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Heiberg E, Engblom H, Carlsson M, Erlinge D, Atar D, Aletras AH, Arheden H. Infarct quantification with cardiovascular magnetic resonance using "standard deviation from remote" is unreliable: validation in multi-centre multi-vendor data. J Cardiovasc Magn Reson 2022; 24:53. [PMID: 36336693 PMCID: PMC9639305 DOI: 10.1186/s12968-022-00888-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 09/08/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The objective of the study was to investigate variability and agreement of the commonly used image processing method "n-SD from remote" and in particular for quantifying myocardial infarction by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR). LGE-CMR in tandem with the analysis method "n-SD from remote" represents the current reference standard for infarct quantification. This analytic method utilizes regions of interest (ROIs) and defines infarct as the tissue with a set number of standard deviations (SD) above the signal intensity of remote nulled myocardium. There is no consensus on what the set number of SD is supposed to be. Little is known about how size and location of ROIs and underlying signal properties in the LGE images affect results. Furthermore, the method is frequently used elsewhere in medical imaging often without careful validation. Therefore, the usage of the "n-SD" method warrants a thorough validation. METHODS Data from 214 patients from two multi-center cardioprotection trials were included. Infarct size from different remote ROI positions, ROI size, and number of standard deviations ("n-SD") were compared with reference core lab delineations. RESULTS Variability in infarct size caused by varying ROI position, ROI size, and "n-SD" was 47%, 48%, and 40%, respectively. The agreement between the "n-SD from remote" method and the reference infarct size by core lab delineations was low. Optimal "n-SD" threshold computed on a slice-by-slice basis showed high variability, n = 5.3 ± 2.2. CONCLUSION The "n-SD from remote" method is unreliable for infarct quantification due to high variability which depends on different placement and size of remote ROI, number "n-SD", and image signal properties related to the CMR-scanner and sequence used. Therefore, the "n-SD from remote" method should not be used, instead methods validated against an independent standard are recommended.
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Affiliation(s)
- Einar Heiberg
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, Lund University, 222 42, Lund, SE, Sweden.
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden.
| | - Henrik Engblom
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, Lund University, 222 42, Lund, SE, Sweden
| | - Marcus Carlsson
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, Lund University, 222 42, Lund, SE, Sweden
- Laboratory of Clinical Physiology, National Heart, Lung, and Blood Institute, NIH, Bethesda, USA
| | - David Erlinge
- Department of Cardiology, Skåne University Hospital, Lund University Hospital, Lund University, Lund, Sweden
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital Ullevål, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anthony H Aletras
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, Lund University, 222 42, Lund, SE, Sweden
- Laboratory of Computing, Medical Informatics and Biomedical-Imaging Technologies, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Håkan Arheden
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, Lund University, 222 42, Lund, SE, Sweden
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