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MRI evaluation in patients with mitral regurgitation

Authors : Dr Alessia Gimelli, Dr Pier Giorgio Masci and Prof. Massimo Lombardi.


 

Mitral regurgitation is visible on cine images as an area of signal loss extending from the mitral valve into left atrium. The signal loss can be graded in a similar way to x-ray angiography or color-Doppler echocardiography:

  • grade 1 = signal loss close to the valve;
  • grade 2 = signal loss extending into the left atrium;
  • grade 3 = signal loss filling the whole of the left atrium;
  • grade 4 = signal loss in atrium throughout systole.

This semi-quantitative method has been validated although its reproducibility is quite unsatisfactory and it is affected by the same intrinsic limitations as color-Doppler echocardiography and invasive angiography.

http://www.youtube.com/watch?v=zjuvHn06jFA
http://www.youtube.com/watch?v=HGfstqGvTRA
MRI in MR secondary to dilated cardiomyopathy: 2 chambers long axis view. MRI in MR secondary to dilated cardiomyopathy: 4 chambers long axis axis view.

 

http://www.youtube.com/watch?v=OZkPUcJgyx4
http://www.youtube.com/watch?v=ektlQLPFg3I
MRI in MR secondary to dilated cardiomyopathy: 4 chambers long axis axis view. MRI in MR secondary to billowing of leaflets: 4 chambers long axis axis view.

 

http://www.youtube.com/watch?v=du98zoFmbic
MRI in MR secondary to mitral valve prolapse: 3 chambers long axis axis view

 

A combination of left ventricular volumetric quantification and phase-contrast imaging performed at level of ascending aorta, however, allows accurate and reproducible assessment of mitral regurgitation. In the presence of regurgitation, the difference in cardiac output between the left ventricle and ascending aorta yields the regurgitation volume. Regurgitation fraction is calculated by normalizing the regurgitation volume to the left ventricular stroke volume. Use of regurgitation fraction should be recommended as this parameter has the advantage to be relatively insensitive to concomitant other valve abnormalities. Regurgitation fraction limits for mitral and aortic regurgitations have been estimated by using cardiac MRI: mild ≤ 15%; moderate 16-25%; moderate-severe 26-48%; severe > 48%.