Infarct quantification with cardiovascular magnetic resonance using "standard deviation from remote" is unreliable : validation in multi-centre multi-vendor data
Heiberg, Einar LU ; Engblom, Henrik LU ; Carlsson, Marcus LU ; Erlinge, David LU
; Atar, Dan
; Aletras, Anthony H.
LU
and Arheden, Håkan
LU
(2022)
In Journal of Cardiovascular Magnetic Resonance
24(1).
- Abstract
Background: The objective of the study was to investigate variability and agreement of the commonly used image processing method “n-SD from remote” and in particular for quantifying myocardial infarction by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR). LGE-CMR in tandem with the analysis method “n-SD from remote” represents the current reference standard for infarct quantification. This analytic method utilizes regions of interest (ROIs) and defines infarct as the tissue with a set number of standard deviations (SD) above the signal intensity of remote nulled myocardium. There is no consensus on what the set number of SD is supposed to be. Little is known about how size and location of ROIs and underlying... (More)
Background: The objective of the study was to investigate variability and agreement of the commonly used image processing method “n-SD from remote” and in particular for quantifying myocardial infarction by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR). LGE-CMR in tandem with the analysis method “n-SD from remote” represents the current reference standard for infarct quantification. This analytic method utilizes regions of interest (ROIs) and defines infarct as the tissue with a set number of standard deviations (SD) above the signal intensity of remote nulled myocardium. There is no consensus on what the set number of SD is supposed to be. Little is known about how size and location of ROIs and underlying signal properties in the LGE images affect results. Furthermore, the method is frequently used elsewhere in medical imaging often without careful validation. Therefore, the usage of the “n-SD” method warrants a thorough validation. Methods: Data from 214 patients from two multi-center cardioprotection trials were included. Infarct size from different remote ROI positions, ROI size, and number of standard deviations (“n-SD”) were compared with reference core lab delineations. Results: Variability in infarct size caused by varying ROI position, ROI size, and “n-SD” was 47%, 48%, and 40%, respectively. The agreement between the “n-SD from remote” method and the reference infarct size by core lab delineations was low. Optimal “n-SD” threshold computed on a slice-by-slice basis showed high variability, n = 5.3 ± 2.2. Conclusion: The “n-SD from remote” method is unreliable for infarct quantification due to high variability which depends on different placement and size of remote ROI, number “n-SD”, and image signal properties related to the CMR-scanner and sequence used. Therefore, the “n-SD from remote” method should not be used, instead methods validated against an independent standard are recommended.
(Less)
- author
- Heiberg, Einar
LU
; Engblom, Henrik
LU
; Carlsson, Marcus
LU
; Erlinge, David
LU
; Atar, Dan
; Aletras, Anthony H.
LU
and Arheden, Håkan
LU
- organization
- publishing date
- 2022-12
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Journal of Cardiovascular Magnetic Resonance
- volume
- 24
- issue
- 1
- article number
- 53
- publisher
- BioMed Central (BMC)
- external identifiers
-
- scopus:85141363366
- pmid:36336693
- ISSN
- 1097-6647
- DOI
- 10.1186/s12968-022-00888-8
- language
- English
- LU publication?
- yes
- id
- 933d908c-28a4-4631-8ce1-85c4e2fc7c10
- date added to LUP
- 2022-12-05 12:52:47
- date last changed
- 2024-06-13 21:00:43
@article{933d908c-28a4-4631-8ce1-85c4e2fc7c10,
abstract = {{<p>Background: The objective of the study was to investigate variability and agreement of the commonly used image processing method “n-SD from remote” and in particular for quantifying myocardial infarction by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR). LGE-CMR in tandem with the analysis method “n-SD from remote” represents the current reference standard for infarct quantification. This analytic method utilizes regions of interest (ROIs) and defines infarct as the tissue with a set number of standard deviations (SD) above the signal intensity of remote nulled myocardium. There is no consensus on what the set number of SD is supposed to be. Little is known about how size and location of ROIs and underlying signal properties in the LGE images affect results. Furthermore, the method is frequently used elsewhere in medical imaging often without careful validation. Therefore, the usage of the “n-SD” method warrants a thorough validation. Methods: Data from 214 patients from two multi-center cardioprotection trials were included. Infarct size from different remote ROI positions, ROI size, and number of standard deviations (“n-SD”) were compared with reference core lab delineations. Results: Variability in infarct size caused by varying ROI position, ROI size, and “n-SD” was 47%, 48%, and 40%, respectively. The agreement between the “n-SD from remote” method and the reference infarct size by core lab delineations was low. Optimal “n-SD” threshold computed on a slice-by-slice basis showed high variability, n = 5.3 ± 2.2. Conclusion: The “n-SD from remote” method is unreliable for infarct quantification due to high variability which depends on different placement and size of remote ROI, number “n-SD”, and image signal properties related to the CMR-scanner and sequence used. Therefore, the “n-SD from remote” method should not be used, instead methods validated against an independent standard are recommended.</p>}},
author = {{Heiberg, Einar and Engblom, Henrik and Carlsson, Marcus and Erlinge, David and Atar, Dan and Aletras, Anthony H. and Arheden, Håkan}},
issn = {{1097-6647}},
language = {{eng}},
number = {{1}},
publisher = {{BioMed Central (BMC)}},
series = {{Journal of Cardiovascular Magnetic Resonance}},
title = {{Infarct quantification with cardiovascular magnetic resonance using "standard deviation from remote" is unreliable : validation in multi-centre multi-vendor data}},
url = {{http://dx.doi.org/10.1186/s12968-022-00888-8}},
doi = {{10.1186/s12968-022-00888-8}},
volume = {{24}},
year = {{2022}},
}