CARDIAC Differences in myocardial strain between pectus excavatum patients and healthy subjects assessed by cardiac MRI: a pilot study André Lollert 1 & Tilman Emrich 2 & Jakob Eichstädt 2 & Christoph Kampmann 3 & Tariq Abu-Tair 3 & Salmai Turial 4 & Christoph Düber 2 & Karl-Friedrich Kreitner 2 & Gundula Staatz 1 Received: 19 June 2017 /Revised: 14 August 2017 /Accepted: 18 August 2017 # European Society of Radiology 2017 Abstract Objectives To evaluate differences in myocardial strain be- tween pectus excavatum (PE) patients and healthy subjects (HS) assessed by cardiac MRI using the feature-tracking algorithm. Methods Cardiac MRI was performed in 14 PE patients and 14 HS (9:5 male to female in each group; age 11–30 years) using a 3T scanner. Post-examination analysis included man- ual biventricular contouring with volumetry and ejection frac- tion measurement by two independent radiologists. Dedicated software was used for automated strain assessment. Results In five of the PE patients, the right ventricular ejection fraction was slightly impaired (40–44 %). PE patients had a significantly higher left ventricular longitudinal strain (P=0.004), mid (P=0.035) and apical (P=0.001) circumferential strain as well as apical circumferential strain rate (P=0.001), mid right ventricular circumferential strain (P=0.008) and strain rate (P=0.035), and apical right ventricular circumferential strain (P=0.012) and strain rate (P=0.044) than HS. The right ventricular longitudinal strain and strain rate did not differ sig- nificantly between PE patients and HS. Conclusions Myocardial strain differs significantly between PE patients and HS. Higher myocardial strain in the mid and apical ventricles of PE patients indicates a compensation mechanism to enhance ventricular output against basal sternal compression. Key Points • The right ventricle is frequently affected by the pectus excavatum deformity. • Cardiac MRI revealed differences in myocardial strain in pectus excavatum patients. • Pectus excavatum patients exhibited higher strain in the mid/ apical ventricles. • A compensation mechanism to enhance ventricular output against sternal compression is possible. Keywords Cardiac MRI . Pectus excavatum . Quantitative imaging . Myocardial strain . Feature tracking Abbreviations ARVC Arrhythmogenic right ventricular cardiomyopathy FoV Field of view GRAPPA Generalized Autocalibrating Partially Parallel Acquisition HARP Harmonic phase HASTE Half-Fourier Acquisition Single Shot Turbo Spin Echo HS Healthy subjects Karl-Friedrich Kreitner and Gundula Staatz contributed equally to this work as senior authors * André Lollert andre.lollert@unimedizin-mainz.de 1 Department of Diagnostic and Interventional Radiology, Section of Paediatric Radiology, Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany 2 Department of Diagnostic and Interventional Radiology, Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany 3 Center for Diseases in Childhood and Adolescence, Division of Paediatric Cardiology and Congenital Heart Diseases, Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany 4 Department of Paediatric Surgery and Congenital Malformations, HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany Eur Radiol DOI 10.1007/s00330-017-5042-2