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. 2023 Apr 14;102(15):e33549. doi: 10.1097/MD.0000000000033549

Three-Tesla magnetic resonance imaging of left ventricular volume and function in comparison with computed tomography and echocardiography

Fu-Qian Guo a, Bai-Lin Wu a, Xiao-Wei Liu a, Tong Pan a, Bu-Lang Gao a, Cai-Ying Li a,*
PMCID: PMC10101249  PMID: 37058049

Abstract

This study investigated the correlation between 3-Tesla magnetic resonance imaging (MRI) and 256 multiple-slice computed tomography (MSCT) or 2-dimensional echocardiography (ECHO) in evaluating left ventricle. Forty patients were retrospectively enrolled to undergo cardiac MSCT, 3-Tesla MRI and 2-dimensional ECHO within 1 week. The end-diastolic (EDV) and end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF) were analyzed and compared. MSCT was highly significantly correlated with MRI. Compared with MRI, MSCT slightly overestimated ESV for about 8.7 mL, but slightly underestimated EF and SV for about 6.8% and 5.8 mL, respectively. A high consistency existed between MSCT and MRI, with the 95% limit of agreement (−19.6, 25.4) mL for EDV, (−2.6,20.1) mL for ESV, (−28.3,16.6) mL for SV, and (−18.8%,5.1) % for EF. ECHO was also significantly correlated with MRI. The ECHO slightly underestimated the left ventricular function compared with MRI, with an underestimation of 9.4 mL for EDV, 3.5 mL for ESV, 5.8 mL for SV and 1.0% for EF. A wider agreement limit existed between MRI and ECHO. MSCT has a better correlation and agreement relationship with MRI parameters than 2-dimensional ECHO in assessing the left ventricle and may serve as a possible alternative to MRI.

Keywords: multiple detectors computed tomography, magnetic resonance imaging, echocardiography, left ventricle, function

1. Introduction

Evaluation of cardiac function and volumes is substantially valuable in the diagnostic, prognostic and therapeutic implications for patients with dysfunction of the left ventricle.[1–5] Cardiac remodeling has been increasingly recognized, and estimation of this remodeling process in terms of cardiac function and volumes is frequently needed to evaluate a patient’s need for and response to therapy. These parameters are also used by many therapeutic trials as a threshold for randomization and outcome measurements. Nowadays, the 3 most commonly used modalities for cardiac evaluation are the cardiac magnetic resonance imaging (MRI), 2-dimensional echocardiography (ECHO) and cardiac computed tomography (CT). Cardiac MRI has high accuracy and reproducibility in assessing left ventricular function, morphology, volume, and mass.[6–9] The longitudinal myocardial function can also be evaluated by cardiac MRI through detection of the mitral annular displacement, which is a potentially sensitive parameter of the left ventricular systolic function.[10–13] Moreover, cardiac MRI is free from radiation and noninvasive, allows imaging acquisition in any desired plane, and can provide images with excellent temporal and spatial resolution irrespective of patient features or operator’s experience especially for 3-Tesla MRI, therefore being currently considered the reference standard in evaluating cardiac function.[14,15] Nonetheless, cardiac MRI is contraindicated in patients with an implanted pacemaker or defibrillator, claustrophobia or any clinical conditions which prohibit long-time cardiac MRI examination.[16] In these cases, ECHO and cardiac CT are applied instead. ECHO is widely used as it is readily available and noninvasive. However, echocardiographic evaluation of the cardiac function is limited and may be dependent on the operator’s experience, especially for the right ventricle which is of complex geometry.[17] Two-dimensional ECHO is highly dependent on good endocardial boundary conditions and extrapolates data from limited sampling of the heart.[18] Recently, cardiac CT has undergone substantial development in technology allowing quantification of cardiac function with low dose radiation exposure, and the high quality CT images can also provide superb endocardial boundary detection, suggesting a possible reproducible reference technique.[16] The value of cardiac CT in assessing cardiac function and the coronary artery morphology has also been increasingly recognized, especially multiple-slice CT (MSCT).[19–21] Most researchers have been focusing on the accuracy and reproducibility of each imaging technique, but readily ignored the interchangeable value of 1 technique to another.[18] The objective of this study was to investigate the correlation and agreement between cardiac 3-Tesla MRI and 256-slice MSCT or 2-dimensional ECHO in evaluation of cardiac volume and function.

