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Jada L, Holtackers RJ, Martens B, Nies HMJM, Van De Heyning CM, Botnar RM, Wildberger JE, Ismail TF, Razavi R, Chiribiri A. Quantification of myocardial scar of different etiology using dark- and bright-blood late gadolinium enhancement cardiovascular magnetic resonance. Sci Rep 2024; 14:5395. [PMID: 38443457 PMCID: PMC10914833 DOI: 10.1038/s41598-024-52058-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 01/12/2024] [Indexed: 03/07/2024] Open
Abstract
Dark-blood late gadolinium enhancement (LGE) has been shown to improve the visualization and quantification of areas of ischemic scar compared to standard bright-blood LGE. Recently, the performance of various semi-automated quantification methods has been evaluated for the assessment of infarct size using both dark-blood LGE and conventional bright-blood LGE with histopathology as a reference standard. However, the impact of this sequence on different quantification strategies in vivo remains uncertain. In this study, various semi-automated scar quantification methods were evaluated for a range of different ischemic and non-ischemic pathologies encountered in clinical practice. A total of 62 patients referred for clinical cardiovascular magnetic resonance (CMR) were retrospectively included. All patients had a confirmed diagnosis of either ischemic heart disease (IHD; n = 21), dilated/non-ischemic cardiomyopathy (NICM; n = 21), or hypertrophic cardiomyopathy (HCM; n = 20) and underwent CMR on a 1.5 T scanner including both bright- and dark-blood LGE using a standard PSIR sequence. Both methods used identical sequence settings as per clinical protocol, apart from the inversion time parameter, which was set differently. All short-axis LGE images with scar were manually segmented for epicardial and endocardial borders. The extent of LGE was then measured visually by manual signal thresholding, and semi-automatically by signal thresholding using the standard deviation (SD) and the full width at half maximum (FWHM) methods. For all quantification methods in the IHD group, except the 6 SD method, dark-blood LGE detected significantly more enhancement compared to bright-blood LGE (p < 0.05 for all methods). For both bright-blood and dark-blood LGE, the 6 SD method correlated best with manual thresholding (16.9% vs. 17.1% and 20.1% vs. 20.4%, respectively). For the NICM group, no significant differences between LGE methods were found. For bright-blood LGE, the 5 SD method agreed best with manual thresholding (9.3% vs. 11.0%), while for dark-blood LGE the 4 SD method agreed best (12.6% vs. 11.5%). Similarly, for the HCM group no significant differences between LGE methods were found. For bright-blood LGE, the 6 SD method agreed best with manual thresholding (10.9% vs. 12.2%), while for dark-blood LGE the 5 SD method agreed best (13.2% vs. 11.5%). Semi-automated LGE quantification using dark-blood LGE images is feasible in both patients with ischemic and non-ischemic scar patterns. Given the advantage in detecting scar in patients with ischemic heart disease and no disadvantage in patients with non-ischemic scar, dark-blood LGE can be readily and widely adopted into clinical practice without compromising on quantification.
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Affiliation(s)
- Lamis Jada
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom
- King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Robert J Holtackers
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom.
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Bibi Martens
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Hedwig M J M Nies
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Caroline M Van De Heyning
- GENCOR, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | - Rene M Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom
- Institute for Biological and Medical Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile
| | - Joachim E Wildberger
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Tevfik F Ismail
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom
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Nies HMJM, Gommers S, Bijvoet GP, Heckman LIB, Prinzen FW, Vogel G, Van De Heyning CM, Chiribiri A, Wildberger JE, Mihl C, Holtackers RJ. Histopathological validation of semi-automated myocardial scar quantification techniques for dark-blood late gadolinium enhancement magnetic resonance imaging. Eur Heart J Cardiovasc Imaging 2022; 24:364-372. [PMID: 35723673 PMCID: PMC9936958 DOI: 10.1093/ehjci/jeac107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS To evaluate the performance of various semi-automated techniques for quantification of myocardial infarct size on both conventional bright-blood and novel dark-blood late gadolinium enhancement (LGE) images using histopathology as reference standard. METHODS AND RESULTS In 13 Yorkshire pigs, reperfused myocardial infarction was experimentally induced. At 7 weeks post-infarction, both bright-blood and dark-blood LGE imaging were performed on a 1.5 T magnetic resonance scanner. Following magnetic resonance imaging (MRI), the animals were sacrificed, and histopathology was obtained. The percentage of infarcted myocardium was assessed per slice using various semi-automated scar quantification techniques, including the signal threshold vs. reference mean (STRM, using 3 to 8 SDs as threshold) and full-width at half-maximum (FWHM) methods, as well as manual contouring, for both LGE methods. Infarct size obtained by histopathology was used as reference. In total, 24 paired LGE MRI slices and histopathology samples were available for analysis. For both bright-blood and dark-blood LGE, the STRM method with a threshold of 5 SDs led to the best agreement to histopathology without significant bias (-0.23%, 95% CI [-2.99, 2.52%], P = 0.862 and -0.20%, 95% CI [-2.12, 1.72%], P = 0.831, respectively). Manual contouring significantly underestimated infarct size on bright-blood LGE (-1.57%, 95% CI [-2.96, -0.18%], P = 0.029), while manual contouring on dark-blood LGE outperformed semi-automated quantification and demonstrated the most accurate quantification in this study (-0.03%, 95% CI [-0.22, 0.16%], P = 0.760). CONCLUSION The signal threshold vs. reference mean method with a threshold of 5 SDs demonstrated the most accurate semi-automated quantification of infarcted myocardium, without significant bias compared to histopathology, for both conventional bright-blood and novel dark-blood LGE.
