Cardiac magnetic resonance imaging with standard imaging planes for mitral valve scallop pathology: interrater agreement
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ORIGINAL PAPER
Cardiac magnetic resonance imaging with standard imaging planes for mitral valve scallop pathology: interrater agreement and comparison with echocardiography Stinne Byrholdt Søgaard1 · Pia Gustavsen2 · Morten Dalsgaard2 · Niels G. Vejlstrup3 · Per Lav Madsen2,4 Received: 4 May 2020 / Accepted: 9 September 2020 © Springer Nature B.V. 2020
Abstract Magnetic resonance imaging (CMR) is applied in mitral valve regurgitation (MR) to quantify regurgitation volume/fraction and cardiac volumes, but individual scallop pathology is evaluated by echocardiography. To evaluate CMR for determination of individual scallop pathology, interrater variability on evaluation of scallop pathology from echocardiography and a standard clinical CMR protocol including a transversal stack was compared. 318 mitral scallops from 53 patients with primary MR were evaluated by two cardiologists evaluating echocardiography scans and two other cardiologists evaluating CMR scans (blinded). Inter-rater variability was determined with percentage agreement and Cohen’s kappa. In evaluable scallops, interrater agreement on the diagnosis of a prolapsing and/or flail scallop was 77–87% and kappa values of 0.27–0.67, irrespective of physician or modality. Important differences between modalities were primarily related to CMR-evaluators judging the A3 and the P3 to be normal when echocardiography demonstrated prolapsing or even flail scallops; poor imaging of calcification; and flailed scallops occasionally being undetected with CMR since the flow-voids may mask the scallop. Inter-rater agreement for scallop pathology in primary MR is comparable for echocardiography and standard magnetic resonance imaging scans, but CMR has important pitfalls relating to evaluation of A3 and P3 scallops, and suffers from poor visualization of calcification and lower spatial resolution than echo. CMR with standard planes cannot replace CMR with longitudinal planes or echo for the evaluation of specific scallop pathology in severe primary MR. Keywords Cardiovascular magnetic resonance imaging · Mitral valve regurgitation · Echocardiography · Scallop pathology · Interrater agreement
Introduction Cardiovascular magnetic resonance imaging (CMR) is a non-invasive reference technique for quantitation of mitral valve regurgitation (MR) severity, but it is not known how * Per Lav Madsen [email protected] 1
Department of Diagnostic Radiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
2
Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark
3
Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
4
Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
well CMR can be applied for the determination of individual scallop pathology. Thus, by comparison with integrative echocardiography, values for the mitral valve regurgitation volume and regurgitation fraction determine severity on a quantitative sca
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