Circulation, Vol 82, 154-163, Copyright © 1990 by American Heart Association
GB Cranney, CS Lotan, L Dean, W Baxley, A Bouchard and GM Pohost
Proton nuclear magnetic resonance (NMR) imaging has the potential to
serially assess left ventricular (LV) volumes with optimal accuracy because
it is a high-resolution, three-dimensional, noninvasive modality. Previous
NMR studies to assess LV volumes have been suboptimal, as they have used
either planes aligned with the axes of the body, which are compromised by
partial volume effects, or spin-echo techniques that have been
time-consuming to acquire and analyze. Accordingly, for LV volume
measurement, we developed a gradient-echo (cine) NMR strategy that uses two
orthogonal planes intersecting along the intrinsic long axis of the heart
(two-chamber and four-chamber). This approach was validated against
calibrated contrast biplane LV cineangiography (CATH) and also compared
with a previously reported short-axis spin-echo NMR method. Twenty-one
patients underwent CATH and NMR (long-axis, n = 21; short-axis, n = 14)
within a 3-day interval. Although both long- and short-axis NMR LV volumes
and ejection fractions correlated well with CATH (r greater than 0.90, p
less than 0.001 in all), end-diastolic volumes by both long-axis (161 +/-
85 ml) and short-axis (151 +/- 81 ml) NMR were systematically less than
those by CATH (182 +/- 85 ml) (p less than 0.05). Consequently, ejection
fractions by long-axis (48 +/- 17%) and short-axis (49 +/- 17%) NMR
consistently underestimated those by CATH (54 +/- 16%, p less than 0.05).
End-systolic volumes by long-axis (94 +/- 71 ml) and short-axis (87 +/- 72
ml) NMR were not significantly different from those by CATH (92 +/- 69 ml).
Both NMR techniques had low intraobserver and interobserver variation (less
than 11%); however, short-axis spin-echo NMR involved longer
acquisition/reconstruction (35 versus 18 minutes) and analysis (25 versus
10 minutes) times. We conclude that both short- axis spin-echo and
long-axis gradient-echo NMR approaches reliably estimate LV volumes.
Currently, the long-axis strategy appears more practical for clinical use
because the scan and analysis times are relatively short.
ARTICLES
Left ventricular volume measurement using cardiac axis nuclear magnetic resonance imaging. Validation by calibrated ventricular angiography
Department of Medicine, University of Alabama, Birmingham 35294.
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