MR imaging of arrhythmogenic right ventricular cardiomyopathy: Morphologic findings and interobserver reliability
MR imaging of arrhythmogenic right ventricular cardiomyopathy: Morphologic findings and interobserver reliability
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DOI：
10.1159/000070672
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发表时间：
2003-01-01
期刊：
影响因子：
1.9
通讯作者：
Marcus, F
中科院分区：
文献类型：
--
作者：
Bluemke, DA;Krupinski, EA;Marcus, F
背景磁共振（MR）成像常用于诊断致心律失常性右心室心肌病/发育不良（ARVC/D）。然而，各种MR成像特征诊断ARVC/D的可靠性尚不清楚。本研究的目的是确定哪些形态学MR成像特征对诊断ARVC/D具有最大的观察者间可靠性。方法：将45套心脏MR图像发送给8名放射科医生和5名有该领域经验的心脏科医生。根据工作组标准，有7例明确的ARVC/D病例。6例为对照组。其余32例因临床怀疑ARVC/D而进行MR成像。阅片人评价图像是否存在（a）右心室（RV）扩大，（B）RV异常形态，（c）左心室扩大，（d）心肌中是否存在高T信号（脂肪），以及（e）高T信号（脂肪）的位置，采用Likert量表，并给出格式回答。结果：读者表示，工作组ARVC/D病例显著多于（x（2）= 119.93，d. f. = 10，p < 0.0001）RV腔室尺寸扩大（58%），高于疑似ARVC/D（12%）或无ARVC/D（14%）病例。当读片者报告右心室腔室尺寸增大时，他们更有可能报告存在ARVC/D（x（2）= 33.98，d. f. = 1，p < 0.0001）。当阅片者报告形态异常时，他们更有可能将病例诊断为存在ARVC/D（x（2）= 78.4，d. f. = 1，p < 0.0001），工作组ARVC/D病例（47%）收到的异常报告明显多于疑似ARVC/D病例（20%）或非ARVC/D病例（15%）。在报告的RV中存在高信号强度（脂肪）方面，患者组之间没有显著差异（x（2）= 0.9，d.f. = 2，p > 0.05）。结论：综述者发现右心室异常的大小和形状是鉴别ARVD的关键MR成像。随后的方案开发和多中心试验需要解决这些参数。提高准确性和降低变异性的基本步骤包括标准化采集协议和标准化分析，包括区域RV功能的动态电影审查以及RV和左心室容积的量化。版权所有（C）2003 S. Karger AG，巴塞尔。
Background. Magnetic resonance (MR) imaging is frequently used to diagnose arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D). However, the reliability of various MR imaging features for diagnosing ARVC/D is unknown. The purpose of this study was to determine which morphologic MR imaging features have the greatest interobserver reliability for diagnosing ARVC/D. Methods: Forty-five sets of films of cardiac MR images were sent to 8 radiologists and 5 cardiologists with experience in this field. There were 7 cases of definite ARVC/D as defined by the Task Force criteria. Six cases were controls. The remaining 32 cases had MR imaging because of clinical suspicion of ARVC/D. Readers evaluated the images for the presence of (a) right ventricle (RV) enlargement, (b) RV abnormal morphology, (c) left ventricle enlargement, (d) presence of high T, signal (fat) in the myocardium, and (e) location of high T, signal (fat) on a Likert scale with formatted responses. Results: Readers indicated that the Task Force ARVC/D cases had significantly more (x(2) = 119.93, d.f. = 10, p < 0.0001) RV chamber size enlargement (58%) than either the suspected ARVC/D (12%) or no ARVC/D (14%) cases. When readers reported the RV chamber size as enlarged they were significantly more likely to report the case as ARVC/D present (x(2) = 33.98, d.f. = 1, p < 0.0001). When readers reported the morphology as abnormal they were more likely to diagnose the case as ARVC/D present (x(2) = 78.4, d.f. = 1, p < 0.0001), and the Task Force ARVC/D (47%) cases received significantly more abnormal reports than either suspected ARVC/D (20%) or non-ARVC/D (15%) cases. There was no significant difference between patient groups in the reported presence of high signal intensity (fat) in the RV (x(2) = 0.9, d.f. = 2, p > 0.05). Conclusions: Reviewers found that the size and shape of abnormalities in the RV are key MR imaging discriminates of ARVD. Subsequent protocol development and multicenter trials need to address these parameters. Essential steps in improving accuracy and reducing variability include a standardized acquisition protocol and standardized analysis with dynamic cine review of regional RV function and quantification of RV and left ventricle volumes. Copyright (C) 2003 S. Karger AG, Basel.