Table of Contents
ISRN Cardiology
Volume 2013, Article ID 268697, 9 pages
Clinical Study

The Transaxial Orientation Is Superior to Both the Short Axis and Horizontal Long Axis Orientations for Determining Right Ventricular Volume and Ejection Fraction Using Simpson's Method with Cardiac Magnetic Resonance

1Department of Diagnostic Imaging, Rhode Island Hospital, Warren Alpert School of Medicine of Brown University, 593 Eddy Street, Providence, RI 02903, USA
2Association of Alexandria Radiologists, 4660 Kenmore Avenue, Suite 525, Alexandria, VA 22304, USA
3Departments of Orthopaedics and Surgery, Warren Alpert School of Medicine of Brown University, Providence, RI 02903, USA
4Biostatistics Research, Rhode Island Hospital, Providence, RI 02903, USA
5Department of Medicine (Cardiology), University of Washington, Box 356422, Seattle, WA 98195, USA

Received 22 January 2013; Accepted 18 February 2013

Academic Editors: F. Cademartiri, Y. Furukawa, and M. Petretta

Copyright © 2013 Michael K. Atalay et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


We sought to determine which of the three orientations is the most reliable and accurate for quantifying right ventricular (RV) volume and ejection fraction (EF) by cardiac magnetic resonance using Simpson’s method. We studied 20 patients using short axis (SA), transaxial (TA), and horizontal long axis (HLA) orientations. Three readers independently traced RV endocardial contours at end-diastole and end-systole for each orientation. End-diastolic volumes (EDVs), end-systolic volumes (ESVs), and EF were calculated and compared with the 3D piecewise smooth subdivision surface (PSSS) method. The intraclass correlation coefficients among the 3 readers for EDV, ESV, and EF were 0.92, 0.82, and 0.42, respectively, for SA, 0.95, 0.92, and 0.67 for TA, and 0.85, 0.93, and 0.69 for HLA. For mean data there was no significant difference between TA and PSSS for EDV (−2.6%, 95% CI: −8.2 to 3.3%), ESV (−5.9%, −15.2 to 4.5%), and EF (1.7%, −1.5 to 4.9%). HLA was accurate for ESV (−8.9%, −18.5 to 1.8%) and EF (−0.7%, −3.8 to 2.5%) but significantly underestimated EDV (−9.8, −16.6 to −2.4%). SA was accurate for EDV (0.5%, −6.0 to 7.5%) but overestimated ESV (10.5%, 0.1 to 21.9%) and had poor interrater reliability for EF. Conclusions. The TA orientation provides the most reliable and accurate measures of EDV, ESV, and EF.