title: Standardizing the definition of hyperenhancement in the quantitative assessment of infarct size and myocardial viability using delayed contrast-enhanced CMR.
abstract: OBJECTIVE
  To evaluate a standardized definition of delayed hyperenhancement in the analysis of contrast-enhanced cardiac magnetic resonance (ceCMR) imaging.
  
  
  METHODS
  CeCMR was performed in 15 patients with chronic ischemic heart disease. Delayed hyperenhancement was analyzed both by visual analysis by an experienced team of observers, and after thresholding the window setting of the images at 2, 3, 4, 5, and 6 SD above the mean signal intensity of remote, normal myocardium in the same slice. In each patient, total infarct size (TIS) and segmental infarct extent (SIE) were calculated.
  
  
  RESULTS
  TIS and SIE were 22.9 +/- 12.2 mL and 32 +/- 28% after visual analysis. Thresholding the window setting at 2, 3, 4, and 6 SD above signal intensity of remote caused a 40%, 31%, and 17% increase (p < 0.007) and a 7% decrease (p = NS) in TIS, and a 75%, 41%, and 16% increase and 22% decrease in SIE (p < 0.001), respectively. There was no difference between visual analysis and analysis after thresholding at 5 SD.
  
  
  CONCLUSIONS
  Analyzing ceCMR with a standardized definition of hyperenhancement related to the signal of remote, nonenhanced myocardium may result in considerable overestimation of infarct size at the usual cut-off of 2 SD.
authors.affiliation: Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands. o.bondarenko@vumc.nl
authors.forename: Olga
authors.initials: O
authors.lastname: Bondarenko
authors.forename: Aernout M
authors.initials: AM
authors.lastname: Beek
authors.forename: Mark B M
authors.initials: MB
authors.lastname: Hofman
authors.forename: Harald P
authors.initials: HP
authors.lastname: Kühl
authors.forename: Jos W R
authors.initials: JW
authors.lastname: Twisk
authors.forename: Willem G
authors.initials: WG
authors.lastname: van Dockum
authors.forename: Cees A
authors.initials: CA
authors.lastname: Visser
authors.forename: Albert C
authors.initials: AC
authors.lastname: van Rossum
mesh_terms: D003287:Contrast Media; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D009203:Myocardial Infarction / Q000473:pathology*; D009206:Myocardium / Q000473:pathology*; D014022:Tissue Survival
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA