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CLINICAL RESEARCH: CARDIAC IMAGING

Reproducibility of Chronic and Acute Infarct Size Measurement by Delayed Enhancement-Magnetic Resonance Imaging

Holger Thiele, MD^_*,_*, Mathias J.E. Kappl, MD^_*, Stefan Conradi, MD, Josef Niebauer, MD, PhD^_*, Rainer Hambrecht, MD^_* and Gerhard Schuler, MD^_*

^_* Department of Cardiology, University of Leipzig-Heart Center, Leipzig, Germany
Department of Radiology, University of Leipzig-Heart Center, Leipzig, Germany

Manuscript received May 11, 2005; revised manuscript received October 31, 2005, accepted November 16, 2005.

^_* Reprint requests and correspondence: Dr. Holger Thiele, Department of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Strümpellstr. 39, 14289 Leipzig, Germany. (Email: thielh{at}medizin.uni-leipzig.de).

OBJECTIVES: The aim of this study was to evaluate the reproducibility of acute and chronic infarct size (IS) by delayed enhancement (DE) magnetic resonance imaging (MRI).

BACKGROUND: Infarct size measurements can be used as surrogate end point to reduce the sample size in studies comparing different reperfusion strategies in myocardial infarction (MI). Delayed enhancement MRI is a rather new technique, and so far infarct IS reproducibility has not been established appropriately.

METHODS: In 21 patients (10 acute MI and 11 chronic MI), IS was assessed repeatedly on consecutive days by DE-MRI. Reproducibility, interobserver, and intraobserver variabilities were assessed and compared by the Bland-Altman method.

RESULTS: Acute and chronic IS were 17.1 ± 19.6% (range 5.1% to 69.8%) of LV mass (%LV) and 16.9 ± 9.9 %LV (range 2.0% to 36.0%), respectively. Infarct size difference (bias) between scan I and scan II was –0.5 %LV, and limits of agreement were ±2.4 %LV. Mean bias (–0.7 %LV) and limits of agreement (±3.2%) were slightly higher for acute in comparison with chronic MI with –0.4 ± 1.3 %LV. Intraobserver and interobserver variability was low with a mean bias of 0.3 %LV (limits of agreement ± 1.7 %LV) and –0.7 %LV (limits of agreement ± 2.2 %LV), respectively.

CONCLUSIONS: Infarct size measurement by DE-MRI is an excellent tool for IS assessment, owing to its excellent repeatability in chronic and acute MI. It has therefore the potential to serve as a surrogate end point to uncover advantages of new reperfusion strategies.

Abbreviations and Acronyms   DE = delayed enhancement   IR = inversion-recovery   IS = infarct size   LV = left ventricle/ventricular   MI = myocardial infarction   MRI = magnetic resonance imaging   %LV = percentage infarct size of left ventricular mass   SPECT = single-photon emission computed tomography

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