Quality assessment of cardiovascular magnetic resonance in the setting of the European CMR registry: description and validation of standardized criteria.
Quality assessment of cardiovascular magnetic resonance in the setting of the European CMR registry: description and validation of standardized criteria.
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DOI：
10.1186/1532-429x-15-55
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发表时间：
2013-06-20
期刊：
影响因子：
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通讯作者：
Schwitter J
中科院分区：
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作者：
Klinke V;Muzzarelli S;Lauriers N;Locca D;Vincenti G;Monney P;Lu C;Nothnagel D;Pilz G;Lombardi M;van Rossum AC;Wagner A;Bruder O;Mahrholdt H;Schwitter J
心血管磁共振（CMR）已成为心血管医学中重要的影像诊断手段。然而，图像质量不足可能会影响其诊断准确性。我们的目的是描述和验证标准化标准，以评估a）电影稳态自由进动（SSFP），B）晚期钆增强（LGE）和c）应力首过灌注图像。这些标准将用于欧洲公路货运登记册的质量评估。定义了35个定性标准（评分0-3），评分越低表示图像质量越好。此外，测量定量参数，产生2个额外的质量标准，即LGE的非梗死心肌的信噪比（SNR）（作为健康心肌的正确信号归零的测量）和灌注图像的造影剂首过期间的信号增加%。在总共90名患者中评估了这些定性和定量标准（在我们自己的机构在1.5T（n=30）和3 T（n=30）下扫描的60名患者和在1.5T下检查的从Euro-CMR登记研究中随机选择的30名患者）。由2名SCMR 3级专家、1名经过培训的研究护士和1名经过培训的医学生进行分析。总体质量评分为6.7±4.6（n=90，4名观察员的平均值，最大可能评分64），范围为6.4-6.9（观察员之间的p=0.76）。1.5T的范围为4.0-4.3（观察者之间p=0.96），3 T为5.9-6.9（观察者之间p=0.33），Euro-CMR病例为8.6-10.3（观察者之间p=0.40）。总体质量评分的观察者间（n=4）和观察者内（n=2）一致性，即分配至相同质量三分位数的百分比范围分别为80%至88%和90%至98%。LGE图像定量评估的一致性（SNR <2、2-5、>5分别为0-2分）在整个人群中的范围为78-84%，在1.5T下为70-93%，在3 T下为64-88%，在Euro-CMR病例中为72-90%。灌注图像的一致性（%SI增加> 200%、100%-200%、<100%分别为0-2分）范围为整个人群的81-91%，1.5T时为76-100%，3 T时为67-96%，Euro-CMR登记研究病例为62-90%。整体质量得分的类内相关系数为0.83。所描述的CMR图像质量评估标准具有良好的观察者间和观察者内一致性。需要进一步的研究来确定图像质量对CMR研究的诊断和预后的影响。
Cardiovascular magnetic resonance (CMR) has become an important diagnostic imaging modality in cardiovascular medicine. However, insufficient image quality may compromise its diagnostic accuracy. We aimed to describe and validate standardized criteria to evaluate a) cine steady-state free precession (SSFP), b) late gadolinium enhancement (LGE), and c) stress first-pass perfusion images. These criteria will serve for quality assessment in the setting of the Euro-CMR registry. Thirty-five qualitative criteria were defined (scores 0–3) with lower scores indicating better image quality. In addition, quantitative parameters were measured yielding 2 additional quality criteria, i.e. signal-to-noise ratio (SNR) of non-infarcted myocardium (as a measure of correct signal nulling of healthy myocardium) for LGE and % signal increase during contrast medium first-pass for perfusion images. These qualitative and quantitative criteria were assessed in a total of 90 patients (60 patients scanned at our own institution at 1.5T (n=30) and 3T (n=30) and in 30 patients randomly chosen from the Euro-CMR registry examined at 1.5T). Analyses were performed by 2 SCMR level-3 experts, 1 trained study nurse, and 1 trained medical student. The global quality score was 6.7±4.6 (n=90, mean of 4 observers, maximum possible score 64), range 6.4-6.9 (p=0.76 between observers). It ranged from 4.0-4.3 for 1.5T (p=0.96 between observers), from 5.9-6.9 for 3T (p=0.33 between observers), and from 8.6-10.3 for the Euro-CMR cases (p=0.40 between observers). The inter- (n=4) and intra-observer (n=2) agreement for the global quality score, i.e. the percentage of assignments to the same quality tertile ranged from 80% to 88% and from 90% to 98%, respectively. The agreement for the quantitative assessment for LGE images (scores 0–2 for SNR <2, 2–5, >5, respectively) ranged from 78-84% for the entire population, and 70-93% at 1.5T, 64-88% at 3T, and 72-90% for the Euro-CMR cases. The agreement for perfusion images (scores 0–2 for %SI increase >200%, 100%-200%,<100%, respectively) ranged from 81-91% for the entire population, and 76-100% at 1.5T, 67-96% at 3T, and 62-90% for the Euro-CMR registry cases. The intra-class correlation coefficient for the global quality score was 0.83. The described criteria for the assessment of CMR image quality are robust with a good inter- and intra-observer agreement. Further research is needed to define the impact of image quality on the diagnostic and prognostic yield of CMR studies.