Comparison of Cine-MRI and Transthoracic Echocardiography for the Assessment of Aortic Root Diameters in Patients with Suspected Marfan Syndrome

P. Bannas; M. Rybczynski; S. Sheikhzadeh; Y. von Kodolitsch; T. Derlin; J. Yamamura; G. Lund; G. Adam; M. Groth

doi:10.1055/s-0035-1553224

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, Inhaltsverzeichnis

Rofo 2015; 187(11): 1022-1028
DOI: 10.1055/s-0035-1553224

Vessels

Comparison of Cine-MRI and Transthoracic Echocardiography for the Assessment of Aortic Root Diameters in Patients with Suspected Marfan Syndrome

Vergleich von Cine-MRT und transthorakaler Echokardiografie zur Erfassung des Aortenwurzeldiameters bei Patienten mit Verdacht auf Marfan-Syndrom

P. Bannas

¹Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

,

M. Rybczynski

²Department of General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

,

S. Sheikhzadeh

²Department of General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

,

Y. von Kodolitsch

²Department of General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

,

T. Derlin

¹Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

,

J. Yamamura

¹Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

,

G. Lund

¹Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

,

G. Adam

¹Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

,

M. Groth

³Department of Diagnostic and Interventional Radiology, Section for Pediatric Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

› Institutsangaben

Abstract

Purpose: Patients with Marfan syndrome require repeated imaging for monitoring of aortic root aneurysms. Therefore, we evaluated the agreement and reproducibility of cine-MRI and echocardiography measurements of the sinuses of Valsalva in patients with suspected Marfan syndrome.

Materials and Methods: 51 consecutive patients with suspected Marfan syndrome were prospectively examined using cine-MRI and echocardiography. Two readers independently measured aortic root diameters at the level of the sinuses of Valsalva in both cine-MRI and echocardiography. Statistics included intraclass correlation coefficient, Pearson correlation coefficient, Bland-Altman analysis, and two-sided t-test.

Results: In 38 of the 51 individuals (74.5 %), the diagnosis of Marfan syndrome was established according to the criteria of the Ghent-2 nosology. Cine-MRI measurements of the sinuses of Valsalva revealed a strong correlation with echocardiography (r = 0.929), but a statistically significant bias of –1.0 mm (p < 0.001). The mean absolute diameter for sinuses of Valsalva obtained by cine-MRI was 32.3 ± 5.8 mm as compared to 33.4 ± 5.4 mm obtained by echocardiography. Interobserver agreement of measurements of the sinuses of Valsalva was higher for cine-MRI than for echocardiography (p = 0.029).

Conclusion: Despite small, but statistically significant differences in terms of agreement and reproducibility, cine-MRI and echocardiographic measurements of aortic root diameters provide comparable results without a significant clinical difference. Therefore both techniques may be used for monitoring of the aortic root in patients with Marfan syndrome.

Key points:

• Cine-MRI (ICC: 0.93, CI: 0.88 – 0.96) and echocardiography (ICC: 0.90, CI: 0.82 – 0.94) allow assessment of aortic root diameters in patients with Marfan syndrome

• Cine-MRI offers higher reproducibility of aortic root diameters than echocardiography (95 % limits of agreement of ± 3.6 mm versus ± 5.0 mm, p = 0.029)

• Aortic root measurements with cine-MRI and echocardiography reveal a small (mean difference; -1.0 mm) but statistically significant offset (p = 0.0004)

Citation Format:

• Bannas P., Rybczynski M., Sheikhzadeh S. et al. Comparison of Cine-MRI and Transthoracic Echocardiography for the Assessment of Aortic Root Diameters in Patients with Suspected Marfan Syndrome. Fortschr Röntgenstr 2015; 187: 1022 – 1028

Zusammenfassung

Ziel: Patienten mit einem Marfan-Syndrom benötigen eine regelmäßige Bildgebung zur Detektion von Aneurysmen der Aorta ascendens. Ziel dieser Studie war es, die Reproduzierbarkeit von Messungen des Sinus valsalvae mittels Cine-MRT und Echokardiografie an Patienten mit Verdacht auf Marfan-Syndrom zu untersuchen.