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Affiliation(s)
| | - Suzanne Gommers
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, PO Box 5800, AZ 6202, Maastricht, The Netherlands
| | - Geertruida P Bijvoet
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands,Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Luuk I B Heckman
- Department of Physiology, Maastricht University, Maastricht, The Netherlands
| | - Frits W Prinzen
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands,Department of Physiology, Maastricht University, Maastricht, The Netherlands
| | - Gaston Vogel
- Pie Medical Imaging, Maastricht, The Netherlands
| | - Caroline M Van De Heyning
- Department of Cardiology, Antwerp University Hospital and GENCOR, University of Antwerp, Antwerp, Belgium
| | - Amedeo Chiribiri
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
| | - Joachim E Wildberger
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands,Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, PO Box 5800, AZ 6202, Maastricht, The Netherlands
| | - Casper Mihl
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands,Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, PO Box 5800, AZ 6202, Maastricht, The Netherlands
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Lee H, Han M, Yoo T, Jung C, Son HJ, Cho M. Evaluation of nuclear chromatin using grayscale intensity and thresholded percentage area in liquid-based cervical cytology. Diagn Cytopathol 2018; 46:384-389. [DOI: 10.1002/dc.23906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 01/18/2018] [Accepted: 01/31/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Hyekyung Lee
- Department of Pathology; Medical Center of Eulji University; Daejeon South Korea
| | - Myungein Han
- Bio-medical Engineering; University of Melbourne; Melbourne Australia
| | - Taejo Yoo
- Department of Pathology; Medical Center of Eulji University; Daejeon South Korea
| | - Chanho Jung
- Department of Electric Engineering; Hanbat National University; Daejeon South Korea
| | - Hyun-Jin Son
- Department of Pathology; Medical Center of Eulji University; Daejeon South Korea
| | - Migyung Cho
- School of Information and Communication; Tongmyong University; Tongmyong South Korea
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Zhang L, Huttin O, Marie PY, Felblinger J, Beaumont M, Chillou CDE, Girerd N, Mandry D. Myocardial infarct sizing by late gadolinium-enhanced MRI: Comparison of manual, full-width at half-maximum, and n-standard deviation methods. J Magn Reson Imaging 2016; 44:1206-1217. [PMID: 27096741 DOI: 10.1002/jmri.25285] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 03/31/2016] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To compare three widely used methods for myocardial infarct (MI) sizing on late gadolinium-enhanced (LGE) magnetic resonance (MR) images: manual delineation and two semiautomated techniques (full-width at half-maximum [FWHM] and n-standard deviation [SD]). MATERIALS AND METHODS 3T phase-sensitive inversion-recovery (PSIR) LGE images of 114 patients after an acute MI (2-4 days and 6 months) were analyzed by two independent observers to determine both total and core infarct sizes (TIS/CIS). Manual delineation served as the reference for determination of optimal thresholds for semiautomated methods after thresholding at multiple values. Reproducibility and accuracy were expressed as overall bias ± 95% limits of agreement. RESULTS Mean infarct sizes by manual methods were 39.0%/24.4% for the acute MI group (TIS/CIS) and 29.7%/17.3% for the chronic MI group. The optimal thresholds (ie, providing the closest mean value to the manual method) were FWHM30% and 3SD for the TIS measurement and FWHM45% and 6SD for the CIS measurement (paired t-test; all P > 0.05). The best reproducibility was obtained using FWHM. For TIS measurement in the acute MI group, intra-/interobserver agreements, from Bland-Altman analysis, with FWHM30%, 3SD, and manual were -0.02 ± 7.74%/-0.74 ± 5.52%, 0.31 ± 9.78%/2.96 ± 16.62% and -2.12 ± 8.86%/0.18 ± 16.12, respectively; in the chronic MI group, the corresponding values were 0.23 ± 3.5%/-2.28 ± 15.06, -0.29 ± 10.46%/3.12 ± 13.06% and 1.68 ± 6.52%/-2.88 ± 9.62%, respectively. A similar trend for reproducibility was obtained for CIS measurement. However, semiautomated methods produced inconsistent results (variabilities of 24-46%) compared to manual delineation. CONCLUSION The FWHM technique was the most reproducible method for infarct sizing both in acute and chronic MI. However, both FWHM and n-SD methods showed limited accuracy compared to manual delineation. J. Magn. Reson. Imaging 2016;44:1206-1217.
