Left ventricular noncompaction in pediatric population: could cardiovascular magnetic resonance derived fractal analysis aid diagnosis?

Figures

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  Fig. 1. A Cardiovascular Magnetic Resonance (CMR) Trabecular Fractal Analysis using OsiriX Plugin (MATLAB graphical user interface). B Example of segmentation using fractal plug-in in a patient with left ventricular non-compaction (LVNC)

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  Fig. 2. Global (A) and maximum fractal dimension (FD) (B) in all studied subjects. Violin plots show the distribution of global (A) and maximum FD (B) in the LVNC, hyper-trabeculated group and controls. There was no overlap between the LVNC and hyper-trabeculated/ normal groups for mean maximum FD. Both global and maximum FD were higher in the LVNC group than in the hyper-trabeculation group (p < 0.001) and controls (p < 0.001). Mean ± SEM

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  Fig. 3. Distribution of maximum fractal dimension (FD) within the LV for the LVNC, hyper-trabeculation and normal groups. The LVNC group (A) had a different pattern of maximum FD distribution when compared to the hyper-trabeculated group (B) and normal (C). There was an increase in maximum FD from base to apex in the LVNC group [maximum FD at apex 1.467 (0.035)] whereas the hyper-trabeculated and normal groups showed highest maximum FD in the middle third of the LV [1.327 (0.025), 1.251 (0.042), respectively]

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  Fig. 4. Bland Altman graphs showing the intraobserver variability for all 3 methods—Fractal analysis (A), Petersen (B) and Jacquier (C). Fractal analysis showed the best intraobserver variability from all 3 methods [intraclass correlation coefficient (ICC) 0.99, 95% CI 0.98, 1.00]. The Petersen method had more intraobserver variability than the fractal method (ICC 0.95, 95% CI 0.90, 0.98) and the Jacquier method showed the worst intraobserver variability (ICC 0.82, 95% CI 0.63, 0.92)

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  Fig. 5. Bland Altman graphs showing the interobserver variability for all 3 methods—Fractal analysis (A), Petersen (B) and Jacquier (C). Interobserver variability was better using the fractal method (ICC 0.97, 95% CI 0.95, 0.99), and considerably more using the Petersen (ICC 0.92, 95% CI 0.83, 0.96) and Jacquier methods (ICC 0.74, 95% CI 0.45, 0.88)