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CLINICAL RESEARCH: CARDIAC IMAGING

Magnetic Resonance Imaging of Arrhythmogenic Right Ventricular Dysplasia

Sensitivity, Specificity, and Observer Variability of Fat Detection Versus Functional Analysis of the Right Ventricle

Harikrishna Tandri, MD^_*, Ernesto Castillo, MD, Victor A. Ferrari, MD, Khurram Nasir, MD^_*, Darshan Dalal, MD^_*, Chandra Bomma, MD^_*, Hugh Calkins, MD^_* and David A. Bluemke, MD, PhD^,_*

^_* Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
Department of Radiology, Johns Hopkins University, Baltimore, Maryland
Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Manuscript received January 27, 2006; revised manuscript received July 6, 2006, accepted July 12, 2006.

^_* Reprint requests and correspondence: Dr. David A. Bluemke, MRI, Room 143 (Nelson Basement), Johns Hopkins Hospital, 600, N. Wolfe Street, Baltimore, Maryland 21287. (Email: dbluemke{at}jhmi.edu).

OBJECTIVES: The purpose of this study was to determine interobserver agreement for interpretation of magnetic resonance imaging (MRI) examinations of arrhythmogenic right ventricular dysplasia (ARVD) and to determine sensitivity and specificity of fat detection versus functional parameters measured by MRI.

BACKGROUND: The interobserver variability of MRI and the relative importance of different MRI parameters (fat detection, regional and global right ventricular [RV] function) for ARVD diagnosis is unknown.

METHODS: Two experienced observers blinded to the clinical history independently analyzed MRI datasets obtained from 40 patients evaluated for ARVD. Twenty normal subjects underwent MRI and served as control subjects. The MRI scans were performed according to a standard protocol on a 1.5-T scanner. The observers reported on fat infiltration, global and regional RV function, myocardial thinning, and chamber dilatation qualitatively. The RV volumes were measured on the cine sequences.

RESULTS: Interobserver kappa scores for fat infiltration, global and regional RV function, wall thinning, and RV outflow dilatation were 0.74, 0.94, 0.89, 0.93, and 0.93, respectively. Correlation coefficients between observers for RV end-diastolic volume, end-systolic volume, and ejection fraction were 0.93, 0.94, and 0.95, respectively (p < 0.001). Fifteen patients were diagnosed with ARVD using Task Force criteria. Sensitivity of fat infiltration, RV enlargement, and regional RV dysfunction for diagnosing ARVD was 84%, 68%, and 78%, and specificity was 79%, 96%, and 94%, respectively.

CONCLUSIONS: Qualitative assessment of RV structure and function is highly reproducible for experienced observers. Among the qualitative parameters, fat infiltration is less reproducible and lacks specificity compared with RV kinetic abnormalities.

Abbreviations and Acronyms   ARVD = arrhythmogenic right ventricular dysplasia   FSE = fast spin-echo   MRI = magnetic resonance imaging   RAD = right atrial diameter   RV = right ventricle/ventricular   RVEDD = right ventricular end-diastolic diameter   RVESD = right ventricular end-systolic diameter   RVOT = right ventricular outflow tract   SSFP = steady-state free precession   VT = ventricular tachycardia

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