2. Materials and Methods

2.1. Subjects

Between August 1, 2013 and August 31, 2014, patients who were suspected of coronary heart disease were prospectively enrolled in this study. Patients were excluded if they had the following conditions: valvular and congenital heart diseases, implantation of metal materials in the body including pacemaker and defibrillator, claustrophobia or any other clinical conditions that prohibits long-time examination. A total of 40 patients were enrolled to undergo 256-multiple-slice computed tomography angiography (MSCTA), 3-Tesla magnetic resonance imaging (MRI) and 2-dimensional (2D) ECHO. There were 21 male and 19 female patients with an age range of 32 to 72 years of age (mean 51.7). All the patients had 256-slice MSCT first, and then 3-Tesla cardiac MRI or 2D ECHO was performed within 1 week. The study was approved by the ethics committee for scientific research of the Second Hospital of Hebei Medical University, and all patients signed the informed consent to participate. All methods were performed in accordance with the relevant guidelines and regulations.

2.2. MSCTA

All patients had the MSCTA in a 256-slice CT scanner (Brilliance iCT, Philips Healthcare, Cleveland, OH) in the period of a breath hold of 4 to 7 seconds. The MSCTA was performed in retrospective electrocardiogram (ECG)-gated helical examinations with intravenously injected contrast medium of iohexol (1.0 mL /kg or 350 mg/ mL) at a flow rate of 4 to 5 mL/s into the antecubital vein through a single-tube high pressure syringe. The following scan parameters were used: tube voltage 100 to 120 kV, tube current 600 to 800 mAs/r, detector collimation 128 × 0.625 mm, pitch 0.16 to 0.2, gantry rotation time 270 to 330 ms, matrix 512 × 512, and field of view 180 to 250 mm. The MSCTA scanning was started from 0.5 cm below the tracheal bifurcation to the superior border of the liver and was ECG-trigged when the CT value reached 110 HU at the interest area. The raw data were reconstructed into 10 phases (5%–95% with an interval of 10%) with the slice thickness of 0.9 mm and an interval of 0.45mm and were then transferred to the Philips EBW 4.5 workstation (Extended BrillianceTM Workspace, V4.5.2.4031, Philips Healthcare Nederland B.V., The Netherlands) for further analysis with specialized software (Vitrea 2; Vital Images, Inc., Minneapolis, MN).

2.3. Cardiac MRI

The 3-Tesla MRI was performed in all patients with a 3-T MRI whole body system (Achieva 3.0 T Quarsa Dual, Philips Healthcare, Best, the Netherlands). This scanner was equipped with dual-source parallel radiofrequency transmission, 16-element cardiac phased-array coils for radiofrequency reception and a 4-lead vectorcardiogram for cardiac gating. The cine-balanced turbo-field-echo sequence in axial view image and short-axis view image acquired in parallel to the atrioventricular groove from the base to the apex were conducted with following scanning parameters: slice thickness 6.5 mm, repetition time 3.44 ms, echo time 1.72 ms, flip angle 45°, matrix size 176 × 193, field of view 380 mm, scanning time 20 minutes. The raw data of 8 to 10 slices of axial images were transferred to the Extended Work Space (Philips Medical Systems, Philips Healthcare, Best, the Netherlands) for analysis.

The end-diastolic and end-systolic images were selected as the maximal and minimal mid-ventricular cross-sectional areas in a cinematic display. At end-diastolic and end-systolic phases, the epi- and endocardial borders were traced manually on the short-axis for each slice (Fig.1), and then, the cardiac software automatically recognizes all phases that extend to the entire layer. These areas were multiplied by the slice thickness and added together to obtain the end-diastolic volume (EDV) and end-systolic volume (ESV), respectively. The stroke volume was calculated as stroke volume (SV) = EDV-ESV, and the ejection fraction (EF) as EF = SV/EDV × 100%. Papillary muscles were excluded from the volume measurements.

Figure 1.

Figure 1.

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Measurement of left ventricular volume and function. (A) 3D volume-rendering image shows the heart and the coronary artery. (B) Volume-phase curve of the left ventricle. (C–F) The epi- and endocardial contours are traced on reformatted short-axis images of the computed tomography (C and D) or magnetic resonance imaging (E and F).

2.4. Two-dimensional ECHO

The 2D ECHO was performed in all patients with a Doppler ultrasound diagnostic apparatus (Philips iU22, Philips Healthcare Solutions, Bothell, WA) with the patients in the left lateral position. Data for 3 consecutive cardiac cycles were collected in the parasternal (long- and short-axis) and apical (2- and 4-chamber views) planes and were saved in cine loop format.

2.5. Statistical analysis

The measured data were expressed as mean ± standard deviation. A paired t test was applied to evaluate the differences between cardiac 3-Tesla MRI and 256-slice MSCT or 2-dimensional ECHO parameters. The relationship between 2 imaging modalities was tested by 2-variable linear regression analysis, with Pearson correlation coefficient. The Bland-Altman analysis was performed to detect the agreement between 2 modalities of imaging. The intraclass correlation coefficient was calculated for detecting the interobserver reliability. The statistical software SPSS 19.0 (IBM, Somers, NY) was used for analysis, with the significant P value set at < .05.

3. Results

All the 40 patients had normal sinus rhythm and all 3 imaging checkup without any complications. The mean heart rate was 62.8 ± 7.9 per minute for MSCTA, 68.0 ± 9.3 for cardiac MRI, and 64.9 ± 10.1 for ECHO, with a significant (P = .009) difference between the MSCTA and MRI.

Between MSCTA and MRI, a significant (P < .05) difference existed in all the parameters for the left ventricular function except EDV, and these 2 methods were highly significantly correlated with each other (Fig.2), with the correlation efficient of 0.89 for EDV, 0.85 for ESV, 0.79 for SV, and 0.64 for EF (Table 1). The Bland-Altman analysis revealed high consistency between MSCTA and MRI (Fig.3). Compared with the cardiac MRI, MSCTA slightly overestimated ESV for about 8.7 mL, but slightly underestimated EF and SV for about 6.8% and 5.8 mL, with 95% limit of agreement of (−19.6, 25.4) mL for EDV, (−2.6, 20.1) mL for ESV, (−28.3, 16.6) mL for SV, and (−18.8%, 5.1%) for EF. The interobserver correlation coefficients between 2 senior physicians were 0.998 and 0.984 for the cardiac MRI measurement of EDV and ESV, respectively, but 0.999 and 0.998 for the MSCTA measurement of the EDV and ESV, respectively.

Figure 2.

Figure 2.

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Scatter plot with regression slope and 95% confidence intervals for EDV (end-diastolic volume), ESV (end-systolic volume), stroke volume (SV), and EF (ejection fraction). X axis stands for the magnetic resonance imaging (MRI) parameters while Y axis stands for 256-slice computed tomography (CT) parameters. EDV = end-diastolic volume, EF = ejection fraction, ESV = end-systolic volume.

Table 1.

Left ventricular function parameters in MSCT and MRI.

MSCT (Y) MRI (X) P value R Regression equation Agreement limit
EDV (mL) 120.1 ± 24.2 117.2 ± 22.8 .117 0.89 Y = 0.93X + 10.4 −19.6 to 25.4
ESV (mL) 50.2 ± 10.7 41.5 ± 10.6 <.001 0.85 Y = 0.86X + 14.4 −2.6 to 20.1
SV (mL) 69.9 ± 18.6 75.7 ± 16.7 .003 0.79 Y = 0.89X + 2.65 −28.3 to 16.6
EF (%) 57.6 ± 7.0 64.5 ± 6.9 <.001 0.64 Y = 0.63X + 16.7 −18.8 to 5.1
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EDV = end-diastolic volume, EF = ejection fraction, ESV = end-systolic volume, MRI = magnetic resonance imaging, MSCT = multiple-slice computed tomography, SV = stroke volume.

Figure 3.

Figure 3.

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Results of Bland-Altman plot analysis for EDV (end-diastolic volume), ESV (end-systolic volume), stroke volume (SV), and EF (ejection fraction) as assessed in 256-slice computed tomography (CT) and cardiac magnetic resonance imaging (MRI). The diagrams indicate the difference versus the mean values (drawn through) of both modalities and ± 1.96-fold standard deviations (dashed lines). CT.EDV (ESV, SV or EF)-MRI. EDV (ESV, SV, or EF) means the difference between the EDV (ESV, SV or EF) value of CT and those of MRI. EDV = end-diastolic volume, EF = ejection fraction, ESV = end-systolic volume.

Between cardiac MRI and 2D ECHO, a significant (P < .05) difference existed in all the parameters for the left ventricular function except EF, and these 2 methods were significantly correlated with each other (Fig.4), with the correlation efficient of 0.77 for EDV, 0.55 for ESV, 0.79 for SV and 0.62 for EF (Table 2). However, the ECHO slightly underestimated the left ventricular function compared with the cardiac MRI, with an underestimation of 9.4 mL for EDV, 3.5 mL for ESV, 5.8 mL for SV, and 1.0% for EF. The Bland-Altman analysis revealed wider agreement limit between MRI and ECHO (Fig.5): (−21.4, 40.1) mL for EDV, (−22.0, 33.6) mL for ESV, (−16.7, 23.7) mL for SV, and (−15.9%, 17.9%) for EF.

