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Myocardial infarct sizing by late gadolinium-enhanced MRI: Comparison of manual, full-width at half-maximum, and
Lin Zhang1,2, Olivier Huttin3, Pierre-Yves Marie2,4,5
1INSERM, U947, IADI, Nancy, F-54000, France.
Purpose:
To compare three widely used methods for myocardial infarct (MI) sizing on late gadolinium-enhanced (LGE) magnetic resonance (MR) images: manual delineation and two semiautomated techniques (full-width at half-maximum [FWHM] and n-standard deviation [SD]).
Materials And Methods:
3T phase-sensitive inversion-recovery (PSIR) LGE images of 114 patients after an acute MI (2-4 days and 6 months) were analyzed by two independent observers to determine both total and core infarct sizes (TIS/CIS). Manual delineation served as the reference for determination of optimal thresholds for semiautomated methods after thresholding at multiple values. Reproducibility and accuracy were expressed as overall bias ± 95% limits of agreement.
Results:
Mean infarct sizes by manual methods were 39.0%/24.4% for the acute MI group (TIS/CIS) and 29.7%/17.3% for the chronic MI group. The optimal thresholds (ie, providing the closest mean value to the manual method) were FWHM30% and 3SD for the TIS measurement and FWHM45% and 6SD for the CIS measurement (paired t-test; all P > 0.05). The best reproducibility was obtained using FWHM. For TIS measurement in the acute MI group, intra-/interobserver agreements, from Bland-Altman analysis, with FWHM30%, 3SD, and manual were -0.02 ± 7.74%/-0.74 ± 5.52%, 0.31 ± 9.78%/2.96 ± 16.62% and -2.12 ± 8.86%/0.18 ± 16.12, respectively; in the chronic MI group, the corresponding values were 0.23 ± 3.5%/-2.28 ± 15.06, -0.29 ± 10.46%/3.12 ± 13.06% and 1.68 ± 6.52%/-2.88 ± 9.62%, respectively. A similar trend for reproducibility was obtained for CIS measurement. However, semiautomated methods produced inconsistent results (variabilities of 24-46%) compared to manual delineation.
Conclusion:
The FWHM technique was the most reproducible method for infarct sizing both in acute and chronic MI. However, both FWHM and n-SD methods showed limited accuracy compared to manual delineation. J. Magn. Reson. Imaging 2016;44:1206-1217.
Insights
The full-width at half-maximum (FWHM) technique offers the most reproducible method for measuring myocardial infarct (MI) size. However, both FWHM and n-standard deviation (SD) methods show limited accuracy compared to manual delineation in late gadolinium-enhanced (LGE) MRI.
Area of Science:
- Cardiovascular Imaging
- Medical Physics
- Radiology
Background:
- Accurate myocardial infarct (MI) sizing is crucial for assessing cardiac damage and guiding treatment.
- Late gadolinium-enhanced (LGE) magnetic resonance (MR) imaging is a standard technique for visualizing myocardial scar tissue.
- Manual delineation is considered the reference standard but is time-consuming and subjective.
Purpose of the Study:
- To compare the accuracy and reproducibility of three methods for quantifying myocardial infarct size on LGE-MR images.
- Methods compared include manual delineation, full-width at half-maximum (FWHM), and n-standard deviation (SD) semiautomated techniques.
Main Methods:
- Analysis of 3T phase-sensitive inversion-recovery (PSIR) LGE images from 114 patients with acute myocardial infarction (MI) at two time points (acute and chronic).
- Manual delineation served as the reference for determining optimal thresholds for semiautomated methods.
- Reproducibility and accuracy were assessed using Bland-Altman analysis and expressed as bias ± 95% limits of agreement.
Main Results:
- The full-width at half-maximum (FWHM) technique demonstrated the best reproducibility for both total infarct size (TIS) and core infarct size (CIS) measurements in both acute and chronic MI.
- Optimal thresholds were identified as FWHM30% and 3SD for TIS, and FWHM45% and 6SD for CIS.
- Despite good reproducibility, both FWHM and n-SD methods exhibited limited accuracy and higher variability compared to manual delineation.
Conclusions:
- The FWHM technique is the most reproducible method for infarct sizing in both acute and chronic myocardial infarction.
- Semiautomated methods (FWHM and n-SD) show limitations in accuracy when compared to manual delineation.
- Further optimization or alternative semiautomated approaches may be needed to improve accuracy in LGE-MR-based infarct sizing.
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