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European Radiology
Published in: European Radiology 7/2016

01-07-2016 | Cardiac

Comparison between visual grading and planimetric quantification of microvascular obstruction extent assessment in reperfused acute myocardial infarction

Authors: Marc Sirol, Heger Gzara, Etienne Gayat, Raphael Dautry, Barnabas Gellen, Damien Logeart, Philippe Soyer, Eric Vicaut, Jean-Jacques Mercadier

Published in: European Radiology | Issue 7/2016

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Abstract

Objectives

Current methods for infarct size and microvascular obstruction (MVO) quantification by cardiac magnetic resonance (CMR) imaging rely on planimetry. This method is time-consuming. We sought to evaluate a direct assessment of MVO severity based on visual evaluation and to compare it to a reference method.

Methods

CMR was performed in 112 consecutive patients after reperfused myocardial infarction. MVO was estimated by direct visual assessment based on a three-grade severity scale (MVO 1, mild; MVO 2, moderate; MVO 3, severe) on late gadolinium-enhancement (LGE).

Results

MVO was present in 69 patients (61.6 %). Quantitative MVO extent significantly increased accordingly to visual MVO grading (p < 0.01). Correlation between visual grading and quantitative assessment was excellent (r = 0.92, IQR 0.88–0.95, p < 0.001). CMR inter- and intraobserver variability for visual MVO evaluation was low (κ = 0.93 and κ = 0.96, respectively), whereas quantitative MVO assessment suffered from moderate agreement (interobserver, bias = −0.81 ± 1.8 g LV; intraobserver, −0.83 ± 2.1 g LV). Visual evaluation was significantly faster than reference method (0.65 ± 0.37 vs. 10.2 ± 2.9 min, p < 0.0001).

Conclusions

MVO severity based on direct visual assessment on LGE images is feasible, rapid, reproducible and agrees very well with quantitative methods, with a very low inter- and intraobserver variability. Our approach could be used for routine evaluation in patients undergoing CMR after acute myocardial infarction.

Key Points

• Microvascular obstruction direct visual evaluation is feasible, rapid and highly reproducible.
• Microvascular obstruction direct visual evaluation correlates well with quantification by planimetry.
• Microvascular obstruction or no-reflow phenomenon is determined on late gadolinium-enhanced images.
• Cardiac MRI is useful for myocardial damage assessment after myocardial infarction.
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Metadata
Title
Comparison between visual grading and planimetric quantification of microvascular obstruction extent assessment in reperfused acute myocardial infarction
Authors
Marc Sirol
Heger Gzara
Etienne Gayat
Raphael Dautry
Barnabas Gellen
Damien Logeart
Philippe Soyer
Eric Vicaut
Jean-Jacques Mercadier
Publication date
01-07-2016
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 7/2016
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-015-4069-5

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