Figure 4.

Figure 4.

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Scatter plot with regression slope and 95% confidence intervals for EDV (end-diastolic volume), ESV (end-systolic volume), stroke volume (SV), and EF (ejection fraction). X axis stands for the cardiac magnetic resonance imaging (MRI) parameters while Y axis stands for 2-dimensional echocardiography (ECHO). EDV = end-diastolic volume, EF = ejection fraction, ESV = end-systolic volume.

Table 2.

Left ventricular function parameters in MRI and echocardiography.

Echocardiography (Y) MRI (X) P value R Regression equation
EDV (mL) 107.9 ± 23.1 117.2 ± 22.8 .001 0.77 Y = 16.9 + 0.8X
ESV (mL) 38.0 ± 9.9 41.5 ± 10.6 .039 0.55 Y = 18.5 + 0.5X
SV (mL) 69.9 ± 23.0 75.7 ± 16.7 .014 0.79 Y = -12.6 + 1.1X
EF (%) 63.5 ± 11.0 64.5 ± 6.9 .477 0.62 Y = -0.3 + 1.0X
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EDV = end-diastolic volume, EF = ejection fraction, ESV = end-systolic volume, MRI = magnetic resonance imaging, SV = stroke volume.

Figure 5.

Figure 5.

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Results of Bland-Altman plot analysis for EDV (end-diastolic volume), ESV (end-systolic volume), stroke volume (SV), and EF (ejection fraction) as assessed in 2-dimensional echocardiography (ECHO) and cardiac magnetic resonance imaging (MRI). The diagrams indicate the difference versus the mean values (drawn through) of both modalities and ± 1.96-fold standard deviations (dashed lines). MRI.EDV (ESV, SV, or EF) - ECHO.EDV (ESV, SV or EF) means the difference between the EDV (ESV, SV or EF) value of MRI and those of echocardiography. EDV = end-diastolic volume, EF = ejection fraction, ESV = end-systolic volume.

4. Discussion

This study demonstrated good correlation and agreement between 256-slice MSCT and 3-Tesla MRI in obtaining the left ventricular parameters, and Bland-Altman analysis showed higher agreement in MSCT than in 2-dimensional ECHO in comparison with MRI. When using MRI as the standard in assessing EDV, MSCT had no significant difference while ECHO had a significantly (P < .05) smaller EDV. In assessing SV, MSCT and ECHO had similar values. For ESV and EF evaluation, significant (P < .05) differences existed in either MSCT or ECHO compared with MRI.

The primary factor of MSCT in affecting the accuracy of left ventricular function measurements is the worse temporal resolution with MSCT than with MRI.[22] A single helical CT study has a temporal resolution of 400 msec,[23] and fast development of the multi-detector row CT technique has improved the temporal resolution substantially from 250 msec to 42 msec in the 64-detector row CT. As the temporal resolution was improved, the quality of the images has also been greatly improved. Low temporal resolution may greatly damage the quality of systolic images because of motion artifacts, especially in patients with higher heart rates,[24,25] and studies have demonstrated that multiple-slice CT with temporal resolution of 125 to 250 msec performed with a half or biphasic reconstruction algorithm had a close correlation with cine-ventriculography and MRI.[24,25] The 256-slice CT scanner in our study has a temporal resolution of 27 msec and can more accurately capture the relatively static phase in the cardiac cycle compared with traditional 16- or 64-slice CT scanners in studying the heart and the coronary artery. Even so, underestimation of the SV and EF was still noted in our study with the 256-slice MSCT. MSCT scanner with 256 slices has a larger detector coverage and low dosage scanning conditions, which can reduce the irradiation dosage over 80%.

Nowadays, MRI is the noninvasive diagnostic standard of reference for evaluation of left ventricular volumes and global or regional myocardial function, and MRI is able to clearly detect the myocardial boundary, which is good for manual depiction of the boundary with good accuracy and reproducibility.[26] However, MRI checkup is costly and time-consuming and may be affected by body motion. Children, elderly patients, or patients with claustrophobia are not suitable for MRI. This is probably the reason why patients had higher heart rate during MRI checkup in our study. Overestimation of MSCT of the left ventricular volume compared to MRI may be caused by transient rises in preload due to rapid inflow of contrast materials. Inter-modality differences in the ability to visualize the endocardial boundary details and to include or exclude prominent trabeculae may also affect accurate measurement of the left ventricular volume and function.[16,27] In a study with 179 patients, significant differences were observed in the left ventricular parameters between both papillary muscles included and excluded groups,[28] with the differences range of 5.6% to 30.1% for the left ventricular volume, 5.8% to 9.4% for the left ventricular mass, and 4.3% to 6.0% for the left ventricular EF. This study emphasized the importance of including the papillary muscles in the measurement of the left ventricular volume.