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Affiliation(s)
- Lin Zhang
- INSERM, U947, IADI, Nancy, F-54000, France.,Université de Lorraine, Nancy, F-54000, France
| | - Olivier Huttin
- CHRU Nancy, Departement de Cardiologie, Nancy, F-54000, France
| | - Pierre-Yves Marie
- Université de Lorraine, Nancy, F-54000, France.,INSERM, U961, Nancy, F-54000, France.,CHRU Nancy, Pôle Imagerie, Nancy, F-54000, France
| | - Jacques Felblinger
- INSERM, U947, IADI, Nancy, F-54000, France.,Université de Lorraine, Nancy, F-54000, France.,CHRU Nancy, Pôle Imagerie, Nancy, F-54000, France.,INSERM, CIC-IT 1433, Nancy, F-54000, France
| | - Marine Beaumont
- INSERM, U947, IADI, Nancy, F-54000, France.,INSERM, CIC-IT 1433, Nancy, F-54000, France
| | - Christian DE Chillou
- INSERM, U947, IADI, Nancy, F-54000, France.,Université de Lorraine, Nancy, F-54000, France.,CHRU Nancy, Departement de Cardiologie, Nancy, F-54000, France
| | - Nicolas Girerd
- Université de Lorraine, Nancy, F-54000, France.,CHRU Nancy, Departement de Cardiologie, Nancy, F-54000, France.,INSERM, CIC-P 9501, Nancy, F-54000, France
| | - Damien Mandry
- INSERM, U947, IADI, Nancy, F-54000, France. .,Université de Lorraine, Nancy, F-54000, France. .,CHRU Nancy, Pôle Imagerie, Nancy, F-54000, France.
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Yetgin T, van Kranenburg M, Ten Cate T, Duncker DJ, de Boer MJ, Diletti R, van Geuns RJM, Zijlstra F, Manintveld OC. Ischemic Postconditioning After Routine Thrombus Aspiration During Primary Percutaneous Coronary Intervention: Rationale and Design of the POstconditioning Rotterdam Trial. Catheter Cardiovasc Interv 2015; 88:508-514. [PMID: 27022882 DOI: 10.1002/ccd.26239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/31/2015] [Accepted: 08/24/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Whether ischemic postconditioning (IPOC) immediately after routine thrombus aspiration (TA) reduces infarct size (IS) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) has not been established. STUDY DESIGN The POstconditioning Rotterdam Trial (PORT) is a dual-center, prospective, open-label, randomized trial with blinded endpoint evaluation enrolling 72 subjects with first-time STEMI, and an occluded infarct-related artery (IRA) without collaterals undergoing PPCI. Subjects are randomized 1:1 to a strategy of IPOC immediately after TA followed by stenting of the IRA or to conventional percutaneous coronary intervention (PCI), including TA followed by stenting of the IRA (controls). Cardiac magnetic resonance imaging (MRI) is performed at 3-5 days after STEMI and at 3 months. The primary endpoint is IS at 3 months measured by delayed enhancement MRI. Other secondary endpoints include MRI-derived microvascular obstruction (MVO), left ventricular ejection fraction, myocardial salvage index, enzymatic IS, ST-segment resolution, myocardial blush grade, microcirculatory resistance, inflammation markers, and clinical events through 3-month follow-up. CONCLUSIONS PORT is testing the hypothesis that adding IPOC (against lethal reperfusion injury) to TA (against distal embolization and MVO) is cardioprotective and reduces ultimate IS in STEMI patients undergoing PPCI (Dutch Trial Register identifier: NTR4040). © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Tuncay Yetgin
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands.,Interuniversity Cardiology Institute of the Netherlands, ICIN-KNAW, Utrecht, the Netherlands
| | | | - Tim Ten Cate
- Department of Cardiology, UMC St. Radboud, Nijmegen, the Netherlands
| | - Dirk J Duncker
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands.,Interuniversity Cardiology Institute of the Netherlands, ICIN-KNAW, Utrecht, the Netherlands
| | - Menko-Jan de Boer
- Department of Cardiology, UMC St. Radboud, Nijmegen, the Netherlands
| | - Roberto Diletti
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands
