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Effect of Endocardial Trabeculae on Left Ventricular Measurements and Measurement Reproducibility at Cardiovascular MR Imaging¹

¹ From Medical Clinic I (T.P., T.S.) and Dept of Radiology (M.S., C.K.B.), Univ Hosp of Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; and Dept of Cardiology, VU Univ Medical Ctr, Amsterdam, the Netherlands (H.P.K., O.B., A.B., M.M.B.H., A.C.v.R.). Received Apr 8, 2004; revision requested Jun 18; revision received Jul 30; accepted Aug 25. T.P. supported by a grant from the Medical Faculty of the Univ of Mannheim. H.P.K. supported in part by grants from the Medical Faculty of the Rheinisch-Wesfälische Technische Hochschule, Aachen, Germany, and the Grimmke-Stiftung, Düsseldorf, Germany. O.B. supported by grant 2001.158 from the Netherlands Heart Foundation. Address correspondence to T.P. (e-mail: theano.papavassilliu{at}med.ma.uni-heidelberg.de).

PURPOSE: To prospectively assess the effect of including or excluding endocardial trabeculae in left ventricular (LV) measurements and the reproducibility of these measurements at cine cardiovascular magnetic resonance (MR) imaging with true fast imaging with steady-state precession (FISP).

MATERIALS AND METHODS: The study was approved by the local ethics committee, and each subject gave informed consent before participating. Twenty healthy subjects and 20 consecutive patients underwent 1.5-T cardiovascular MR imaging. Seven to 12 short-axis views encompassing the entire LV were acquired by using true FISP. Endocardial and epicardial contours were traced manually. The data sets in each patient were analyzed twice: with inclusion of endocardial trabeculae in the LV cavity volume and with exclusion of endocardial trabeculae from the cavity volume. On the basis of these two contour sets, the end-diastolic (ED) and end-systolic (ES) LV volumes, ejection fraction (EF), and LV mass were calculated. Additionally, interobserver and interexamination reproducibility was assessed by using Bland-Altman analysis.

RESULTS: Compared with exclusion of trabeculae, inclusion of trabeculae in the LV cavity volume resulted in significantly larger ED and ES LV volumes (mean differences, 21 mL ± 11 [standard deviation] and 19 mL ± 33, respectively; P < .001) and lower EFs (mean difference, –2% ± 2; P < .001). The calculated LV mass was significantly smaller with inclusion than with exclusion of trabeculae (mean difference, –21 g ± 12; P < .001). All interobserver and interexamination limits of agreement based on inclusion of trabeculae, except those for EF measurements, were superior to those based on exclusion of trabeculae. At measurement reproducibility comparisons, differences in interobserver ED LV volume and LV mass and interexamination LV mass were statistically significant, favoring the inclusion of trabeculae in the LV cavity volume.

CONCLUSION: Trabeculae significantly affect quantifications of LV volume and mass. The superior reproducibility of LV measurements with the inclusion of endocardial trabeculae in the cavity volume favors this tracing algorithm for clinical use.

© RSNA, 2005

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