Abstract
Purpose
Our aim was to evaluate the reliability of visual quantification of infarct extent on delayed enhanced magnetic resonance images.
Materials and methods
Eighty patients with previous myocardial infarction underwent cine and contrast-enhanced cardiac magnetic resonance imaging. The gadolinium-enhanced images were evaluated using a segmental model with two different methods: a visual score on a 5-point scale (0 no hyperenhancement, 4 hyperenhancement > 76% of myocardial wall) and a quantitative analysis based on the manual tracing of infarct contours with automatic threshold analysis. Each segment was also assigned a wall-motion score ranging from 0 (normokinesia) to 4 (dyskinesia). Statistical evaluation was performed.
Results
Out of 1,280 segments, 322 (25.1%) showed wall-motion abnormalities with enhancement in 327 (25.5%) evaluated with visual score and in 414 (32.3%) quantitatively. Among segments with normal or mild hypokinesia, 89.2% had a delayed-enhancement score ≤ 1, whereas 80.2% of akinetic or dyskinetic segments had a score ≥ 3. Mean time required for the visual and quantitative approach was 7±3 and 18±9 min, respectively. There was strong agreement between the visual and quantitative method (k=0.92; p<0.01).
Conclusions
Visual analysis of delayed enhancement is a timesaving approach that is sufficient to assess the transmural extent of infarction. Moreover, it has high correlation with wall-motion abnormalities.
Riassunto
Obiettivo
Valutare l’affidabilità della quantificazione visiva dell’estensione dell’infarto sulle immagini di delayed enhancement.
Materiali e metodi
Ottanta pazienti con precedente infarto sono stati sottoposti a risonanza magnetica cardiaca cine e con contrasto. Le immagini post-gadolinio sono state valutate utilizzando un modello segmentale con 2 metodi: uno score visuale con scala a 5 punti ( 0=assenza di enhancement, 4=enhancement > 76% della parete) ed un’analisi quantitativa disegnando manualmente l’area dell’infarto con correzione automatica dei contorni. Ad ogni segmento è stato assegnato uno score di contrattilità.
Risultati
Dei 1280 segmenti, 322 (25,1%) presentavano contrattilità alterata con enhancement in 327 (25,5%) valutati visivamente e in 414 (32,3%) quantitativamente. Tra i segmenti con normale o lieve ipocinesia l’89,2% aveva uno score di enhancement ≤ 1, mentre l’80,2% dei segmenti discinetici o acinetici aveva uno score ≥ 3. Il tempo necessario per la misura visuale e quantitativa è stato rispettivamente di 7 ± 3 e 18 ± 9 minuti. La concordanza fra analisi visuale e quantitativa è alta (k=0,92; p<0,01).
Conclusioni
L’analisi visuale del delayed enhancement è un approccio più rapido e sufficiente per definire l’estensione transmurale dell’infarto; inoltre ha un’alta correlazione con la disfunzione contrattile.
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Ligabue, G., Fiocchi, F., Ferraresi, S. et al. How to quantify infarct size on delayed-enhancement MR images: a comparison between visual and quantitative approach. Radiol med 112, 959–968 (2007). https://doi.org/10.1007/s11547-007-0196-7
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DOI: https://doi.org/10.1007/s11547-007-0196-7