Abstract
Background Myocardial scar volume quantification has been shown to predict response to medical, surgical, and device therapy. Phase sensitive inversion recovery (PSIR)-based Late Gadolinium Enhancement (LGE) image reconstruction is clinically attractive for its reduced dependence on accurate prescription of the Time from Inversion (TI time), and is becoming a preferred approach for many centers. However, while an efficient approach for the visual interpretation of myocardial injury, the influence of this approach on signal-threshold based scar volume quantification has been poorly explored. Methods A total of 80 patients with obvious myocardial scar by LGE imaging (40 ischemic, 40 non-ischemic) underwent blinded evaluations of total scar volume (%LV mass) using matched MIR and PSIR short axis images. Analysis was performed using the Signal Threshold Versus Reference Myocardium (STRM) technique at ≥2, ≥3, and ≥5 SD thresholds. In those with ischemic scar the Full Width at Half Maximum (FWHM) approach was incrementally evaluated. Linear regression and BlandAltman analyses comparing MIR verses PSIR-based scar quantification was performed. Results Linear regression analysis demonstrated an excellent correlation between PSIR and MIR-based STRM scar volumes at all 3 STRM-based thresholds for both ischemic scar (r=0.96, 0.95, and 0.88, respectively) and non-ischemic scar (r=0.86, 0.89, 0.90, respectively). FWHM analysis showed good correlation in ischemic scar (r=0.83). Bland-Altman analysis of STRM analysis showed a systematic bias with lower scar volumes produced by PSIR reconstruction images for both ischemic and non-ischemic scar. These differences were modest using STRM for ischemic scar (-3.3, -4.0 and -4.9%,
Highlights
Myocardial scar volume quantification has been shown to predict response to medical, surgical, and device therapy
Phase sensitive inversion recovery (PSIR)-based Late Gadolinium Enhancement (LGE) image reconstruction is clinically attractive for its reduced dependence on accurate prescription of the Time from Inversion (TI time), and is becoming a preferred approach for many centers
Linear regression analysis demonstrated an excellent correlation between PSIR and MIR-based STRM scar volumes at all 3 STRM-based thresholds for both ischemic scar (r=0.96, 0.95, and 0.88, respectively) and non-ischemic scar (r=0.86, 0.89, 0.90, respectively)
Summary
Myocardial scar volume quantification has been shown to predict response to medical, surgical, and device therapy. Comparison of scar signal quantification using phase corrected and conventional magnitude inversion recovery delayed enhancement imaging in patients with ischemic and non-ischemic cardiomyopathy While an efficient approach for the visual interpretation of myocardial injury, the influence of this approach on signal-threshold based scar volume quantification has been poorly explored.
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