Zusammenfassung.
Ziel: Methodenvergleich von schneller Magnetresonanztomographie (MRT), Echokardiographie (Echo) und Herzkatheter (HK) in der Bestimmung linksventrikulärer globaler Funktionsparameter. Material und Methoden: Bei 62 Patienten (35 koronare Herzerkrankungen, 16 Herzklappenvitien (KV), 9 idiopathische dilatative Kardiomyopathien (DCM), 1 kongenitale Herzerkrankung und 1 Herztransplantation) wurde ein Methodenvergleich zwischen schneller Cine MRT im Kurzachsenschnitt, biplanarem HK und 2D Echo durchgeführt. Verglichen wurden in MRT und HK linksventrikuläres enddiastolisches (EDV) und endsystolisches Volumen (ESV), Schlagvolumen (SV), Herzzeitvolumen (HZV) und Ejektionsfraktion (EF). In der Echo wurde die EF visuell durch einen erfahrenen Untersucher bestimmt. Ergebnisse: Der HK überschätzte die EF im Vergleich zur MRT um 8,4 %, Echo unterschätzte sie im Mittel um 5,6 %. Der Toleranzbereich der EF von MRT und HK betrug ± 23,8 %, von MRT und Echo ± 18 % und von Echo und HK ± 19,4 %. Signifikante Mittelwertunterschiede zwischen HK und MRT in der Herzvoluminabestimmung ergaben sich für EDV, SV und HZV, nicht aber für ESV. Die größte Übereinstimmung der EF bestand in der Gruppe mit DCM, die schlechteste in der Gruppe mit KV. Schlußfolgerung: Deutliche zufällige und systematische Abweichungen sind im Methodenvergleich von MRT, Echo und HK zu erwarten. Für Therapieentscheidung und Verlaufskontrolle sollten die Methoden nicht bedenkenlos ausgetauscht werden.
Goal: Comparison of fast MRI, echocardiography (Echo), and ventricular angiography (Cath) in the assessment of left ventricular global function. Methods: Fast MRI in short axis plane, biplane Cath, and 2D Echo were performed in 62 patients [35 coronary artery diseases, 16 acquired valvular diseases (VD), 9 dilated cardiomyopathies (DCM), 1 congenital heart disease and 1 heart transplantation]. Enddiastolic (EDV), endsystolic (ESV), stroke volumes (SV), cardiac output (CO), and ejection fraction (EF) were compared in MRI and Cath. EF was visually estimated in 2D Echo by an experienced observer. Results: In comparison to MRI, Cath overestimated EF by 8.4 %, and Echo underestimated EF by 5.6 %. The limits of agreement between MRI and Cath in EF were ± 23.8 %, between MRI and Echo ± 18 %, and between Echo and Cath ± 19.4 %. Significant differences were found between Cath and MRI in EDV, SV, and CO, but not for ESV. The best agreement in EF was found in the group with DCM, the worst in the group with VD. Conclusion: Important systemic and random errors were found in the comparison of MRI, Echo, and Cath. For therapy decision and follow-up, the methods should not be exchanged unscrupulously.
Schlüsselwörter:
Herz - MR-Herz - Funktion-Herz - Volumen-MR - Kinobildgebung-MR - schnelle Bildgebung
Key words:
Heart - MR-Heart - Function-Heart - Volumes-MR - Cine-MR - Fast imaging
Literatur
1
Dodge H T, Sandler H, Ballew D W, Lord J D Jr.
The use of biplane angiocardiography for the measurement of left ventricular volume in man.
Amer Heart J.
1960;
60
762-766
2
Strauss H W, Zaret B L, Hurley P J, Natarajan T K, Pitt B.
A scintiphotographic method for measuring left ventricular ejection fraction in man without cardiac catheterization.
Amer J Cardiol.
1971;
28
575-580
3
Von Ramm O T, Thurstone F L.
Cardiac imaging using a phased array ultrasound system. I. System design.
Circulation..
1976;
53
258-262
4
Stratemeier E J, Thompson R, Brady T J, Miller S W, Saini S, Wismer G L, Okada R D, Dinsmore R E.
Ejection fraction determination by MR imaging: comparison with left ventricular angiography.
Radiology.
1986;
158
775-777
5
Sechtem U, Pflugfelder P W, Gould R G, Cassidy M M, Higgins C B.
Measurement of right and left ventricular volumes in healthy individuals with cine MR imaging.
Radiology.
1987;
163
697-702
6
Semelka R C, Tomei E, Wagner S, Mayo J, Kondo C, Suzuki J, Caputo G R, Higgins C B.
Normal left ventricular dimensions and function: interstudy reproducibility of measurements with cine MR imaging.
Radiology.
1990;
174
763-768
7
Cranney G B, Lotan C S, Dean L, Baxley W, Bouchard A, Pohost G M.
Left ventricular volume measurement using cardiac axis nuclear magnetic resonance imaging.
Circulation.
1990;
82
154-163
8
Pattynama P MT, Lamb H J, van der Velde E A, van der Wall E E, de Roos A.
Left ventricular measurements with cine and spin-echo MR imaging: a study of reproducibility with variance component analysis.
Radiology.
1993;
187
261-268
9
Atkinson D J, Edelman R R.
Cineangiography of the heart in a single breath hold with a segmented TurboFLASH sequence.
Radiology.
1991;
178
357-360
10
Foo T KF, Bernstein M A, Aisen A M, Hernandez R J, Collick B D, Bernstein T.
Improved ejection fraction and flow velocity estimates with use of view sharing and uniform repetition time excitation with fast cardiac techniques.
