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Quantification of myocardial deformation by deformable registration–based analysis of cine MRI: validation with tagged CMR

  • Cardiac
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Abstract

Objectives

To validate deformable registration algorithms (DRAs) for cine balanced steady-state free precession (bSSFP) assessment of global longitudinal strain (GLS) and global circumferential strain (GCS) using harmonic phase (HARP) cardiovascular magnetic resonance as standard of reference (SoR).

Methods

Seventeen patients and 17 volunteers underwent short axis stack and 2-/4-chamber cine bSSFP imaging with matching slice long-axis and mid-ventricular spatial modulation of magnetization (SPAMM) myocardial tagging. Inverse DRA was applied on bSSFP data for assessment of GLS and GCS while myocardial tagging was processed using HARP. Intra- and inter-observer variability assessment was based on repeated analysis by a single observer and analysis by a second observer, respectively. Standard semi-automated short axis stack segmentation was performed for analysis of left ventricular (LV) volumes and ejection fraction (EF).

Results

DRA demonstrated strong relationships to HARP for myocardial GLS (R2 = 0.75; p < 0.0001) and endocardial GLS (R2 = 0.61; p < 0.0001). GCS result comparison also demonstrated significant relationships between DRA and HARP for myocardial strain (R2 = 0.61; p < 0.0001) and endocardial strain (R2 = 0.51; p < 0.0001). Both methods demonstrated small systematic errors for intra- and inter-observer variability but DRA demonstrated consistently lower CV. Global LVEF was significantly lower (p = 0.0099) in patients (53.7%; IQR 43.9/64.0%) than in healthy volunteers (62.6%; IQR 61.1/66.2%). DRA and HARP strain data demonstrated significant relationships to LVEF.

Conclusions

Non-rigid deformation method–based DRA provides a reliable measure of peak systolic GCS and GLS based on cine bSSFP with superior intra- and inter-observer reproducibility compared to HARP.

Key Point

• Myocardial strain can be reliably analyzed using inverse deformable registration algorithms (DRAs) on cine CMR.

• Inverse DRA-derived strain shows higher reproducibility than tagged CMR.

• DRA and tagged CMR-based myocardial strain demonstrate strong relationships to global left ventricular function.

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Abbreviations

BSA:

Body surface area

bSSFP:

Balanced steady-state free precession

CMR:

Cardiovascular magnetic resonance

CV:

Coefficient of variation

DENSE:

Displacement encoding with stimulated echoes

DRA:

Deformable registration algorithms

EDV:

End-diastolic volume

EF:

Ejection fraction

ESV:

End-systolic volume

FLASH:

Fast low angle shot

FT:

Feature tracking

GCS:

Global circumferential strain

GLS:

Global longitudinal strain

GRAPPA:

Generalized autocalibrating partial parallel acquisition

GRS:

Global radial strain

HARP:

Harmonic phase

IQR:

Interquartile range

LV:

Left ventricle

LVEF:

Left ventricular ejection fraction

MASS:

Myocardial mass

REB:

Research Ethics Board

SENC:

Strain encoded

SoR:

Standard of reference

SPAMM:

Spatial modulation of magnetization

SV:

Stroke volume

TPM:

Tissue phase mapping

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Acknowledgments

Results of this study have in part been presented at RSNA 2017 (oral presentation).

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Medical Imaging, University Health Network, 1 PMB-273, 585 University Avenue, Toronto, Ontario, M5G 2N2, Canada

    Mariana M. Lamacie, Christian P. Houbois, Paaladinesh Thavendiranathan & Bernd J. Wintersperger

  2. Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada

    Christian P. Houbois & Bernd J. Wintersperger

  3. Siemens Healthcare GmbH, Erlangen, Germany

    Andreas Greiser

  4. Siemens Healthcare AG, Medical Imaging Technologies, Princeton, NJ, USA

    Marie-Pierre Jolly

  5. Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada

    Paaladinesh Thavendiranathan

Authors
  1. Mariana M. Lamacie
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  2. Christian P. Houbois
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  3. Andreas Greiser
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  4. Marie-Pierre Jolly
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  5. Paaladinesh Thavendiranathan
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  6. Bernd J. Wintersperger
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Corresponding author

Correspondence to Bernd J. Wintersperger.

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Guarantor

The scientific guarantor of this publication is Dr. Bernd J. Wintersperger.

Conflict of interest

The authors of this manuscript declare relationships with the following companies:

Bernd J. Wintersperger, Research Support Siemens Healthineers

Bernd J. Wintersperger, Speakers Honorarium Siemens Healthineers

Andreas Greiser, Employee Siemens Healthineers, Erlangen, Germany

Marie-Pierre Jolly, Employee (former, at time of study) Siemens Healthineers, Medical Imaging Technologies, Princeton, NJ, USA

The study was performed under a Master Research Agreement (MRA) between the University Health Network and Siemens Healthineers.

Statistics and biometry

One of the authors has significant statistical expertise (Dr. Thavendiranathan).

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• case-control study

• performed at one institution

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Lamacie, M.M., Houbois, C.P., Greiser, A. et al. Quantification of myocardial deformation by deformable registration–based analysis of cine MRI: validation with tagged CMR. Eur Radiol 29, 3658–3668 (2019). https://doi.org/10.1007/s00330-019-06019-9

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  • DOI: https://doi.org/10.1007/s00330-019-06019-9

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