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Updated: Jun 14, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Quantitative analysis of late gadolinium enhancement in hypertrophic cardiomyopathy
Giovanni Donato Aquaro1, Vincenzo Positano, Alessandro Pingitore
1MRI laboratory, Foundation G, Monasterio Regione Toscana/CNR, Pisa, Italy. aquaro@ifc.cnr.it
Insights
The Rayleigh curve method accurately quantifies myocardial fibrosis in Hypertrophic Cardiomyopathy (HCM) patients using Cardiovascular Magnetic Resonance (CMR) imaging. This approach is more precise than standard fixed cut-off methods for LGE analysis.
Area of Science:
- Cardiology
- Medical Imaging
- Biophysics
Background:
- Cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) detects myocardial fibrosis in Hypertrophic Cardiomyopathy (HCM).
- Accurate quantification of LGE is crucial for HCM patient management.
- Comparing automated LGE quantification methods is essential for improving diagnostic accuracy.
Purpose of the Study:
- To compare the accuracy of three automated methods for quantifying LGE in HCM patients.
- To evaluate the performance of SD2, SD6, and Rayleigh Curve (RC) methods in LGE quantification.
- To determine the most reliable method for assessing myocardial fibrosis in HCM.
Main Methods:
- CMR imaging with LGE was performed on 40 HCM patients and 20 controls.
- Three automated LGE quantification methods were compared: SD2, SD6, and RC.
- The RC method utilizes a Rayleigh curve derived from image background noise to establish signal intensity cut-offs.
Main Results:
- Patients with HCM showed significantly lower concordance with the Rayleigh curve compared to controls (63.7% vs 92.2%).
- A concordance cut-off of <82.9% demonstrated high sensitivity (97.1%) and specificity (92.3%) in distinguishing HCM from controls.
- The RC method received higher scores, and while SD6 showed similar extent measurements, it exhibited under/overestimation in 12%/5% of HCM patients.
Conclusions:
- The Rayleigh curve method provides a more accurate quantification of myocardial fibrosis in LGE images compared to fixed cut-off methods.
- Automated LGE quantification using a Rayleigh curve-derived cut-off improves diagnostic accuracy for HCM.
- This study highlights the superiority of the RC method for LGE analysis in HCM.
Background:
Cardiovascular magnetic resonance (CMR) with the late gadolinium enhancement (LGE) technique allows the detection of myocardial fibrosis in Hypertrophic cardiomyopathy (HCM). The aim of this study was to compare different methods of automatic quantification of LGE in HCM patients.
Methods:
Forty HCM patients (mean age 48 y, 30 males) and 20 normal subjects (mean age 38 y, 16 males) underwent CMR, and we compared 3 methods of quantification of LGE: 1) in the SD2 method a region of interest (ROI) was placed within the normal myocardium and enhanced myocardium was considered as having signal intensity >2 SD above the mean of ROI; 2) in the SD6 method enhanced myocardium was defined with a cut-off of 6 SD above mean of ROI; 3) in the RC method a ROI was placed in the background of image, a Rayleigh curve was created using the SD of that ROI and used as ideal curve of distribution of signal intensity of a perfectly nulled myocardium. The maximal signal intensity found in the Rayleigh curve was used as cut-off for enhanced myocardium. Parametric images depicting non enhanced and enhanced myocardium was created using each method. Three investigators assigned a score to each method by the comparison of the original LGE image to the respective parametric map generated.
Results:
Patients with HCM had lower concordance between the measured curve of distribution of signal intensity and the Rayleigh curve than controls (63.7 +/- 12.3% vs 92.2 +/- 2.3%, p < 0.0001).A cut off of concordance < 82.9% had a 97.1% sensitivity and 92.3% specificity to distinguish HCM from controls. The RC method had higher score than the other methods. The average extent of enhanced myocardium measured by SD6 and Rayleigh curve method was not significant different but SD6 method showed underestimation of enhancement in 12% and overestimation in 5% of patients with HCM.
Conclusions:
Quantification of fibrosis in LGE images with a cut-off derived from the Rayleigh curve is more accurate than using a fixed cut-off.
