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Published online before print January 5, 2005, 10.1148/radiol.2343040151
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Interventricular Septal Configuration at MR Imaging and Pulmonary Arterial Pressure in Pulmonary Hypertension1

Roald J. Roeleveld, MD, J. Tim Marcus, PhD, Theo J. C. Faes, PhD, Tji-Joong Gan, MSc, Anco Boonstra, MD, PhD, Pieter E. Postmus, MD, PhD, FCCP and Anton Vonk-Noordegraaf, MD, PhD, FCCP

1 From the Departments of Pulmonology (R.J.R., T.J.G., A.B., P.E.P., A.V.N.) and Physics and Medical Technology (J.T.M., T.J.C.F.), VU University Medical Center/Institute of Cardiovascular Research ICaR-VU, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands. Received January 26, 2004; revision requested April 6; revision received June 6; accepted September 22. Address correspondence to A.V.N. (e-mail: a.vonk@vumc.nl).



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  		Figure 1. MR images show all short-axis levels of the left and right ventricle from base (top) to apex (bottom). First image of each row corresponds in time with electrocardiograhic R wave. Enlarged image was selected for curvature measurement: Within uppermost row of images that do not show any RV outflow tract, it had the most severe LVSB. For reproduction purposes, only phases 1, 5, 9, 13, and 17 are shown. Full acquisition in this patient consisted of 119 images (seven sections x 17 phases). A movie of the section used for curvature analysis can be seen as a digital data supplement (Movie 1, radiology.rsnajnls.org/cgi/content/full/2343040151/DC1). Pulse sequence: steady-state free precession, flip angle of 48°, acquisition matrix of 153 x 256 pixels, field of view of 290 x 340 mm, section thickness of 5 mm, repetition time msec/echo time msec of 3/1.5.

 


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  		Figure 2. Simultaneous measurement of LV and RV pressure and calculated pressure difference (LV pressure – RV pressure). Graph is an average of five consecutive heartbeats in a patient with pulmonary hypertension. Note that RV pressure exceeds LV pressure by 15 mm Hg 500-550 msec after R wave and remains higher throughout diastole. Horizontal axis represents time after R wave.

 


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  		Figure 3. Graph shows correlation between systolic PAP (sPAP) and septum curvature (r = 0.77, P < .001). Dashed line is regression line: systolic PAP = –114.7 · curvature + 67.2.

 


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  		Figure 4. Effect of afterload reduction on septal curvature. Short-axis MR images on which curvature was evaluated before (left) and after (right) administration of 10 mg of nifedipine. Images were acquired at the exact same anatomic location, both 425 msec after R wave triggering. Note difference in shape of interventricular septum. Heart rate was not affected by the drug. Pulse sequence: steady-state free precession, flip angle of 50°, acquisition matrix of 153 x 256 pixels, field of view of 270 x 340 mm, section thickness of 5 mm, 3.2/1.6.

 


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  		Figure 5. Graph shows changes in systolic PAP (sPAP) and curvature as a result of vasodilatation. Arrows connect pressure-curvature relationships before (arrow origin) and after (arrow head) use of nifedipine as a vasodilator in two patients. When pressure is reduced, curvature changes. Dashed line is same correlation line as in Figure 3.

 


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  		Figure 6. Graph shows correlation between curvatures, as determined by two observers. r = 0.96, P < .001.

 


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  		Figure 7. Bland-Altman plot of agreement between two observers. A small bias of –0.01 cm–1 was calculated. This is not represented in the graph, as it would be hard to distinguish from the horizontal axis. Dashed lines represent upper and lower 95% confidence interval limits of agreement, respectively (+0.07 and –0.09 cm–1).

 


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  		Figure A1. Curvature calculation. Three points on the septum are given by xa and ya, xb and yb, and xc and yc. Relevant formula is given in the Appendix.

 




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