Detection of Myocardial Tissue Alterations in Hypertrophic Cardiomyopathy Using Texture Analysis of T2-Weighted Short Inversion Time Inversion Recovery Magnetic Resonance Imaging

Abstract

Objective The aim of this study was to evaluate the usefulness of texture analysis of T2-weighted short inversion time inversion recovery (T2-STIR) for detecting myocardial tissue alterations in hypertrophic cardiomyopathy (HCM). Methods Twenty patients with HCM and 11 controls were examined. Texture analysis was performed for the hypertrophied regions with and without and abnormal hyperintensity (AHI) and for the interventricular septum of the controls on T2-STIR. T2 mapping was performed to measure myocardial T2 values. Results A gray-level nonuniformity value of 64.7 was the best discriminator between patients and controls with an area under the curve of 0.93 on a receiver operating characteristic curve. T2 values did not differ between them. The gray-level nonuniformity was significantly smaller in AHI regions than in the hypertrophied regions without AHI in HCM patients. Conclusions Texture analysis is useful for quantitatively detecting myocardial tissue altenations, including AHI, associated with HCM on T2-STIR.

Clinical Importance of Myocardial T₂ Mapping and Texture Analysis

“…[16][17][18] The texture analysis has been applied to cardiac T 2 -weighted images, which identifies diffuse myocardial tissue abnormalities associated with hypertrophic cardiomyopathy. 16 These MRI and postprocessing tools may be valuable for evaluating myocardial diseases in clinical practice. In this review, the T 2 -weighted cardiac MRI techniques, cardiac T 2 mapping, and texture analysis, and their clinical relevance for several myocardial diseases are described.…”

“…[27][28][29] ECG gating, fat and blood signal suppression, and fast data acquisition techniques are commonly applied to T 2 mapping to measure myocardial T 2 values accurately during a single breath-holding. 16,[27][28][29] Otherwise, navigator gating is used to minimize respiratory artifacts. 5 The advantages of T 2 mapping over T 1 mapping are the fewer selection of MRI sequences, the reduced variability of myocardial T 2 values (i.e., 45-55 ms) despite magnetic field strength, imaging sequences and MR machine vendors, its high sensitivity to myocardial edema, and the ability of visual comparison between T 2 mapping and T 2 -weighted images.…”

“… 17 , 18 , 31 , 32 Texture analysis has been already used in the field of cardiac MRI, resulting in the identification of myocardial tissue alterations. 16 , 31 , 32 A combination of T 2 mapping and texture analysis has been also performed to evaluate myocarditis showing the acute-onset symptoms. 33 In this case, texture analysis is applied to grey-level reflecting myocardial T 2 values.…”

“… 29 However, T 2 mapping fails to evaluate diffuse myocardial damage associated with hypertrophic cardiomyopathy, which is identified by native T 1 mapping. 16 , 29 , 43 Texture analysis can be used to assess both regional and diffuse myocardial damages on the T 2 -weighted images ( Fig. 10d ).…”

“…Texture analysis provides a lot of parameters, such as skewness, entropy, and grey-scale nonuniformity, without the need for additional sequences. 16 – 18 The texture analysis has been applied to cardiac T 2 -weighted images, which identifies diffuse myocardial tissue abnormalities associated with hypertrophic cardiomyopathy. 16 These MRI and postprocessing tools may be valuable for evaluating myocardial diseases in clinical practice.…”