Biases in the Assessment of Left Ventricular Function by Compressed Sensing Cardiovascular Cine MRI

Jong-Hyun Yoon; Pan-ki Kim; Young-Joong Yang; Jinho Park; Byoung Wook Choi; Chang-Beom Ahn

doi:10.13104/imri.2019.23.2.114

Journal List > Investig Magn Reson Imaging > v.23(2) > 1130366

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Yoon, Kim, Yang, Park, Choi, and Ahn: Biases in the Assessment of Left Ventricular Function by Compressed Sensing Cardiovascular Cine MRI

Original Article

iMRI 2019;23(2):114-124.

Published online: 10 January 2019

DOI: https://doi.org/10.13104/imri.2019.23.2.114

Biases in the Assessment of Left Ventricular Function by Compressed Sensing Cardiovascular Cine MRI

Jong-Hyun Yoon¹, Pan-ki Kim², Young-Joong Yang¹, Jinho Park³, Byoung Wook Choi², Chang-Beom Ahn¹

¹Department of Electrical Engineering, Kwangwoon University, Seoul, Korea

²Department of Radiology, Severance Hospital, Yonsei University, Seoul, Korea

³Developing Brain Research Laboratory, Children's National Health System, Washington, DC, USA

Correspondence to: Chang-Beom Ahn, Ph.D. Department of Electrical Engineering, Kwangwoon University, 20 Kwangwoon-ro, Nowon-gu, Seoul 01897, Korea Tel. +82-2-940-5148 Fax. +82-2-909-3159 E-mail: cbahn@kw.ac.kr

Received 8 February 2019 Revised 25 March 2019 Accepted 16 April 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We investigate biases in the assessments of left ventricular function (LVF), by compressed sensing (CS)-cine magnetic resonance imaging (MRI).

Materials and Methods

Cardiovascular cine images with short axis view, were obtained for 8 volunteers without CS. LVFs were assessed with subsampled data, with compression factors (CF) of 2, 3, 4, and 8. A semi-automatic segmentation program was used, for the assessment. The assessments by 3 CS methods (ITSC, FOCUSS, and view sharing (VS)), were compared to those without CS. Bland-Altman analysis and paired t-test were used, for comparison. In addition, real-time CS-cine imaging was also performed, with CF of 2, 3, 4, and 8 for the same volunteers. Assessments of LVF were similarly made, for CS data. A fixed compensation technique is suggested, to reduce the bias.

Results

The assessment of LVF by CS-cine, includes bias and random noise. Bias appeared much larger than random noise. Median of end-diastolic volume (EDV) with CS-cine (ITSC or FOCUSS) appeared −1.4% to −7.1% smaller, compared to that of standard cine, depending on CF from (2 to 8). End-systolic volume (ESV) appeared +1.6% to +14.3% larger, stroke volume (SV), −2.4% to −16.4% smaller, and ejection fraction (EF), −1.1% to −9.2% smaller, with P < 0.05. Bias was reduced from −5.6% to −1.8% for EF, by compensation applied to real-time CS-cine (CF = 8).

Conclusion

Loss of temporal resolution by adopting missing data from nearby cardiac frames, causes an underestimation for EDV, and an overestimation for ESV, resulting in underestimations for SV and EF. The bias is not random. Thus it should be removed or reduced for better diagnosis. A fixed compensation is suggested, to reduce bias in the assessment of LVF.

Keywords: Cardiovascular cine MRI, Left ventricular function, Compressed sensing, Bias, Compensation

References

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Fig. 1.

Reconstructions for CS and parallel imaging, are performed sequentially. First, (a) reconstruction for CS is performed, and folded image is obtained, and then (b) SENSE reconstruction is applied to the folded image, to obtain unfolded image. Only even phase encoding locations are used.

Fig. 2.

Normalized differences for EDV and ESV for 8 volunteers are depicted, as a function of CF for 3 CS methods. Mean and median of the normalized differences, are shown in broken and solid lines, respectively.

Fig. 3.

Normalized differences for SV and EF for 8 volunteers are shown, as a function of CF for 3 CS methods. Mean and median are shown in broken and solid lines.

Fig. 4.

