Automated threshold-based 3D segmentation versus short-axis planimetry for assessment of global left ventricular function with dual-source MDCT.

OBJECTIVE The purpose of this study was to evaluate software for threshold-based 3D segmentation of the left ventricle in comparison with traditional 2D short axis-based planimetry (Simpson method) for measurement of left ventricular (LV) volume and global function with state-of-the-art dual-source CT. SUBJECTS AND METHODS Fifty patients with known or suspected coronary artery disease underwent coronary CT angiography. LV end-diastolic, end-systolic, and stroke volumes and ejection fraction were determined from axial images to which 3D segmentation had been applied and from short-axis reformations from 2D planimetry. Interobserver variability was assessed for both approaches. RESULTS Threshold-based 3D LV segmentation had excellent correlation with 2D short-axis results (end-diastolic volume, R = 0.99; end-systolic volume, R = 0.99; stroke volume, R = 0.90; ejection fraction, R = 0.97; p < 0.0001). Bland-Altman analyses revealed systematic underestimation of LV end-diastolic volume (-7.4 +/- 8.9 mL) and LV end-systolic volume (-7.0 +/- 4.4 mL) with the 3D segmentation approach and 2.8 +/- 3.3% overestimation of LV ejection fraction. Interobserver variation with 3D segmentation analysis was significantly (p < 0.001) less (e.g., LV ejection fraction, 0.1 +/- 1.7%) than with the 2D technique, and mean analysis time was significantly shorter (172 +/- 20 vs 248 +/- 29 seconds; p < 0.05). CONCLUSION Automated threshold-based 3D segmentation enables accurate and reproducible dual-source CT assessment of LV volume and function with excellent correlation with results of 2D short-axis analysis. Exclusion of papillary muscles from LV volume results in small systematic differences in quantitative values.

[1]  D. Mandry,et al.  cardiovasculaire - Comparaison des méthodes 2D et 3D dans l’évaluation des fonctions ventriculaires globales en scanner multi-détecteurs , 2008 .

[2]  Masashi Komeda,et al.  Cardiac functional analysis with multi-detector row CT and segmental reconstruction algorithm: comparison with echocardiography, SPECT, and MR imaging. , 2005, Radiology.

[3]  W. Heindel,et al.  Evaluation of Global Left Ventricular Myocardial Function with Electrocardiogram-Gated Multidetector Computed Tomography: Comparison with Magnetic Resonance Imaging , 2003, Investigative radiology.

[4]  R. Günther,et al.  Influence of Heart Rate and Temporal Resolution on Left-Ventricular Volumes in Cardiac Multislice Spiral Computed Tomography: A Phantom Study , 2006, Investigative radiology.

[5]  P. Kaufmann,et al.  Reply: Comparison of 64-Slice CT with Gated SPECT for Evaluation of Left Ventricular Function , 2007, Journal of Nuclear Medicine.

[6]  P. Hunold,et al.  MR Evaluation of Left Ventricular Volumes and Function: Threshold-Based 3D Segmentation Versus Short-Axis Planimetry , 2009, Investigative radiology.

[7]  T. Schlosser,et al.  Rapid MR assessment of left ventricular systolic function after acute myocardial infarction using single breath-hold cine imaging with the temporal parallel acquisition technique (TPAT) and 4D guide-point modelling analysis of left ventricular function , 2009, European Radiology.

[8]  Jeroen J. Bax,et al.  Noninvasive coronary imaging and assessment of left ventricular function using 16-slice computed tomography. , 2005, The American journal of cardiology.

[9]  B. Desjardins,et al.  ECG-gated cardiac CT. , 2004, AJR. American journal of roentgenology.

[10]  A. Huber,et al.  [Dual-source cardiac CT imaging with improved temporal resolution: Impact on image quality and analysis of left ventricular function]. , 2007, Der Radiologe.

[11]  Victor Mor-Avi,et al.  Quantitative Assessment of Left Ventricular Size and Function: Side-by-Side Comparison of Real-Time Three-Dimensional Echocardiography and Computed Tomography With Magnetic Resonance Reference , 2006, Circulation.

[12]  Walter Heindel,et al.  Assessment of regional left ventricular function with multidetector-row computed tomography versus magnetic resonance imaging , 2007, European Radiology.

[13]  Peter Hunold,et al.  Assessment of left ventricular parameters using 16-MDCT and new software for endocardial and epicardial border delineation. , 2005, AJR. American journal of roentgenology.

[14]  W. Heindel,et al.  Multi-detector row CT of left ventricular function with dedicated analysis software versus MR imaging: initial experience. , 2004, Radiology.

[15]  A. Engel,et al.  Comparison of multidetector computed tomography versus echocardiography for assessing regional left ventricular function. , 2005, The American journal of cardiology.

[16]  Shunichi Homma,et al.  Region-based endocardium tracking on real-time three-dimensional ultrasound. , 2009, Ultrasound in medicine & biology.

