PMID- 25315701 OWN - NLM STAT- MEDLINE DCOM- 20150824 LR - 20240117 IS - 1532-429X (Electronic) IS - 1097-6647 (Print) IS - 1097-6647 (Linking) VI - 16 IP - 1 DP - 2014 Oct 7 TI - Accuracy and reproducibility of semi-automated late gadolinium enhancement quantification techniques in patients with hypertrophic cardiomyopathy. PG - 85 LID - 10.1186/s12968-014-0085-x [doi] LID - 85 AB - BACKGROUND: The presence and extent of late gadolinium enhancement (LGE) has been associated with adverse events in patients with hypertrophic cardiomyopathy (HCM). Signal intensity (SI) threshold techniques are routinely employed for quantification; Full-Width at Half-Maximum (FWHM) techniques are suggested to provide greater reproducibility than Signal Threshold versus Reference Mean (STRM) techniques, however the accuracy of these approaches versus the manual assignment of optimal SI thresholds has not been studied. In this study, we compared all known semi-automated LGE quantification techniques for accuracy and reproducibility among patients with HCM. METHODS: Seventy-six HCM patients (51 male, age 54 +/- 13 years) were studied. Total LGE volume was quantified using 7 semi-automated techniques and compared to expert manual adjustment of the SI threshold to achieve optimal segmentation. Techniques tested included STRM based thresholds of >2, 3, 4, 5 and 6 SD above mean SI of reference myocardium, the FWHM technique, and the Otsu-auto-threshold (OAT) technique. The SI threshold chosen by each technique was recorded for all slices. Bland-Altman analysis and intra-class correlation coefficients (ICC) were reported for each semi-automated technique versus expert, manually adjusted LGE segmentation. Intra- and inter-observer reproducibility assessments were also performed. RESULTS: Fifty-two of 76 (68%) patients showed LGE on a total of 202 slices. For accuracy, the STRM >3SD technique showed the greatest agreement with manual segmentation (ICC = 0.97, mean difference and 95% limits of agreement = 1.6 +/- 10.7 g) while STRM >6SD, >5SD, 4SD and FWHM techniques systematically underestimated total LGE volume. Slice based analysis of selected SI thresholds similarly showed the STRM >3SD threshold to most closely approximate manually adjusted SI thresholds (ICC = 0.88). For reproducibility, the intra- and inter-observer reproducibility of the >3SD threshold demonstrated an acceptable mean difference and 95% limits of agreement of -0.5 +/- 6.8 g and -0.9 +/- 5.6 g, respectively. CONCLUSIONS: FWHM segmentation provides superior reproducibility, however systematically underestimates total LGE volume compared to manual segmentation in patients with HCM. The STRM >3SD technique provides the greatest accuracy while retaining acceptable reproducibility and may therefore be a preferred approach for LGE quantification in this population. FAU - Mikami, Yoko AU - Mikami Y AD - Stephenson Cardiac Imaging Centre at the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada. ymikami@ucalgary.ca. FAU - Kolman, Louis AU - Kolman L AD - Stephenson Cardiac Imaging Centre at the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada. loukolman@gmail.com. FAU - Joncas, Sebastien X AU - Joncas SX AD - Stephenson Cardiac Imaging Centre at the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada. sebastien.joncas@usherbrooke.ca. FAU - Stirrat, John AU - Stirrat J AD - Imaging Research Laboratory - Robarts Research Institute, Western University, London, ON, Canada. jstirrat2015@meds.uwo.ca. FAU - Scholl, David AU - Scholl D AD - Imaging Research Laboratory - Robarts Research Institute, Western University, London, ON, Canada. david.scholl@mail.utoronto.ca. FAU - Rajchl, Martin AU - Rajchl M AD - Imaging Research Laboratory - Robarts Research Institute, Western University, London, ON, Canada. mrajchl@robarts.ca. FAU - Lydell, Carmen P AU - Lydell CP AD - Stephenson Cardiac Imaging Centre at the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada. carmen.lydell@gmail.com. AD - Diagnostic Imaging, University of Calgary, Calgary, AB, Canada. carmen.lydell@gmail.com. FAU - Weeks, Sarah G AU - Weeks SG AD - Stephenson Cardiac Imaging Centre at the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada. sgweeks@ucalgary.ca. AD - Cardiac Sciences, University of Calgary, Calgary, AB, Canada. sgweeks@ucalgary.ca. FAU - Howarth, Andrew G AU - Howarth AG AD - Stephenson Cardiac Imaging Centre at the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada. ahowarth@ucalgary.ca. AD - Cardiac Sciences, University of Calgary, Calgary, AB, Canada. ahowarth@ucalgary.ca. FAU - White, James A AU - White JA AD - Stephenson Cardiac Imaging Centre at the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada. jawhit@ucalgary.ca. AD - Cardiac Sciences, University of Calgary, Calgary, AB, Canada. jawhit@ucalgary.ca. LA - eng PT - Comparative Study PT - Evaluation Study PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20141007 PL - England TA - J Cardiovasc Magn Reson JT - Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance JID - 9815616 RN - 0 (Contrast Media) RN - 0 (Organometallic Compounds) RN - 1BJ477IO2L (gadobutrol) RN - K2I13DR72L (Gadolinium DTPA) SB - IM MH - Adult MH - Aged MH - Automation MH - Cardiomyopathy, Hypertrophic/*diagnosis/pathology/physiopathology MH - *Contrast Media MH - Fibrosis MH - *Gadolinium DTPA MH - Humans MH - Image Interpretation, Computer-Assisted/*methods MH - Magnetic Resonance Imaging, Cine/*methods MH - Male MH - Middle Aged MH - Myocardium/*pathology MH - *Organometallic Compounds MH - Predictive Value of Tests MH - Registries MH - Reproducibility of Results MH - Stroke Volume MH - Ventricular Function, Left PMC - PMC4189726 EDAT- 2014/10/16 06:00 MHDA- 2015/08/25 06:00 PMCR- 2014/10/07 CRDT- 2014/10/16 06:00 PHST- 2014/04/04 00:00 [received] PHST- 2014/09/23 00:00 [accepted] PHST- 2014/10/16 06:00 [entrez] PHST- 2014/10/16 06:00 [pubmed] PHST- 2015/08/25 06:00 [medline] PHST- 2014/10/07 00:00 [pmc-release] AID - S1097-6647(23)00152-7 [pii] AID - 85 [pii] AID - 10.1186/s12968-014-0085-x [doi] PST - epublish SO - J Cardiovasc Magn Reson. 2014 Oct 7;16(1):85. doi: 10.1186/s12968-014-0085-x.