Radiology.
1995;
195
471-478
11
Sakuma H, Fujita N, Foo T KF, Caputo G R, Nelson S J, Hartiala J, Shimakawa A, Higgins C B.
Evaluation of left ventricular volume and mass with breath-hold cine MR imaging.
Radiology.
1993;
188
377-380
12
Bluemke D A, Boxermann J L, Atalar E, McVeigh E R.
Segmented k-space cine breath-hold cardiovascular MR imaging: part 1. Principles und techniques.
Amer J Roentgenol.
1997;
169
395-400
13
Higgins C B.
Which standard has the gold?.
J Amer Coll Cardiol.
1992;
19
1608-1609
14
Utz J A, Herfkens R J, Heinsimer J A, Bashore T, Califf R, Glover G, Pelc N, Shimakawa A.
Cine MR determination of left ventricular ejection fraction.
Amer J Roentgenol.
1987;
148
839-843
15
Van Rossum A C, Visser F C, Sprenger M, Van Eenige M J, Valk J, Roos J P.
Evaluation of magnetic resonance imaging for determination of left ventricular ejection fraction and comparison with angiography.
Amer J Cardiol.
1988;
62
628-633
16
Møgelvang J, Stokholm K H, Saunamäki K, Reimer A, Stubgaard M, Thomsen C, Fritz-Hansen P, Henriksen O.
Assessment of left ventricular volumes by magnetic resonance in comparison with radionuclide angiography, contrast angiography and echocardiography.
European Heart Journal.
1992;
13
1677-1683
17
Matsumura K, Nakase E, Haiyama T, Shimizu K, Yamasaki K, Kohno K.
Determination of cardiac ejection fraction and left ventricular volume: contrast-enhanced ultrafast cine MR imaging vs iv digital subtraction ventriculography.
Amer J Roentgenol.
1993;
160
979-985
18
Niwa K, Uschishiba M, Aotsuka H, Tobita K, Matsuo K, Fujiwara T, Tateno S, Hamada H.
Measurement of ventricular volumes by cine magnetic resonance imaging in complex congenital heart disease with morphologically abnormal ventricles.
Amer Heart J.
1996;
131
567-575
19
Rominger M B, Bachmann G F, Geuer M, Puzik M, Boedeker R-H, Ricken W W, Rau W S.
Genauigkeit der rechts- und linksventrikulären Herzvolumen- und linksventrikulären Muskelmassenbestimmung mittels Cine MRT in Atemanhaltetechnik.
Fortschr Röntgenstr.
1999;
170
54-60
20
Bland J M, Altman D G.
Statistical methods for assessing agreement between two methods of clinical measurement.
Lancet.
1986;
1
307-310
21
Buck T, Hunold P, Wentz K U, Tkalec W, Nesser H J, Erbel R.
Tomographic three-dimensional echocardiographic determination of chamber size and systolic function in patients with left ventricular aneurysm.
Circulation.
1997;
96
4286-4297
22
Wynne J, Green L H, Mann T, Levin D, Grossman W.
Estimation of left ventricular volumes in man from biplane cineangiograms filmed in oblique projections.
Amer J Cardiol.
1978;
41
726-732
23
Rich S, Sheikh A, Gallastegui J, Kondos G T, Mason T, Lam W.
Determination of left ventricular ejection fraction by visual estimation during real time two-dimensional echocardiography.
Amer Heart J.
1982;
104
603-606
24
Stamm R B, Carabello B A, Mayers D L, Martin R P.
Two-dimensional echocardiographic measurement of left ventricular ejection fraction: prospective analysis of what constitutes an adequate determination.
Amer Heart J.
1982;
104
136-144
25
Amico A F, Lichtenberg G S, Reisner S A, Stone C K, Schwartz R G, Meltzer R S.
Superiority of visual versus computerized echocardiographic estimation of radionuclide left ventricular ejection fraction.
Amer Heart J.
1989;
118
1259-1260
26
Rifkin R D, Koito H.
Comparison with radionuclide angiography of two new geometric and four nongeometric models for echocardiographic estimation of left ventricular ejection fraction using segmental wall motion scoring.
Amer J Cardiol.
1990;
65
1485-1490
27
Gopal A S, Shen Z, Sapin P M, Keller A M, Schnellbaecher M J, Leibowitz D W, Akinboboye O O, Rodney R A, Blood D K, King D L.
Assessment of cardiac function by three-dimensional echocardiography compared with conventional noninvasive methods.
Circulation.
1995;
92
842-853
28
Higgins C B, Holt W, Pflugfelder P, Sechtem U.
Functional evaluation of the heart with magnetic resonance imaging.
Magn Reson Med.
1988;
6
121-139
29
Pflugfelder P W, Landzberg J S, Cassidy M M, Cheitlin M D, Schiller N B, Auffermann W, Higgins C B.
Comparison of cine MR imaging with Doppler echocardiography for the evaluation of aortic regurgitation.
Amer J Roentgenol.
1989;
152
729-735
30
Gopal A S, Keller A M, Rigling R, King D L Jr, King D L.
Left ventricular volume and endocardial surface area by three-dimensional echocardiography: comparison with two-dimensional echocardiography and nuclear magnetic resonance imaging in normal subjects.
J Amer Coll Cardiol.
1993;
22
258-270
Dr. med. M. B. Rominger
Abt. Diagn. Radiologie
Justus-Liebig-Universität
Klinikstraße 36
35385 Giessen
Phone: 0641-9941801
Fax: 0641-9941809
Email: Marga.B.Rominger@radiol.med.uni-giessen.de