Operator Induced Variability in Cardiovascular MR: Left Ventricular Measurements and Their Reproducibility.

Purpose: To assess the intra- and inter-operator variability of the manual planning of cardiovascular magnetic resonance imaging and to evaluate the influence of these factors on the functional parameters of the left ventricle (LV). Method: The study population consisted of 10 healthy volunteers. For each subject the manual planning of the short-axis cine acquisitions was carried out twice by one operator and once by a second operator. Left ventricular volume, mass, and function were manually evaluated twice by one experienced observer, resulting in an approximation of the intra-observer variability factor. The intra- and inter-operator variation factors were estimated as the difference between the total and intra-observer variation components. Results: LV end-diastolic volume varied by 3.3% and 4.16%, and LV end-systolic volume by 5.84% and 6.23% for intra- and inter-operator studies, respectively. The variability for LV mass at end-diastole was equal to 4.23% in both studies. For the ejection fraction the variability was 3.56% and 2.97% for intra- and inter-operator studies, respectively. Comparison of reproducibility between intra- and inter-operator studies resulted in insignificant statistical differences. Bland-Altman limits of agreements revealed no systematic bias in differences between measurements with respect to their means. Reliability of the planning expressed as the angular deviation of the short-axis imaging planes amounts to 2.67 ± 1.5° and 4.99 ± 2.17° for the intra-operator and inter-operator studies, respectively. For EDV, ESV, and EF approximately 75–80% of the total variation can be explained by the within or between operator variation, while the same percentage is 60% for LVM. Conclusions: Our study confirms the excellent inter- and intra-operator reproducibility of the cardiovascular magnetic resonance measurements of the left ventricular volumes and mass in a group of healthy volunteers. [ABSTRACT FROM AUTHOR]