The Bland-Altman test revealed better agreement of MSCT than ECHO to MRI in our study, with a narrower agreement limit in the MSCT and MRI group than in the ECHO and MRI group, which suggests large variations and low reliability and reproducibility in ECHO evaluation. Bellenger et al[18] investigated the left ventricular EF and volumes in heart failure patients and found wider limits of agreement between the ECHO and MRI, indicating a poor agreement of the ECHO with the MRI data. In spite of good agreement with MRI, MSCT is not likely to replace MRI as the preferred imaging modality for cardiac function evaluation due to radiation exposure and application of contrast medium. But in patients with bad echocardiographic compliance or contra-indications to MRI, MSCT may provide valuable information to evaluate the cardiac function because of the isotropic submillimeter spatial resolution, high temporal resolution and good contrast between ventricular lumen and myocardium.[29,30] For right ventricular function analysis, an alternative imaging tool of MSCT may be even more important because the right ventricle has a complex shape which lends itself poorly for evaluation of function in ECHO.[31,32] Although ECHO is the cheapest and most commonly used approach for measurement of cardiac function, ECHO may be limited by poor acoustic windows in patients with chronic pulmonary disease, obesity, or narrow rib intercostal spaces. ECHO is unreliable in evaluating heart failure where the left ventricle becomes more spherical and the relationship between length and diameter is also altered. Our study indicates that MSCT may be a reliable alternative to MRI for patients with poor ECHO compliance and contra-indications to MRI.

This study has some limitations. One limitation lies in the determination of the basic plane of the left ventricle which lacks a uniform standard. This may result in interpersonal deviation and subsequent difference in the evaluation. Another limitation is a small sample of research which may affect the sampling error. A large randomized clinical study with multiple centers involved may be needed in the future to further determine the role of different imaging modalities in assessing the left ventricle volume and function.

5. Conclusion

MSCT has a better correlation and agreement relationship with MRI parameters than 2-dimensional ECHO in assessing the left ventricular volume and function and may serve as a possible alternative to MRI in evaluating suitable patients with contra-indications to MRI.

Author contributions

Conceptualization: Cai-Ying Li.

Data curation: Fu-Qian Guo, Bai-Lin Wu, Xiao-Wei Liu, Tong Pan.

Formal analysis: Fu-Qian Guo, Bu-Lang Gao, Cai-Ying Li.

Investigation: Fu-Qian Guo, Bai-Lin Wu, Xiao-Wei Liu, Tong Pan, Bu-Lang Gao.

Methodology: Fu-Qian Guo, Bai-Lin Wu, Xiao-Wei Liu, Tong Pan, Cai-Ying Li.

Project administration: Fu-Qian Guo, Tong Pan.

Resources: Bai-Lin Wu, Xiao-Wei Liu, Bu-Lang Gao, Cai-Ying Li.

Supervision: Fu-Qian Guo, Tong Pan, Cai-Ying Li.

Validation: Fu-Qian Guo, Bai-Lin Wu, Xiao-Wei Liu, Tong Pan, Bu-Lang Gao, Cai-Ying Li.

Visualization: Xiao-Wei Liu, Bu-Lang Gao.

Writing – original draft: Fu-Qian Guo.

Writing – review & editing: Bu-Lang Gao.

Abbreviations:

2D
two-dimensional
CT
computed tomography
ECHO
echocardiography
EDV
end-diastolic volume
EF
ejection fraction
ESV
end-systolic volume
MRI
magnetic resonance imaging
MSCT
multiple-slice computed tomography
MSCTA
multiple-slice computed tomography angiography
SV
stroke volume

This study was approved by the Ethics Committee of the Second Hospital of Hebei Medical University, and all patients had signed the informed consent to participate.

The datasets generated during and/or analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request.

The authors have no funding and conflicts of interest to disclose.

How to cite this article: Guo F-Q, Wu B-L, Liu X-W, Pan T, Gao B-L, Li C-Y. Three-Tesla magnetic resonance imaging of left ventricular volume and function in comparison with computed tomography and echocardiography. Medicine 2023;102:15(e33549).

Contributor Information

Fu-Qian Guo, Email: guofuqian@163.com.

Bai-Lin Wu, Email: wubailin@163.com.

Xiao-Wei Liu, Email: liuxiaowei@163.com.

Tong Pan, Email: pantong@163.com.

Bu-Lang Gao, Email: browngao@163.com.

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