NORMAL MCMR
Research type
Research Study
Full title
Normative cardiovascular magnetic resonance values for measurement of cardiovascular structure and function at MCMR
IRAS ID
299730
Contact name
Chris Miller
Contact email
Sponsor organisation
Manchester University NHS Foundation Trust
Duration of Study in the UK
1 years, 0 months, 1 days
Research summary
Summary of research:
Cardiovascular magnetic resonance (CMR) imaging is an important clinical and research tool.Measurements of cardiovascular structure and function can vary according to scanner vendor, scanner field strength, imaging sequence and patient population. As such, the Society for Cardiovascular Magnetic Resonance (SCMR) and the European Association for Cardiovascular Imaging (EACVI) state that local normal reference ranges for CMR measurements should be established.
In this study, we plan to establish reference ranges for measurements of cardiovascular structure and function at the British Heart Foundation Manchester Centre for Heart and Lung Magnetic Resonance Research (MCMR). The work will underpin many other research projects and clinical practice.
The study will involve volunteers having a CMR scan that will last about 30 minutes. No contrast agent will be administered. MRI scanning uses magnetic fields to make the pictures. The NHS website describes MRI scanning as “a painless and safe procedure” and “one of the safest medical procedures available”.
Summary of results:
Background: Cardiovascular magnetic resonance (CMR) provides gold standard, and often unique, measurements of cardiovascular structure, function and tissue character. Fundamental to such capabilities are clearly defined normal ranges. This study aimed to 1. Determine normal ranges for an extensive set of CMR measurements and the inter-scan reproducibility of these measurements; 2. Determine the impact of common variations in practice, and; 3. Systematically evaluate the findings in the context of published reference ranges.Methods: 122 healthy adults, including a minimum of 10 men and 10 women per age decile from age 20 to 70 and over, underwent assessment including CMR (3T, Siemens). 20 participants returned for a second CMR. Image analysis was performed using cvi42 by experienced observers.
Results: Age- and gender-specific reference ranges, in tabular and normogram formats, and their interscan reproducibility, are provided for left and right ventricular mass, wall thickness, volumes and ejection fraction; longitudinal, radial and circumferential LV strains; atrial area, volume and strains; native T1, T2, T2*, aortic distensibility and pulse wave velocity. Measurement reproducibility improved when baseline scans were used for reference e.g., basal slice selection. Myocardial T1 was the most reproducible of all CMR measurements. Common variations in practice resulted in significant measurement differences e.g., indexed left atrial volume was larger (47.3 vs 40.3 ml/m2, P<0.0001), and its measurement less variable, when measured from atrial short-axis cine stacks compared to biplanar measurement from 4- and 2-chamber cines. Studies using similar methods to define normal ranges demonstrate clinically-relevant differences in the normal ranges produced.
Conclusions: A comprehensive set of age and gender specific CMR reference ranges are provided, along with the impact of common variations in practice. Single centre studies, whilst meticulous in design and delivery, result in clinically-relevant variations in normal ranges. We advocate that much larger cohorts should be used to define normal ranges for common measurements, such as the Healthy Hearts Consortium.
REC name
Wales REC 6
REC reference
21/WA/0272
Date of REC Opinion
14 Sep 2021
REC opinion
Further Information Favourable Opinion