Myocardial infarct sizing by late gadolinium-enhanced MRI: Comparison of manual, full-width at half-maximum, and n-standard deviation methods.
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]).



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.



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.



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.
INSERM, U947, IADI, Nancy, F-54000, France.|Université de Lorraine, Nancy, F-54000, France.
Lin
L
Zhang
CHRU Nancy, Departement de Cardiologie, Nancy, F-54000, France.
Olivier
O
Huttin
Université de Lorraine, Nancy, F-54000, France.|INSERM, U961, Nancy, F-54000, France.|CHRU Nancy, Pôle Imagerie, Nancy, F-54000, France.
Pierre-Yves
PY
Marie
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.
Jacques
J
Felblinger
INSERM, U947, IADI, Nancy, F-54000, France.|INSERM, CIC-IT 1433, Nancy, F-54000, France.
Marine
M
Beaumont
INSERM, U947, IADI, Nancy, F-54000, France.|Université de Lorraine, Nancy, F-54000, France.|CHRU Nancy, Departement de Cardiologie, Nancy, F-54000, France.
Christian DE
C
Chillou
Université de Lorraine, Nancy, F-54000, France.|CHRU Nancy, Departement de Cardiologie, Nancy, F-54000, France.|INSERM, CIC-P 9501, Nancy, F-54000, France.
Nicolas
N
Girerd
INSERM, U947, IADI, Nancy, F-54000, France. damien.mandry@univ-lorraine.fr.|Université de Lorraine, Nancy, F-54000, France. damien.mandry@univ-lorraine.fr.|CHRU Nancy, Pôle Imagerie, Nancy, F-54000, France. damien.mandry@univ-lorraine.fr.
Damien
D
Mandry
D000465:Algorithms; D002908:Chronic Disease; D003287:Contrast Media / Q000008:administration & dosage; D003627:Data Interpretation, Statistical; D005260:Female; D005682:Gadolinium / Q000008:administration & dosage*; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
D003287:Contrast Media; D005682:Gadolinium
full-width at half-maximum, FWHM; late gadolinium enhancement, LGE; myocardial infarct sizing; n-standard deviation, n-SD