Authors: Olurotimi Mesubi Kelechi EgoOsuala Jean Jeudy James Purtilo Stephen Synowski Ameer Abutaleb Michelle Niekoop Mohammed Abdulghani Ramazan Asoglu Vincent See Anastasios Saliaris Stephen Shorofsky Timm Dickfeld
Publish Date: 2014/10/29
Volume: 31, Issue: 2, Pages: 359-368
Abstract
Late gadolinium enhancement cardiac magnetic resonance LGECMR imaging is the gold standard for myocardial scar evaluation Heterogeneous areas of scar ‘gray zone’ may serve as arrhythmogenic substrate Various gray zone protocols have been correlated to clinical outcomes and ventricular tachycardia channels This study assessed the quantitative differences in gray zone and scar core sizes as defined by previously validated signal intensity SI threshold algorithms High quality LGECMR images performed in 41 cardiomyopathy patients ischemic 33 or nonischemic 8 were analyzed using previously validated SI threshold methods Full Width at Half Maximum FWHM nstandard deviation NSD and modifiedFWHM Myocardial scar was defined as scar core and gray zone using SI thresholds based on these methods Scar core gray zone and total scar sizes were then computed and compared among these models The median gray zone mass was 2–3 times larger with FWHM 15 g IQR 8–26 g compared to NSD or modifiedFWHM 5 g IQR 3–9 g and 8 g IQR 6–12 g respectively p 0001 Conversely infarct core mass was 23 times larger with NSD 30 g IQR 17–53 g versus FWHM and modifiedFWHM 13 g IQR 7–23 g p 0001 The gray zone extent percentage of total scar that was gray zone also varied significantly among the three methods 51 IQR 42–61 17 IQR 11–21 versus 38 IQR 33–43 for FWHM NSD and modifiedFWHM respectively p 0001 Considerable variability exists among the current methods for MRI defined gray zone and scar core Infarct core and total myocardial scar mass also differ using these methods Further evaluation of the most accurate quantification method is needed
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