Abstract
The right ventricle´s (RV) characteristics—thin walls and trabeculation—make it challenging to evaluate extracellular volume (ECV). We aimed to assess the feasibility of RV ECV measurements in congenital heart disease (CHD), and to introduce a novel ECV analysis tool. Patients (n = 39) and healthy controls (n = 17) underwent cardiovascular magnetic resonance T1 mapping in midventricular short axis (SAX) and transverse orientation (TRANS). Regions of interest (ROIs) were evaluated with regard to image quality and maximum RV wall thickness per ROI in pixels. ECV from plane ROIs was compared with values obtained with a custom-made tool that derives the mean T1 values from a “line of interest” (LOI) centered in the RV wall. In CHD, average image quality was good (no artifacts in the RV, good contrast between blood/myocardium), and RV wall thickness was 1–2 pixels. RV ECV was not quantifiable in 4/39 patients due to insufficient contrast or wall thickness < 1 pixel. RV myocardium tended to be more clearly delineated in SAX than TRANS. ECV from ROIs and corresponding LOIs correlated strongly in both directions (SAX/TRANS: r = 0.97/0.87, p < 0.001, respectively). In conclusion, RV ECV can be assessed if image quality allows sufficient distinction between myocardium and blood, and RV wall thickness per ROI is ≥ 1 pixel. T1 maps in SAX are recommended for RV ECV analysis. LOI application simplifies RV ECV measurements.
Highlights
The right ventricles (RV) characteristics—thin walls and trabeculation—make it challenging to evaluate extracellular volume (ECV)
ECV could not be determined in short axis (SAX) in 6/39 patients due to insufficient image quality (n = 2) or RV wall thickness (n = 4)
RV ECV could be determined in the majority of congenital heart disease (CHD) subjects given that image quality was sufficient for differentiation between RV myocardium and blood pool, and maximum RV wall thickness per Regions of interest (ROIs) was ≥ 1 pixel
Summary
The right ventricles (RV) characteristics—thin walls and trabeculation—make it challenging to evaluate extracellular volume (ECV). In CHD, average image quality was good (no artifacts in the RV, good contrast between blood/myocardium), and RV wall thickness was 1–2 pixels. RV ECV can be assessed if image quality allows sufficient distinction between myocardium and blood, and RV wall thickness per ROI is ≥ 1 pixel. Myocardial fibrosis contributes to the development of heart failure in adult congenital heart disease (CHD)[1] Both focal[2,3,4,5] and diffuse myocardial fibrosis[6,7,8,9,10,11] have been described in different forms of CHD using cardiovascular magnetic resonance (CMR). The RV wall is directly targeted in its center as a “line of interest” (LOI), without the necessity for delineating between myocardial and blood pixels, and facilitating a quick and simple evaluation of myocardial RV ECV
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