Feasibility and reproducibility of semi-automated magnetic resonance angiography measurements of the thoracic aorta using commercial software

Abstract

Background: Centerline semi-automatic measurements (CSAM) of the thoracic aorta have been shown to reduce interobserver variability of diameter measurements. The purpose of this study is to demonstrate the feasibility and efficiency of non-expert CSAM using contrast-enhanced magnetic resonance angiography (CE-MRA) versus double oblique (DO) multiplanar reformation (MPR) measurements obtained by experts, and to assess CSAM failure rate in subjects with and without thoracic aortic disease (TAD). Methods: Image-based navigator (iNAV) and variable density sampling with Cartesian spiral-like trajectories (VD-CASPR) framework for non-rigid motion correction and image acceleration were utilized for inversion recovery gradient echo MRA. Thoracic MRA was obtained in 41 TAD subjects and 27 normals and independently analyzed by expert cardiologists for DO MPR measurements; one cardiovascular imaging fellow (CSAM1) obtained CSAM in all subjects; another (CSAM2) obtained CSAM in TAD patients. Nine prior MRA exams were analyzed for CSAM in seven subjects with stable aneurysms. Post-processing efficiency and intra/interobserver agreement were assessed at the sinus of Valsalva (SOV), sinotubular junction (STJ), and ascending aorta (AAO) using intra/interclass correlation coefficients. Contour failures were graded on a four-point scale: 1-failure of 75% failure. Results: CSAM1 failure rate was 13% and 14% in the TAD and normal cohorts, respectively (p = 0.78). CSAM 2 failure rate was 2% in the TAD cohort. Intraobserver agreement was excellent for both methods. SOV inter-observer agreement with DO MPR performed the worst, with the lowest interclass correlation (ICC) for SOV major (vs physician 1) in the normal cohort (ICC = .69). Otherwise, agreement with DO MPR was near excellent. Major diameter interobserver agreement was excellent in the TAD cohort. Efficiency was highest for CSAM2. In stable TAD, baseline and follow-up major diameter measurements were not significantly different. Conclusion: Non-expert MRA CSAM is feasible with excellent intraobserver and excellent to near excellent interobserver agreement at the STJ and AAO levels compared to expert DO MPR. CSAM failure rates varied significantly between non-expert readers; inter-study CSAM were overall precise.