Rationale and Objectives
The aim of this study was to investigate the impact of ventricular contrast medium attenuation on the accuracy of left ventricular (LV) and right ventricular (RV) function analysis on coronary computed tomographic angiographic (CCTA) imaging compared to cardiac magnetic resonance imaging (CMR).
Materials and Methods
Thirty patients (mean age, 61.9 ± 11.2 years; 14 men) underwent CCTA imaging and CMR. For both the right and left ventricles, end-diastolic volume (EDV), end-systolic volume (ESV), and stroke volume (SV) were computed using multiphase image reconstruction of CCTA data. The accuracy of CCTA imaging was determined by subtracting CCTA measurements from CMR measurements. The accuracy of CCTA imaging was then correlated with the level of LV and RV contrast medium attenuation using regression analysis.
Results
In the right ventricle, there was strong correlation between the accuracy of CCTA functional assessment of EDV ( R 2 = 0.78, P < .001), ESV ( R 2 = 0.36, P < .001), and SV ( R 2 = 0.75, P < .001) and the level of RV contrast medium attenuation. In studies with lower RV enhancement (<176 Hounsfield units; n = 15), the mean CCTA deviations of EDV, ESV, and SV from CMR measurements were 43.6 ± 17.4, 11.2 ± 9.64, and 35.1 ± 11.5 mL, respectively. In studies with higher RV attenuation (>176 Hounsfield units; n = 15), these values were 13.6 ± 10, 8.0 ± 5.28, and 13 ± 4.96 mL, respectively. In the left ventricle, there was weak correlation between functional CCTA accuracy and LV attenuation (mean, 358.31 ± 68.71 Hounsfield units), and there was excellent correlation with CMR for LV EDV ( R 2 = 0.86, P < .001), ESV ( R 2 = 0.85, P < .001), and SV ( R 2 = 0.51, P < .001).
Conclusions
If computed tomographic evaluation of RV function is desired, attention should be paid to the contrast injection protocol, because the accuracy of RV function analysis depends on the level of contrast medium attenuation. The high contrast medium attenuation that is typically achieved in the left ventricle routinely enables highly accurate measurements compared to CMR.
The evaluation of left ventricular (LV) and right ventricular (RV) functional parameters is of substantial clinical importance for determining the prognosis and therapeutic management in patients with various cardiac diseases . Currently, magnetic resonance imaging (MRI) is considered the most accurate and reproducible modality in the evaluation of both LV and RV functional parameters , although in routine clinical practice, echocardiography remains the first-line test for this purpose.
In recent years, computed tomographic (CT) imaging has been increasingly used for the noninvasive assessment of a variety of cardiac diseases. Technological developments have improved temporal and spatial resolution to a point at which multi–detector row CT (MDCT) imaging and automated postprocessing analysis software enable the routine assessment of LV function . More recently, because of the clinical importance of right-heart disease, there is increased interest in the use of MDCT imaging for the evaluation of RV function .
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Materials and methods
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Population
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Multidetector Cardiac CT Imaging
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CMR
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Image Analysis
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Statistical Analysis
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Results
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Analysis of Ventricular Function and Attenuation
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Table 1
Volume Measurements for the LV and RV Obtained by CCTA and CMR: Contrast Medium Attenuation Values Measured for the Three Regions of Interest in the LV and RV
Type Ventricle Variable Mean SD Minimum Median Maximum CCTA RV SV 46.7 14.1 6.96 49.05 68.95 EDV 95.05 20.21 58.28 92.68 135.02 ESV 48.36 13.38 26.97 47.15 75.88 Attenuation Inferior 187.1 50.99 98.35 175.66 297.06 Middle 224.15 48.79 133.65 220.01 334.86 Outflow 256.33 56.02 166.32 240.42 376.26 LV SV 70.38 12.05 45.04 70.1 90.5 EDV 113.27 27.77 70.94 108.88 205.76 ESV 42.86 22.57 16.02 37.82 128.99 Attenuation Inferior 358.31 63.71 248.47 343.1 494.09 Middle 356.49 66.3 237.38 335.87 485.08 Outflow 359.47 58.2 272.71 347.71 485.38 CMR RV SV 68.1 12.82 43.2 69.15 85.6 EDV 119.75 26.15 79.6 115.1 182.1 ESV 51.64 19.74 21.7 51.25 96.5 LV SV 69.31 11.69 42.1 70.95 91.9 EDV 114.88 25.76 67.7 115.95 199.8 ESV 45.61 21.9 19.9 40.8 131.9
CCTA, cardiac computed tomographic angiography; CMR, cardiac magnetic resonance imaging; EDV, end-diastolic volume; ESV, end-systolic volume; LV, left ventricle; RV, right ventricle; SD, standard deviation; SV, stroke volume.
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Attenuation Correlated with RV Function
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Attenuation Correlated with LV Function
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Table 2
LV Function by CCTA Compared to CMR ( n = 30)
CCTA (mL) CMR (mL) CCTA vs CMR Mean Difference (mL) Paired t Test Pearson’s Coefficient SV 70.38 ± 12.05 69.31 ± 11.69 6.69 ± 6.18 0.51 0.71 EDV 113.27 ± 27.22 114.88 ± 25.76 7.76 ±7.10 0.40 0.92 ESV 42.86 ± 22.57 45.61 ± 121.9 6.98 ± 5.89 0.10 0.92
CCTA, cardiac computed tomographic angiography; CMR, cardiac magnetic resonance imaging; EDV, end-diastolic volume; ESV, end-systolic volume; LV, left ventricular; SV, stroke volume.
Data are expressed as mean ± standard deviation.
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Discussion
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Conclusions
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