Skip to main content
SpringerLink
Log in

Lessons on Quality Control in Large Scale Imaging Trials: the Multi-Ethnic Study of Atherosclerosis (MESA)

  • Cardiac Magnetic Resonance (E Nagel and V Puntmann, Section Editors)
  • Published:
Current Cardiovascular Imaging Reports Aims and scope Submit manuscript

Abstract

The Multi-Ethnic Study of Atherosclerosis (MESA), initiated in July 2000, is a six-center longitudinal population-based study that included 6,814 men and women at baseline study. Cardiac MRI was part of the study procedures, representing the first large-scale application of cardiac MRI in a multi-center and multi-ethnic population study in the USA. To date, this is the largest ever MRI study. Such effort would come with a great potential for variability due to the number of professionals involved; therefore, an intensive quality control process was implemented since the very beginning. A workflow for process control was used to match image protocols in different types of MRI scanners, transfer images to the reading center, train technicians, and implement image quality scorecards. This article reviews the influence of research management for quality control and work standardization processes in cardiac magnetic MRI results at the 10th year of follow-up in MESA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11

Similar content being viewed by others

Abbreviations

CC:

Coordinating Center

LV:

Left ventricle

LVEF:

Left ventricular ejection fraction

LVEDV:

Left ventricular end diastolic volume

LGE:

Late gadolinium enhancement

MESA:

Multi-Ethnic Study of Atherosclerosis

PWV:

Pulse wave velocity

SA:

Short axis

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Benneyan JC. Statistical quality control methods in infection control and hospital epidemiology, part I: Introduction and basic theory. Infect Control Hosp Epidemiol: Off J Soc Hosp Epidemiol Am. 1998;19(3):194–214.

    Article  CAS  Google Scholar 

  2. Appelbaum E, Maron BJ, Adabag S, Hauser TH, Lesser JR, Haas TS, et al. Intermediate-signal-intensity late gadolinium enhancement predicts ventricular tachyarrhythmias in patients with hypertrophic cardiomyopathy. Circ Cardiovasc Imaging. 2012;5(1):78–85. doi:10.1161/circimaging.111.963819.

    Article  PubMed  Google Scholar 

  3. Bild DE, Bluemke DA, Burke GL, Detrano R, Diez Roux AV, Folsom AR, et al. Multi-ethnic study of atherosclerosis: objectives and design. Am J Epidemiol. 2002;156(9):871–81.

    Article  PubMed  Google Scholar 

  4. Heckbert SR, Post W, Pearson GD, Arnett DK, Gomes AS, Jerosch-Herold M, et al. Traditional cardiovascular risk factors in relation to left ventricular mass, volume, and systolic function by cardiac magnetic resonance imaging: the Multiethnic Study of Atherosclerosis. J Am Coll Cardiol. 2006;48(11):2285–92. doi:10.1016/j.jacc.2006.03.072.

    Article  PubMed Central  PubMed  Google Scholar 

  5. MESA Coordinating Center UoW. MESA Committees. Seattle, WA. 2012. http://www.mesa-nhlbi.org/committees.aspx. Accessed 05/01/2012 2012.

  6. Saremi F, Grizzard JD, Kim RJ. Optimizing cardiac MR imaging: practical remedies for artifacts. RadioGraphics. 2008;28(4):1161–87. doi:10.1148/rg.284065718.

    Article  PubMed  Google Scholar 

  7. Young AA, Cowan BR, Thrupp SF, Hedley WJ, Dell'Italia LJ. Left ventricular mass and volume: fast calculation with guide-point modeling on MR images. Radiology. 2000;216(2):597–602.

    Article  CAS  PubMed  Google Scholar 

  8. Liu Y, Liu C-Y, van der Geest R, Liu S, Nacif M, Lima J, et al. Myocardial T1 measurement: comparison of modified Look-Locker inversion recovery (MOLLI) and TI scout in the Multi-ethnic Study of Atherosclerosis (MESA). J Cardiovasc Magn Reson. 2012;14 Suppl 1:265.

    Article  Google Scholar 

  9. Tao Q, Milles J, Zeppenfeld K, Lamb HJ, Bax JJ, Reiber JH, et al. Automated segmentation of myocardial scar in late enhancement MRI using combined intensity and spatial information. Magn Reson Med: Off J Soc Magn Reson Med / Soc Magn Reson Med. 2010;64(2):586–94. doi:10.1002/mrm.22422.

    Google Scholar 

  10. Herment A, Kachenoura N, Lefort M, Bensalah M, Dogui A, Frouin F, et al. Automated segmentation of the aorta from phase contrast MR images: validation against expert tracing in healthy volunteers and in patients with a dilated aorta. J Magn Reson Imaging : JMRI. 2010;31(4):881–8. doi:10.1002/jmri.22124.

