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  • Title: 3D image fusion of whole-heart dynamic cardiac MR perfusion and late gadolinium enhancement: Intuitive delineation of myocardial hypoperfusion and scar.
    Author: von Spiczak J, Mannil M, Kozerke S, Alkadhi H, Manka R.
    Journal: J Magn Reson Imaging; 2018 Oct; 48(4):1129-1138. PubMed ID: 29603482.
    Abstract:
    BACKGROUND: Since patients with myocardial hypoperfusion due to coronary artery disease (CAD) with preserved viability are known to benefit from revascularization, accurate differentiation of hypoperfusion from scar is desirable. PURPOSE: To develop a framework for 3D fusion of whole-heart dynamic cardiac MR perfusion and late gadolinium enhancement (LGE) to delineate stress-induced myocardial hypoperfusion and scar. STUDY TYPE: Prospective feasibility study. SUBJECTS: Sixteen patients (61 ± 14 years, two females) with known/suspected CAD. FIELD STRENGTH/SEQUENCE: 1.5T (nine patients); 3.0T (seven patients); whole-heart dynamic 3D cardiac MR perfusion (3D-PERF, under adenosine stress); 3D LGE inversion recovery sequences (3D-SCAR). ASSESSMENT: A software framework was developed for 3D fusion of 3D-PERF and 3D-SCAR. Computation steps included: 1) segmentation of the left ventricle in 3D-PERF and 3D-SCAR; 2) semiautomatic thresholding of perfusion/scar data; 3) automatic calculation of ischemic/scar burden (ie, pathologic relative to total myocardium); 4) projection of perfusion/scar values onto artificial template of the left ventricle; 5) semiautomatic coregistration to an exemplary heart contour easing 3D orientation; and 6) 3D rendering of the combined datasets using automatically defined color tables. All tasks were performed by two independent, blinded readers (J.S. and R.M.). STATISTICAL TESTS: Intraclass correlation coefficients (ICC) for determining interreader agreement. RESULTS: Image acquisition, postprocessing, and 3D fusion were feasible in all cases. In all, 10/16 patients showed stress-induced hypoperfusion in 3D-PERF; 8/16 patients showed LGE in 3D-SCAR. For 3D-PERF, semiautomatic thresholding was possible in all patients. For 3D-SCAR, automatic thresholding was feasible where applicable. Average ischemic burden was 11 ± 7% (J.S.) and 12 ± 7% (R.M.). Average scar burden was 8 ± 5% (J.S.) and 7 ± 4% (R.M.). Interreader agreement was excellent (ICC for 3D-PERF = 0.993, for 3D-SCAR = 0.99). DATA CONCLUSION: 3D fusion of 3D-PERF and 3D-SCAR facilitates intuitive delineation of stress-induced myocardial hypoperfusion and scar. LEVEL OF EVIDENCE: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;48:1129-1138.
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