Cardiac MRI (CMR) is the key exam for Fallot patients but remains tricky. The CMR report should at least mention left and right ventricle end-diastole volumes (Vl and Vr), ejection fraction (EFl and EFr) and pulmonary regurgitation (PR). Obviously, these variables are linked together by basic physiology rules and indeed Vl×EFl=Vr×EFr×(1-PR). We investigated the interest of using such formula as quality check during Fallot CMR exams in our center.

98 consecutive CMR examinations for Fallot (or Fallot-like) cardiopathy between 2010 and 2014 were retrospectively included. The exams failing to pass the formula (with a 10% tolerance) constituted the Invalid-group and a control group of the same size was also constituted. CMR of both groups were randomly submitted to a blinded senior observer. The inter-observer limits of agreements were compared for the different variables within both groups.

(Fig. 1) 12 CMR (12%) failed to pass the validation formula. From the 24 reanalyzed CMR, only 4 failed to pass the formula (all from the Invalid-group). Two had persistent defect (VSD or ASD) which were not mentioned to the radiologist and not detected during the CMR. Two had significant artefacts in the aorta or pulmonary trunk due to sterna wires. The inter-observer disagreements for the 8 other CMR of the Invalid-group concerned the Right ventricle end-diastole volume (P<0.05).

The use of a simple formula as quality check of CMR examinations for Fallot patients was useful to detect a total of 12% of CMR with issues. 8% of the CMR corresponded to uncertain right ventricle contours, 2% to persistent septal defects that should have been noticed during the examination and 2% to unreliable aortic or pulmonary flow due to artifacts. The formula could have permitted either to detect the anomalies or at least to conclude that the quality of the exams was impaired.