Diagnostic Accuracy and Clarity of Steady‑State Free Precession Imaging of Cardiac Valve Morphology in Congenital Heart Disease

Evaluation of cardiac valve morphology has not been considered an indication for cardiac magnetic resonance imaging (MRI) due to suboptimal imaging quality. Our study aims to evaluate cine of cardiac magnetic resonance-steady-state free precession (CMR-SSFP) imaging quality and diagnostic accuracy in the assessment of cardiac valve morphology for congenital heart disease.

We retrospectively reviewed consecutive pediatric/congenital cardiac MRI cases. A 5-grade diagnostic clarity score was assigned to the aortic valve annulus and leaflets, tricuspid valve and mitral valve annuli, leaflets, chordae, and papillary muscles by examination of standard cine CMR-SSFP imaging. Among patients with aortic valve imaging, we compared morphologic diagnosis by CMR-SSFP to echocardiography. High-quality diagnostic imaging was defined as a clarity score of 1 or 2.

There were a total of 234 cardiac MRI studies evaluated with a total of 1892 valve components. The majority of valve annuli, leaflets, and papillary muscles had high diagnostic clarity score 64%–80% of the time – the tricuspid valve papillary muscles had a high diagnostic clarity score 53% of the time. Among the 39 cases with aortic valve imaging, CMR-SSFP correctly identified the aortic valve morphology including the affected commissure.

CMR-SSFP produces high diagnostic quality imaging of cardiac valve morphology in congenital/pediatric cardiac MRI. The valve components with the highest diagnostic clarity score are tricuspid and mitral valve annuli, leaflets and papillary muscles, and aortic valve annuli and leaflets. Aortic valve morphology can be diagnosed with a high degree of reliability