Martens Bibi, van der Meulen Lara R, Crawley Richard J, van Cauteren Yvonne J M, Smulders Martijn W, Streukens Sebastian, Hendriks Babs M F, Houben Ivo P L, Gommers Suzanne, Frey Simon M, Brandts Lloyd, Wildberger Joachim E, Chiribiri Amedeo, Holtackers Robert J
Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands (B.M., L.R.v.d.M., Y.J.M.v.C., B.M.F.H., S.G., J.E.W., R.J.H.); Research Institute for Oncology and Reproduction (GROW), Maastricht University, the Netherlands (B.M.); Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands (L.R.v.d.M., Y.J.M.v.C., M.W.S., B.M.F.H., J.E.W., R.J.H.); School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom (R.J.C., S.M.F., A.C., R.J.H.); Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands (Y.J.M.v.C., M.W.S., S.S.); Department of Radiology and Nuclear Medicine, Zuyderland, Heerlen, the Netherlands (I.P.L.H.); Department of Cardiology, University Hospital Basel, Basel, Switzerland (S.M.F.); and Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands (L.B.).
Invest Radiol. 2025 Sep 1;60(9):561-568. doi: 10.1097/RLI.0000000000001161.
This study aimed to evaluate the influence of reader training and experience on the detection of (small) myocardial infarctions (MIs) and the assessment of ischemic scar transmurality using dark-blood late gadolinium enhancement (LGE) and bright-blood LGE magnetic resonance imaging. It was hypothesized that dark-blood LGE simplifies the detection of (small) MIs for less experienced readers, compared with bright-blood LGE imaging.
One hundred patients referred for cardiac magnetic resonance imaging for suspected ischemic scar were retrospectively included. Dark-blood LGE was performed first, followed by bright-blood LGE. Nine clinicians, grouped into three levels based on their training and experience, assessed the LGE images for the presence of MI and ischemic scar transmurality. Their assessment was subsequently compared with a European Association of Cardiovascular Imaging level 3 consultant. Reader confidence was evaluated with a 4-point Likert scale. Multilevel logistic regression was used to compare the 2 LGE methods and assess differences in myocardial infarction detection and transmurality among the 3 experience levels. Wilcoxon signed rank tests were performed to compare the reader confidence between the 2 LGE methods, whereas Friedman omnibus tests were conducted to assess differences in reader confidence among the 3 experience levels.
Dark-blood LGE resulted in increased correct detection of MIs compared with bright-blood LGE for both level 1 (87.3% vs 82.7%, odds ratio [OR]: 1.55 [95% confidence interval (CI): 0.94-2.54], P = 0.083) and level 2 readers (89.7% vs 83.0%, OR: 2.05 [95% CI: 1.20-3.51], P = 0.009). There was no significant difference observed between dark-blood LGE and bright-blood LGE for level 3 readers (88.7% vs 87.0%, OR: 1.20 [95% CI: 0.70-2.06], P = 0.495). Level 2 readers significantly detected more small MIs correctly when using dark-blood LGE compared with bright-blood LGE (66.7% vs 50.8%, OR: 2.40 [95% CI: 1.03-5.60], P = 0.042). All experience levels showed significantly increased confidence in presence of ischemic scar and transmurality with dark-blood LGE.
Readily available dark-blood LGE can assist less experienced readers in correctly detecting and assessing (small) MIs compared with conventional bright-blood LGE. Regardless of experience level, dark-blood LGE improves reader confidence in assessing the presence and transmurality of MIs.
本研究旨在评估读者培训和经验对使用黑血晚期钆增强（LGE）和亮血LGE磁共振成像检测（小）心肌梗死（MI）以及评估缺血性瘢痕透壁性的影响。研究假设，与亮血LGE成像相比，黑血LGE能简化经验不足的读者对（小）MI的检测。
回顾性纳入100例因疑似缺血性瘢痕而接受心脏磁共振成像检查的患者。先进行黑血LGE检查，随后进行亮血LGE检查。9名临床医生根据其培训和经验分为三个级别，他们对LGE图像进行MI和缺血性瘢痕透壁性评估。随后将他们的评估结果与欧洲心血管影像协会3级顾问的评估结果进行比较。使用4点李克特量表评估读者信心。采用多水平逻辑回归比较两种LGE方法，并评估三个经验水平之间在心肌梗死检测和透壁性方面的差异。进行Wilcoxon符号秩检验以比较两种LGE方法之间的读者信心，而进行Friedman综合检验以评估三个经验水平之间读者信心的差异。
与亮血LGE相比，黑血LGE使1级读者（87.3%对82.7%，优势比[OR]：1.55[95%置信区间（CI）：0.94 - 2.54]，P = 0.083）和2级读者（89.7%对83.0%，OR：2.05[95%CI：1.20 - 3.51]，P = 0.009）对MI的正确检测率提高。对于3级读者，黑血LGE与亮血LGE之间未观察到显著差异（88.7%对87.0%，OR：1.20[95%CI：0.70 - 2.06]，P = 0.495）。与亮血LGE相比，2级读者使用黑血LGE时正确检测到的小MI显著更多（66.7%对50.8%，OR：2.40[95%CI：1.03 - 5.60]，P = 0.042）。所有经验水平的读者在使用黑血LGE时对缺血性瘢痕和透壁性的信心均显著提高。
与传统的亮血LGE相比，现成的黑血LGE可帮助经验不足的读者正确检测和评估（小）MI。无论经验水平如何，黑血LGE均可提高读者对MI存在情况和透壁性评估的信心。
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