Material und Methoden: 51 konsekutive Patienten mit Verdacht auf Marfan-Syndrom wurden prospektiv mittels Cine-MRT und Echokardiografie untersucht. Jeweils zwei Auswerter bestimmten den Aortenwurzeldiameter auf Höhe des Sinus valsalvae mittels Cine-MRT und Echokardiografie. Die statistische Auswertung erfolgte mittels Intraklassen- sowie Pearson-Korrelationskoeffizient, Bland-Altman-Analyse sowie zweiseitigen t-Test.

Ergebnisse: Bei 38 der 51 Patienten (74,5 %) wurde ein Marfan-Syndrom entsprechend der Ghent-2-Nosologie diagnostiziert. Es zeigte sich eine starke Korrelation zwischen den Diametermessungen des Sinus valsalvae mit der Cine-MRT und Echokardiografie (r = 0,929). Gleichzeitig konnte jedoch eine statistisch signifikante Messdifferenz von –1 mm zwischen den beiden Modalitäten nachgewiesen werden (p < 0,001). Der mittlere Diameter des Sinus valsalvae betrug 32,3 ± 5,8 mm für die Cine-MRT verglichen mit 33,4 ± 5,4 mm für die Echokardiografie. Die Interobserverübereinstimmung der Diametermessungen war signifikant besser für die Cine-MRT im Vergleich zur Echokardiografie (p = 0,029).

Schlussfolgerung: Trotz kleiner, aber statistisch signifikanter Unterschiede der Übereinstimmung und Reproduzierbarkeit erreichen sowohl die Cine-MRT als auch die Echokardiografie vergleichbare Messwerte, welche mutmaßlich ohne klinisch relevante Differenz sind. Daher eignen sich beide Methoden zur Überwachung der Aortenwurzeldiameter von Patienten mit Marfan-Syndrom.

Kernaussagen:

• Cine-MRT (ICC: 0,93; CI: 0,88 – 0,96) und Echokardiografie (ICC: 0,90; CI: 0,82 – 0,94) sind zur Evaluation des Aortenbogens beim Marfan-Syndrom geeignet.

• Cine-MRT-Messungen der Aortenwurzel haben im Vergleich zur Echokardiografie eine höhere Reliabilität (mittlere Abweichung: +/- 3,6 mm versus +/- 5,0 mm; p = 0,029).

• Mit Cine-MRT und Echokardiografie erhobene Aortenwurzelmessungen zeigen eine kleine (mittlere Messabweichung: – 1 mm), aber statistisch signifikante Messdifferenz (p = 0,0004).

Key words

Marfan syndrome - magnetic resonance imaging - echocardiography - aneurysm - aorta

