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Clinical experience of strain imaging using DENSE for detecting infarcted cardiac segments.

Kihlberg J, Haraldsson H, Sigfridsson A, Ebbers T, Engvall JE - J Cardiovasc Magn Reson (2015)

Bottom Line: We hypothesised that myocardial deformation determined with magnetic resonance imaging (MRI) will detect myocardial scar.Using a cut-off value of -17%, sensitivity was 95% at a specificity of 80%.Interobserver and scan-rescan reproducibility was high with an intraclass correlation coefficient (ICC) >0.93.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. johan.kihlberg@cmiv.liu.se.

ABSTRACT

Background: We hypothesised that myocardial deformation determined with magnetic resonance imaging (MRI) will detect myocardial scar.

Methods: Displacement Encoding with Stimulated Echoes (DENSE) was used to calculate left ventricular strain in 125 patients (29 women and 96 men) with suspected coronary artery disease. The patients also underwent cine imaging and late gadolinium enhancement. 57 patients had a scar area >1% in at least one segment, 23 were considered free from coronary artery disease (control group) and 45 had pathological findings but no scar (mixed group). Peak strain was calculated in eight combinations: radial and circumferential strain in transmural, subendocardial and epicardial layers derived from short axis acquisition, and transmural longitudinal and radial strain derived from long axis acquisitions. In addition, the difference between strain in affected segments and reference segments, "differential strain", from the control group was analysed.

Results: In receiver-operator-characteristic analysis for the detection of 50% transmurality, circumferential strain performed best with area-under-curve (AUC) of 0.94. Using a cut-off value of -17%, sensitivity was 95% at a specificity of 80%. AUC did not further improve with differential strain. There were significant differences between the control group and global strain circumferential direction (-17% versus -12%) and in the longitudinal direction (-13% versus -10%). Interobserver and scan-rescan reproducibility was high with an intraclass correlation coefficient (ICC) >0.93.

Conclusions: DENSE-derived circumferential strain may be used for the detection of myocardial segments with >50 % scar area. The repeatability of strain is satisfactory. DENSE-derived global strain agrees with other global measures of left ventricular ejection fraction.

No MeSH data available.


Related in: MedlinePlus

Layer strain versus segmental transmurality of scar. The box plots show median, the two central quartiles in the box, one quartile in each wisker and outliers. The upper three rows show radial (left) and circumferential (right) strain boxplots obtained from transmural (top), subendocardial (2nd from top) and epicardial (3rd from top) measurements. The fourth row shows transmural radial (left) and lonitudinal (right) strain obtained from the long axis in segments with various degree of transmurality of scar
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Fig1: Layer strain versus segmental transmurality of scar. The box plots show median, the two central quartiles in the box, one quartile in each wisker and outliers. The upper three rows show radial (left) and circumferential (right) strain boxplots obtained from transmural (top), subendocardial (2nd from top) and epicardial (3rd from top) measurements. The fourth row shows transmural radial (left) and lonitudinal (right) strain obtained from the long axis in segments with various degree of transmurality of scar

Mentions: Strain was determined with DENSE in 16 segments, for a combination of 8 layers and directions creating 128 measurements per patient. The success rate was 94 % (14 986 of 16 000 measurements). Failure to determined strain was in all cases due to inability of the patients to hold breath for approximately 15 s. Results from the DENSE analysis are reported in Fig. 1. Strain from the SA acquisition is given in the circumferential and radial direction and divided into transmural, subendocardial and epicardial components (Fig. 1, upper 6 panels). Subendocardial strain was on average higher than epicardial and transmural strain for all patients. Strain from the LA slices was calculated as longitudinal transmural and radial transmural strain (Fig. 1, lowest panels). For incremental increases in transmurality of scar, the absolute value of strain was reduced in all directions and layers (Fig. 1).Fig. 1


Clinical experience of strain imaging using DENSE for detecting infarcted cardiac segments.

Kihlberg J, Haraldsson H, Sigfridsson A, Ebbers T, Engvall JE - J Cardiovasc Magn Reson (2015)

Layer strain versus segmental transmurality of scar. The box plots show median, the two central quartiles in the box, one quartile in each wisker and outliers. The upper three rows show radial (left) and circumferential (right) strain boxplots obtained from transmural (top), subendocardial (2nd from top) and epicardial (3rd from top) measurements. The fourth row shows transmural radial (left) and lonitudinal (right) strain obtained from the long axis in segments with various degree of transmurality of scar
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4478716&req=5

Fig1: Layer strain versus segmental transmurality of scar. The box plots show median, the two central quartiles in the box, one quartile in each wisker and outliers. The upper three rows show radial (left) and circumferential (right) strain boxplots obtained from transmural (top), subendocardial (2nd from top) and epicardial (3rd from top) measurements. The fourth row shows transmural radial (left) and lonitudinal (right) strain obtained from the long axis in segments with various degree of transmurality of scar
Mentions: Strain was determined with DENSE in 16 segments, for a combination of 8 layers and directions creating 128 measurements per patient. The success rate was 94 % (14 986 of 16 000 measurements). Failure to determined strain was in all cases due to inability of the patients to hold breath for approximately 15 s. Results from the DENSE analysis are reported in Fig. 1. Strain from the SA acquisition is given in the circumferential and radial direction and divided into transmural, subendocardial and epicardial components (Fig. 1, upper 6 panels). Subendocardial strain was on average higher than epicardial and transmural strain for all patients. Strain from the LA slices was calculated as longitudinal transmural and radial transmural strain (Fig. 1, lowest panels). For incremental increases in transmurality of scar, the absolute value of strain was reduced in all directions and layers (Fig. 1).Fig. 1

Bottom Line: We hypothesised that myocardial deformation determined with magnetic resonance imaging (MRI) will detect myocardial scar.Using a cut-off value of -17%, sensitivity was 95% at a specificity of 80%.Interobserver and scan-rescan reproducibility was high with an intraclass correlation coefficient (ICC) >0.93.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. johan.kihlberg@cmiv.liu.se.

ABSTRACT

Background: We hypothesised that myocardial deformation determined with magnetic resonance imaging (MRI) will detect myocardial scar.

Methods: Displacement Encoding with Stimulated Echoes (DENSE) was used to calculate left ventricular strain in 125 patients (29 women and 96 men) with suspected coronary artery disease. The patients also underwent cine imaging and late gadolinium enhancement. 57 patients had a scar area >1% in at least one segment, 23 were considered free from coronary artery disease (control group) and 45 had pathological findings but no scar (mixed group). Peak strain was calculated in eight combinations: radial and circumferential strain in transmural, subendocardial and epicardial layers derived from short axis acquisition, and transmural longitudinal and radial strain derived from long axis acquisitions. In addition, the difference between strain in affected segments and reference segments, "differential strain", from the control group was analysed.

Results: In receiver-operator-characteristic analysis for the detection of 50% transmurality, circumferential strain performed best with area-under-curve (AUC) of 0.94. Using a cut-off value of -17%, sensitivity was 95% at a specificity of 80%. AUC did not further improve with differential strain. There were significant differences between the control group and global strain circumferential direction (-17% versus -12%) and in the longitudinal direction (-13% versus -10%). Interobserver and scan-rescan reproducibility was high with an intraclass correlation coefficient (ICC) >0.93.

Conclusions: DENSE-derived circumferential strain may be used for the detection of myocardial segments with >50 % scar area. The repeatability of strain is satisfactory. DENSE-derived global strain agrees with other global measures of left ventricular ejection fraction.

No MeSH data available.


Related in: MedlinePlus