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CLINICAL RESEARCH: VALVULAR HEART DISEASE

Quantification of stenotic mitral valve area with magnetic resonance imaging and comparison with Doppler ultrasound

Shiow Jiuan Lin, MS^*, Peggy A. Brown, RDCS^*, Mary P. Watkins, RT^*, Todd A. Williams, RT^*, Katherine A. Lehr, BSN^*, Wei Liu, MS, Gregory M. Lanza, MD, PhD^*, Samuel A. Wickline, MD^* and Shelton D. Caruthers, PhD^*,*

^* Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
Department of Biomedical Engineering, Washington University, St. Louis, Missouri, USA
Philips Medical Systems, Best, Netherlands

Manuscript received December 10, 2003; revised manuscript received February 26, 2004, accepted March 23, 2004.

^* Reprint requests and correspondence: Dr. Shelton D. Caruthers, Cardiovascular Division, Washington University School of Medicine, Campus Box 8086, 660 South Euclid Avenue, St. Louis, Missouri 63110, USA.
scaruthers{at}cmrl.wustl.edu

OBJECTIVES: The purpose of this study was to evaluate the reliability of the pressure half-time (PHT) method for estimating mitral valve areas (MVAs) by velocity-encoded cardiovascular magnetic resonance (VE-CMR) and to compare the method with paired Doppler ultrasound.

BACKGROUND: The pressure half-time Doppler echocardiography method is a practical technique for clinical evaluation of mitral stenosis. As CMR continues evolving as a routine clinical tool, its use for estimating MVA requires thorough evaluation.

METHODS: Seventeen patients with mitral stenosis underwent echocardiography and CMR. Using VE-CMR, MVA was estimated by PHT method. Additionally, peak E and peak A velocities were defined. Interobserver repeatability of VE-CMR was evaluated.

RESULTS: By Doppler, MVAs ranged from 0.87 to 4.49 cm²; by CMR, 0.91 to 2.70 cm², correlating well between modalities (r = 0.86). The correlation coefficient for peak E and peak A between modalities was 0.81 and 0.89, respectively. Velocity-encoded CMR data analysis provided robust, repeatable estimates of peak E, peak A, and MVA (r = 0.99, 0.99, and 0.96, respectively).

CONCLUSIONS: Velocity-encoded cardiovascular magnetic resonance can be used routinely as a robust tool to quantify MVA via mitral flow velocity analysis with PHT method.

Abbreviations and Acronyms   AF = atrial fibrillation   CMR = cardiovascular magnetic resonance   MS = mitral stenosis   MVA = mitral valve area   PHT = pressure half-time   ROI = region of interest   VENC = velocity encoding (maximum) value

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