Cardiovascular magnetic resonance imaging feature tracking: Impact of training on observer performance and reproducibility

• Published in: PloS one Vol. 14; no. 1; p. e0210127
• Main Authors: Backhaus, Sören J, Metschies, Georg, Billing, Marcus, Kowallick, Johannes T, Gertz, Roman J, Lapinskas, Tomas, Pieske, Burkert, Lotz, Joachim, Bigalke, Boris, Kutty, Shelby, Hasenfuß, Gerd, Beerbaum, Philipp, Kelle, Sebastian, Schuster, Andreas
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 25.01.2019; Public Library of Science (PLoS)
• Subjects: Adult; Aged; Biology and Life Sciences; Cardiology; Cardiomyopathy; Care and treatment; College campuses; Computer programs; Congestive heart failure; Deformation; Diagnosis; Diagnostic systems; Female; Healthy Volunteers; Heart; Heart attack; Heart attacks; Heart failure; Heart Failure - diagnosis; Heart Failure - etiology; Heart Failure - physiopathology; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Humans; Image Interpretation, Computer-Assisted; Internal medicine; Magnetic resonance; Magnetic resonance imaging; Magnetic Resonance Imaging, Cine - methods; Male; Medical prognosis; Medicine; Medicine and Health Sciences; Methods; Middle Aged; Muscle contraction; Myocardial Contraction - physiology; NMR; Nuclear magnetic resonance; Observer Variation; Patients; Physical Sciences; Reproducibility; Reproducibility of Results; Research and Analysis Methods; Resonance; Software; Studies; Tracking; Training; Ventricle; Ventricular Dysfunction - complications; Ventricular Dysfunction - diagnosis; Ventricular Dysfunction - physiopathology; Canada; Germany
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0210127

Cardiovascular magnetic resonance feature tracking (CMR-FT) is increasingly used for myocardial deformation assessment including ventricular strain, showing prognostic value beyond established risk markers if used in experienced centres. Little is known about the impact of appropriate training on CMR-FT performance. Consequently, this study aimed to evaluate the impact of training on observer variance using different commercially available CMR-FT software. Intra- and inter-observer reproducibility was assessed prior to and after dedicated one-hour observer training. Employed FT software included 3 different commercially available platforms (TomTec, Medis, Circle). Left (LV) and right (RV) ventricular global longitudinal as well as LV circumferential and radial strains (GLS, GCS and GRS) were studied in 12 heart failure patients and 12 healthy volunteers. Training improved intra- and inter-observer reproducibility. GCS and LV GLS showed the highest reproducibility before (ICC >0.86 and >0.81) and after training (ICC >0.91 and >0.92). RV GLS and GRS were more susceptible to tracking inaccuracies and reproducibility was lower. Inter-observer reproducibility was lower than intra-observer reproducibility prior to training with more pronounced improvements after training. Before training, LV strain reproducibility was lower in healthy volunteers as compared to patients with no differences after training. Whilst LV strain reproducibility was sufficient within individual software solutions inter-software comparisons revealed considerable software related variance. Observer experience is an important source of variance in CMR-FT derived strain assessment. Dedicated observer training significantly improves reproducibility with most profound benefits in states of high myocardial contractility and potential to facilitate widespread clinical implementation due to optimized robustness and diagnostic performance.