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Background While multiple cardiovascular magnetic resonance (CMR) methods provide excellent reproducibility of global circumferential and global longitudinal strain, achieving highly reproducible segmental strain is more challenging. Previous single-center studies have demonstrated excellent reproducibility of displacement encoding with stimulated echoes (DENSE) segmental circumferential strain. The present study evaluated the reproducibility of DENSE for measurement of whole-slice or global circumferential (E cc ), longitudinal (E ll ) and radial (E rr ) strain, torsion, and segmental E cc  at multiple centers. Methods Six centers participated and a total of 81 subjects were studied, including 60 healthy subjects and 21 patients with various types of heart disease. CMR utilized 3 T scanners, and cine DENSE images were acquired in three short-axis planes and in the four-chamber long-axis view. During one imaging session, each subject underwent two separate DENSE scans to assess inter-scan reproducibility. Each subject was taken out of the scanner and repositioned between the scans. Intra-user, inter-user-same-site, inter-user-different-site, and inter-user-Human-Deep-Learning (DL) comparisons assessed the reproducibility of different users analyzing the same data. Inter-scan comparisons assessed the reproducibility of DENSE from scan to scan. The reproducibility of whole-slice or global E cc , E ll  and E rr , torsion, and segmental E cc  were quantified using Bland–Altman analysis, the coefficient of variation (CV), and the intraclass correlation coefficient (ICC). CV was considered excellent for CV ≤ 10%, good for 10%   40. ICC values were considered excellent for ICC &gt; 0.74, good for ICC 0.6 &lt; ICC ≤ 0.74, fair for ICC 0.4 &lt; ICC ≤ 0.59, poor for ICC &lt; 0.4. Results Based on CV and ICC, segmental E cc  provided excellent intra-user, inter-user-same-site, inter-user-different-site, inter-user-Human-DL reproducibility and good–excellent inter-scan reproducibility. Whole-slice E cc  and global E ll  provided excellent intra-user, inter-user-same-site, inter-user-different-site, inter-user-Human-DL and inter-scan reproducibility. The reproducibility of torsion was good–excellent for all comparisons. For whole-slice E rr , CV was in the fair-good range, and ICC was in the good–excellent range. Conclusions Multicenter data show that 3 T CMR DENSE provides highly reproducible whole-slice and segmental E cc , global E ll , and torsion measurements in healthy subjects and heart disease patients.

journal of cardiovascular magnetic resonance

Reproducibility of global and segmental myocardial strain using cine DENSE at 3 T: a multicenter cardiovascular magnetic resonance study in healthy subjects and patients with heart disease