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Differences in quantitative assessment of myocardial scar and gray zone by LGE-CMR imaging using established gray zone protocols

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Abstract

Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) imaging is the gold standard for myocardial scar evaluation. Heterogeneous areas of scar (‘gray zone’), may serve as arrhythmogenic substrate. Various gray zone protocols have been correlated to clinical outcomes and ventricular tachycardia channels. This study assessed the quantitative differences in gray zone and scar core sizes as defined by previously validated signal intensity (SI) threshold algorithms. High quality LGE-CMR images performed in 41 cardiomyopathy patients [ischemic (33) or non-ischemic (8)] were analyzed using previously validated SI threshold methods [Full Width at Half Maximum (FWHM), n-standard deviation (NSD) and modified-FWHM]. Myocardial scar was defined as scar core and gray zone using SI thresholds based on these methods. Scar core, gray zone and total scar sizes were then computed and compared among these models. The median gray zone mass was 2–3 times larger with FWHM (15 g, IQR: 8–26 g) compared to NSD or modified-FWHM (5 g, IQR: 3–9 g; and 8 g. IQR: 6–12 g respectively, p < 0.001). Conversely, infarct core mass was 2.3 times larger with NSD (30 g, IQR: 17–53 g) versus FWHM and modified-FWHM (13 g, IQR: 7–23 g, p < 0.001). The gray zone extent (percentage of total scar that was gray zone) also varied significantly among the three methods, 51 % (IQR: 42–61 %), 17 % (IQR: 11–21 %) versus 38 % (IQR: 33–43 %) for FWHM, NSD and modified-FWHM respectively (p < 0.001). Considerable variability exists among the current methods for MRI defined gray zone and scar core. Infarct core and total myocardial scar mass also differ using these methods. Further evaluation of the most accurate quantification method is needed.

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Abbreviations

FWHM:

Full width at half maximum

CMR:

Cardiac magnetic resonance

LGE-CMR:

Late gadolinium enhancement cardiac magnetic resonance

LV:

Left ventricle

LVEDV:

Left ventricular end-diastolic volume

LVESV:

Left ventricular end-systolic volume

m-FWHM:

Modified full width at half maximum

MRI:

Magnetic resonance imaging

MI:

Myocardial infarction

NSD:

N-standard deviation

ROI:

Region of interest

SCMR:

Society for cardiovascular magnetic resonance

SI:

Signal intensity

VT:

Ventricular tachycardia

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Acknowledgments

The authors would like to thank Medis Medical Imaging Systems for the strong research support and Martine Etienne-Mesubi, DrPH, for her assistance with the statistical analysis. We sincerely appreciate the administrative and research assistance of Travis L. Mann, MPH, BSRT, and Robert Altom.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Maryland Arrhythmia and Cardiology Imaging Group (MACIG), University of Maryland, Baltimore, MD, USA

    Olurotimi Mesubi, Kelechi Ego-Osuala, Jean Jeudy, Ameer Abutaleb, Michelle Niekoop, Mohammed Abdulghani, Ramazan Asoglu, Vincent See, Anastasios Saliaris, Stephen Shorofsky & Timm Dickfeld

  2. Division of Cardiology, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD, 21201, USA

    Olurotimi Mesubi, Kelechi Ego-Osuala, Stephen Synowski, Mohammed Abdulghani, Ramazan Asoglu, Vincent See, Anastasios Saliaris, Stephen Shorofsky & Timm Dickfeld

  3. Division of Cardiovascular Medicine, University of Iowa, Iowa City, IA, USA

    Olurotimi Mesubi

  4. Division of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA

    Jean Jeudy

  5. Department of Computer Science, University of Maryland, College Park, MD, USA

    James Purtilo

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  1. Olurotimi Mesubi
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Correspondence to Timm Dickfeld.

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Mesubi, O., Ego-Osuala, K., Jeudy, J. et al. Differences in quantitative assessment of myocardial scar and gray zone by LGE-CMR imaging using established gray zone protocols. Int J Cardiovasc Imaging 31, 359–368 (2015). https://doi.org/10.1007/s10554-014-0555-0

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  • DOI: https://doi.org/10.1007/s10554-014-0555-0

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