Comparison of Cine-MRI and Transthoracic Echocardiography for the Assessment of Aortic Root Diameters in Patients with Suspected Marfan Syndrome

Abstract

Purpose: Patients with Marfan syndrome require repeated imaging for monitoring of aortic root aneurysms. Therefore, we evaluated the agreement and reproducibility of cine-MRI and echocardiography measurements of the sinuses of Valsalva in patients with suspected Marfan syndrome.

Materials and Methods: 51 consecutive patients with suspected Marfan syndrome were prospectively examined using cine-MRI and echocardiography. Two readers independently measured aortic root diameters at the level of the sinuses of Valsalva in both cine-MRI and echocardiography. Statistics included intraclass correlation coefficient, Pearson correlation coefficient, Bland-Altman analysis, and two-sided t-test.

Results: In 38 of the 51 individuals (74.5 %), the diagnosis of Marfan syndrome was established according to the criteria of the Ghent-2 nosology. Cine-MRI measurements of the sinuses of Valsalva revealed a strong correlation with echocardiography (r = 0.929), but a statistically significant bias of –1.0 mm (p < 0.001). The mean absolute diameter for sinuses of Valsalva obtained by cine-MRI was 32.3 ± 5.8 mm as compared to 33.4 ± 5.4 mm obtained by echocardiography. Interobserver agreement of measurements of the sinuses of Valsalva was higher for cine-MRI than for echocardiography (p = 0.029).

Conclusion: Despite small, but statistically significant differences in terms of agreement and reproducibility, cine-MRI and echocardiographic measurements of aortic root diameters provide comparable results without a significant clinical difference. Therefore both techniques may be used for monitoring of the aortic root in patients with Marfan syndrome.

Key points:

• Cine-MRI (ICC: 0.93, CI: 0.88 – 0.96) and echocardiography (ICC: 0.90, CI: 0.82 – 0.94) allow assessment of aortic root diameters in patients with Marfan syndrome

• Cine-MRI offers higher reproducibility of aortic root diameters than echocardiography (95 % limits of agreement of ± 3.6 mm versus ± 5.0 mm, p = 0.029)

• Aortic root measurements with cine-MRI and echocardiography reveal a small (mean difference; -1.0 mm) but statistically significant offset (p = 0.0004)

Citation Format:

• Bannas P., Rybczynski M., Sheikhzadeh S. et al. Comparison of Cine-MRI and Transthoracic Echocardiography for the Assessment of Aortic Root Diameters in Patients with Suspected Marfan Syndrome. Fortschr Röntgenstr 2015; 187: 1022 – 1028

Zusammenfassung

Ziel: Patienten mit einem Marfan-Syndrom benötigen eine regelmäßige Bildgebung zur Detektion von Aneurysmen der Aorta ascendens. Ziel dieser Studie war es, die Reproduzierbarkeit von Messungen des Sinus valsalvae mittels Cine-MRT und Echokardiografie an Patienten mit Verdacht auf Marfan-Syndrom zu untersuchen.

Material und Methoden: 51 konsekutive Patienten mit Verdacht auf Marfan-Syndrom wurden prospektiv mittels Cine-MRT und Echokardiografie untersucht. Jeweils zwei Auswerter bestimmten den Aortenwurzeldiameter auf Höhe des Sinus valsalvae mittels Cine-MRT und Echokardiografie. Die statistische Auswertung erfolgte mittels Intraklassen- sowie Pearson-Korrelationskoeffizient, Bland-Altman-Analyse sowie zweiseitigen t-Test.

Ergebnisse: Bei 38 der 51 Patienten (74,5 %) wurde ein Marfan-Syndrom entsprechend der Ghent-2-Nosologie diagnostiziert. Es zeigte sich eine starke Korrelation zwischen den Diametermessungen des Sinus valsalvae mit der Cine-MRT und Echokardiografie (r = 0,929). Gleichzeitig konnte jedoch eine statistisch signifikante Messdifferenz von –1 mm zwischen den beiden Modalitäten nachgewiesen werden (p < 0,001). Der mittlere Diameter des Sinus valsalvae betrug 32,3 ± 5,8 mm für die Cine-MRT verglichen mit 33,4 ± 5,4 mm für die Echokardiografie. Die Interobserverübereinstimmung der Diametermessungen war signifikant besser für die Cine-MRT im Vergleich zur Echokardiografie (p = 0,029).

Schlussfolgerung: Trotz kleiner, aber statistisch signifikanter Unterschiede der Übereinstimmung und Reproduzierbarkeit erreichen sowohl die Cine-MRT als auch die Echokardiografie vergleichbare Messwerte, welche mutmaßlich ohne klinisch relevante Differenz sind. Daher eignen sich beide Methoden zur Überwachung der Aortenwurzeldiameter von Patienten mit Marfan-Syndrom.

Kernaussagen:

• Cine-MRT (ICC: 0,93; CI: 0,88 – 0,96) und Echokardiografie (ICC: 0,90; CI: 0,82 – 0,94) sind zur Evaluation des Aortenbogens beim Marfan-Syndrom geeignet.

• Cine-MRT-Messungen der Aortenwurzel haben im Vergleich zur Echokardiografie eine höhere Reliabilität (mittlere Abweichung: +/- 3,6 mm versus +/- 5,0 mm; p = 0,029).

• Mit Cine-MRT und Echokardiografie erhobene Aortenwurzelmessungen zeigen eine kleine (mittlere Messabweichung: – 1 mm), aber statistisch signifikante Messdifferenz (p = 0,0004).

Key words

Marfan syndrome - magnetic resonance imaging - echocardiography - aneurysm - aorta

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