    Article  PubMed  Google Scholar 

  11. Woodard PK, Bluemke DA, Cascade PN, Finn JP, Stillman AE, Higgins CB, et al. ACR practice guideline for the performance and interpretation of cardiac magnetic resonance imaging (MRI). J Am College Radiol: JACR. 2006;3(9):665–76. doi:10.1016/j.jacr.2006.06.007.

    Article  PubMed  Google Scholar 

  12. Tandri H, Daya SK, Nasir K, Bomma C, Lima JA, Calkins H, et al. Normal reference values for the adult right ventricle by magnetic resonance imaging. Am J Cardiol. 2006;98(12):1660–4. doi:10.1016/j.amjcard.2006.07.049.

    Article  PubMed  Google Scholar 

  13. Hudsmith LE, Petersen SE, Francis JM, Robson MD, Neubauer S. Normal human left and right ventricular and left atrial dimensions using steady state free precession magnetic resonance imaging. J Cardiovasc Magn Reson : Off J Soc Cardiovasc Magn Reson. 2005;7(5):775–82.

    Article  Google Scholar 

  14. Rominger MB, Bachmann GF, Geuer M, Puzik M, Boedeker RH, Ricken WW, et al. Accuracy of right and left ventricular heart volume and left ventricular muscle mass determination with cine MRI in breath holding technique]. RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin. 1999;170(1):54–60. doi:10.1055/s-2007-1011007.

    Article  CAS  PubMed  Google Scholar 

  15. Castillo E, Osman NF, Rosen BD, El-Shehaby I, Pan L, Jerosch-Herold M, et al. Quantitative assessment of regional myocardial function with MR-tagging in a multi-center study: interobserver and intraobserver agreement of fast strain analysis with Harmonic Phase (HARP) MRI. J Cardiovasc Magn Reson : Off J Soc Cardiovasc Magn Reson. 2005;7(5):783–91.

    Article  Google Scholar 

  16. Whitney CW, Lind BK, Wahl PW. Quality assurance and quality control in longitudinal studies. Epidemiol Rev. 1998;20(1):71–80.

    Article  CAS  PubMed  Google Scholar 

  17. Kottner J, Audigé L, Brorson S, Donner A, Gajewski BJ, Hróbjartsson A, et al. Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were proposed. J Clin Epidemiol. 2011;64(1):96–106. doi:10.1016/j.jclinepi.2010.03.002.

    Article  PubMed  Google Scholar 

  18. Danilouchkine MG, Westenberg JJM, de Roos A, Reiber JHC, Lelieveldt BPF. Operator induced variability in cardiovascular MR: left ventricular measurements and their reproducibility. J Cardiovasc Magn Reson. 2005;7(2):447–57.

    Article  PubMed  Google Scholar 

  19. Finn JP, Saleh R, Thesen S, Ruehm SG, Lee MH, Grinstead J, et al. MR imaging with remote control: feasibility study in cardiovascular disease. Radiology. 2006;241(2):528–37. doi:10.1148/radiol.2412051898.

    Article  PubMed  Google Scholar 

  20. Karamitsos TD, Hudsmith LE, Selvanayagam JB, Neubauer S, Francis JM. Operator induced variability in left ventricular measurements with cardiovascular magnetic resonance is improved after training. J Cardiovasc Magn Reson. 2007;9(5):777–83. doi:10.1080/10976640701545073.

    Article  PubMed  Google Scholar 

  21. Natori S, Lai S, Finn JP, Gomes AS, Hundley WG, Jerosch-Herold M, et al. Cardiovascular function in multi-ethnic study of atherosclerosis: normal values by age, sex, and ethnicity. AJR Am J Roentgenol. 2006;186(6 Suppl 2):S357–65. doi:10.2214/AJR.04.1868.

    Article  PubMed  Google Scholar 

  22. Alfakih K, Reid S, Jones T, Sivananthan M. Assessment of ventricular function and mass by cardiac magnetic resonance imaging. Eur Radiol. 2004;14(10):1813–22. doi:10.1007/s00330-004-2387-0.

    Article  PubMed  Google Scholar 

  23. Fernandes VR, Cheng S, Cheng YJ, Rosen B, Agarwal S, McClelland RL, et al. Racial and ethnic differences in subclinical myocardial function: the Multi-Ethnic Study of Atherosclerosis. Heart. 2011;97(5):405–10. doi:10.1136/hrt.2010.209452.

    Article  PubMed Central  PubMed  Google Scholar 

  24. el Ibrahim SH, Johnson KR, Miller AB, Shaffer JM, White RD. Measuring aortic pulse wave velocity using high-field cardiovascular magnetic resonance: comparison of techniques. J Cardiovasc Magn Reson. 2010;12(1):26. doi:10.1186/1532-429x-12-26.

    Article  PubMed Central  Google Scholar 

  25. Mahrholdt H, Wagner A, Holly TA, Elliott MD, Bonow RO, Kim RJ, et al. Reproducibility of chronic infarct size measurement by contrast-enhanced magnetic resonance imaging. Circulation. 2002;106(18):2322–7.

