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Sources of variability in quantification of cardiovascular magnetic resonance infarct size - reproducibility among three core laboratories.

Publication ,  Journal Article
Klem, I; Heiberg, E; Van Assche, L; Parker, MA; Kim, HW; Grizzard, JD; Arheden, H; Kim, RJ
Published in: J Cardiovasc Magn Reson
August 11, 2017

BACKGROUND: Acute myocardial infarct (AMI) size depicted by late gadolinium enhancement cardiovascular magnetic resonance (CMR) is increasingly used as an efficacy endpoint in randomized trials comparing AMI therapies. Infarct size is quantified using manual planimetry (MANUAL), visual scoring (VISUAL), or automated techniques using signal-intensity thresholding (AUTO). Although AUTO is considered the most reproducible, prior studies did not account for the subjective determination of endocardial/epicardial borders, which all methods require. For MANUAL and VISUAL, prior studies did not address how to treat intermediate signal intensities due to partial volume. METHODS: To assess sources of variability, AMI size was measured in 30 patients and 12 controls by 3 core-laboratories using 8 methods, each separated by more than 2 months time (n = 720 evaluations). The methods were: (1,2) AUTOSegment, AUTOFWHM (using Segment software or the full-width-at-half-maximum algorithm, respectively); (3,4) AUTO-UCSegment, AUTO-UCFWHM (user correction for endocardial border pixels, no-reflow, etc.); (5) MANUAL; (6) MANUAL-ISI (adjustment for intermediate signal-intensities); (7) VISUAL; (8) VISUAL-ISI. RESULTS: Mean infarct size varied between 16.8% and 27.2% of LV mass depending on method. Even automated techniques with no user interaction for infarct borders resulted in significant within-patient variability given the need to subjectively trace endocardial/epicardial contours. The coefficient-of-variation (CV) was 10.6% and 14.6% for AUTOSegment and AUTOFWHM, respectively. For manual and visual categories, reproducibility was improved when intermediate signal-intensities were considered (MANUAL-ISI vs MANUAL: CV = 8.3% vs 14.4%; p = 0.03; VISUAL-ISI vs VISUAL: CV = 8.4% vs 10.9%; p = 0.01). For AUTO-UCSegment, MANUAL-ISI, and VISUAL-ISI (best technique in each category) within-patient variability due to the quantification method was less than 10% of total variability, and the required sample sizes for detecting a 5% absolute difference in infarct size were 62, 63, and 62 patients, respectively. CONCLUSION: Among CMR core-laboratories, an important source of variability in infarct size quantification is the subjective delineation of endocardial/epicardial borders. When intermediate signal intensities are considered in manual planimetry and visual scoring, reproducibility and impact on sample size are similar to automated techniques.

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Published In

J Cardiovasc Magn Reson

DOI

EISSN

1532-429X

Publication Date

August 11, 2017

Volume

19

Issue

1

Start / End Page

62

Location

England

Related Subject Headings

  • United States
  • Sweden
  • ST Elevation Myocardial Infarction
  • Reproducibility of Results
  • Predictive Value of Tests
  • Organometallic Compounds
  • Observer Variation
  • Nuclear Medicine & Medical Imaging
  • Myocardium
  • Middle Aged
 

Citation

APA
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Klem, I., Heiberg, E., Van Assche, L., Parker, M. A., Kim, H. W., Grizzard, J. D., … Kim, R. J. (2017). Sources of variability in quantification of cardiovascular magnetic resonance infarct size - reproducibility among three core laboratories. J Cardiovasc Magn Reson, 19(1), 62. https://doi.org/10.1186/s12968-017-0378-y
Klem, Igor, Einar Heiberg, Lowie Van Assche, Michele A. Parker, Han W. Kim, John D. Grizzard, Håkan Arheden, and Raymond J. Kim. “Sources of variability in quantification of cardiovascular magnetic resonance infarct size - reproducibility among three core laboratories.J Cardiovasc Magn Reson 19, no. 1 (August 11, 2017): 62. https://doi.org/10.1186/s12968-017-0378-y.
Klem I, Heiberg E, Van Assche L, Parker MA, Kim HW, Grizzard JD, et al. Sources of variability in quantification of cardiovascular magnetic resonance infarct size - reproducibility among three core laboratories. J Cardiovasc Magn Reson. 2017 Aug 11;19(1):62.
Klem, Igor, et al. “Sources of variability in quantification of cardiovascular magnetic resonance infarct size - reproducibility among three core laboratories.J Cardiovasc Magn Reson, vol. 19, no. 1, Aug. 2017, p. 62. Pubmed, doi:10.1186/s12968-017-0378-y.
Klem I, Heiberg E, Van Assche L, Parker MA, Kim HW, Grizzard JD, Arheden H, Kim RJ. Sources of variability in quantification of cardiovascular magnetic resonance infarct size - reproducibility among three core laboratories. J Cardiovasc Magn Reson. 2017 Aug 11;19(1):62.
Journal cover image

Published In

J Cardiovasc Magn Reson

DOI

EISSN

1532-429X

Publication Date

August 11, 2017

Volume

19

Issue

1

Start / End Page

62

Location

England

Related Subject Headings

  • United States
  • Sweden
  • ST Elevation Myocardial Infarction
  • Reproducibility of Results
  • Predictive Value of Tests
  • Organometallic Compounds
  • Observer Variation
  • Nuclear Medicine & Medical Imaging
  • Myocardium
  • Middle Aged