Pediatric Cardiology

, Volume 40, Issue 3, pp 616–622 | Cite as

Can Abbreviated Cardiac Magnetic Resonance Imaging Adequately Support Clinical Decision Making After Repair of Tetralogy of Fallot?

  • Aswathy Vaikom House
  • Vivek Muthurangu
  • Alan J. Spanel
  • David A. Danford
  • Bilal Mir
  • Andreas Schuster
  • Hao Hsu
  • Shelby KuttyEmail author
Original Article


Quantification of pulmonary regurgitation (PR), pulmonary flow distribution, and ventricular function is important for clinical surveillance in repaired Tetralogy of Fallot (TOF). Cardiovascular magnetic resonance (CMR) is the established reference, but cost, test duration, and patient discomfort are potential limitations to its serial use. We investigated whether an Abbreviated CMR protocol would alter clinical decisions in TOF from those that would have been made using a full protocol. Patients > 7 years with repaired TOF were identified. CMR was performed according to standard complete imaging protocol. CMRs were prepared in two ways, Full and Abbreviated and submitted for review by two imaging specialists. In conjunction with clinical information and case-specific quantitative CMR data (PR fraction, ventricular volumes, ejection fraction, branch pulmonary artery flow), Full and Abbreviated image sets were anonymized and uploaded for review. For the first half, Imager 1 received Abbreviated, and Imager 2 Full and for the remaining, Imager 1 received Full and Imager 2 received Abbreviated. Blinded to the other’s choices, Imagers provided clinical decisions. Inter-rater agreement for each decision was measured. In all, 124 studies from 80 patients (mean 17.8 years) were analyzed. For ‘intervention versus no-intervention’ decision, the inter-rater agreement was strong [κ 0.75, p < 0.0001, 95% CI (0.630, 0.869)]. Agreement for recommended timing of follow-up imaging was good (κ 0.64, p < 0.0001, 95% CI (0.474, 0.811)] in the ‘no-intervention’ group. When raters were asked whether or not further imaging was necessary, agreement was modest [κ 0.363 (p < 0.0001), 95% CI (0.038, 0.687)]. In conclusion, Abbreviated CMR yield decisions for clinical care similar to those made using the standard full protocol. These results suggest a potential enhancement of clinical practice in which efficiency and cost saving might be achieved using Abbreviated CMR for routine follow-up surveillance of TOF.


Tetralogy of Fallot Pediatric cardiology Adult congenital heart disease, Cardiovascular magnetic resonance 



Cardiac magnetic resonance


Tetralogy of Fallot


Pulmonary valve replacement


Pulmonary regurgitation


Right ventricular



The authors appreciate the assistance of Valerie Shostrom BS. SK receives support from the National Institute of Health and the Children’s Hospital and Medical Center Foundation.

Compliance with Ethical Standards

Conflict of interest

There is no disclosure of potential conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the Ethical Standards of the Institutional and/or National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Our study is retrospective study, that the study formal consent is not required.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Aswathy Vaikom House
    • 1
  • Vivek Muthurangu
    • 2
  • Alan J. Spanel
    • 1
  • David A. Danford
    • 1
  • Bilal Mir
    • 3
  • Andreas Schuster
    • 4
  • Hao Hsu
    • 1
  • Shelby Kutty
    • 1
    Email author
  1. 1.Division of Pediatric CardiologyUniversity of Nebraska College of Medicine and Children’s Hospital and Medical CenterOmahaUSA
  2. 2.Institute of Cardiovascular ScienceUniversity College LondonLondonUK
  3. 3.Heart Imaging TechnologiesDurhamUSA
  4. 4.University Medical Center GöttingenGottingenGermany

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