P363Feasibility of dynamic assessment of 3D tricuspid annulus morphology by magnetic resonance imaging

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Purpose: Cardiac magnetic resonance (CMR) is considered the reference technique for the evaluation of right ventricular function. Nevertheless, the assessment of tricuspid valve morphology using CMR is intrinsically limited due to its 2D nature. Our purpose was to test the feasibility of a new approach to study the evolution of tricuspid annulus (TA) morphology through the cardiac cycle.Methods: Ten healthy subjects (age 31±10 yrs) were enrolled in the study. CMR imaging (1.5 T, spatial resolution 0.74 mm, slice thickness 6 mm) of 18 long-axis planes, evenly rotated of 10° along the axis ideally passing through the center of TA (Figure, left), was performed using SSFP sequences (20 frames per cardiac cycle). Custom software was developed: in each plane, TA points were manually identified at end-systole and end-diastole, and then automatically tracked based on the normalized cross-correlation between subsequent frames. As a result, a 3D model of TA in each frame and several parameters considered: area, height, minimum and maximum diameters, and the peak systolic excursion along the TA perimeter.Results: Feasibility of both acquisition and post-processing was 100%. CMR acquisition took about 3 minutes, while TA analysis 10 minutes including manual correction when needed. The position of the automatically tracked TA points was visually judged by an expert cardiologist, resulting accurate in 87% of the cases. A representative example of the obtained parameter is shown in the figure.Conclusions: We demonstrated analysis of TA morphology through the cardiac cycle is feasible and accurate, requiring minimal manual interaction. This approach could serve as a starting point for studying the physiologic dynamic of TA, with potential benefits in patient evaluation and surgical planning.

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