Related Experiment Video
Updated: Mar 28, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Comparison between visual grading and planimetric quantification of microvascular obstruction extent assessment in
Marc Sirol1, Heger Gzara2, Etienne Gayat3
1Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM UMR 1018 ; EpReC Team Assistance Publique - Hôpitaux de Paris, Imagerie Cardiaque et Vasculaire interventionnelle, Hôpital Ambroise Paré, 9 avenue du Général De Gaulle, 92104, Boulogne-Billancourt, France. marc.sirol@gmail.com.
Objectives:
Current methods for infarct size and microvascular obstruction (MVO) quantification by cardiac magnetic resonance (CMR) imaging rely on planimetry. This method is time-consuming. We sought to evaluate a direct assessment of MVO severity based on visual evaluation and to compare it to a reference method.
Methods:
CMR was performed in 112 consecutive patients after reperfused myocardial infarction. MVO was estimated by direct visual assessment based on a three-grade severity scale (MVO 1, mild; MVO 2, moderate; MVO 3, severe) on late gadolinium-enhancement (LGE).
Results:
MVO was present in 69 patients (61.6 %). Quantitative MVO extent significantly increased accordingly to visual MVO grading (p < 0.01). Correlation between visual grading and quantitative assessment was excellent (r = 0.92, IQR 0.88-0.95, p < 0.001). CMR inter- and intraobserver variability for visual MVO evaluation was low (κ = 0.93 and κ = 0.96, respectively), whereas quantitative MVO assessment suffered from moderate agreement (interobserver, bias = -0.81 ± 1.8 g LV; intraobserver, -0.83 ± 2.1 g LV). Visual evaluation was significantly faster than reference method (0.65 ± 0.37 vs. 10.2 ± 2.9 min, p < 0.0001).
Conclusions:
MVO severity based on direct visual assessment on LGE images is feasible, rapid, reproducible and agrees very well with quantitative methods, with a very low inter- and intraobserver variability. Our approach could be used for routine evaluation in patients undergoing CMR after acute myocardial infarction.
Key Points:
• Microvascular obstruction direct visual evaluation is feasible, rapid and highly reproducible. • Microvascular obstruction direct visual evaluation correlates well with quantification by planimetry. • Microvascular obstruction or no-reflow phenomenon is determined on late gadolinium-enhanced images. • Cardiac MRI is useful for myocardial damage assessment after myocardial infarction.
Insights
Visual assessment of microvascular obstruction (MVO) using cardiac MRI is a fast, reproducible, and accurate method. This direct visual evaluation of MVO on late gadolinium-enhancement images correlates well with quantitative techniques.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Cardiac magnetic resonance (CMR) imaging is crucial for assessing myocardial infarction.
- Current quantification of microvascular obstruction (MVO) using planimetry is time-consuming.
Purpose of the Study:
- To evaluate a direct visual assessment of MVO severity.
- To compare visual MVO assessment with a reference quantitative method.
Main Methods:
- CMR was performed in 112 patients post-myocardial infarction.
- MVO severity was visually graded (mild, moderate, severe) on late gadolinium-enhancement (LGE) images.
Main Results:
- Visual MVO grading showed a significant increase in quantitative MVO extent (p < 0.01).
- Excellent correlation was found between visual grading and quantitative assessment (r = 0.92).
- Visual assessment was significantly faster (0.65 min) than the quantitative method (10.2 min) with low inter- and intraobserver variability.
Conclusions:
- Direct visual assessment of MVO on LGE images is feasible, rapid, reproducible, and agrees well with quantitative methods.
- This visual approach offers a reliable alternative for routine MVO evaluation in clinical practice.
