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Comparative Study
. 2012 Mar;28(3):595-601.
doi: 10.1007/s10554-011-9871-9. Epub 2011 Apr 19.

Image quality assessment of the right ventricle with three different delayed enhancement sequences in patients suspected of ARVC/D

A S Plaisier  1 , M C Burgmans, E P A Vonken, N H Prakken, M G P J Cox, R N Hauer, B K Velthuis, M J M Cramer
Affiliations
Comparative Study

Image quality assessment of the right ventricle with three different delayed enhancement sequences in patients suspected of ARVC/D

A S Plaisier et al. Int J Cardiovasc Imaging. 2012 Mar.

Abstract

Histopathologic findings in arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) are replacement of the normal myocardium with fatty and fibrous elements with preferential involvement of the right ventricle. The right ventricular fibrosis can be visualised by post-gadolinium delayed enhancement inversion recovery imaging (DE imaging). We compared the image quality of three different gradient echo MRI sequences for short axis DE imaging of the right ventricle (RV). We retrospectively analysed MRI scans performed between February 2005 and December 2008 in 97 patients (mean age: 41.2 years, 67% men) suspected of ARVC/D. For DE imaging either a 2D Phase Sensitive (PSIR), a 2D (2D) or a 3D (3D) inversion recovery sequence was used in respectively 38, 32 and 27 MRI-examinations. The RV, divided in 10 segments, was assessed for image quality by two radiologists in random sequence. A consensus reading was performed if results differed between the two readings. Image quality was good in 24% of all segments in the 3D group, 66% in the 2D group and 79% in the PSIR group. Poor image quality was observed in 51% (3D), 10% (2D), and 2% (PSIR) of all segments. Exams were considered suitable for clinical use in 7% of exams in the 3D group, 75% of exams in the 2D group and 90% of exams of the PSIR group. Breathing-artifacts occurred in 22% (3D), 59% (2D) and 53% (PSIR). Motion-artifacts occurred in 56% (3D), 28% (2D) and 29% (PSIR). Post-gadolinium imaging using the PSIR sequence results in better and more consistent image quality of the RV compared to the 2D and 3D sequences.

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Figures

Fig. 1
Fig. 1
Example of delayed enhancement of the lateral and anterior wall of the right ventricle in a 47 year old male with ARVC/D. The diagnosis of ARVC/D was made according to McKenna criteria
Fig. 2
Fig. 2
Segmental division of the right ventricle supplemental to the 17-segment model of the left ventricle used by the American Heart Association [14, 15]
Fig. 3
Fig. 3
Example of 3 patients with good, moderate and poor image quality (from left to right) of the right ventricular inferior wall (segment 29) in a PSIR exam
Fig. 4
Fig. 4
Differentiation between image quality of segments by type of sequence
Fig. 5
Fig. 5
Individual patient score sorted by type of sequence
Fig. 6
Fig. 6
Score differentiation by type of sequence
Fig. 7
Fig. 7
Segmental differentiation of quality in the 3D group
Fig. 8
Fig. 8
Segmental differentiation of quality in the 2D group
Fig. 9
Fig. 9
Segmental differentiation of quality in the PSIR group
See this image and copyright information in PMC

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