Evaluating the Systemic Right Ventricle by Cardiovascular Magnetic Resonance: Short Axis or Axial Slices?

Abstract

There are significant differences in volume, mass, and function between measurements in axial and short axis orientation. Ejection fraction and stroke volume, which have a high clinical relevance, were measured more consistently in axial slice orientation. Consequently, we recommend using axial slice orientation in patients with a systemic right ventricle.

Impact of Basal Plane Selection on the Evaluation of Cardiac Performance Parameters with Cardiac Magnetic Resonance Imaging in Patients with Corrected Tetralogy of Fallot: A Systematic Approach

“…However, there were also critical cases in which the delineation of the basal plane was not clear. This partly tricky selection of the basal plane has also been described in previous studies (29,36). If there are any discrepancies between the short axis volume measurements and the velocity encoded gradient echo imaging measurements, an incorrect selection of the basal plane should always be taken into account.…”

“…Nevertheless, right ventricular function represents also a predictive value for the outcome in patients with acquired heart diseases, ischaemic cardiomyopathies, pulmonary hypertension, arrhythmogenic right ventricular dysplasia, valvular heart diseases, myocarditis and dilated cardiomyopathies (8,9,28). Furthermore, underscoring of ventricular performance parameters like right ventricular end-diastolic volume index (RVEDVI), right ventricular ejection fraction (RVEF) and left ventricular ejection fraction (LVEF) can have severe consequences on patient management, such as on c Original measurements representing reference values d Measurements with one slice more at the heart base in end-diastolic phase e Measurements with one slice less at the heart base in end-diastolic phase f Measurements with one slice more at the heart base in end-systolic phase g Measurements with one slice less at the heart base in end-systolic phase timing of surgical intervention or feasibility of pregnancy as known from the literature (29)(30)(31).…”

“…c Original measurements representing reference values d Measurements with one slice more at the heart base in end-diastolic phase e Measurements with one slice less at the heart base in end-diastolic phase f Measurements with one slice more at the heart base in end-systolic phase g Measurements with one slice less at the heart base in end-systolic phase that partial volume effects lead to problems to define the most apical and basal plane (6). Furthermore, the distinction between the ventricle and atrium can be unclear due to the through-plane motion of the atrioventricular valve (29). Therefore, the intra-and interobserver variability of the functional assessment of both ventricles is affected by the selection of the basal slice.…”

“…However, other sources of error should also be Volumetric analysis of the ventricles can be performed using the axial plane method as an alternative. Recent studies recommend that volume measurements done by the axial plane method are more reliable than measurements with the short axis method (28,29). Due to the applicable guidelines at the period in which this study's cardiac MRI examinations were conducted (between August 2009 and September 2011), the volume measurements were done in a stack of short axis slices.…”

“…Therefore, no corresponding comparison between the performance parameters acquired with a short axis and axial plane method could be executed (1,37). However, it is apparent that the distinction between the atrium and ventricle in the axial plane method is substantially better than in the short axis method because both structures are visible in one slice (29).…”