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Quantitative myocardial infarction on delayed enhancement MRI. Part II: Clinical application of an automated feature
Li-Yueh Hsu1, W Patricia Ingkanisorn, Peter Kellman
1Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health/DHHS, 10 Center Drive, Bethesda, MD 20892, USA.
Purpose:
To compare global and regional myocardial infarction (MI) measurements on clinical gadolinium-enhanced magnetic resonance (MR) images using human manual contouring and a computer algorithm previously validated by histopathology, and to study the degree to which visual assessment and human contouring of infarct extent agreed with the computer algorithm.
Materials And Methods:
Infarct size in 20 patients was measured by human manual contouring and with an automated feature analysis and combined thresholding (FACT) computer algorithm. Short-axis slices were divided into myocardial sectors for regional analysis. Extent of infarction was also graded visually by consensus of expert readers and compared to human and computer contouring.
Results:
Despite good correlations (R = 0.93-0.95) between human contouring and the FACT algorithm, human contouring overestimated infarct size by 3.8% of the left ventricle (23.8% of the MI) area (P < 0.001). Human contouring also overestimated the circumferential extent, transmural extent, and extent of infarction within a sector by 7.1%, 18.2%, and 27.9%, respectively (all P < 0.001). Both consensus reading and human contouring overestimated infarct grades compared with the FACT algorithm (P = 0.002 and P < 0.001).
Conclusion:
Clinically relevant overestimation of MI can occur in visual interpretation and in human manual contouring, particularly with respect to extent of infarction on a regional basis.