| | - Robert-Jan M van Geuns
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands.,Department of Radiology, Erasmus MC, Rotterdam, the Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands.,Interuniversity Cardiology Institute of the Netherlands, ICIN-KNAW, Utrecht, the Netherlands
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van Kranenburg M, Magro M, Thiele H, de Waha S, Eitel I, Cochet A, Cottin Y, Atar D, Buser P, Wu E, Lee D, Bodi V, Klug G, Metzler B, Delewi R, Bernhardt P, Rottbauer W, Boersma E, Zijlstra F, van Geuns RJ. Prognostic value of microvascular obstruction and infarct size, as measured by CMR in STEMI patients. JACC Cardiovasc Imaging 2015; 7:930-9. [PMID: 25212799 DOI: 10.1016/j.jcmg.2014.05.010] [Citation(s) in RCA: 241] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 05/08/2014] [Accepted: 05/15/2014] [Indexed: 02/08/2023]
Abstract
The aim of this study was to evaluate the value of microvascular obstruction (MO) and infarct size as a percentage of left ventricular mass (IS%LV), as measured by contrast-enhanced cardiac magnetic resonance, in predicting major cardiovascular adverse events (MACE) at 2 years in patients with ST-segment elevation myocardial infarction reperfused by primary percutaneous coronary intervention. Individual data from 1,025 patients were entered into the pooled analysis. MO was associated with the occurrence of MACE, defined as a composite of cardiac death, congestive heart failure, and myocardial re-infarction (adjusted hazard ratio: 3.74; 95% confidence interval: 2.21 to 6.34). IS%LV ≥25% was not associated with MACE (adjusted hazard ratio: 0.90; 95% confidence interval: 0.59 to 1.37). The authors conclude that MO is an independent predictor of MACE and cardiac death, whereas IS%LV is not independently associated with MACE.
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Affiliation(s)
- Matthijs van Kranenburg
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Radiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Michael Magro
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Holger Thiele
- Medical Clinic II-Cardiology/Angiology/Intensive Care Medicine, University Hospital Schleswig-Holstein, University of Lübeck, Lübeck, Germany
| | - Suzanne de Waha
- Department of Cardiology, Heart Center Bad Segeberg, Bad Segeberg, Germany
| | - Ingo Eitel
- Medical Clinic II-Cardiology/Angiology/Intensive Care Medicine, University Hospital Schleswig-Holstein, University of Lübeck, Lübeck, Germany
| | - Alexandre Cochet
- Departments of Nuclear Medicine and Cardiology, Centre Georges-François Leclerc, Dijon, France
| | - Yves Cottin
- Department of Cardiology, University Hospital of Dijon, Dijon, France
| | - Dan Atar
- Department of Cardiology, Division of Medicine, Oslo University Hospital Ulleval, and Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Peter Buser
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Edwin Wu
- Departments of Medicine and Radiology, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Daniel Lee
- Departments of Medicine and Radiology, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Vicente Bodi
- Department of Cardiology, University of Valencia, Valencia, Spain
| | - Gert Klug
- Department of Cardiology, University Clinic of Internal Medicine II, Innsbruck Medical University, Innsbruck, Austria
| | - Bernhard Metzler
- Department of Cardiology, University Clinic of Internal Medicine II, Innsbruck Medical University, Innsbruck, Austria
| | - Ronak Delewi
- Department of Cardiology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Peter Bernhardt
- Department of Internal Medicine, University of Ulm, Ulm, Germany
| | | | - Eric Boersma
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Robert-Jan van Geuns
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Radiology, Erasmus Medical Center, Rotterdam, the Netherlands.
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