj
AU - Emrich, Tilman
AU - Hirsch, Alexander
AU - Töger, Johannes
AU - Westenberg, Jos J. M.
N1 - Funding Information: The authors thank Jean-Paul Aben and Gaston Vogel from Pie Medical Imaging, Maastricht, the Netherlands, for providing the CAAS MR Solutions v5.1 software and software training. Skane University Hospital and University Medical Center Mainz thank Ning Jin from Siemens Medical Solutions USA, Inc (Cleveland, Ohio), for providing the 4D flow sequence as a work-in-progress package. Fuwai Hospital thanks Gang Yin at Fuwai Hospital, Beijing, China, for his assistance during the data collection. Publisher Copyright: © 2021 American College of Cardiology Foundation
PY - 2021/7
Y1 - 2021/7
N2 - Objectives: This study determined: 1) the interobserver agreement; 2) valvular flow variation; and 3) which variables independently predicted the variation of valvular flow quantification from 4-dimensional (4D) flow cardiac magnetic resonance (CMR) with automated retrospective valve tracking at multiple sites. Background: Automated retrospective valve tracking in 4D flow CMR allows consistent assessment of valvular flow through all intracardiac valves. However, due to the variance of CMR scanners and protocols, it remains uncertain if the published consistency holds for other clinical centers. Methods: Seven sites each retrospectively or prospectively selected 20 subjects who underwent whole heart 4D flow CMR (64 patients and 76 healthy volunteers; aged 32 years [range 24 to 48 years], 47% men, from 2014 to 2020), which was acquired with locally used CMR scanners (scanners from 3 vendors; 2 1.5-T and 5 3-T scanners) and protocols. Automated retrospective valve tracking was locally performed at each site to quantify the valvular flow and repeated by 1 central site. Interobserver agreement was evaluated with intraclass correlation coefficients (ICCs). Net forward volume (NFV) consistency among the valves was evaluated by calculating the intervalvular variation. Multiple regression analysis was performed to assess the predicting effect of local CMR scanners and protocols on the intervalvular inconsistency. Results: The interobserver analysis demonstrated strong-to-excellent agreement for NFV (ICC: 0.85 to 0.96) and moderate-to-excellent agreement for regurgitation fraction (ICC: 0.53 to 0.97) for all sites and valves. In addition, all observers established a low intervalvular variation (≤10.5%) in their analysis. The availability of 2 cine images per valve for valve tracking compared with 1 cine image predicted a decreasing variation in NFV among the 4 valves (beta = −1.3; p = 0.01). Conclusions: Independently of locally used CMR scanners and protocols, valvular flow quantification can be performed consistently with automated retrospective valve tracking in 4D flow CMR.
AB - Objectives: This study determined: 1) the interobserver agreement; 2) valvular flow variation; and 3) which variables independently predicted the variation of valvular flow quantification from 4-dimensional (4D) flow cardiac magnetic resonance (CMR) with automated retrospective valve tracking at multiple sites. Background: Automated retrospective valve tracking in 4D flow CMR allows consistent assessment of valvular flow through all intracardiac valves. However, due to the variance of CMR scanners and protocols, it remains uncertain if the published consistency holds for other clinical centers. Methods: Seven sites each retrospectively or prospectively selected 20 subjects who underwent whole heart 4D flow CMR (64 patients and 76 healthy volunteers; aged 32 years [range 24 to 48 years], 47% men, from 2014 to 2020), which was acquired with locally used CMR scanners (scanners from 3 vendors; 2 1.5-T and 5 3-T scanners) and protocols. Automated retrospective valve tracking was locally performed at each site to quantify the valvular flow and repeated by 1 central site. Interobserver agreement was evaluated with intraclass correlation coefficients (ICCs). Net forward volume (NFV) consistency among the valves was evaluated by calculating the intervalvular variation. Multiple regression analysis was performed to assess the predicting effect of local CMR scanners and protocols on the intervalvular inconsistency. Results: The interobserver analysis demonstrated strong-to-excellent agreement for NFV (ICC: 0.85 to 0.96) and moderate-to-excellent agreement for regurgitation fraction (ICC: 0.53 to 0.97) for all sites and valves. In addition, all observers established a low intervalvular variation (≤10.5%) in their analysis. The availability of 2 cine images per valve for valve tracking compared with 1 cine image predicted a decreasing variation in NFV among the 4 valves (beta = −1.3; p = 0.01). Conclusions: Independently of locally used CMR scanners and protocols, valvular flow quantification can be performed consistently with automated retrospective valve tracking in 4D flow CMR.
KW - automated retrospective valve tracking
KW - valvular flow assessment regurgitation
KW - whole heart 4D flow CMR
UR - http://www.scopus.com/inward/record.url?scp=85101675502&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jcmg.2020.12.014
DO - https://doi.org/10.1016/j.jcmg.2020.12.014
M3 - Article
C2 - 33582060
SN - 1936-878X
VL - 14
SP - 1354
EP - 1366
JO - JACC. Cardiovascular imaging
JF - JACC. Cardiovascular imaging
IS - 7
ER -