Skip to main content
SpringerLink
Log in

Cardiac magnetic resonance: is phonocardiogram gating reliable in velocity-encoded phase contrast imaging?

  • Cardiac
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To assess the diagnostic accuracy of phonocardiogram (PCG) gated velocity-encoded phase contrast magnetic resonance imaging (MRI).

Methods

Flow quantification above the aortic valve was performed in 68 patients by acquiring a retrospectively PCG- and a retrospectively ECG-gated velocity-encoded GE-sequence at 1.5 T. Peak velocity (PV), average velocity (AV), forward volume (FV), reverse volume (RV), net forward volume (NFV), as well as the regurgitant fraction (RF) were assessed for both datasets, as well as for the PCG-gated datasets after compensation for the PCG trigger delay.

Results

PCG-gated image acquisition was feasible in 64 patients, ECG-gated in all patients. PCG-gated flow quantification overestimated PV (Δ 3.8 ± 14.1 cm/s; P = 0.037) and underestimated FV (Δ -4.9 ± 15.7 ml; P = 0.015) and NFV (Δ -4.5 ± 16.5 ml; P = 0.033) compared with ECG-gated imaging. After compensation for the PCG trigger delay, differences were only observed for PV (Δ 3.8 ± 14.1 cm/s; P = 0.037). Wide limits of agreement between PCG- and ECG-gated flow quantification were observed for all variables (PV: -23.9 to 31.4 cm/s; AV: -4.5 to 3.9 cm/s; FV: -35.6 to 25.9 ml; RV: -8.0 to 7.2 ml; NFV: -36.8 to 27.8 ml; RF: -10.4 to 10.2 %).

Conclusions

The present study demonstrates that PCG gating in its current form is not reliable enough for flow quantification based on velocity-encoded phase contrast gradient echo (GE) sequences.

Key Points

• Phonocardiogram gating is an alternative to ECG-gating in cardiac MRI.

• Phonocardiogram gating shows only limited reliability for velocity-encoded cardiac MRI.

• Further refinements of the post-processing algorithm are necessary.

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

Similar content being viewed by others

References

  1. Ladd ME (2007) High-field-strength magnetic resonance: potential and limits. Top Magn Reson Imaging 18:139–152

    Article  PubMed  Google Scholar 

  2. Kuhl CK, Traber F, Schild HH (2008) Whole-body high-field-strength (3.0-T) MR imaging in clinical practice. Part I. Technical considerations and clinical applications. Radiology 246:675–696

    Article  PubMed  Google Scholar 

  3. Schenck JF (2005) Physical interactions of static magnetic fields with living tissues. Prog Biophys Mol Biol 87:185–204

    Article  PubMed  Google Scholar 

  4. Frauenrath T, Hezel F, Renz W et al (2010) Acoustic cardiac triggering: a practical solution for synchronization and gating of cardiovascular magnetic resonance at 7 Tesla. J Cardiovasc Magn Reson 12:67

    Article  PubMed  Google Scholar 

  5. Frauenrath T, Hezel F, Heinrichs U et al (2009) Feasibility of cardiac gating free of interference with electro-magnetic fields at 1.5 Tesla, 3.0 Tesla and 7.0 Tesla using an MR-stethoscope. Invest Radiol 44:539–547

    Article  PubMed  Google Scholar 

  6. Becker M, Frauenrath T, Hezel F et al (2010) Comparison of left ventricular function assessment using phonocardiogram- and electrocardiogram-triggered 2D SSFP CINE MR imaging at 1.5 T and 3.0 T. Eur Radiol 20:1344–1355

    Google Scholar 

  7. Nassenstein K, Orzada S, Haering L et al (2012) Cardiac MRI: evaluation of phonocardiogram-gated cine imaging for the assessment of global und regional left ventricular function in clinical routine. Eur Radiol 22:559–568

    Article  PubMed  Google Scholar 

  8. Kramer CM, Barkhausen J, Flamm SD, Kim RJ, Nagel E (2008) Standardized cardiovascular magnetic resonance imaging (CMR) protocols, society for cardiovascular magnetic resonance: board of trustees task force on standardized protocols. J Cardiovasc Magn Reson 10:35

    Article  PubMed  Google Scholar 

  9. Hundley WG, Bluemke DA, Finn JP et al (2010) ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. Circulation 121:2462-2508

    Article  PubMed  Google Scholar 

  10. Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310

    Article  PubMed  CAS  Google Scholar 

  11. Passing H, Bablok (1983) A new biometrical procedure for testing the equality of measurements from two different analytical methods. Application of linear regression procedures for method comparison studies in clinical chemistry, Part I. J Clin Chem Clin Biochem 21:709–720

    PubMed  CAS  Google Scholar 

  12. Bilic-Zulle L (2011) Comparison of methods: Passing and Bablok regression. Biochem Med (Zagreb) 21:49–52

    Google Scholar 

  13. Cawley PJ, Maki JH, Otto CM (2009) Cardiovascular magnetic resonance imaging for valvular heart disease: technique and validation. Circulation 119:468–478

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45122, Essen, Germany

    Kai Nassenstein, Stephan Orzada, Thomas Schlosser, Mark E. Ladd & Stefan Maderwald

  2. Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany

    Stephan Orzada, Mark E. Ladd & Stefan Maderwald

  3. Department of Communication Systems, University Duisburg-Essen, Duisburg, Germany

    Lars Haering & Andreas Czylwik

  4. Department of Cardiology and Angiology, Elisabeth Hospital Essen, Essen, Germany

    Christoph Jensen & Oliver Bruder

Authors
  1. Kai Nassenstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephan Orzada
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lars Haering
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andreas Czylwik
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christoph Jensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Thomas Schlosser
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Oliver Bruder
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mark E. Ladd
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Stefan Maderwald
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kai Nassenstein.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nassenstein, K., Orzada, S., Haering, L. et al. Cardiac magnetic resonance: is phonocardiogram gating reliable in velocity-encoded phase contrast imaging?. Eur Radiol 22, 2679–2687 (2012). https://doi.org/10.1007/s00330-012-2547-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-012-2547-6

Keywords

Search

Navigation