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Magnetization-transfer flow-independent dark-blood delayed enhancement cardiac MRI optimizes discrimination of ST-elevation myocardial infarct borders

医学 核医学 心肌梗塞 磁共振成像 血流 置信区间 图像质量 心脏病学 一致性 神经组阅片室 内科学 放射科 神经学 图像(数学) 精神科 人工智能 计算机科学
作者
Paulina Poskaite,Christian Kremser,Mathias Pamminger,Felix Troger,Gert Reiter,Sebastian J. Reinstadler,Bernhard Metzler,Wolfgang G Rehwald,Raymond J. Kim,Agnes Mayr
出处
期刊:European Radiology [Springer Science+Business Media]
标识
DOI:10.1007/s00330-024-11192-7
摘要

Abstract Objectives To prospectively compare image quality and infarct sizing methods between magnetization-transfer “flow-independent dark-blood delayed enhancement” (MT-FIDDLE) and standard “bright-blood”-late gadolinium enhancement (LGE) cardiac-magnetic-resonance (CMR) sequence. Methods “Bright-blood”-LGE and MT-FIDDLE sequence were acquired in 110 patients at 4 days ( n = 33), 4 months ( n = 39) and 12 months ( n = 38) after acute ST-elevation myocardial infarction (STEMI). Subjective image quality, including confidence in infarct segmentation and blood-pool bordering, were each rated on a 4-point Likert scale. Objective image quality was assessed by the detectability index (DI). Infarct volumes derived via full-width at half-maximum (FWHM) and different number of standard deviations (“n-SD”) methods on MT-FIDDLE images were compared with FWHM and reference 5-SD results from “bright-blood-LGE images. Results Overall subjective median image quality was excellent for both LGE sequences. Qualitative analysis revealed a significantly higher confidence in infarct segmentation and in blood-pool bordering for MT-FIDDLE as compared to “bright-blood”-LGE (all p < 0.001). Infarct volumes assessed by the FWHM technique on MT-FIDDLE and “bright-blood”-LGE showed excellent agreement overall (Concordance correlation coefficient, CCC = 0.96). The 3-SD technique for MT-FIDDLE showed the best agreement with the 5-SD method for “bright-blood”-LGE overall (CCC = 0.94), as well as in the subgroup with excellent confidence in infarct segmentation on “bright-blood”-LGE (CCC = 0.96). DI of scar versus LV blood-pool was higher for MT-FIDDLE (8.9 ± 5.5) compared to “bright-blood”-LGE sequence (2.0 ± 1.5; p < 0.001). Conclusion MT-FIDDLE significantly optimizes the discrimination between myocardial infarction and adjacent blood-pool in STEMI patients. As compared to the established 5-SD technique on “bright-blood”-LGE, the 3-SD method on MT-FIDDLE results in consistent infarct volumes. Key Points Question Does magnetization-transfer “flow-independent dark-blood delayed enhancement” (MT-FIDDLE) offer any benefits over standard “bright-blood”-late gadolinium enhancement (LGE) cardiac-magnetic-resonance (CMR) for identifying STEMI infarct borders? Findings MT-FIDDLE image quality was higher than LGE CMR and measured infarct volume comparability to the standard 5-SD-threshold-technique. Clinical relevance MT-FIDDLE facilitates the assessment of myocardial infarctions at the subendocardial border, improving the discrimination between myocardial infarction and adjacent blood-pool in STEMI patients.
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