Abstract
IntroductionPediatric z scores are necessary to describe size and structure of the heart in growing children, however, development of an accurate z score calculator requires robust normal datasets, which are difficult to obtain with cardiovascular magnetic resonance (CMR) in children. Motion-corrected (MOCO) cines from re-binned, reconstructed real-time cine offer a free-breathing, rapid acquisition resulting in cines with high spatial and temporal resolution. In combination with child-friendly positioning and entertainment, MOCO cine technique allows for rapid cine volumetry in patients of all ages without sedation. Thus, our aim was to prospectively enroll normal infants and children birth-12 years for creation and validation of a z score calculator describing normal right ventricular (RV) and left ventricular (LV) size.MethodsWith IRB approval and consent/assent, 149 normal children successfully underwent a brief noncontrast CMR on a 1.5 T scanner including MOCO cines in the short axis, and RV and LV volumes were measured. 20% of scans were re-measured for interobserver variability analyses. A general linear modeling (GLM) framework was employed to identify and properly represent the relationship between CMR-based assessments and anthropometric data. Scatter plots of model fit and Akaike’s information criteria (AIC) results were used to guide the choice among alternative models.ResultsA total of 149 subjects aged 22 days–12 years (average 5.1 ± 3.6 years), with body surface area (BSA) range 0.21–1.63 m2 (average 0.8 ± 0.35 m2) were scanned. All ICC values were > 95%, reflecting excellent agreement between raters. The model that provided the best fit of volume measure to the data included BSA with higher order effects and gender as independent variables. Compared with earlier z score models, there is important additional growth inflection in early toddlerhood with similar z score prediction in later childhood.ConclusionsFree-breathing, MOCO cines allow for accurate, reliable RV and LV volumetry in a wide range of infants and children while awake. Equations predicting fit between LV and RV normal values and BSA are reported herein for purposes of creating z scores.Trial registrationclinicaltrials.gov NCT02892136, Registered 7/21/2016.
Highlights
Pediatric z scores are necessary to describe size and structure of the heart in growing children, development of an accurate z score calculator requires robust normal datasets, which are difficult to obtain with cardiovascular magnetic resonance (CMR) in children
Free-breathing, MOCO cines allow for accurate, reliable right ventricular (RV) and left ventricular (LV) volumetry in a wide range of infants and children while awake
Subject recruitment With IRB approval and informed consent/assent where appropriate, 213 healthy children, and 5 infants with known normal intracardiac anatomy who presented for a nonsedate “feed and bundle” CMR to evaluate for a vascular ring, were prospectively enrolled in this study
Summary
Pediatric z scores are necessary to describe size and structure of the heart in growing children, development of an accurate z score calculator requires robust normal datasets, which are difficult to obtain with cardiovascular magnetic resonance (CMR) in children. In growing children, a single measurement of a cardiac structure without context is minimally informative, and measurements are ideally interpreted in light of that child’s anthropometric data with z scores This contextual requirement for interpreting measurements is fairly unique to pediatric medicine, and is compounded by the depth and breadth of congenital heart disease that can drastically alter cardiovascular structure and size in growing children. In this way, physicians can more clearly understand if observed measurements are within 2SD of the mean, and more importantly, if change in a measurement is expected or unexpected for growth. Z scores gauging the relative size of a cardiac structure in children are valuable to the cardiac imaging community, as well as the larger pediatric cardiology and cardiothoracic surgery community to provide standards for decision-making regarding interventions and for the evaluation of outcomes
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