Quantitative multi-slice computed tomography assessment of the mitral valvular complex for transcatheter mitral valve interventions part 1: systematic measurement methodology and inter-observer variability
Quantitative multi-slice computed tomography assessment of the mitral valvular complex for transcatheter mitral valve interventions part 1: systematic measurement methodology and inter-observer variability
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DOI：
10.4244/eijy15m11_09
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发表时间：
2016-10-01
期刊：
影响因子：
6.2
通讯作者：
Piazza, Nicolo
中科院分区：
文献类型：
--
作者：
Theriault-Lauzier, Pascal;Mylotte, Darren;Piazza, Nicolo
目的：经导管二尖瓣置换术（TMVR）是一项新兴技术，有潜力治疗二尖瓣手术风险过高的严重二尖瓣反流患者。二尖瓣复合体和周围结构的多模态成像将成为 TMVR 患者选择的重要组成部分。我们的目的是描述和评估系统的多层计算机断层扫描 (MSCT) 图像分析方法，该方法提供与经导管二尖瓣置换术相关的测量。方法和结果：描述了一种系统的逐步测量方法，用于二尖瓣复合体的结构，包括：二尖瓣环、左心室、左心房、乳头肌和左心室流出道。为了评估重复性，两名观察者将这种方法应用于对患有心力衰竭和严重二尖瓣反流的患者进行的 49 次心脏 MSCT 扫描的回顾性系列研究。对于 25 个几何指标中的每一个，我们评估了观察者间差异和类内相关性。对于 TMVR 装置尺寸确定中至关重要的测量值（二尖瓣环直径、面积、周长、三角区间距离和主动脉-二尖瓣角），观察者间差异低于 10%，组内相关性高于 0.81。 结论：MSCT 可以提供对于患者选择和 TMVR 装置尺寸确定非常重要的测量值。这些测量对于功能性二尖瓣反流患者具有出色的观察者间重现性。
Aims: Transcatheter mitral valve replacement (TMVR) is an emerging technology with the potential to treat patients with severe mitral regurgitation at excessive risk for surgical mitral valve surgery. Multimodality imaging of the mitral valvular complex and surrounding structures will be an important component for patient selection for TMVR. Our aim was to describe and evaluate a systematic multi-slice computed tomography (MSCT) image analysis methodology that provides measurements relevant for transcatheter mitral valve replacement.Methods and results: A systematic step-by-step measurement methodology is described for structures of the mitral valvular complex including: the mitral valve annulus, left ventricle, left atrium, papillary muscles and left ventricular outflow tract. To evaluate reproducibility, two observers applied this methodology to a retrospective series of 49 cardiac MSCT scans in patients with heart failure and significant mitral regurgitation. For each of 25 geometrical metrics, we evaluated inter-observer difference and intra-class correlation. The inter-observer difference was below 10% and the intra-class correlation was above 0.81 for measurements of critical importance in the sizing of TMVR devices: the mitral valve annulus diameters, area, perimeter, the inter-trigone distance, and the aorto-mitral angle.Conclusions: MSCT can provide measurements that are important for patient selection and sizing of TMVR devices. These measurements have excellent inter-observer reproducibility in patients with functional mitral regurgitation.