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Extracellular volume-guided late gadolinium enhancement analysis for non-ischemic cardiomyopathy: The Women’s Interagency HIV Study

Authors :
Yoko Kato
Jorge R. Kizer
Mohammad R. Ostovaneh
Jason Lazar
Qi Peng
Rob J. van der Geest
Joao A. C. Lima
Bharath Ambale-Venkatesh
Source :
BMC Medical Imaging, Vol 21, Iss 1, Pp 1-15 (2021)
Publication Year :
2021
Publisher :
BMC, 2021.

Abstract

Abstract Background Quantification of non-ischemic myocardial scar remains a challenge due to the patchy diffuse nature of fibrosis. Extracellular volume (ECV) to guide late gadolinium enhancement (LGE) analysis may achieve a robust scar assessment. Methods Three cohorts of 80 non-ischemic-training, 20 non-ischemic-validation, and 10 ischemic-validation were prospectively enrolled and underwent 3.0 Tesla cardiac MRI. An ECV cutoff to differentiate LGE scar from non-scar was identified in the training cohort from the receiver-operating characteristic curve analysis, by comparing the ECV value against the visually-determined presence/absence of the LGE scar at the highest signal intensity (SI) area of the mid-left ventricle (LV) LGE. Based on the ECV cutoff, an LGE semi-automatic threshold of n-times of standard-deviation (n-SD) above the remote-myocardium SI was optimized in the individual cases ensuring correspondence between LGE and ECV images. The inter-method agreement of scar amount in comparison with manual (for non-ischemic) or full-width half-maximum (FWHM, for ischemic) was assessed. Intra- and inter-observer reproducibility were investigated in a randomly chosen subset of 40 non-ischemic and 10 ischemic cases. Results The non-ischemic groups were all female with the HIV positive rate of 73.8% (training) and 80% (validation). The ischemic group was all male with reduced LV function. An ECV cutoff of 31.5% achieved optimum performance (sensitivity: 90%, specificity: 86.7% in training; sensitivity: 100%, specificity: 81.8% in validation dataset). The identified n-SD threshold varied widely (range 3 SD–18 SD), and was independent of scar amount (β = −0.01, p = 0.92). In the non-ischemic cohorts, results suggested that the manual LGE assessment overestimated scar (%) in comparison to ECV-guided analysis [training: 4.5 (3.2–6.4) vs. 0.92 (0.1–2.1); validation: 2.5 (1.2–3.7) vs. 0.2 (0–1.6); P

Details

Language :
English
ISSN :
14712342
Volume :
21
Issue :
1
Database :
Directory of Open Access Journals
Journal :
BMC Medical Imaging
Publication Type :
Academic Journal
Accession number :
edsdoj.433cb669f4224aeb81ca8b43c52ba794
Document Type :
article
Full Text :
https://doi.org/10.1186/s12880-021-00649-6