Auto‐Threshold quantification of late gadolinium enhancement in patients with acute heart disease

Vermès, Emmanuelle; Childs, Helene; Carbone, Iacopo; Barckow, Philipp; Friedrich, Matthias G.

doi:10.1002/jmri.23814

Cited by 50 publications

(48 citation statements)

References 27 publications

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“…The good performance of the ATA in the detection of LGE matched the results of a recent study [13] that identified the Otsu algorithm [14] as the best method for fully automated thresholding. Ridler's algorithm that was used in the present study, is very similar to Otsu's algorithm.…”

Section: Discussionsupporting

confidence: 77%

Integrated Assessment of Cardiac PET/MRI: Co-Registered PET and MRI Polar Plots by Mutual MR-Based Segmentation of the Left Ventricular Myocardium

Nensa¹,

Poeppel²,

Tezgah³

et al. 2017

WJCD

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Background: In the present study, we sought to describe a procedure for the creation of co-registered positron emission tomography (PET) and magnetic resonance imaging (MRI) polar plots of cardiac PET/MRI examinations, validate the resulting plots against available standard methods in patients with myocardial infarction and provide examples that demonstrate the advantage of the novel approach over existing standards. Methods: Co-registered LGE and PET short-axis images were transformed into polar maps based on a radial sampling pattern. LGE was automatically detected using an automated thresholding algorithm (ATA). In 20 PET/MRI examinations in patients with acute myocardial infarction, agreement between manual LGE assessment and the ATA classification was calculated. Also agreement between MRI-segmentation based PET polar plots and standard PET polar plots (created with the Corridor4DM software package) was assessed. Results: No statistically significant difference in infarct sizes between manual and ATA segmentation was found (p = 0.12). Both methods were highly correlated (Pearson's r = 0.96, p < 0.01). Bland-Altman analysis revealed lower and upper limits of agreement of −4.7 g and 3.6 g. Agreement between MRI-segmentation based PET polar plots and standard PET polar plots was very high (mean kappa of 0.91 ± 0.10; p < 0.01 in all cases). In three additional patients with myocardial inflammation, the software successfully created polar plots that demonstrate How to cite this paper: Nensa, F., Poeppel, T.D., Tezgah, E., Heusch, P., Nassenstein, K., Forsting, M., Bockisch, A., Erbel, R. and 92the location and extent of pathologic tracer uptake in the left ventricular myocardium. Conclusion: A straightforward software approach for the creation of co-registered PET and MRI polar plots was described and successfully demonstrated in PET/MRI studies of myocardial infarction and inflammation.

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Section: Discussionsupporting

confidence: 77%

Integrated Assessment of Cardiac PET/MRI: Co-Registered PET and MRI Polar Plots by Mutual MR-Based Segmentation of the Left Ventricular Myocardium

Nensa¹,

Poeppel²,

Tezgah³

et al. 2017

WJCD

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“…[26,27] There is no histological validation in humans and hence no ‘gold standard’ quantification. We thus used manual assessment as has been used previously [6,12], however derived from the mean of repeated analyses by three experienced CMR cardiologists to increase the robustness of our reference standard.…”

Section: Discussionmentioning

confidence: 99%

“…The same signal intensity threshold was set for all slices on 5/6/7/8 SD and FWHM thresholding. OAT automatically calculates a unique signal intensity threshold for each slice by dividing the greyscale signal intensity histogram in each slice into 2 groups (enhanced, normal) based on the signal intensity threshold giving the least intraclass variance (lowest sum of variances) and thus most homogeneity of signal intensities within each group (Figure 2) [11,12]. The only user input, and thus potential sources of variation are the endocardial and epicardial contours, and manual correction of noise artefact.…”

Section: Methodsmentioning

confidence: 99%

Comparison of semi-automated methods to quantify infarct size and area at risk by cardiovascular magnetic resonance imaging at 1.5T and 3.0T field strengths

et al. 2015

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BackgroundThere is currently no gold standard technique for quantifying infarct size (IS) and ischaemic area-at-risk (AAR [oedema]) on late gadolinium enhancement imaging (LGE) and T2-weighted short tau inversion recovery imaging (T2w-STIR) respectively. This study aimed to compare the accuracy and reproducibility of IS and AAR quantification on LGE and T2w-STIR imaging using Otsu’s Automated Technique (OAT) with currently used methods at 1.5T and 3.0T post acute ST-segment elevation myocardial infarction (STEMI).MethodsTen patients were assessed at 1.5T and 10 at 3.0T. IS was assessed on LGE using 5–8 standard-deviation thresholding (5-8SD), full-width half-maximum (FWHM) quantification and OAT. AAR was assessed on T2w-STIR using 2SD and OAT. Accuracy was assessed by comparison with manual quantification. Interobserver and intraobserver variabilities were assessed using Intraclass Correlation Coefficients and Bland-Altman analysis. IS using each technique was correlated with left ventricular ejection fraction (LVEF).ResultsFWHM and 8SD-derived IS closely correlated with manual assessment at both field strengths (1.5T: 18.3 ± 10.7% LV Mass [LVM] with FWHM, 17.7 ± 14.4% LVM with 8SD, 16.5 ± 10.3% LVM with manual quantification; 3.0T: 10.8 ± 8.2% LVM with FWHM, 11.4 ± 9.0% LVM with 8SD, 11.5 ± 9.0% LVM with manual quantification). 5SD and OAT overestimated IS at both field strengths. OAT, 2SD and manually quantified AAR closely correlated at 1.5T, but OAT overestimated AAR compared with manual assessment at 3.0T. IS and AAR derived by FWHM and OAT respectively had better reproducibility compared with manual and SD-based quantification. FWHM IS correlated strongest with LVEF.ConclusionsFWHM quantification of IS is accurate, reproducible and correlates strongly with LVEF, whereas 5SD and OAT overestimate IS. OAT accurately assesses AAR at 1.5T and with excellent reproducibility. OAT overestimated AAR at 3.0T and thus cannot be recommended as the preferred method for AAR quantification at 3.0T.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-015-1007-1) contains supplementary material, which is available to authorized users.

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“…The Ridler algorithm is an iterative version of the Otsu method, which was demonstrated to be accurate and reproducible for defining infarct size in patients with acute myocardial infarction (16). On the basis of the wave-front theory, areas of microvascular obstruction (with no reflow) were defined as subthreshold areas located under LGE areas (in the epicardial-endocardial direction) and were automatically detected with a radial search algorithm.…”

Section: Mr Imaging Protocolmentioning

confidence: 99%

Integrated FDG PET/MR Imaging for the Assessment of Myocardial Salvage in Reperfused Acute Myocardial Infarction

Nensa¹,

Poeppel²,

Tezgah³

et al. 2015

Radiology

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Auto‐Threshold quantification of late gadolinium enhancement in patients with acute heart disease

Abstract: Automatic thresholding using OAT may serve as an accurate and reproducible method to quantify irreversible myocardial injury in acute heart disease.

Cited by 50 publications

References 27 publications

Integrated Assessment of Cardiac PET/MRI: Co-Registered PET and MRI Polar Plots by Mutual MR-Based Segmentation of the Left Ventricular Myocardium

Integrated Assessment of Cardiac PET/MRI: Co-Registered PET and MRI Polar Plots by Mutual MR-Based Segmentation of the Left Ventricular Myocardium

Comparison of semi-automated methods to quantify infarct size and area at risk by cardiovascular magnetic resonance imaging at 1.5T and 3.0T field strengths

Integrated FDG PET/MR Imaging for the Assessment of Myocardial Salvage in Reperfused Acute Myocardial Infarction

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