Assessment of Left Ventricular Volumes and Function: Can We accurately do it after Contrast Administration?

Purpose: Cine­imaging represents the cornerstone technique of cardiovascular magnetic resonance (CMR) to assess function of the heart. Conventionally performed prior to intravenous contrast­injection, many centers postpone cine­ module after gadolinium administration and prior to late gadolinium enhancement (LGE) imaging to shorten total examination time. We sought to determine the agreement between non­contrast (C­) and contrast­enhanced (C+) cine­ imaging for the quantification of derived left ventricular (LV) volumes and ejection fraction (EF). Methods & Materials: This was a single­cohort parallel­group study comparing LV volumes and ejection fraction (EF) either before (C­) and after contrast­administration (C+) in thirty consecutive patients. Measurements were obtained by the same observer along standardized planes in end­systolic and end­diastolic breath­held 2D SSFP sequences. LV functional parameters [end­systolic (ESV), end­diastolic (EDV) and stroke (SV) volumes and ejection fraction (EF)] were computed using semi­automated software and normalized to the body­surface­area (BSA). Results: Paired sample t­test showed significant differences between C­ and C+ measurements of EDV (p<0.05) and ESV (p<0.05) while no differences were seen for SV and EF. C+ measurements of EDV and ESV showed a mean overestimation of 3.7ml and 2.9ml respectively. Correlation was excellent for all measured parameters (ICC>0.895; p< 0.001). Conclusion: Our data show that cine­imaging performed after contrast administration provides a significant overestimation of EDV and ESV values, whereas there is no difference of SV and EF. Despite this bias is probably not relevant for clinical practice it should be taken into account for scientific or follow­up studies.