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Methods 161 consecutive patients with abnormal DE findings were included. Blinded visual quantification of segmental (AHA 17-segment model) scar was performed using a 5point scale, as follows; 0 = none, 1 = 1-25%, 2 = 26-50%, 3 = 51-75%, 4 = 76-100%. Each segment was assumed to represent 1/17th of the LV mass. Computerized, signal threshold-based analysis of total myocardial scar volume was also performed using cut-offs of 2, 3 and 5 SD above mean normal (nulled) myocardial signal. Comparison of visual scar quantification and signal-threshold based quantification was then performed using linear regression. Bland-Altman plots were then performed between visual scar volume and threshold-based scar volume measurements. Results Of 161 patients studied, the mean age was 57.5 ± 13.0 years. The mean LV ejection fraction was 46.3 ± 20.6%. Sixty-six (41%) patients had an ischemic DE pattern, 76 (47%) had a non-ischemic DE pattern, and 19 (12%) had a combined pattern. The Pearson correlation coefficients for visual versus threshold-based quantitative analysis at 5, 3, and 2 SD signal intensity thresholds were r = 0.81, r = 0.79 and r = 0.63 (p < 0.0001), respectively. Coefficients for patient sub-groups with ischemic and non-ischemic DE were r = 0.81, r = 0.81, r = 0.74 (p < 0.0001) and r = 0.72, r = 0.69, r = 0.46 (p = 0.0001), respectively. BlandAltman analysis of the mean difference in total scar volume between visual and threshold-based analysis (5 SD) for all patients, patients with ischemic DE, and patients with non-ischemic DE was 4.3 ± 7.9%, 4.8 ± 7.8, and 2.6 ± 7.6%, respectively.

journal of cardiovascular magnetic resonance

Validation of segmental visual scar quantification in ischemic and non-ischemic cardiomyopathy: Comparison to signal threshold analysis of delayed enhancement MR images