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Multimodality Comparison of Quantitative Volumetric Analysis of the Right Ventricle

Lissa Sugeng, MD^_*,_*, Victor Mor-Avi, PhD^_*, Lynn Weinert, BS^_*, Johannes Niel, MD, Christian Ebner, MD, Regina Steringer-Mascherbauer, MD, Ralf Bartolles, MS, Rolf Baumann, MS, Georg Schummers, MS, Roberto M. Lang, MD^_*, Hans-Joachim Nesser, MD

^_* University of Chicago Medical Center, Chicago, Illinois
Public Hospital Elisabethinen, Linz, Austria
TomTec Imaging Systems, Unterschleissheim, Germany

^_* Reprint requests and correspondence: Dr. Lissa Sugeng, University of Chicago, MC5084, 5841 South Maryland Avenue, Chicago, Illinois 60637 (Email: lsugeng{at}medicine.bsd.uchicago.edu).

Objectives: We undertook volumetric analysis of the right ventricle (RV) by real-time 3-dimensional echocardiography (RT3DE), cardiac magnetic resonance (CMR), and cardiac computed tomography (CCT) on images obtained in RV-shaped phantoms and in patients with a wide range of RV geometry.

Background: Assessment of the RV by 2-dimensional (2D) echocardiography remains challenging due to its unique geometry and limitations of the current analysis techniques. RT3DE, CMR, and CCT, which can quantify RV volumes, promise to overcome the limitations of 2D echocardiography.

Methods: Images were analyzed using RV Analysis software. Volumes measured in vitro were compared with the true volumes. The human protocol included 28 patients who underwent RT3DE, CMR, and CT on the same day. Volumetric analysis of CMR images was used as a reference, against which RT3DE and CCT measurements were compared using linear regression and Bland-Altman analyses. To determine the reproducibility of the volumetric analysis, repeated measurements were performed for all 3 imaging modalities in 11 patients.

Results: The in vitro measurements showed that: 1) volumetric analysis of CMR images yielded the most accurate measurements; 2) CCT measurements showed slight (4%) but consistent overestimation; and 3) RT3DE measurements showed small underestimation, but considerably wider margins of error. In humans, both RT3DE and CCT measurements correlated highly with the CMR reference (r = 0.79 to 0.89) and showed the same trends of underestimation and overestimation noted in vitro. All interobserver and intraobserver variability values were <14%, with those of CMR being the highest.

Conclusions: Volumetric quantification of RV volume was performed on CMR, CCT, and RT3DE images. Eliminating analysis-related intermodality differences allowed fair comparisons and highlighted the unique limitations of each modality. Understanding these differences promises to aid in the functional assessment of the RV.

Key Words: right ventricle • 3-dimensional echocardiography • cardiac magnetic resonance • multidetector computed tomography

Abbreviations and Acronyms   CCT = cardiac computed tomography   CMR = cardiac magnetic resonance   DS = disc summation   EDV = end-diastolic volume   EF = ejection fraction   ESV = end-systolic volume   RT3DE = real-time 3-dimensional echocardiography   RV = right ventricle/ventricular   RVOT = right ventricular outflow tract   2D = 2-dimensional   3DE = 3-dimensional echocardiography

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