Controversial role of magnetic resonance imaging in the diagnosis of arrhythmogenic right ventricular dysplasia

Abstract

Kayser et al 1 Kayser H.W. de Roos A. Schalij M.J. Bootsma M. Wellens H.J. Van der Wall E.E. Usefulness of magnetic resonance imaging in diagnosis of arrhythmogenic right ventricular dysplasia and agreement with electrocardiographic criteria. Am J Cardiol. 2003; 91: 365-367 Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar reported the usefulness of magnetic resonance imaging (MRI) in diagnosis of arrhythmogenic right ventricular dysplasia (ARVD) in patients presenting with left bundle branch block-ventricular tachycardia. The article makes an original and potentially useful diagnostic observation, that patients with ARVD have diastolic dysfunction that can be detected by MRI. A similar observation has been reported with 2-dimensional echocardiography. 2 Lindstrom L. Wilkenshoff U.M. Larsson H. Wranne B. Echocardiographic assessment of arrhythmogenic right ventricular cardiomyopathy. Heart. 2001; 86: 31-38 Crossref PubMed Scopus (68) Google Scholar The diagnosis of ARVD is made in the presence of major and minor criteria proposed by the ARVD Task Force in 1994. 3 McKenna W.J. Thiene G. Nava A. Fontaliran F. Blomstrom-Lundqvist C. Fontaine G. Camerini F. Diagnosis of arrhythmogenic right ventricular dysplasia/cardiomyopathy. Br Heart J. 1994; 71: 215-218 Crossref PubMed Google Scholar Of the 25 patients with left bundle branch block-ventricular tachycardia in the study, 14 were diagnosed with ARVD, not based on Task Force criteria, but solely based on the presence or absence of MRI abnormalities compatible with ARVD described by Midiri et al. 4 Midiri M. Finazzo M. Brancato M. Hoffmann E. Indovina G. Maria M.D. Lagalla R. Arrhythmogenic right ventricular dysplasia MR features. Eur Radiol. 1997; 7: 307-312 Crossref PubMed Scopus (84) Google Scholar The diagnosis of ARVD by MRI has not been compared with other imaging techniques like angiography or 2-dimensional echocardiography. First, the diagnostic role of MRI in ARVD is controversial. Currently, there is a major problem with interobserver variability for detection of intramural fat for the diagnosis of ARVD. 4 Midiri M. Finazzo M. Brancato M. Hoffmann E. Indovina G. Maria M.D. Lagalla R. Arrhythmogenic right ventricular dysplasia MR features. Eur Radiol. 1997; 7: 307-312 Crossref PubMed Scopus (84) Google Scholar In our experience, MRI features such as fat replacement, wall thinning, and regional contraction abnormalities were not reproducible among experienced readers. 5 Bluemke DA, Krupinski EA, Ovitt T, Gear K, Unger E, Axel L, Boxt LM, Casolo G, Ferrari VA, Funaki B, et al. MR imaging of arrhythmogenic right ventricular cardiomyopathy: morphologic findings and interobserver reliability. Cardiology 2003;in press Google Scholar Most imaging centers have little or no experience with the diagnosis of ARVD. When this fact is added to technical and other problems—such as a lack of standardized protocol for ARVD, a lack of experience by readers of MR images, the problem of imaging thin walled structures like the right ventricle, differentiating normal epicardial fat from intramural fat—we believe that MRI should not be relied on in imaging studies for ARVD, except in a few select MRI centers with extensive experience with MR imaging and the interpretation of ARVD.