3D-assessment of RVOT dimensions prior percutaneous pulmonary valve implantation: comparison of contrast-enhanced magnetic resonance angiography versus 3D steady-state free precession sequence

Fig. 1. a, b Curved multiplanar reformats of the right ventricle, the right ventricle outflow tract (RVOT) and the pulmonary trunk reconstructed from the 3D steady-state free precession (SSFP) (a) “whole heart” images during systole and from ceMRA (b). The centerline (green) starts at the bottom of the right ventricle, proceeds through the RVOT and the pulmonary trunk and ends at the pulmonary bifurcation. All measurements were carried out perpendicular to the centerline. c, d Multiplanar reformations of a cross-section of the pulmonary trunk in SSFP-sequences showing the change in shape and size at the exact same level during systole and diastole

Fig. 2. Curved multiplanar reformats of the right ventricle outflow tract and the pulmonary trunk reconstructed from the 3D steady-state free precession (SSFP) “whole heart” images during systole. a Shows the measurements of the distance between the possible landing zone (landing zone) and the left coronary artery (LCA). b Shows the measurements of the distance between the possible landing zone (landing zone) and the sternum

Fig. 3. a Box-plot of the mean effective diameter in SSFPdiastole, ceMRA, and SSFPsystole. Triple asterisk indicate significant differences between SSFPdiastole and SSFPsystole (p < 0.001). b Bland Altman analysis of the mean effective diameter, measured in SSFP systole and SSFP diastole. The mean effective diameter in systole is measured 4.1 mm larger than the mean effective diameter in diastole. c Bland Altman analysis of the mean effective diameter, measured in SSFP systole and ceMRA. The mean effective diameter in systole is measured 3.1 mm larger than the mean effective diameter in ceMRA. EDsys Effective diameter, measured in SSFP acquired during systole, EDdia Effective diameter, measured in SSFP acquired during diastole, EDceMRA Effective diameter, measured in ceMRA

Fig. 4. Scatterplot of the interobserver variability of measurements of the effective diameter of a possible landing zone in SSFP systole (a) (Correlation coefficient (R) = 0.8466; p < 0.0001), SSFP diastole (b) (r = 0.8348; p < 0.0001) and ceRMA (c) (r = 0.5507; p = 0.0007). Bland Altman-analysis of interobserver variability (d–f)

Fig. 5. Scatterplot of the intraobserver variabilty of measurements of the effective diameter of a possible landing zone in SSFP systole (a) (Correlation coefficient (R) = 0.9467; p < 0.0001), SSFP diastole (b) (r = 0.9043; p < 0.0001) and ceRMA (c) (R) = 0.7336; p = 0.0028. Bland Altman analysis of interobserver variability (d–f)

Fig. 6. Scatterplot of comparison of measurements of the effective diameter of a possible landing zone in SSFP systole and invasive measurements (a) (Correlation coefficient (R) = 0.99; p < 0.0001) (b) Bland Altman analysis showed no relevant over- or undersizing and narrow limits of agreement