    Article  CAS  PubMed  Google Scholar 

  26. Messroghli DR, Plein S, Higgins DM, Walters K, Jones TR, Ridgway JP, et al. Human myocardium: single-breath-hold MR T1 mapping with high spatial resolution–reproducibility study. Radiology. 2006;238(3):1004–12. doi:10.1148/radiol.2382041903.

    Article  PubMed  Google Scholar 

  27. Liu CY, Liu YC, Wu C, Armstrong A, Volpe GJ, van der Geest RJ, et al. Evaluation of age-related interstitial myocardial fibrosis with cardiac magnetic resonance contrast-enhanced T1 mapping: MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol. 2013;62(14):1280–7. doi:10.1016/j.jacc.2013.05.078. Description of gender and age related differences in T1 mapping parameters related to intersticial fibrosis in MESA exam 5.

    Article  PubMed  Google Scholar 

  28. Ambale Venkatesh B, Volpe GJ, Donekal S, Mewton N, Liu CY, Shea S, et al. Association of longitudinal changes in left ventricular structure and function with myocardial fibrosis: the Multi-Ethnic Study of Atherosclerosis study. Hypertension. 2014;64(3):508–15. doi:10.1161/hypertensionaha.114.03697. Myocardial fibrosis evaluated by late gadolinium enhancement and T1 mapping could be related to longitudinal changes in LV structure. Data combinanton from MESA at baseline and the 10th year examinatio.

    Article  CAS  PubMed  Google Scholar 

  29. Bluemke DA, Kronmal RA, Lima JA, Liu K, Olson J, Burke GL, et al. The relationship of left ventricular mass and geometry to incident cardiovascular events: the MESA (Multi-Ethnic Study of Atherosclerosis) study. J Am Coll Cardiol. 2008;52(25):2148–55. doi:10.1016/j.jacc.2008.09.014.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Ambale-Venkatesh B, Armstrong AC, Liu CY, Donekal S, Yoneyama K, Wu CO, et al. Diastolic function assessed from tagged MRI predicts heart failure and atrial fibrillation over an 8-year follow-up period: the multi-ethnic study of atherosclerosis. Eur Heart J Cardiovasc Imaging. 2014;15(4):442–9. doi:10.1093/ehjci/jet189.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Elzbieta Chamera, Jason Ortman, and Stephen Granite for assistance in collection, transfer, organization, and analysis of the image data. This study was supported by the National Heart, Lung, and Blood Institute grant (RO1-HL66075-01) and the MESA study contracts NO1-HC-9808, NO1-HC-95168, and NO1-HC-95169. This project incorporates tools whose development was funded in part by the NIH through the NHLBI grant: The Cardiovascular Research Grid (R24HL085343).

Compliance with Ethics Guidelines

ᅟ

Conflict of Interest

All authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Division of Cardiology, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Blalock 524, Baltimore, MD, 21287, USA

    Gustavo J. Volpe, Patricia Rizzi, Marcelo S. Nacif, David A. Bluemke & João A. C. Lima

  2. Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA

    Marcelo S. Nacif, Chia-Ying Liu & David A. Bluemke

  3. Department of Radiology, UCLA School of Medicine, Los Angeles, CA, USA

    Antoinette S. Gomes

  4. Department of Internal Medicine and Radiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA

    W. Gregory Hundley

  5. Cornell MRI, Cornell and Columbia Universities, New York, NY, USA

    Martin R. Prince

  6. Division of Radiology, Northwestern University Medical School, Chicago, IL, USA

    James C. Carr

  7. Department of Biostatistics, University of Washington, Seattle, WA, USA

    Robyn L. McClelland & W. Craig Johnson

  8. Department of Preventive Medicine, Northwestern University Medical School, Chicago, IL, USA

    Kiang Liu

  9. Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Erin P. Ricketts, Bharath Ambale Venkatesh & John Eng

  10. Institute for Computational Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Raimond L. Winslow

  11. Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Raimond L. Winslow

Authors
  1. Gustavo J. Volpe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patricia Rizzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marcelo S. Nacif
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Erin P. Ricketts
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bharath Ambale Venkatesh
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Chia-Ying Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Antoinette S. Gomes
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. W. Gregory Hundley
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Martin R. Prince
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. James C. Carr
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Robyn L. McClelland
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Kiang Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. John Eng
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. W. Craig Johnson
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Raimond L. Winslow
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. David A. Bluemke
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. João A. C. Lima
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to João A. C. Lima.

Additional information

Gustavo J. Volpe and Patricia Rizzi contributed equally as first author.

This article is part of the Topical Collection on Cardiac Magnetic Resonance

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Volpe, G.J., Rizzi, P., Nacif, M.S. et al. Lessons on Quality Control in Large Scale Imaging Trials: the Multi-Ethnic Study of Atherosclerosis (MESA). Curr Cardiovasc Imaging Rep 8, 13 (2015). https://doi.org/10.1007/s12410-015-9329-x

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s12410-015-9329-x

Keywords

Search

Navigation