Cardiac function assessment using the free-breathing 3D cine cardiac MRI compared with conventional 2D cine in congenital heart disease patients.

Friday, February 6, 2026

2:50 PM - 3:00 PM

Location: Asia I and Hall 1 (3rd Floor)

Presenting Author(s)

Patanin Chindarungrueangkun

Radiologic technologist
Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Mueang, Chiang Mai, Thailand

Primary Author(s)

Patanin Chindarungrueangkun

Radiologic technologist
Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Mueang, Chiang Mai, Thailand

Co-Author(s)

NN

Nabhat Noparatkailas, MD

Attending Physician
Faculty of Medicine, Chiang Mai University
Mueang Chiang Mai, Chiang Mai, Thailand
PW

Pakpoom Wongyikul, MD

Attending Physician
Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Mueang, Chiang Mai, Thailand
PP

Phichayut Phinyo, MD, PhD

Attending Physician
Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Mueang, Chiang Mai, Thailand
JR

Jinnawat Rattanang, RT

Radiologic technologist
Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Mueang, Chiang Mai, Thailand
kwannapas Saengsin, MD, Ph.D

Instructor
Faculty of Medicine, Chiang Mai University
Chiang Mai, Chiang Mai, Thailand

Background: Cardiac magnetic resonance imaging (CMR) is the gold standard for evaluating ventricular size and function in patients with congenital heart disease (CHD). However, conventional 2D cine CMR requires multiple breath-holds, which may be challenging for pediatric patients and those with limited breath-holding capacity. Free-breathing 3D cine CMR offers a promising alternative, allowing for volumetric assessment without breath-hold constraints.To compare free-breathing 3D cine CMR with conventional breath-hold 2D cine CMR in assessing ventricular size and function in patients with biventricular congenital heart disease.

Methods: This prospective study included CHD patients who underwent both 2D and 3D cine CMR using a 1.5T MRI scanner. Quantitative ventricular parameters—including ventricular volumes, ejection fraction, stroke volume, and cardiac output—were compared between techniques. Image quality was scored, scan times were recorded, and agreement was assessed using paired t-tests, intraclass correlation coefficients (ICC), and Bland-Altman plots.

Results: A total of 30 patients (median age 21.3 years, 30% male) were included. The 3D cine technique significantly reduced scan time
(mean difference −33.9 minutes, p< 0.001) compared to 2D cine. Image quality was rated excellent or good in 96.6% of 3D studies.
While good agreement was observed for end-diastolic volumes, discrepancies were noted in systolic volume and derived parameters.
ICC values for ventricular volume measurements ranged from 0.995 to 0.998, indicating excellent inter-rater reliability.

Conclusion: Free-breathing 3D cine CMR provides a feasible and time-efficient alternative to conventional 2D cine CMR for assessing ventricular function in CHD patients, with high image quality and strong measurement agreement

Table 1: patient characteristic

Variable
Age (years), median (IQR)	21.3 (14.4, 25.2)
Male, n (%)	9 (30.0)
Weight (kg), mean ±SD	49.9 ±15.4
Height (cm), mean ±SD	151.7 ±11.5
Body surface area (kg/m2), mean ±SD	1.44 ±0.27
Body mass index, median (IQR)	21.2 ±4.8
Genetic syndrome, n (%)	10 (16.7)
- Noonan syndrome	1 (3.3)
< - Loeys-Dietz	1 (3.3)
< - No syndrome	27 (90)
< - Not report	1 (3.3)
Cardiac diagnosis, n (%)
< - Tetralogy of Fallot	20 (66.7)
< - Aortic stenosis	1 (3.3)
< - Bicuspid aortic valve	3 (10.0)
< - Pulmonary stenosis	1 (3.3)
< - D-Transposition of great artery	1 (3.3)
< - Double outlet right ventricle	1 (3.3)
< - Ventricular septal defect	2 (6.7)
< - Not report	1 (3.3)

Table 2: CMR technique and measurement

	3D cine	2D cine	P value	Mean differences ± SD	P10 (95% CI)
Scan time, (minutes) mean± SD	296.8 ±22.1	330.7 ±34.3	< 0.001	-33.9 ±32.4	NA
< - SAX	NA	255.4 ±23.3	NA	NA	NA
< - SAX and long axis	NA	330.7 ±34.3	NA	NA	NA
Image quality score (1-5)
1-Excellent	25 (83.3)	30 (100.0)
2-Good	4 (13.3)	0 (0.0)
3-Intermidate	1 (13.4)	0 (0.0)
4-Impaired	0 (0.0)	0 (0.0)
5-Poor	0 (0.0)	0 (0.0)
Measurement
LV mass (g) mean± SD	56.6 ±18.3	64.9 ±21.8	< 0.001	-8.3 ±8.0	33.3 (17.3-52.8)
LV end diastolic volume (ml)	118.2 ±37.9	121.8 ±41.7	0.118	-3.6 ±12.2	80.0 (61.4-92.2)
LV end diastolic volume index (ml)	82.5 ±22.8	85.8 ±4.6	0.111	-3.2 ±10.7	76.7 (57.7-90.1)
LV end systolic volume (ml)	53.6 ±25.8	50.2 ±23.4	0.047	3.4 ±8.9	30 (14.7-49.4)
LV end systolic volume index (ml)	37.1 ±16.3	35.0 ±14.1	0.098	2.1 ±6.6	30 (14.7-49.4)
LV stoke volume (m)	64.6 ±15.4	71.6 ±3.6	0.005	-7.0 ±12.5	46.7 (28.3-65.7)
LV cardiac output (L/min)	4.83 ± 1.35	4.34 ± 2.19	0.218	0.48 ± 0.38	36.7 (20.0-56.1)
LV cardiac output (ml/min)	4,830.0 ±1,352.6	4,346.7 ±2,189.4	0.218	483.3 ±384.0	36.7 (20.0-56.1)
LV ejection fraction (%)	56.4 ±8.5	60.0 ±6.0	0.005	-3.6 ±6.5	56.7 (37.4-74.5)
RV end diastolic volume (ml)	179.4 ±69.6	175.2 ±70.5	0.656	4.2 ±51.5	80.0 (61.4-92.3)
RV end diastolic volume index (ml)	125.5 ±51.8	123.2 ±49.8	0.797	2.3 ±48.9	83.3 (65.3-94.4)
RV end systolic volume (ml)	97.9 ±43.9	86.3 ±42.0	0.088	11.6 ±36.1	26.7 (12.3-45.9)
RV end systolic volume index (ml)	67.9 ±32.9	60.5 ±30.9	0.235	7.4 ±33.3	26.7 (12.3-45.9)
RV stoke volume (m)	81.5 ±30.9	88.9 ±32.0	0.075	-7.4 ±22.0	46.7 (28.3-65.7)
RV cardiac output (ml/min)	6,074.8 ±2,499.4	5,454.9 ±2,719.8	0.251	619.8 ±2,898.7	36.7 (19.9-56.1)
RV ejection fraction (%)	46.8 9.8	52.0 7.08	< 0.001	-5.1 7.3	50 (31.3-68.7)

2D-CINE and 3D-CINE cardic MRI acquired in standard orientations, Both techniques provide comparable visualization of ventricular morphology and function.

Bland-Altman plots comparing left and right ventricular end-systolic and end-diastolic volume obtained from 2D-CINE versus 3D-CINE