Cardiac MR Imaging in the Evaluation of Rheumatic Valvular Heart Diseases

Abstract

Introduction: Rheumatic heart disease is the most common cause of valvular heart disease throughout the world. Echocardiography is the dominant imaging investigation in the assessment of cardiac valvular disease and the role of Magnetic Resonance Imaging (MRI) is so far limited. However, due to rapid improvements in the cardiac MRI technology in past few years, this non invasive technique is gaining interest in the examination of cardiac valves.

Aim: Our study was undertaken to define the role of MRI in the evaluation of Rheumatic valvular heart disease and to compare the role of MRI with transthoracic echocardiography with regard to quantity of stenosis and volume regurgitation.

Materials and methods: ECG gated Cardiac MRI was performed with a 1.5-Tesla system (MAGNETOM SYMPHONY- Model 2005) using basic cardiac software (Argus viewer) by a phased-array multicoil on 50 subjects who were known cases of Rheumatic valvular heart disease. A chest radiograph and echocardiography were done in all patients before MR examination. Informed consent was taken from all patients.

Results: Mitral stenosis either as an isolated valvular abnormality or in combination with other valvular abnormalities constituted the major bulk of Rheumatic valvular heart disease in our study population. The average ejection fraction by ECHO is 64.94±7.11 and by MRI 67.52±7.84. The average mitral valve area by ECHO is 1.79±0.43 cm(2) and by MRI 1.82±0.47 cm(2). The average aortic valve area by ECHO is 1.10±0.21 cm(2) and by MRI 1.12±0.25 cm(2). The Coefficient of Correlation (r) is 0.82 for ejection fraction, 0.98 for mitral valve area and 0.92 for aortic valve area which means a strong positive association between the results by ECHO and MRI. In all instances, the p-value is <0.00001, suggesting that the test is highly significant.

Conclusion: In our study echocardiography was found to be the gold standard for the diagnosis of Rheumatic valvular heart disease and the role of MRI remained only complimentary to Echocardiography. However with advanced cardiac software, more advanced techniques, and faster imaging sequences, MRI may become a valuable procedure for investigation and follow-up of patients with valvular heart disease.

Keywords: Noninvasive imaging; Regurgitation; Stenosis.

[Table/Fig-4]:

A) Spin echo image shows four chamber view, B) Cine imaging shows regurgitation through mitral valve into left atrium in a 22 year old female.

[Table/Fig-5]:

A) Spin echo image shows four chamber view, B) Cine imaging shows regurgitation through aortic valve into left ventricle in a 45 year old male.

[Table/Fig-6]:

A) Spin echo image shows aortic stenosis, B) Cine imaging in sagittal plane shows jet through stenosed aortic valve into Aorta in a 62 year old male.

[Table/Fig-7]:

A) Spin echo image shows mitral stenosis, B) Cine imaging shows jet through stenosed mitral valve into left ventricle in a 41 year old male.