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Comparison of semi-automated scar quantification techniques using high-resolution, 3-dimensional late-gadolinium-enhancement magnetic resonance imaging

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Abstract

The quantification and modeling of myocardial scar is of expanding interest for image-guided therapy, particularly in the field of arrhythmia management. Migration towards high-resolution, three-dimensional (3D) MRI techniques for spatial mapping of myocardial scar provides superior spatial registration. However, to date no systematic comparison of available approaches to 3D scar quantification have been performed. In this study we compare the reproducibility of six 3D scar segmentation algorithms for determination of left ventricular scar volume. Additionally, comparison to two-dimensional (2D) scar quantification and 3D manual segmentation is performed. Thirty-five consecutive patients with ischemic cardiomyopathy were recruited and underwent conventional 2D late gadolinium enhancement (LGE) and 3D isotropic LGE imaging (voxel size 1.3 mm3) using a 3 T scanner. 3D LGE datasets were analyzed using six semi-automated segmentation techniques, including the signal threshold versus reference mean (STRM) technique at >2, >3, >5 and >6 standard deviations (SD) above reference myocardium, the full width at half maximum (FWHM) technique, and an optimization-based technique called hierarchical max flow (HMF). The mean ejection fraction was 32.1 ± 12.7 %. Reproducibility was greatest for HMF and FWHM techniques with intra-class correlation coefficient values ≥0.95. 3D scar quantification and modeling is clinically feasible in patients with ischemic cardiomyopathy. While several approaches show acceptable reproducibility, HMF appears superior due to maintenance of accuracy towards manual segmentations.

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Abbreviations

LGE:

Late gadolinium enhancement

CMR:

Cardiac magnetic resonance

MF:

Myocardial fibrosis

2D:

Two-dimensional

3D:

Three-dimensional

WH:

Whole-heart

SI:

Signal intensity

SAX:

Short-axis

FWHM:

Full-width-at-half-maximum

STRM:

Signal-threshold-to-reference-mean

SD:

Standard deviation

HMF:

Hierarchical max-flow

MVO:

Mean voxel overlap

AVD:

Absolute volume difference

ICC:

Intra-class correlation coefficient

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Acknowledgments

All authors have read and agree to the manuscript as written. M.R. and J.A.W. have had full access to the study data and take responsibility for its integrity. Dr. White was supported by a Clinician Scientist award with the Heart and Stroke Foundation of Ontario, Canada. This research was supported in part by the Canada Foundation of Innovation Leaders Opportunity Fund and the Ontario Research Fund, Imaging in Cardiovascular Therapeutics grant. The authors would like to thank Linda Marziali, Kris Carter (RN), Kim Krueger (RMT) and John Butler (RMT) for their contributions to this research.

Conflict of interest

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Authors and Affiliations

  1. Imaging Laboratories, Robarts Research Institute, Western University, London, ON, Canada

    Martin Rajchl, John Stirrat, Maged Goubran, David Scholl, Terry M. Peters & James A. White

  2. Division of Cardiology, Department of Medicine, Western University, London, ON, Canada

    Jeff Yu & James A. White

  3. Lawson Health Research Institute, Western University, London, ON, Canada

    Jeff Yu & James A. White

  4. Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Suite 0700 – Special Services Building, Foothills Medical Centre, 1403 – 29th Street NW, Calgary, AB, T2N 2T9, Canada

    James A. White

Authors
  1. Martin Rajchl
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  2. John Stirrat
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  3. Maged Goubran
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  4. Jeff Yu
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  5. David Scholl
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  6. Terry M. Peters
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  7. James A. White
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Correspondence to James A. White.

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Rajchl, M., Stirrat, J., Goubran, M. et al. Comparison of semi-automated scar quantification techniques using high-resolution, 3-dimensional late-gadolinium-enhancement magnetic resonance imaging. Int J Cardiovasc Imaging 31, 349–357 (2015). https://doi.org/10.1007/s10554-014-0553-2

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  • DOI: https://doi.org/10.1007/s10554-014-0553-2

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