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Comparison of Magnetic Resonance Feature Tracking for Strain Calculation With Harmonic Phase Imaging Analysis

Kan N. Hor, MD^_*, William M. Gottliebson, MD^_*, Christopher Carson, MD^_*, Erin Wash, BS^_*, James Cnota, MD^_*, Robert Fleck, MD, Janaka Wansapura, PhD, Piotr Klimeczek, MD, Hussein R. Al-Khalidi, PhD, Eugene S. Chung, MD^||, D. Woodrow Benson, MD, PhD^_*, Wojciech Mazur, MD^||,_*

^_* Department of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
College of Pharmacy, University of Cincinnati, Cincinnati, Ohio
Scanlab, MRI Department, Lodz, Poland
^|| Ohio Heart and Vascular Center and The Christ Hospital, Cincinnati, Ohio

^_* Reprint requests and correspondence: Dr. Wojciech Mazur, Ohio Heart and Vascular Center, The Christ Hospital, 2123 Auburn Avenue, Suite 136, Cincinnati, Ohio 45219 (Email: mazurw{at}ohioheart.org).

Objectives: To compare a steady-state free precession cine sequence–based technique (feature tracking [FT]) to tagged harmonic phase (HARP) analysis for peak average circumferential myocardial strain (_cc) analysis in a large and heterogeneous population of boys with Duchenne muscular dystrophy (DMD).

Background: Current _cc assessment techniques require cardiac magnetic resonance–tagged imaging sequences, and their analysis is complex. The FT method can readily be performed on standard cine (steady-state free precession) sequences.

Methods: We compared mid-left ventricular whole-slice _cc by the 2 techniques in 191 DMD patients grouped according to age and severity of cardiac dysfunction: group B: DMD patients 10 years and younger with normal ejection fraction (EF); group C: DMD patients older than 10 years with normal EF; group D: DMD patients older than 10 years with reduced EF but negative myocardial delayed enhancement (MDE); group E: DMD patients older than 10 years with reduced EF and positive MDE; and group A: 42 control subjects. Retrospective, offline analysis was performed on matched tagged and steady-state free precession slices.

Results: For the entire study population (N = 233), mean FT _cc values (–13.3 ± 3.8%) were highly correlated with HARP _cc values (–13.6 ± 3.4%), with a Pearson correlation coefficient of 0.899. The mean _cc of DMD patients determined by HARP (–12.52 ± 2.69%) and FT (–12.16 ± 3.12%) was not significantly different (p = NS). Similarly, the mean _cc of the control subjects by determined HARP (–18.85 ± 1.86) and FT (–18.81 ± 1.83) was not significantly different (p = NS). Excellent correlation between the 2 methods was found among subgroups A through E, except there was no significant difference in strain between groups B and C with FT analysis.

Conclusions: FT-based assessment of _cc correlates highly with _cc derived from tagged images in a large DMD patient population with a wide range of cardiac dysfunction and can be performed without additional imaging.

Key Words: circumferential strain • Duchenne Muscular Dystrophy • magnetic resonance feature tracking

Abbreviations and Acronyms   CMR = cardiac magnetic resonance   DMD = Duchenne muscular dystrophy    cc = average peak systolic circumferential strain   EF = ejection fraction   FT = feature tracking   HARP = harmonic phase   LV = left ventricular   MDE = myocardial delayed enhancement   SSFP = steady-state free precession   TE/TR = echo time/repetition time

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