Bland-Altman plots for assessments of LVF by CS-cine (FOCUSS, CF = 4) and standard cine: (a) EDV, (b) ESV, (c) SV, and (d) EF. Mean of difference (‘Mean’) and range of 95% confidence interval of the mean difference (CIMD), are shown in blue solid and dashed lines. The 95% confidence interval of the difference (CID), is also shown in dark-brown dotted lines. P-value is shown next to the mean of difference. Significant biases (P < 0.005) are found for all EDV, ESV, SV, and EF.

Fig. 5.

Bland-Altman plots for assessments of LVF by real time CS-cine (ITSC, CF = 8) and standard cine: (a) EDV, (b) ESV, (c) SV, and (d) EF. Significant biases are found for all EDV, ESV, SV, and EF (P < 0.02).

Fig. 6.

Bland-Altman plots for assessments of LVF by CS-cine (FOCUSS, CF = 4) and standard cine after compensation: (a) EDV, (b) ESV, (c) SV, and (d) EF. As shown, biases are reduced substantially for all EDV, ESV, SV, and EF.

Fig. 7.

Bland-Altman plots for assessments of LVF by real-time CS-cine (ITSC, CF = 8) and standard cine after compensation: (a) EDV, (b) ESV, (c) SV, and (d) EF.

Table 1.

The Median, Mean, SD, and P Values of the Normalized Differences of LVF for 8 Volunteers are Summarized for 3 CS-cine Methods

LVF	CS method	CF = 2				CF = 3				CF = 4				CF = 8
LVF	CS method	median	mean	SD	P	median	mean	SD	P	median	mean	SD	P	median	mean	SD	P
EDV	ITSC	–1.97	–2.12	2.27	3.50	–1.67	–1.78	2.05	4.63	–2.47	–2.33	2.44	3.25	–4.52	–4.25	2.82	0.59
	FOCUSS	–1.38	–1.26	0.66	0.11	–2.21	–2.33	1.37	0.24	–3.19	–3.68	2.01	0.12	–7.06	–8.71	4.75	0.13
	VS	–1.48	–1.54	1.76	4.76	–3.39	–3.42	3.02	1.14	–5.14	–5.52	3.87	0.80	–11.01	–11.72	6.00	0.05
ESV	ITSC	1.60	2.20	2.60	4.88	2.72	3.84	3.70	1.76	4.08	6.07	5.08	0.10	5.93	8.29	5.91	0.03
	FOCUSS	1.65	1.81	1.54	0.27	4.55	4.87	2.03	0.01	5.86	7.18	4.69	0.01	14.28	16.34	6.28	0.01
	VS	3.14	3.60	2.33	0.01	4.49	4.68	3.48	0.15	8.66	9.57	4.86	0.00	20.90	21.49	9.66	0.01
SV	ITSC	–3.02	–3.46	2.91	1.63	–4.20	–3.60	2.97	1.38	–5.55	–4.93	3.34	0.57	–8.18	–8.35	3.37	0.09
	FOCUSS	–2.39	–2.28	0.89	0.03	–4.88	–4.82	1.62	0.01	–7.93	–7.32	2.51	0.01	–16.39	–17.43	4.97	0.01
	VS	–3.30	–3.22	2.27	0.57	–6.52	–5.92	4.16	0.46	–9.45	–10.58	4.38	0.10	–24.08	–23.14	7.64	0.01
EF	ITSC	–1.15	–1.38	1.07	0.82	–1.67	–1.86	1.44	0.77	–2.56	–2.68	1.32	0.11	–4.47	–4.30	1.17	0.00
	FOCUSS	–1.09	–1.03	0.43	0.03	–2.41	–2.56	0.67	0.00	–3.80	–3.79	1.15	0.00	–9.18	–9.57	1.98	0.00
	VS	–1.55	–1.71	0.71	0.03	–2.85	–2.62	1.50	0.18	–5.35	–5.38	1.05	0.00	–11.94	–13.05	4.20	0.00

All the units are in percentage.

CF = compression factor; CS = compressed sensing; EDV = end-diastolic volume; EF = ejection fraction; ESV = end-systolic volume; FOCUSS = FOCal Underdetermined System Solver; LVF = left ventricular function; ITSC = Iterative Truncation of Small transformed Coefficients; SD = standard deviation; SV = stroke volume; VS = view sharing

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