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CLINICAL RESEARCH: CARDIAC IMAGING

Planimetry of Mitral Valve Stenosis by Magnetic Resonance Imaging

Behrus Djavidani, MD^_*,_*, Kurt Debl, MD, Markus Lenhart, MD^_*, Johannes Seitz, MD^_*, Christian Paetzel, MD^_*, Franz X. Schmid, MD, Wolfgang R. Nitz, PhD^_*, Stefan Feuerbach, MD^_*, Günter Riegger, MD and Andreas Luchner, MD

^_* Department of Diagnostic Radiology, University Hospital of Regensburg, Regensburg, Germany.
Department of Internal Medicine II, University Hospital of Regensburg, Regensburg, Germany.
Department of Cardiothoracic Surgery, University Hospital of Regensburg, Regensburg, Germany.

Manuscript received October 7, 2004; revised manuscript received March 4, 2005, accepted March 10, 2005.

^_* Reprint requests and correspondence: Dr. Behrus Djavidani, Department of Radiology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, D-93042 Regensburg, Germany. (Email: behrus.djavidani{at}klinik.uni-regensburg.de).

OBJECTIVES: We sought to determine whether noninvasive planimetry of the mitral valve area (MVA) by magnetic resonance imaging (MRI) is feasible and reliable in patients with mitral stenosis (MS).

BACKGROUND: Accurate assessment of MVA is particularly important for the management of patients with valvular stenosis. Current standard techniques for assessing the severity of MS include echocardiography (ECHO) and cardiac catheterization (CATH).

METHODS: In 22 patients with suspected or known MS, planimetry of MVA was performed with a 1.5-T magnetic resonance scanner using a breath-hold balanced gradient echo sequence (true FISP). Data were compared with echocardiographically determined MVA (ECHO-MVA, n = 22), as well as with invasively calculated MVA by the Gorlin-formula at (CATH-MVA, n = 17).

RESULTS: The correlation between MRI- and CATH-MVA was 0.89 (p < 0.0001), and the correlation between MRI- and ECHO-MVA was 0.81 (p < 0.0001). The MRI-MVA slightly overestimated CATH-MVA by 5.0% (1.60 ± 0.45 cm² vs. 1.52 ± 0.49 cm², p = NS) and ECHO-MVA by 8.1% (1.61 ± 0.42 cm² vs. 1.48 ± 0.42 cm², p < 0.05). On receiver-operating characteristic curve analysis, a value of MRI-MVA below 1.65 cm² indicated mitral stenosis (CATH-MVA 1.5 cm²), with a good sensitivity and specificity (89% and 75%, respectively).

CONCLUSIONS: Magnetic resonance planimetry of the mitral valve orifice in mitral stenosis offers a reliable and safe method for noninvasive quantification of mitral stenosis. In the clinical management of patients with mitral stenosis, it has to be considered that planimetry by MRI slightly overestimates MVA, as compared with MVA calculated echocardiographically and at catheterization.

Abbreviations and Acronyms   CATH = cardiac catheterization   ECHO = echocardiography   MRI = magnetic resonance imaging   MS = mitral stenosis   MVA = mitral valve area

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