PMID- 29446527 OWN - NLM STAT- Publisher LR - 20240227 IS - 1522-2586 (Electronic) IS - 1053-1807 (Linking) DP - 2018 Feb 15 TI - Nonbinary quantification technique accounting for myocardial infarct heterogeneity: Feasibility of applying percent infarct mapping in patients. LID - 10.1002/jmri.25973 [doi] AB - BACKGROUND: Binary threshold-based quantification techniques ignore myocardial infarct (MI) heterogeneity, yielding substantial misquantification of MI. PURPOSE: To assess the technical feasibility of MI quantification using percent infarct mapping (PIM), a prototype nonbinary algorithm, in patients with suspected MI. STUDY TYPE: Prospective cohort POPULATION: Patients (n = 171) with suspected MI referred for cardiac MRI. FIELD STRENGTH/SEQUENCE: Inversion recovery balanced steady-state free-precession for late gadolinium enhancement (LGE) and modified Look-Locker inversion recovery (MOLLI) T(1) -mapping on a 1.5T system. ASSESSMENT: Infarct volume (IV) and infarct fraction (IF) were quantified by two observers based on manual delineation, binary approaches (2-5 standard deviations [SD] and full-width at half-maximum [FWHM] thresholds) in LGE images, and by applying the PIM algorithm in T(1) and LGE images (PIM(T1) ; PIM(LGE) ). STATISTICAL TEST: IV and IF were analyzed using repeated measures analysis of variance (ANOVA). Agreement between the approaches was determined with Bland-Altman analysis. Interobserver agreement was assessed by intraclass correlation coefficient (ICC) analysis. RESULTS: MI was observed in 89 (54.9%) patients, and 185 (38%) short-axis slices. IF with 2, 3, 4, 5SDs and FWHM techniques were 15.7 +/- 6.6, 13.4 +/- 5.6, 11.6 +/- 5.0, 10.8 +/- 5.2, and 10.0 +/- 5.2%, respectively. The 5SD and FWHM techniques had the best agreement with manual IF (9.9 +/- 4.8%) determination (bias 1.0 and 0.2%; P = 0.1426 and P = 0.8094, respectively). The 2SD and 3SD algorithms significantly overestimated manual IF (9.9 +/- 4.8%; both P < 0.0001). PIM(LGE) measured significantly lower IF (7.8 +/- 3.7%) compared to manual values (P < 0.0001). PIM(LGE) , however, showed the best agreement with the PIM(T1) reference (7.6 +/- 3.6%, P = 0.3156). Interobserver agreement was rated good to excellent for IV (ICCs between 0.727-0.820) and fair to good for IF (0.589-0.736). DATA CONCLUSION: The application of the PIM(LGE) technique for MI quantification in patients is feasible. PIM(LGE) , with its ability to account for voxelwise MI content, provides significantly smaller IF than any thresholding technique and shows excellent agreement with the T(1) -based reference. LEVEL OF EVIDENCE: 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018. CI - (c) 2018 International Society for Magnetic Resonance in Medicine. FAU - Mastrodicasa, Domenico AU - Mastrodicasa D AD - Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA. AD - Department of Neuroscience and Imaging, Section of Diagnostic Imaging and Therapy - Radiology Division, SS. Annunziata Hospital, "G. d'Annunzio" University, Chieti, Italy. FAU - Elgavish, Gabriel A AU - Elgavish GA AD - Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA. FAU - Schoepf, U Joseph AU - Schoepf UJ AD - Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA. FAU - Suranyi, Pal AU - Suranyi P AD - Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA. FAU - van Assen, Marly AU - van Assen M AD - Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA. AD - University of Groningen, University Medical Center Groningen, Center for Medical Imaging - North East Netherlands, Groningen, The Netherlands. FAU - Albrecht, Moritz H AU - Albrecht MH AD - Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA. AD - Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany. FAU - De Cecco, Carlo N AU - De Cecco CN AD - Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA. FAU - van der Geest, Rob J AU - van der Geest RJ AD - Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. FAU - Hardy, Rayphael AU - Hardy R AD - Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA. FAU - Mantini, Cesare AU - Mantini C AD - Department of Neuroscience and Imaging, Section of Diagnostic Imaging and Therapy - Radiology Division, SS. Annunziata Hospital, "G. d'Annunzio" University, Chieti, Italy. FAU - Griffith, L Parkwood AU - Griffith LP AD - Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA. FAU - Ruzsics, Balazs AU - Ruzsics B AD - Department of Cardiology, Royal Liverpool and Broadgreen University Hospital, Liverpool, UK. FAU - Varga-Szemes, Akos AU - Varga-Szemes A AUID- ORCID: 0000-0002-2781-7462 AD - Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA. LA - eng PT - Journal Article DEP - 20180215 PL - United States TA - J Magn Reson Imaging JT - Journal of magnetic resonance imaging : JMRI JID - 9105850 OTO - NOTNLM OT - T1 mapping OT - late gadolinium enhancement OT - magnetic resonance imaging OT - myocardial infarct heterogeneity OT - myocardial infarct quantification OT - percent infarct mapping EDAT- 2018/02/16 06:00 MHDA- 2018/02/16 06:00 CRDT- 2018/02/16 06:00 PHST- 2017/12/11 00:00 [received] PHST- 2018/01/24 00:00 [accepted] PHST- 2018/02/16 06:00 [entrez] PHST- 2018/02/16 06:00 [pubmed] PHST- 2018/02/16 06:00 [medline] AID - 10.1002/jmri.25973 [doi] PST - aheadofprint SO - J Magn Reson Imaging. 2018 Feb 15. doi: 10.1002/jmri.25973.