Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association

Cerqueira, Manuel D.; Weissman, Neil J.; Dilsizian, Vasken; Jacobs, Alice K.; Kaul, Sanjiv; Laskey, Warren K.; Pennell, Dudley J; Rumberger, John A.; Ryan, Thomas J.; Verani, Mario S.

doi:10.1067/mje.2002.123374

Cited by 1,496 publications

(1,936 citation statements)

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“…Comprehensive myocardial coverage is critically important, as it is likely to determine sensitivity to the detection of coronary artery disease. Although a greater number of short axis slices are acquired by some centers, three slices has been considered by many as sufficient, ensuring myocardial coverage includes 16 of the 17 myocardial segments (30). There was sufficient time within the RR interval at stress in many cases, particularly with hEPI, to have acquired at least one long axis image to cover the apex.…”

Section: Discussionmentioning

confidence: 99%

“…For subsequent analysis of these parameters the average of measurements obtained by both observers was used. On a second occasion observers reviewed images together, blinded to the sequence used and the patients clinical status, recording epicardial territories consistent with the segments of hypoperfused myocardium (30). In cases of disagreement between the two observers, a consensus decision was reached.…”

Section: Methodsmentioning

confidence: 99%

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Direct comparison of myocardial perfusion cardiovascular magnetic resonance sequences with parallel acquisition

Lyne

Gatehouse

Assomull

et al. 2007

Magnetic Resonance Imaging

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Purpose:To directly compare the three main myocardial perfusion cardiovascular magnetic resonance (CMR) sequences incorporating parallel acquisition methods. Materials and Methods:In 15 subjects (12 men, 57 Ϯ 15.7 years) referred for diagnostic coronary angiography, we acquired first-pass perfusion images (0.1 mmol/kg gadolinium-DTPA) at rest and during adenosine (140 g/kg/ min) on three separate occasions using three sequences incorporating parallel acquisition methods and approximately equivalent spatiotemporal resolution: hybrid echo planar imaging (hEPI), steady-state free precession (SSFP), and gradient echo imaging (GRE). We calculated the contrast-to-noise ratio (CNR) of each scan and blinded observers scored the presence and severity of artifacts (1, worst to 4, best), diagnostic confidence (0, low to 2, high), transmurality, area, and epicardial vessel territory of perfusion defects.Results: CNR was greatest with SSFP and least with hEPI (13.15 vs 7.85 P Ͻ 0.001). The most artifacts were recorded with SSFP and least with hEPI (2.00 vs 3.03 P Ͻ 0.001). Observers were significantly more confident in reporting hEPI images (1.6 hEPI vs 0.9 SSFP, P Ͻ 0.001). Results for GRE were intermediate for all assessments. Conclusion:The hEPI sequence scored best for diagnostic performance despite the SSFP sequence having greater CNR. This trial favors hEPI for clinical myocardial perfusion CMR and suggests CNR should not be the sole criterion used to gauge the best candidate sequence.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Direct comparison of myocardial perfusion cardiovascular magnetic resonance sequences with parallel acquisition

Lyne

Gatehouse

Assomull

et al. 2007

Magnetic Resonance Imaging

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“…12 For SPECT interpretation, the myocardium of the left ventricle was divided into 17 segments, according to previous reports. 20,21 Two independent experienced observers blindly evaluated the reconstructed images, the polar maps and the three-dimensional images of both stress and rest studies by scoring the radiotracer uptake in each of the 17 regions, using a 5-point scoring system (0: normal uptake; 1: mildly reduced uptake; 2: moderately reduced uptake; 3: severely reduced uptake and 4: no uptake). 20,21 In 12 studies (5.8%) in which discordance between the two observers was detected (difference 42 in SSS and/or SRS values), the view of a third observer was requested and the disagreement was resolved by consensus.…”

Section: Spect Myocardial Perfusion Imagingmentioning

confidence: 99%

Impact of ACE and ApoE polymorphisms on myocardial perfusion: correlation with myocardial single photon emission computed tomographic imaging