Volltext

Referenzen

References
1 Pearson GD, Devereux R, Loeys B et al. Report of the National Heart, Lung, and Blood Institute and National Marfan Foundation Working Group on research in Marfan syndrome and related disorders. Circulation 2008; 118: 785-791
2 Judge DP, Dietz HC. Marfan's syndrome. Lancet 2005; 366: 1965-1976
3 Hiratzka LF, Bakris GL, Beckman JA et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. J Am Coll Cardiol 2010; 55: e27-e129
4 Svensson LG, Kouchoukos NT, Miller DC et al. Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts. Ann Thorac Surg 2008; 85: S1-S41
5 Gott VL, Greene PS, Alejo DE et al. Replacement of the aortic root in patients with Marfan's syndrome. N Engl J Med 1999; 340: 1307-1313
6 Jabbour A, Ismail TF, Moat N et al. Multimodality imaging in transcatheter aortic valve implantation and post-procedural aortic regurgitation: comparison among cardiovascular magnetic resonance, cardiac computed tomography, and echocardiography. J Am Coll Cardiol 2011; 58: 2165-2173
7 Bannas P, Groth M, Rybczynski M et al. Assessment of aortic root dimensions in patients with suspected Marfan syndrome: intraindividual comparison of contrast-enhanced and non-contrast magnetic resonance angiography with echocardiography. International journal of cardiology 2013; 167: 190-196
8 Sheikhzadeh S, Kade C, Keyser B et al. Analysis of Phenotype and Genotype Information for the Diagnosis of Marfan Syndrome. Clin Genet 2012; 82: 240-247
9 Loeys BL, Dietz HC, Braverman AC et al. The revised Ghent nosology for the Marfan syndrome. J Med Genet 2010; 47: 476-485
10 Plein S. Cardiovascular MR Manual. Springer; 2011
11 Roman MJ, Devereux RB, Kramer-Fox R et al. Two-dimensional echocardiographic aortic root dimensions in normal children and adults. Am J Cardiol 1989; 64: 507-512
12 Groth M, Muellerleile K, Klink T et al. Improved agreement between experienced and inexperienced observers using a standardized evaluation protocol for cardiac volumetry and infarct size measurement. Rofo 2012; 184: 1131-1137
13 Groth M, Henes FO, Bannas P et al. Intraindividual comparison of contrast-enhanced MRI and unenhanced SSFP sequences of stenotic and non-stenotic pulmonary artery diameters. RoFo: Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin 2011; 183: 47-53
14 La Manna A, Sanfilippo A, Capodanno D et al. Cardiovascular magnetic resonance for the assessment of patients undergoing transcatheter aortic valve implantation: a pilot study. J Cardiovasc Magn Reson 2011; 13: 82
15 Ha HI, Seo JB, Lee SH et al. Imaging of Marfan syndrome: multisystemic manifestations. Radiographics 2007; 27: 989-1004
16 Oezcan S, Attenhofer Jost CH, Pfyffer M et al. Pectus excavatum: echocardiography and cardiac MRI reveal frequent pericardial effusion and right-sided heart anomalies. Eur Heart J Cardiovasc Imaging 2012; 13: 673-679
17 Kawamoto S, Bluemke DA, Traill TA et al. Thoracoabdominal aorta in Marfan syndrome: MR imaging findings of progression of vasculopathy after surgical repair. Radiology 1997; 203: 727-732
18 Kreitner KF, Kunz RP, Kalden P et al. Contrast-enhanced three-dimensional MR angiography of the thoracic aorta: experiences after 118 examinations with a standard dose contrast administration and different injection protocols. Eur Radiol 2001; 11: 1355-1363
19 Bannas P, Groth M, Rybczynski M et al. Assessment of aortic root dimensions in patients with suspected Marfan syndrome: Intraindividual comparison of contrast-enhanced and non-contrast magnetic resonance angiography with echocardiography. Int J Cardiol 2012;
20 Veldhoen S, Behzadi C, Derlin T et al. Exact monitoring of aortic diameters in Marfan patients without gadolinium contrast: intraindividual comparison of 2D SSFP imaging with 3D CE-MRA and echocardiography. Eur Radiol 2014;
21 Francois CJ, Tuite D, Deshpande V et al. Unenhanced MR angiography of the thoracic aorta: initial clinical evaluation. Am J Roentgenol 2008; 190: 902-906
22 Wertman R, Altun E, Martin DR et al. Risk of nephrogenic systemic fibrosis: evaluation of gadolinium chelate contrast agents at four American universities. Radiology 2008; 248: 799-806
23 Broome DR. Nephrogenic systemic fibrosis associated with gadolinium based contrast agents: a summary of the medical literature reporting. Eur J Radiol 2008; 66: 230-234
24 Shellock FG, Spinazzi A. MRI safety update 2008: part 1, MRI contrast agents and nephrogenic systemic fibrosis. Am J Roentgenol 2008; 191: 1129-1139
25 Krishnam MS, Tomasian A, Deshpande V et al. Noncontrast 3D steady-state free-precession magnetic resonance angiography of the whole chest using nonselective radiofrequency excitation over a large field of view: comparison with single-phase 3D contrast-enhanced magnetic resonance angiography. Invest Radiol 2008; 43: 411-420
26 Hoey ET, Pakala V, Kassamali RH et al. A comparative analysis of ECG-gated steady state free precession magnetic resonance imaging versus transthoracic echocardiography for evaluation of aortic root dimensions. Quantitative imaging in medicine and surgery 2014; 4: 300-306
27 Russo V, Renzulli M, La Palombara C et al. Congenital diseases of the thoracic aorta. Role of MRI and MRA. Eur Radiol 2006; 16: 676-684
28 Potthast S, Mitsumori L, Stanescu LA et al. Measuring aortic diameter with different MR techniques: comparison of three-dimensional (3D) navigated steady-state free-precession (SSFP), 3D contrast-enhanced magnetic resonance angiography (CE-MRA), 2D T2 black blood, and 2D cine SSFP. J Magn Reson Imaging 2010; 31: 177-184
29 Koos R, Altiok E, Mahnken AH et al. Evaluation of aortic root for definition of prosthesis size by magnetic resonance imaging and cardiac computed tomography: Implications for transcatheter aortic valve implantation. Int J Cardiol 2012; 158: 353-358