Semi-automatic thresholding using the full-width at half-maximum criterion for CE-MRI accurately measured myocardial infarct size, correlating highly with postmortem pathology (r2=0.94, p<0.001).
Does semi-automatic thresholding using FWHM on CE-MRI accurately measure myocardial infarct size compared to postmortem pathology in a canine model?
Semi-automatic thresholding using the full-width at half-maximum criterion on CE-MRI provides accurate and objective infarct sizing up to 30 minutes after contrast administration in a canine model.
Effect estimate: r2 = 0.94
p-value: p=<0.001
OBJECTIVES: To identify an accurate and reproducible method to define myocardial infarct (MI) size, we conducted a study in a closed-chest canine model of acute myocardial infarction, in which MI size was measured using different thresholding techniques and by imaging at different delay times after contrast administration. BACKGROUND: The MI size by contrast-enhanced magnetic resonance imaging (CE-MRI) is directly related to long-term prognosis. However, previous measurements were done using nonuniform methods and tended to overestimate nonviable areas. METHODS: Thirteen animals underwent 90 min of coronary artery occlusion, followed by reperfusion. The CE-MRI data were acquired within 24 h after reperfusion and compared with triphenyltetrazolium chloride pathology. In the first nine animals, images were obtained approximately 15 min after gadolinium diethylene triamine penta-acetic acid (Gd-DTPA) using an inversion-recovery gradient-echo pulse sequence. To identify the most accurate method, MI size by CE-MRI was measured visually and by semi-automatic thresholding techniques, using different criteria. In four additional animals, images were acquired every 6 min until 30 min after Gd-DTPA. RESULTS: Postmortem MI size was 13.5 +/- 2.6% of left ventricular volume. Semi-automatic techniques, using full-width at half-maximum (FWHM) criterion, correlated best with postmortem data (r(2) = 0.94, p < 0.001; results confirmed by Bland-Altman plots). Using FWHM, there was no difference in MI size between different delay times after contrast (15.2 +/- 2.9% to 14.5 +/- 4.2% at 6 and 30 min, respectively; p = NS). CONCLUSIONS: When an objective technique is used to define MI size by CE-MRI, accurate infarct size measurements can be obtained from images obtained up to 30 min after contrast administration.
“The size of a heart attack matters for determining how well a patient will recover from the trauma. Current methods for measuring the size of an infarct and assessing how much damage was done are highly subjective and arbitrary. Indeed, a person who has suffered damage to more than 30 percent of the left ventricle of the heart is twice as likely to die within a year from the injury than someone who has suffered less damage, and bigger infarcts often require more aggressive drug therapy or, in the most severe cases, surgery to repair heart tissue or prevent further damage.”
Amado et al. (2004) studied Acute myocardial infarction (n=13). Contrast-enhanced magnetic resonance imaging (CE-MRI) vs. Triphenyltetrazolium chloride pathology was evaluated on Correlation of MI size by CE-MRI with postmortem data (r2 = 0.94, p=<0.001). Semi-automatic thresholding using the full-width at half-maximum criterion for CE-MRI accurately measured myocardial infarct size, correlating highly with postmortem pathology (r2=0.94, p<0.001).
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