Key result
Total right ventricular mass index, which includes trabeculation, significantly improved the diagnostic accuracy for pulmonary hypertension (AUC 0.77) compared to compacted mass index alone (AUC 0.61).
Why the study?
Some cardiac MRI methods exclude right ventricle trabeculation when measuring mass, prompting evaluation of whether including trabeculation affects measurement reproducibility and diagnostic accuracy in suspected pulmonary hypertension.
Does semi-automated thresholding of RV trabeculation improve the diagnostic accuracy and reproducibility of CMR in suspected pulmonary hypertension?
Observational (n=144)
Observers were blinded to each other's assessment
No
Does semi-automated thresholding of RV trabeculation improve the diagnostic accuracy and reproducibility of CMR in suspected pulmonary hypertension?
Including trabecular mass using a semi-automated thresholding technique improves the diagnostic accuracy and reproducibility of CMR-derived RV mass measurements in suspected pulmonary hypertension.
Answers are grounded in this paper and cite their sources.
Semi-automated inclusion of trabecular mass may improve CMR diagnostic efficiency in suspected.
Objectives Right ventricle (RV) mass is an imaging biomarker of mean pulmonary artery pressure (MPAP) and pulmonary vascular resistance (PVR). Some methods of RV mass measurement on cardiac MRI (CMR) exclude RV trabeculation. This study assessed the reproducibility of measurement methods and evaluated whether the inclusion of trabeculation in RV mass affects diagnostic accuracy in suspected pulmonary hypertension (PH). Materials and methods Two populations were enrolled prospectively. (i) A total of 144 patients with suspected PH who underwent CMR followed by right heart catheterization (RHC). Total RV mass (including trabeculation) and compacted RV mass (excluding trabeculation) were measured on the end-diastolic CMR images using both semi-automated pixel-intensity-based thresholding and manual contouring techniques. (ii) A total of 15 healthy volunteers and 15 patients with known PH. Interobserver agreement and scan-scan reproducibility were evaluated for RV mass measurements using the semi-automated thresholding and manual contouring techniques. Results Total RV mass correlated more strongly with MPAP and PVR (r = 0.59 and 0.63) than compacted RV mass (r = 0.25 and 0.38). Using a diagnostic threshold of MPAP ≥ 25 mmHg, ROC analysis showed better performance for total RV mass (AUC 0.77 and 0.81) compared to compacted RV mass (AUC 0.61 and 0.66) when both parameters were indexed for LV mass. Semi-automated thresholding was twice as fast as manual contouring (p < 0.001). Conclusion Using a semi-automated thresholding technique, inclusion of trabecular mass and indexing RV mass for LV mass (ventricular mass index), improves the diagnostic accuracy of CMR measurements in suspected PH.
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Macdonald et al. (2023) conducted an observational in Suspected pulmonary hypertension (n=144). Total right ventricular mass index (including trabeculation via semi-automatic thresholding) vs. Compacted right ventricular mass index (excluding trabeculation) was evaluated on Diagnostic accuracy for pulmonary hypertension (mean pulmonary artery pressure ≥ 25 mmHg) (AUC 0.77, p=0.02). Total right ventricular mass index, which includes trabeculation, significantly improved the diagnostic accuracy for pulmonary hypertension (AUC 0.77) compared to compacted mass index alone (AUC 0.61).
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