title: Is magnetic resonance imaging the 'reference standard' for cardiac functional assessment? Factors influencing measurement of left ventricular mass and volumes.
abstract: OBJECTIVE
  MRI is considered reference standard for the assessment of left ventricular (LV) volume and mass measurements. There are few accepted guidelines for uniform assessment of cardiac function with MRI. We sought to investigate different confounding factors influencing LV measurement results.
  
  
  METHODS
  In 60 diabetic type-II patients (group A) we compared intra-/inter-reader variability of MRI for cardiac function measured twice at a 3 month interval by one MRI trained reader and one untrained. In 20 patients (group B) two different techniques were compared for determining the epicardial and endocardial LV-borders.
  
  
  RESULTS
  Bland Altman analysis showed excellent intra-observer measurement agreement for the trained reader 1 for EDM (mean = -2.3 (-23.6-19)), EDV (2.9(-9.2-15.0)), ESV (3.3(-5.8-12.4)) and EF (1.2(-3.3-5.7)). Untrained reader 2 measurement agreement was considerably less appropriate for EDM (mean = -8.2 (-25.8-9.5)), EDV (7.8(-5.1-20.7)), ESV (5.3(-8.0-18.6)). Only for EF (0.8 (-6.5-8.1)) results were comparable to reader 1. Inter-observer measurement in the beginning was poor for EDM (-13.5(-55.6-28.6)) and EDV (7.3(-61.9-76.6)), whereas agreement for ESV (2.1(-29.9-34.2)) and EF (-0.9(-11.6-9.9)) was good. After 3 months, measurement agreement for EDM (-5.3 (-46.4-35.8)) was considerably improved, for EDV (0.4(-67.0-66.2)) was excellent, whereas agreement for ESV (3.1(-34.4-28.1)) and EF (-1.7(-13.0-9.6)) was similar. Using different techniques for determining the epicardial and endocardial borders, only end-diastolic volume was unchanged whereas all other parameters were significantly different using the two methods (p < or = 0.03).
  
  
  CONCLUSIONS
  Intra- and inter-reader variability, analyst experience as well as different techniques for determining the boundaries of the left ventricle significantly affect MRI parameters for cardiac function. These results suggest a need for developing commonly accepted standards for cardiac MRI evaluation.
authors.affiliation: Cardiology Division of the Department of Medicine, of the Johns Hopkins Hospital, Baltimore, USA.
authors.forename: H
authors.initials: H
authors.lastname: Steen
authors.forename: K
authors.initials: K
authors.lastname: Nasir
authors.forename: E
authors.initials: E
authors.lastname: Flynn
authors.forename: I
authors.initials: I
authors.lastname: El-Shehaby
authors.forename: S
authors.initials: S
authors.lastname: Lai
authors.forename: H A
authors.initials: HA
authors.lastname: Katus
authors.forename: D
authors.initials: D
authors.lastname: Bluemcke
authors.forename: J A C
authors.initials: JA
authors.lastname: Lima
mesh_terms: D000328:Adult; D000368:Aged; D002306:Cardiac Volume; D004311:Double-Blind Method; D006321:Heart / Q000503:physiopathology*; D006352:Heart Ventricles / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D015588:Observer Variation