Multimodality Imaging of the Right Ventricle

Abstract

Right ventricular (RV) structure and function is clinically important in a wide range of conditions. While conventional echocardiography (echo) methods are widely used, its limitations in RV assessment due its complex geometry are well recognized. New applications of traditional echo methods as well as emerging echo techniques including 3-dimensional (3D) echo and speckle tracking strain have the potential to overcome limitations of conventional echo, though widespread clinical use remains to be seen. Volumetric methods using cardiac magnetic resonance (CMR) and computed tomography (CT) provide accurate assessment of RV function without geometric assumptions. In addition, tissue characterization imaging for myocardial scar and fat using CMR and CT provides important information regarding the RV beyond structure and function alone and has clinical applications for diagnosis and prognosis in a broad range of pathologies. Limitations also exist for these two advanced modalities including availability and patient suitability for CMR and need for contrast and radiation exposure for CT. The complementary role of each modality for the RV as well as emerging evidence for the use of each imaging method in diagnosis and management of RV pathologies is outlined in this study.

Keywords: 3-dimensional (3D) echo; Cardiac magnetic resonance (CMR); Imaging; Multimodality imaging; Right ventricular (RV) structure.

Figure

M-mode derived TAPSE and tissue Doppler measured S′ obtained in apical four-chamber view (normal >1.6 cm and >10 cm/s, respectively) [top left]. Speckle tracking echo for RV global longitudinal strain assessment (normal >20%) [bottom left]. 3D full volume acquisition in RV focused view for RV volumes and ejection fraction (normal >44%) [right].