Open Access

ARTICLE

Knowledge-based reconstruction for measurement of right ventricular volumes on cardiovascular magnetic resonance images in a mixed population

Elise D. Pieterman^1,2, Ricardo P. J. Budde², Danielle Robbers-Visser^1,2, Ron T. van Domburg³, Willem A. Helbing^1,2

1 Department of Pediatrics, Division of Cardiology, Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, The Netherlands
2 Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
3 Department of Cardiology-Thorax Center, Erasmus Medical Center, Rotterdam, The Netherlands

* Corresponding Author: Willem A. Helbing, Department of Pediatrics, Division of Cardiology, Department of Radiology, Erasmus Medical Center, Sophia Children’s Hospital, Sp- 2429, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands. E-mail:

Congenital Heart Disease 2017, 12(5), 561-569. https://doi.org/10.1111/chd.12484

Abstract

Objective: Follow-up of right ventricular performance is important for patients with congenital heart disease. Cardiac magnetic resonance imaging is optimal for this purpose. However, observerdependency of manual analysis of right ventricular volumes limit its use. Knowledge-based reconstruction is a new semiautomatic analysis tool that uses a database including knowledge of right ventricular shape in various congenital heart diseases. We evaluated whether knowledge-based reconstruction is a good alternative for conventional analysis.
Design: To assess the inter- and intra-observer variability and agreement of knowledge-based versus conventional analysis of magnetic resonance right ventricular volumes, analysis was done by two observers in a mixed group of 22 patients with congenital heart disease affecting right ventricular loading conditions (dextro-transposition of the great arteries and right ventricle to pulmonary artery conduit) and a group of 17 healthy children. We used Bland-Altman analysis and coefficient of variation.
Results: Comparison between the conventional method and the knowledge-based method showed a systematically higher volume for the latter group. We found an overestimation for enddiastolic volume (bias -40 ± 24 mL, r = .956), end-systolic volume (bias -34 ± 24 mL, r = .943), stroke volume (bias -6 ± 17 mL, r = .735) and an underestimation of ejection fraction (bias 7 ± 7%, r = .671) by knowledge-based reconstruction. The intra-observer variability of knowledgebased reconstruction varied with a coefficient of variation of 9% for end-diastolic volume and 22% for stroke volume. The same trend was noted for inter-observer variability.
Conclusion: A systematic difference (overestimation) was noted for right ventricular size as assessed with knowledge-based reconstruction compared with conventional methods for analysis. Observer variability for the new method was comparable to what has been reported for the right ventricle in children and congenital heart disease with conventional analysis.

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