Relationship of image quality to decision accuracy for ARVD in MRI

Rates of agreement for diagnosing ARVC/D using MRI are not known. 45 cardiac MRI cases were sent to 13 expert radiologists. Only 1 of 45 cases had complete agreement among readers. ARVC/D was more likely to be reported present if fat in the myocardium was reported, if the RV chamber size was enlarged, and if RV configuration was abnormal. A normal LV chamber size was more likely with a negative report and an enlarged LV chamber size was just as likely to be called positive as negative. The radiologists were more likely to correctly call a no ARVC/D case negative (71%) than positive, but they were below chance (47%) in calling an ARVC/D case positive. 13% of the cases were rated as having poor image quality, 42% fair, 38% good and 7% excellent. There was no relationship between image quality and percent readers agreeing on presence/absence of ARVC/D. Interreader variability for ARVC/D using MRI cardiac film images is quite high. Image quality does not seem to be a major contributing factor. Inclusion of MRI cine loop images of the heart, standardized protocol, and utilization of the most current MRI equipment may improve reader agreement as well as diagnostic accuracy.