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Master Thesis

Comparaison entre l'échocardiographie et l'IRM 4D flow dans l'évaluation de la sévérité de l'insuffisance mitrale primitive chronique

Abstract : Aim: to study the agreement between transthoracic echocardiography (TTE), gold standard and time-resolved phase-contrast magnetic resonance imaging with flow-encoding in all three spatial directions (4D Flow MRI) in chronic primitive mitral regurgitation (MR) to determine whether this emergent tool can be integrated to the multiparametric approach of this valvulopathy as conventional cine-MRI. Methods: it is a monocentric, prospective study conducted at the Institut Mutualiste Montsouris between November 2016 and 2017 including patients with chronic primitive MR of all mechanism. MR was evaluated by two cardiologists in TTE, was classified as mild, moderate or severe and then evaluated quantitatively by two radiologists in 4D flow MRI, with consensus if disagreement. Operators were independent with blind evaluation. Results: 33 patients were included. Interobserver agreement was good in TTE (Kappa= 0.75 IC 95% [0.57-0.92]) and excellent in 4D Flow MRI (ICC= 0.94 IC 95% [0.79-0.95]). 4D Flow MRI had an excellent internal consistency in its measures in 4D Flow and compared with cine-MRI. Agreement with TTE was excellent after secondary adaptation of severity thresholds (Mild VR=20mL FR=20%, Moderate VR=21–39mL FR=21–36%, Severe VR=40mL FR=37%): kappa= 0.93 IC 95%[0.8-1] for regurgitant volume and kappa= 0.9 IC 95%[0.7-0.9] for regurgitation fraction. Conclusion: 4D Flow MRI is a reliable and consistent tool for MR quantification. A future study to confirm the thresholds hereby obtained will comfort the role of 4D Flow MRI in MR diagnostic and therapeutic algorithm.
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Master Thesis
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Sophie Ribeyrolles. Comparaison entre l'échocardiographie et l'IRM 4D flow dans l'évaluation de la sévérité de l'insuffisance mitrale primitive chronique. Médecine humaine et pathologie. 2018. ⟨dumas-02294556⟩

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