Point estimate and reference normality interval of MRI-derived myocardial extracellular volume in healthy subjects: a systematic review and meta-analysis

Francesco Sardanelli, Simone Schiaffino, Moreno Zanardo, Francesco Secchi, Paola Maria Cannaò, Federico Ambrogi, Giovanni Di Leo

Research output: Contribution to journalReview article

Abstract

Objectives: To estimate the MRI-derived myocardial extracellular volume (ECV) in healthy subjects together with reference normality interval. Methods: The study was registered on PROSPERO and reported according to PRISMA. In October 2017, a systematic search (MEDLINE/EMBASE) was performed for articles reporting MRI-derived ECV in healthy subjects. The pooled ECV (pECV) with 95% confidence interval (CI) was calculated using the random-effect model; the normality interval was calculated as pECV ± 2 root mean square of all study standard deviations. The Newcastle-Ottawa scale was used for assessing study quality, subgroup/meta-regression analyses for technical/biological covariates, and Egger test for publication bias risk. Results: Of 282 articles, 56 were analyzed totaling 1851 subjects with age 16–68 years, body mass index 23–28 kg/m2, and left ventricular ejection fraction 58–74%. Contrast dose varied from 0.075 to 0.200 mmol/kg. Heterogeneity was high (I2 = 92%). The pECV was 25.6% (95% CI 25.2–26.0%) with a normality interval of 19.6–31.6%. pECV was slightly increasing with age (β = 0.03%, p = 0.038) and slightly decreasing with the percentage of males (β = − 0.02%, p = 0.053). Sequence type significantly (p = 0.003) impacted on pECV: the normal interval was 19.9–31.9% for MOLLI and 20.3–33.5% for ShMOLLI. Contrast type/dose, time of acquisition, and magnetic field strength did not significantly impact pECV (p > 0.093). Quality was moderate or high in 48/56 studies (86%). No risk of publication bias (p = 0.728). Conclusions: Myocardial pECV in healthy subjects was 25.6%, increasing by 0.03% for each year of age. The ECV normality interval was 19.9–31.9% for MOLLI and 20.3–33.5% for ShMOLLI. Key Points: • The pooled estimate of normal MRI-derived ECV based on 1851 subjects was 25.6%, slightly increasing with age and slightly decreasing with the percentage of males. • MRI-derived ECV was independent of contrast type/dose and field strength but dependent on the imaging sequence. • The modeled normality reference interval of MRI-derived ECV was 19.9–31.9% for the MOLLI sequence and 20.3–33.5% for the ShMOLLI sequence.

Original languageEnglish
Pages (from-to)6620-6633
Number of pages14
JournalEuropean Radiology
Volume29
Issue number12
DOIs
Publication statusPublished - Dec 1 2019

Keywords

  • Biomarkers
  • Cardiomyopathies
  • Fibrosis
  • Magnetic resonance imaging
  • Meta-analysis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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