Performance of routine SSFP cine cardiac MRI in the assessment of regurgitant valvular lesions, a comparison with echocardiography in a prospective cohort

Background : The accuracy of valvular regurgitation assessment is uncertain by SSFP cine MR imaging. In this study we compared performance of cine images with Doppler echocardiography (echo) in a large prospective cohort. Methods : We prospectively recruited 205 subjects who underwent MRI within 2 hours of echo. Regurgitation was assessed qualitatively and graded as none (0), trace (0.5), mild (1), mild to moderate (1.5), moderate (2.0), moderate to severe (2.5) and severe (3.0) by echo and by cine MRI. Grading from echo was used as reference. Results : Prevalence of the mitral (MR), tricuspid (TR), aortic (AR) and pulmonic (PR) regurgitation was 79%, 87%, 29% and 58% by echo, respectively. When regurgitation was absent the agreement between MRI and echo was good: 86%, 79%, 99% and 96% for MR, TR, AR and PR, respectively. However, few cases were detected by MRI for lesions 1+ or less: 16%, 29%, 10% and 2%, respectively. Detection of significant regurgitation (≥ 1.5+) by MRI was reliable, 97%, 93%, 90% and 100%, with 25%, 14%, 30% and 33% underestimation of severity present, respectively while overestimation was rare. Conclusion : SSFP cine MRI is reliable in detecting the absence or significant (≥ 1.5+) regurgitant lesions but limited for mild or trivial diseases.