[17]  B. Gerber,et al.  Accurate estimation of global and regional cardiac function by retrospectively gated multidetector row computed tomography , 2006, European Radiology.

[18]  S. Halliburton.  Measurement of left ventricular volume and ejection fraction with computed tomography: Small steps toward clinical utility. , 2008, Journal of cardiovascular computed tomography.

[19]  Walter Heindel,et al.  Using ECG-gated multidetector CT to evaluate global left ventricular myocardial function in patients with coronary artery disease. , 2002, AJR. American journal of roentgenology.

[20]  K. Kreitner,et al.  [Multi-slice CT (MSCT) in cardiac function imaging: threshold-value-supported 3D volume reconstructions to determine the left ventricular ejection fraction in comparison to MRI]. , 2002, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[21]  Marco Das,et al.  Global left ventricular function in cardiac CT. Evaluation of an automated 3D region-growing segmentation algorithm , 2006, European Radiology.

[22]  M. Ozgun,et al.  MDCT determination of volume and function of the left ventricle: are short-axis image reformations necessary? , 2006, AJR. American journal of roentgenology.

[23]  D. Altman,et al.  STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT , 1986, The Lancet.

[24]  J Paul Finn,et al.  MR Imaging of the heart with cine true fast imaging with steady-state precession: influence of spatial and temporal resolutions on left ventricular functional parameters. , 2002, Radiology.

[25]  D. Berman,et al.  Variable spectrum and prognostic implications of left and right ventricular ejection fractions in patients with and without clinical heart failure after acute myocardial infarction. , 1986, The American journal of cardiology.

[26]  M. Cassidy,et al.  Use of multidetector computed tomography for evaluation of global and regional left ventricular function. , 2009, Journal of cardiovascular computed tomography.

[27]  S Wildermuth,et al.  Time-effectiveness, Observer-dependence, and Accuracy of Measurements of Left Ventricular Ejection Fraction Using 4-channel MDCT , 2004, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[28]  Jeroen J. Bax,et al.  Assessment of global and regional left ventricular function and volumes with 64-slice MSCT: A comparison with 2D echocardiography , 2006, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[29]  Rainer Raupach,et al.  Erratum: First performance evaluation of a dual-source CT (DSCT) system (European Radiology (2006) vol. 16 (2) (256-268) 10.1007/ s00330-005-2919-2) , 2006 .

[30]  R M Whitlock,et al.  Left ventricular end-systolic volume as the major determinant of survival after recovery from myocardial infarction. , 1987, Circulation.

[31]  Matthew J. Budoff,et al.  Assessment of Cardiac Function Using Multidetector Row Computed Tomography , 2006, Journal of computer assisted tomography.

[32]  K. Stierstorfer,et al.  First performance evaluation of a dual-source CT (DSCT) system , 2006, European Radiology.

[33]  Stephan Achenbach,et al.  Computed tomography coronary angiography. , 2006, Journal of the American College of Cardiology.

[34]  J. Reiber,et al.  Comparison between manual and semiautomated analysis of left ventricular volume parameters from short-axis MR images. , 1997, Journal of computer assisted tomography.

[35]  K. Hammermeister,et al.  Variables predictive of survival in patients with coronary disease. Selection by univariate and multivariate analyses from the clinical, electrocardiographic, exercise, arteriographic, and quantitative angiographic evaluations. , 1979, Circulation.

[36]  Dual source computed tomography: automated, visual or dual analysis? , 2009, The International Journal of Cardiovascular Imaging.

[37]  M. Oudkerk,et al.  The reliability of automatic measurement of left ventricular function with dual-source computed tomography datasets , 2009, European Radiology.

[38]  B. Hamm,et al.  Evaluation of global and regional left ventricular function with 16-slice computed tomography, biplane cineventriculography, and two-dimensional transthoracic echocardiography: comparison with magnetic resonance imaging. , 2006, Journal of the American College of Cardiology.

[39]  B. Hamm,et al.  Multisegment and Halfscan Reconstruction of 16-Slice Computed Tomography for Assessment of Regional and Global Left Ventricular Myocardial Function , 2006, Investigative radiology.

[40]  Georg Mühlenbruch,et al.  Automated vs. manual assessment of left ventricular function in cardiac multidetector row computed tomography: comparison with magnetic resonance imaging , 2006, European Radiology.

[41]  Jeroen J. Bax,et al.  Usefulness of dynamic multislice computed tomography of left ventricular function in unstable angina pectoris and comparison with echocardiography. , 2002, The American journal of cardiology.

[42]  Michael Jerosch-Herold,et al.  Left Ventricular Papillary Muscle Mass: Relationship to Left Ventricular Mass and Volumes by Magnetic Resonance Imaging , 2006, Journal of computer assisted tomography.

[43]  C. Claussen,et al.  Assessment of left ventricular myocardial function using 16-slice multidetector-row computed tomography: comparison with magnetic resonance imaging and echocardiography , 2006, European Radiology.