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Computer-assisted calculation of myocardial infarct size shortens the evaluation time of contrast-enhanced cardiac MRI
Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Clinical Physiology .
Ryhovs sjukhus Jönköping.
Lunds universitet Lund.
Ryhovs sjukhus Jönköping.
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2008 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, Vol. 28, no 1Article in journal (Refereed) Published
Abstract [en]

Background: Delayed enhancement magnetic resonance imaging depicts scar in the left ventricle which can be quantitatively measured. Manual segmentation and scar determination is time consuming. The purpose of this study was to evaluate a software for infarct quantification, to compare with manual scar determination, and to measure the time saved. Methods: Delayed enhancement magnetic resonance imaging was performed in 40 patients where myocardial perfusion single photon emission computed tomography imaging showed irreversible uptake reduction suggesting a myocardial scar. After segmentation, the semi-automatic software was applied. A scar area was displayed, which could be corrected and compared with manual delineation. The different time steps were recorded with both methods. Results: The software shortened the average evaluation time by 12.4min per cardiac exam, compared with manual delineation. There was good correlation of myocardial volume, infarct volume and infarct percentage (%) between the two methods, r = 0.95, r = 0.92 and r = 0.91 respectively. Conclusions: A computer software for myocardial volume and infarct size determination cut the evaluation time by more than 50% compared with manual assessment, with maintained clinical accuracy. © 2007 The Authors Journal compilation 2007 Blackwell Publishing Ltd.

Place, publisher, year, edition, pages
2008. Vol. 28, no 1
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-42739DOI: 10.1111/j.1475-097X.2007.00765.xLocal ID: 68501OAI: diva2:263596
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2011-01-10
In thesis
1. Infarct size and myocardial function: A methodological study
Open this publication in new window or tab >>Infarct size and myocardial function: A methodological study
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The size of a myocardial infarction (MI) and the concurrent effect on left ventricular (LV) function are essential for decisions regarding patient care and treatment. Images produced with the late gadolinium enhancement (LGE) technique visualize the scar with high spatial resolution. The general aim of this thesis was to study methods to assess scar size in chronic MI, primarily with the use of LGE, and to relate area‐at‐risk and LV function to scar size.

Myocardial perfusion single photon emission computed tomography (MPS) is a well established technique for the assessment of MI size. Our study showed that there is a fairly good agreement between MPS and LGE in the determination of scar size. Wall motion score index (WMSI) correlated moderately with both infarct size and infarct extent determined with LGE.

Manual delineation of myocardium and scar is time consuming and subjective and there is a need for help in objective assessment. We showed that the semi‐automatic computer software, Segment, reduced the evaluation time ≥50% with maintained clinical accuracy.

The segmented scar sequence ‐ inversion recovery fast gradient echo, IR_FGRE, is a well documented sequence for scar determination, however, the sequence requires regular heart rhythm and breath holding for good imaging. We showed that a single shot scar sequence ‐ steady state free precession, SS_SSFP ‐ acquired under free breathing in patients with ongoing atrial fibrillation, had significantly better image quality than IR_FGRE. The scar size and the error of determination were equal for both sequences and the examination time was shorter with SS_SSFP.

In an acute MI it is essential to know the myocardial area‐at‐risk. WMSI is clinically the most common way of assessing LV function, but is highly subjective. Tissue Doppler imaging with strain measurements is considered objective and quantitative in assessing both global and regional LV function compared to WMSI. Our results showed that WMSI is superior to strain for the detection of scar with transmurality ≥50% in patients with acute MI. Also WMSI correlated better than strain on all levels (global, regional, segmental) with final scar size determined with LGE.

LGE images visualize myocardial scar much more distinctly than any other modality. This new technique needs clinical validation but promises intense competition with existing modalities such as myocardial scintigraphy and echocardiography.

However, in individual patient care all modalities should be used according to their own advantages and limitation.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2010. 85 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1169
National Category
Medical and Health Sciences
urn:nbn:se:liu:diva-53943 (URN)978‐91‐7393‐437‐4 (ISBN)
Public defence
2010-03-26, Originalet, Qulturum, Hus B4, Länssjukhuset Ryhov, Jönköping, 09:00 (Swedish)
Available from: 2010-03-09 Created: 2010-02-15 Last updated: 2010-03-09Bibliographically approved

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Rosendahl, LeneEngvall, Jan
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