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Ex-vivo validation of nine algorithms for quantifying infarcts with late gadolinium enhancement cardiovascular magnetic resonance

Kopic, Sascha LU ; Heiberg, Einar LU orcid ; Engblom, Henrik LU ; Carlsson, Marcus LU ; Nordlund, David LU ; Jablonowski, Robert LU ; Kanski, Mikael LU ; Xanthis, Christos LU ; Bidhult, Sebastian LU and Aletras, Anthony H. LU orcid , et al. (2025) In Journal of Cardiovascular Magnetic Resonance 27(2).
Abstract

Background: In cardiovascular magnetic resonance, late gadolinium enhancement (LGE) is the standard method to visualize myocardial infarction (MI). Many algorithms quantifying infarct size in LGE images exist. However, only few algorithms have been validated, i.e., benchmarked against an ex-vivo measurement. Furthermore, the reported algorithm performance varies considerably between studies. Objectives: The aim of this study was to compare the performance of all infarct measurement algorithms against an ex-vivo measurement and to promote a discourse regarding advantages and disadvantages of individual measurement methods. Methods: MI was induced in 22 pigs. In-vivo LGE imaging was conducted on d0, d3 or d7 post-MI. For ex-vivo... (More)

Background: In cardiovascular magnetic resonance, late gadolinium enhancement (LGE) is the standard method to visualize myocardial infarction (MI). Many algorithms quantifying infarct size in LGE images exist. However, only few algorithms have been validated, i.e., benchmarked against an ex-vivo measurement. Furthermore, the reported algorithm performance varies considerably between studies. Objectives: The aim of this study was to compare the performance of all infarct measurement algorithms against an ex-vivo measurement and to promote a discourse regarding advantages and disadvantages of individual measurement methods. Methods: MI was induced in 22 pigs. In-vivo LGE imaging was conducted on d0, d3 or d7 post-MI. For ex-vivo validation infarct was measured using high-resolution T1-weighted images. In-vivo infarct size was measured using the full-width at half-maximum (FWHM), n-SD from remote (2,3,5, and 6 SD), feature analysis and combined thresholding (FACT), expectation maximization-weighted A priori information (EWA), Heiberg-08 and Otsu algorithms and manual delineation. No manual adjustments were made to algorithm delineations. Results: Clear differences in variance and bias were observed between algorithm-based methods, and no method performed optimally in this heterogeneous dataset where the best had a bias of −0.48 ± 3.1, −0.3 ± 4.4%, 2.3 ± 4.2% left ventricle for EWA, FWHM, and FACT, respectively. Manual delineation by experienced observers performed well with a bias of 1.9 ± 5.4%. Conclusion: EWA, Heiberg-08, FWHM, and FACT all perform on par with manual delineation, however, Heiberg-08, and FWHM are not suitable for phase sensitive inversion recovery images. The technique used to measure infarct size should be disclosed in clinical trials and in original research. Caution should be applied when comparing datasets employing different infarct quantification methods. Manual infarct delineation by experienced readers remains a reliable technique to measure infarct size.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Accuracy, Infarct size, Late gadolinium enhancement, Precision, Quantification
in
Journal of Cardiovascular Magnetic Resonance
volume
27
issue
2
article number
101915
publisher
Elsevier
external identifiers
  • scopus:105009840153
  • pmid:40449736
ISSN
1097-6647
DOI
10.1016/j.jocmr.2025.101915
language
English
LU publication?
yes
id
ae4104f6-1ebf-43cc-82e7-5bd3d90c032e
date added to LUP
2025-10-23 09:56:47
date last changed
2025-10-23 09:57:14
@article{ae4104f6-1ebf-43cc-82e7-5bd3d90c032e,
  abstract     = {{<p>Background: In cardiovascular magnetic resonance, late gadolinium enhancement (LGE) is the standard method to visualize myocardial infarction (MI). Many algorithms quantifying infarct size in LGE images exist. However, only few algorithms have been validated, i.e., benchmarked against an ex-vivo measurement. Furthermore, the reported algorithm performance varies considerably between studies. Objectives: The aim of this study was to compare the performance of all infarct measurement algorithms against an ex-vivo measurement and to promote a discourse regarding advantages and disadvantages of individual measurement methods. Methods: MI was induced in 22 pigs. In-vivo LGE imaging was conducted on d0, d3 or d7 post-MI. For ex-vivo validation infarct was measured using high-resolution T1-weighted images. In-vivo infarct size was measured using the full-width at half-maximum (FWHM), n-SD from remote (2,3,5, and 6 SD), feature analysis and combined thresholding (FACT), expectation maximization-weighted A priori information (EWA), Heiberg-08 and Otsu algorithms and manual delineation. No manual adjustments were made to algorithm delineations. Results: Clear differences in variance and bias were observed between algorithm-based methods, and no method performed optimally in this heterogeneous dataset where the best had a bias of −0.48 ± 3.1, −0.3 ± 4.4%, 2.3 ± 4.2% left ventricle for EWA, FWHM, and FACT, respectively. Manual delineation by experienced observers performed well with a bias of 1.9 ± 5.4%. Conclusion: EWA, Heiberg-08, FWHM, and FACT all perform on par with manual delineation, however, Heiberg-08, and FWHM are not suitable for phase sensitive inversion recovery images. The technique used to measure infarct size should be disclosed in clinical trials and in original research. Caution should be applied when comparing datasets employing different infarct quantification methods. Manual infarct delineation by experienced readers remains a reliable technique to measure infarct size.</p>}},
  author       = {{Kopic, Sascha and Heiberg, Einar and Engblom, Henrik and Carlsson, Marcus and Nordlund, David and Jablonowski, Robert and Kanski, Mikael and Xanthis, Christos and Bidhult, Sebastian and Aletras, Anthony H. and Arheden, Håkan}},
  issn         = {{1097-6647}},
  keywords     = {{Accuracy; Infarct size; Late gadolinium enhancement; Precision; Quantification}},
  language     = {{eng}},
  number       = {{2}},
  publisher    = {{Elsevier}},
  series       = {{Journal of Cardiovascular Magnetic Resonance}},
  title        = {{Ex-vivo validation of nine algorithms for quantifying infarcts with late gadolinium enhancement cardiovascular magnetic resonance}},
  url          = {{http://dx.doi.org/10.1016/j.jocmr.2025.101915}},
  doi          = {{10.1016/j.jocmr.2025.101915}},
  volume       = {{27}},
  year         = {{2025}},
}