et al. 2009

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Coronary artery disease is associated with multiple genetic and environmental risk factors. In this study, we evaluated the correlation of angiotensin l-converting enzyme (ACE) (I/D) and ApoE gene polymorphisms (E2, E3, E4 and g.-219G/T) with myocardial perfusion. We examined 410 patients using exercise-rest myocardial perfusion single photon emission computed tomography (SPECT), in which the summed stress score (SSS), summed rest score (SRS) and summed difference score (SDS) indexes were calculated. Homozygotes for the ACE D allele had greater mean values of SSS (Po0.001) and SDS (Po0.001). In addition, E3 homozygotes, E4 heterozygotes and E4 homozygotes had significantly higher values of SSS and SDS compared with E3 heterozygotes (Po0.001); E4 homozygotes had significantly higher values of SSS and SDS compared with E3 homozygotes. Furthermore, for the g.-219G4T polymorphic site at the promoter region of ApoE gene, the mean values of SSS and SDS were significantly higher for T heterozygotes/homozygotes than for GG homozygotes. Adjusting for all demographic and clinical data using multiple linear regression analysis it was found that ACE D and both ApoE genotypes were independent predictors with a cumulative contribution for the prediction of SSS and SDS. Furthermore, logistic regression analysis revealed that all three genotypes had an independent predictive ability for abnormal SSS (SSS42). These data provide the first evidence of an association and significant cumulative contribution of the aforementioned genotypes in myocardial perfusion with E4 allele having the strongest association followed by ACE D and ApoE g.-219T alleles.

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“…The myocardium was segmented into 16 regions (26). The reader categorized each segment as viable, nontransmurally nonviable, or transmurally nonviable based on the image enhancement.…”

Section: Image Analysismentioning

confidence: 99%

Free‐breathing delayed hyperenhanced imaging of the myocardium: A clinical application of real‐time navigator echo imaging

Goldfarb

Shinnar

2006

Magnetic Resonance Imaging

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Purpose:To compare a free-breathing (FB) acquisition with the current standard of breath-holding (BH) in a clinical setting using identical two-dimensional MR pulse sequences for imaging of myocardial delayed hyperenhancement. Materials and Methods:Two-dimensional gadolinium-enhanced images were acquired using FB and BH techniques in 18 subjects to evaluate delayed enhancement of myocardial infarction. The FB acquisition used a navigator echo to monitor the position of the right hemidiaphragm for respiratory gating and correction. Visual analysis using a 16-segment model, quantitative signal difference to noise ratios, and percent left ventricle (LV) viability measurements for the two acquisition types were statistically compared.Results: An excellent agreement between two-dimensional BH and two-dimensional FB acquisitions was found. In one patient, a nontransmural infarct was seen only in the FB images. There were no statistically significant differences in the number of infarcted segments or the measured signal difference to noise ratios (SDNR) between the two methods. Linear regression and Bland Altman analysis of the percentage LV viable myocardium yielded a good fit and narrow limits of agreement. Conclusion:An FB navigator echo acquisition can be effectively used in the setting of myocardial delay hyperenhanced imaging. Image quality is similar or superior to that of BH imaging. RECENT STUDIES have shown that reversible myocardial dysfunction can be identified using gadoliniumenhanced MRI (1-5). Images of the myocardium are made after a delay of several minutes following T1 shortening contrast agent administration; this technique is often called "delayed hyperenhanced (DHE) imaging." Nonviable tissue is identified as having a slightly higher concentration than viable tissue of an intravenously injected gadolinium contrast agent. An inversion recovery (IR) T1 weighted sequence (6) is used to minimize the signal intensity from viable myocardium. The inversion time (TI) parameter of the pulse sequence, which is the time between the inversion pulse and the acquired data, is adjusted to minimize the image intensity of healthy myocardium. In these images, nonviable myocardium is identified as hyperenhancing regions.To reduce or eliminate artifacts from motion of the heart during the normal respiratory cycle, image data are most commonly acquired over several heartbeats using pulse sequences synchronized with the cardiac cycle and during suspended respiration. Two-dimensional breath-hold (BH) IR spoiled gradient-echo imaging has been validated in animal models and human studies (7-10) and is currently the standard of reference for MR DHE imaging. Since one slice is acquired each BH, this technique requires many breath-holds for the evaluation of the entire left ventricle. Single-slice BH MRI techniques (11,12) have been proposed and adopted to reduce acquisition time, increase image contrast, resolution, or spatial coverage, but BH-DHE techniques remain limited by BH time and patient cooperation.Free-breathing (F...

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Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association

Cited by 1,496 publications

References 7 publications

Direct comparison of myocardial perfusion cardiovascular magnetic resonance sequences with parallel acquisition

Direct comparison of myocardial perfusion cardiovascular magnetic resonance sequences with parallel acquisition

Impact of ACE and ApoE polymorphisms on myocardial perfusion: correlation with myocardial single photon emission computed tomographic imaging

Free‐breathing delayed hyperenhanced imaging of the myocardium: A clinical application of real‐time navigator echo imaging

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