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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.

View larger version (82K): [in this window] [in a new window] [Download PPT slide]   Figure 1 (A) Axial black blood image of the right ventricle. The right ventricle was divided into free wall (black arrow) and apex (white arrow) by a line drawn in the midanterior wall. (B) Axial black blood image of the outflow tract (white arrow).

View larger version (77K): [in this window] [in a new window] [Download PPT slide]   Figure 2 Axial black blood image at the level of the aortic valve. The image on the left shows the right ventricular outflow tract (RVOT) in a healthy volunteer, which is comparable to the size of the aorta. The image on the right shows a grossly enlarged RVOT from a patient with arrhythmogenic right ventricular dysplasia.

View larger version (17K): [in this window] [in a new window] [Download PPT slide]   Figure 3 (A) Right ventricular end-diastolic volume was significantly greater in patients with arrhythmogenic right ventricular dysplasia (ARVD) compared with idiopathic ventricular tachycardia (VT) and control subjects. No differences were noted in the left ventricular end-diastolic volumes. (B) Right ventricular ejection fraction was significantly lower in patients with ARVD compared with idiopathic VT and control subjects. No differences were noted in the left ventricular ejection fraction.

View larger version (8K): [in this window] [in a new window] [Download PPT slide]   Figure 4 Bland-Altman analysis showing excellent agreement between the two observers for right ventricular end-diastolic volume (RVEDV) (top, mean difference 7.9 ± 3.1 ml; upper and lower limits of agreement –26 ml and 42 ml, respectively) and right ventricular (RV) ejection fraction (bottom, mean difference –0.02 ± 0.04; upper and lower limits of agreement –0.17 and 0.1, respectively). Limits of agreement are displayed as ±2 SD.