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Nonbinary quantification technique accounting for myocardial infarct heterogeneity: Feasibility of applying percent infarct mapping in patients
Author(s) -
Mastrodicasa Domenico,
Elgavish Gabriel A.,
Schoepf U. Joseph,
Suranyi Pal,
Assen Marly,
Albrecht Moritz H.,
Cecco Carlo N.,
Geest Rob J.,
Hardy Rayphael,
Mantini Cesare,
Griffith L. Parkwood,
Ruzsics Balazs,
VargaSzemes Akos
Publication year - 2018
Publication title -
journal of magnetic resonance imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 160
eISSN - 1522-2586
pISSN - 1053-1807
DOI - 10.1002/jmri.25973
Subject(s) - intraclass correlation , medicine , nuclear medicine , limits of agreement , myocardial infarction , coefficient of variation , mathematics , population , full width at half maximum , cardiology , statistics , reproducibility , physics , environmental health , quantum mechanics
Background Binary threshold‐based quantification techniques ignore myocardial infarct (MI) heterogeneity, yielding substantial misquantification of MI. Purpose To assess the technical feasibility of MI quantification using percent infarct mapping (PIM), a prototype nonbinary algorithm, in patients with suspected MI. Study Type Prospective cohort Population Patients ( n = 171) with suspected MI referred for cardiac MRI. Field Strength/Sequence Inversion recovery balanced steady‐state free‐precession for late gadolinium enhancement (LGE) and modified Look–Locker inversion recovery (MOLLI) T 1 ‐mapping on a 1.5T system. Assessment Infarct volume (IV) and infarct fraction (IF) were quantified by two observers based on manual delineation, binary approaches (2–5 standard deviations [SD] and full‐width at half‐maximum [FWHM] thresholds) in LGE images, and by applying the PIM algorithm in T 1 and LGE images (PIM T1 ; PIM LGE ). Statistical Test IV and IF were analyzed using repeated measures analysis of variance (ANOVA). Agreement between the approaches was determined with Bland–Altman analysis. Interobserver agreement was assessed by intraclass correlation coefficient (ICC) analysis. Results MI was observed in 89 (54.9%) patients, and 185 (38%) short‐axis slices. IF with 2, 3, 4, 5SDs and FWHM techniques were 15.7 ± 6.6, 13.4 ± 5.6, 11.6 ± 5.0, 10.8 ± 5.2, and 10.0 ± 5.2%, respectively. The 5SD and FWHM techniques had the best agreement with manual IF (9.9 ± 4.8%) determination (bias 1.0 and 0.2%; P = 0.1426 and P = 0.8094, respectively). The 2SD and 3SD algorithms significantly overestimated manual IF (9.9 ± 4.8%; both P < 0.0001). PIM LGE measured significantly lower IF (7.8 ± 3.7%) compared to manual values ( P < 0.0001). PIM LGE , however, showed the best agreement with the PIM T1 reference (7.6 ± 3.6%, P = 0.3156). Interobserver agreement was rated good to excellent for IV (ICCs between 0.727–0.820) and fair to good for IF (0.589–0.736). Data Conclusion The application of the PIM LGE technique for MI quantification in patients is feasible. PIM LGE , with its ability to account for voxelwise MI content, provides significantly smaller IF than any thresholding technique and shows excellent agreement with the T 1 ‐based reference. Level of Evidence: 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;48:788–798.