Gavrysh Jonathan, Reisdorf Philine, Hadler Thomas, Mayr Thomas, Ammann Clemens, Gröschel Jan, Kuhnt Johanna, von Knobelsdorff-Brenkenhoff Florian, Muehlberg Fabian, Schwenke Carsten, Fenski Maximilian, Schulz-Menger Jeanette
Working Group on CMR, Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité-Universitätsmedizin Berlin, Berlin, Germany.
Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Front Cardiovasc Med. 2025 Aug 1;12:1621292. doi: 10.3389/fcvm.2025.1621292. eCollection 2025.
Late gadolinium enhancement (LGE) assessed by cardiovascular magnetic resonance (CMR) is an established metric for risk stratification and therapeutic guidance. However, consensus on the optimal technique for quantifying left ventricular (LV) LGE extent remains lacking. This study aimed to identify the most reliable method for quantifying LGE in chronic myocardial infarction (CMI), hypertrophic cardiomyopathy (HCM), and inflammatory heart disease (IHD).
A retrospective analysis was conducted on 285 prospectively enrolled patients (CMI: = 98; HCM: = 91; IHD: = 96). LV LGE images in short-axis orientation were analyzed twice by the same reader. The most reliable LGE quantification technique was defined as the one achieving the highest intra-observer reproducibility. A two-step study design was implemented: in the pilot phase ( = 90), three quantification methods were compared: full width at half maximum (FWHM), signal threshold vs. reference mean using 2-6 standard deviations (n-SD), and manual thresholding. Techniques demonstrating the lowest variability were then applied in a validation cohort ( = 195). A mixed model for repeated measures was used to estimate mean differences. Equivalence was confirmed if the 95% confidence interval (CI) for the mean difference remained within predefined margins.
In CMI, FWHM demonstrated the highest reproducibility, with a mean difference of 0.47% (95% CI: -0.40 to 1.35). In HCM, both the 5-SD and 6-SD techniques showed the highest reproducibility, with mean differences of 0.06% (95% CI: -1.28 to 1.39) and -0.16% (95% CI: -1.50 to 1.17), respectively. In IHD, the 5-SD and 6-SD techniques achieved the highest reproducibility, with mean differences of -0.72% (95% CI: -1.54 to 0.11) and -0.71% (95% CI: -1.54 to 0.11).
The distribution and pattern of LGE influence the reproducibility of its quantification. FWHM provided the highest intra-observer reproducibility for sharply demarcated scars, as seen in CMI. For more diffuse fibrosis patterns, such as in HCM and IHD, both the 5-SD and 6-SD techniques offered similarly reproducible performance.
通过心血管磁共振（CMR）评估的延迟钆增强（LGE）是用于风险分层和治疗指导的既定指标。然而，在量化左心室（LV）LGE范围的最佳技术方面仍缺乏共识。本研究旨在确定在慢性心肌梗死（CMI）、肥厚型心肌病（HCM）和炎症性心脏病（IHD）中量化LGE的最可靠方法。
对285例前瞻性入组患者（CMI：=98例；HCM：=91例；IHD：=96例）进行回顾性分析。同一阅片者对短轴方向的左心室LGE图像进行了两次分析。最可靠的LGE量化技术被定义为观察者内重复性最高的技术。实施了两步研究设计：在试点阶段（=90例），比较了三种量化方法：半高全宽（FWHM）、使用2 - 6个标准差（n - SD）的信号阈值与参考均值比较以及手动阈值法。然后将变异性最低的技术应用于验证队列（=195例）。使用重复测量的混合模型来估计均值差异。如果均值差异的95%置信区间（CI）保持在预定义范围内，则确认等效性。
在CMI中，FWHM显示出最高的重复性，均值差异为0.47%（95%CI：-0.40至1.35）。在HCM中，5 - SD和6 - SD技术均显示出最高的重复性，均值差异分别为0.06%（95%CI：-1.28至1.39）和-0.16%（95%CI：-1.50至1.17）。在IHD中，5 - SD和6 - SD技术实现了最高的重复性，均值差异分别为-0.72%（95%CI：-1.54至0.11）和-0.71%（95%CI：-1.54至0.11）。
LGE的分布和模式会影响其量化的重复性。如在CMI中所见，FWHM为界限清晰的瘢痕提供了最高的观察者内重复性。对于更弥漫的纤维化模式，如在HCM和IHD中，5 - SD和6 - SD技术均具有相似的可重复性表现。
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