title: Visual estimation of the extent of myocardial hyperenhancement on late gadolinium-enhanced CMR in patients with hypertrophic cardiomyopathy.
abstract: OBJECTIVE
  So far different approaches have been used to quantify late gadolinium enhancement (LGE) in patients with hypertrophic cardiomyopathy (HCM), but there is no general consensus on the gold standard, since histological data are scarce. The aim of our study was to investigate whether the determination of LGE in patients with HCM using a semiquantitative score based on the 17-segment model is feasible and has comparable accuracy to manual planimetry.
  
  
  METHODS
  Forty-two patients with HCM underwent LGE cardiovascular magnetic resonance imaging. Determination of LGE by planimetry based on visual assessment was used as reference standard. Then the extent of LGE was assessed using a semiquantitative score based on the standard left ventricular 17-segment model. Each segment was scored for the distribution of LGE. The resulting summed score expressed as percentage of the maximum possible score was thereafter compared with the manual planimetric evaluation of LGE, expressed as a percentage of the left ventricular myocardial area.
  
  
  RESULTS
  In 28 patients (66%), LGE was present. There was a good correlation between the semiquantitative score and the planimetric approach (r=0.89; y=0.819x+2.45; standard error of estimation=2.327; P<.0001). Additionally, the Bland-Altmann plot showed a high concordance between the two approaches (mean of the difference +1.7%). The inter- and intraobserver limits of agreement and the coefficients of repeatability based on measurements with the semiquantitative score of the extent of LGE were superior to planimetric measurements. Besides, the time requirement for the LGE determination using the semiquantitative score was found to be significantly reduced compared to manual planimetry (median 2 vs. 10 min).
  
  
  CONCLUSIONS
  Thus, a reliable global index of the size of the LGE is feasible and can easily be obtained from visual assessment with a semiquantitative score of the extent of the hyperenhancement.
authors.affiliation: 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany. christina.doesch@umm.de
authors.forename: Christina
authors.initials: C
authors.lastname: Doesch
authors.forename: Sonia
authors.initials: S
authors.lastname: Huck
authors.forename: Christoph K
authors.initials: CK
authors.lastname: Böhm
authors.forename: Henrik
authors.initials: H
authors.lastname: Michaely
authors.forename: Stephan
authors.initials: S
authors.lastname: Fluechter
authors.forename: Dariusch
authors.initials: D
authors.lastname: Haghi
authors.forename: Dietmar
authors.initials: D
authors.lastname: Dinter
authors.forename: Martin
authors.initials: M
authors.lastname: Borggrefe
authors.forename: Theano
authors.initials: T
authors.lastname: Papavassiliu
mesh_terms: D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis*; D003287:Contrast Media; D005240:Feasibility Studies; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA