Head-to-head comparison of multiple cardiovascular magnetic resonance techniques for the detection and quantification of
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Head-to-head comparison of multiple cardiovascular magnetic resonance techniques for the detection and quantification of intramyocardial haemorrhage in patients with ST-elevation myocardial infarction Anna Giulia Pavon 1,2,3 & Georgios Georgiopoulos 4 & Gabriella Vincenti 1,2 & Olivier Muller 2 & Pierre Monney 1,2,5 & Gregoire Berchier 6 & Chiara Cirillo 4 & Eric Eeckhout 2 & Juerg Schwitter 1,2,5 & Pier Giorgio Masci 1,2,4 Received: 23 June 2020 / Revised: 27 July 2020 / Accepted: 31 August 2020 # The Author(s) 2020
Abstract Objectives T2*-weighted (T2*w) is deemed as a reference standard for post-infarction intramyocardial haemorrhage (IMH). However, high proportion of T2* images is affected by off-resonance artefacts hampering image interpretation. Diagnostic accuracy and precision of alternative techniques for IMH diagnosis and quantification have been seldomly investigated. Methods and results Between April 2016 and May 2017, 50 ST-segment elevation myocardial infarction patients (66% male, 57 ± 17 years) and 15 healthy controls (60% male, 58 ± 13) were consecutively enrolled. Subjects underwent headto-head comparison of single mid-infarct slice acquired on black-blood T2-weighted short-TI-inversion recovery (T2wSTIR), bright-blood T2prep-steady-state-free precession (T2prep-SSFP), and T2/T1 maps for IMH diagnosis and quantification against T2*w. All images were graded for quality (grade 1: very poor; grade 4: excellent) and diagnostic confidence (Likert scale, 1: very unsure and 5: highly confident). Reduced relaxation time/hypointense region (hypocore) embedded in infarct-related oedema on T2 map, T1 map, and T2w-STIR had the best overall diagnostic accuracy (per-subject: 91%, 86%, and 86%, respectively; per segment: 95%, 93%, and 93%, respectively). By mixedeffects analysis, image quality, and diagnostic confidence were higher for T2 map and T1 maps than T2*w (p < 0.05 for both scores). For IMH quantification, hypocore on T2 map and T1 map strongly correlated (Spearman’s r > 0.7, p < 0.001 for both) with IMH extent on T2*w and presented an overall excellent agreement on Bland-Altman analysis. By linear mixed model analysis, absolute hypocore size did not differ among T1-, T2 map, and T2*w. T2/T1 maps had the best intra- and inter-observer reproducibility among CMR techniques. Conclusion Hypocore on T2/T1 map is the best alternative technique to T2*w for diagnosing and quantifying IMH in postSTEMI patients.
Anna Giulia Pavon and Georgios Georgiopoulos are equal first authors. Juerg Schwitter and Pier Giorgio Masci are equal senior authors. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00330-020-07254-1) contains supplementary material, which is available to authorized users. * Georgios Georgiopoulos [email protected]; [email protected] 1
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Centre of Cardiac Magnetic Resonance – Lausanne University Hospital, Lausanne, Switzerland Cardiology Division, Heart & Vessels Department, Lausanne University Hospital, Lausanne, Sw
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