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      Reproducibility of native and contrast-enhanced CMR techniques to measure lesion size following acute myocardial infarction

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          Background The purpose of this study was to analyze the reproducibility of native and contrast-enhanced CMR techniques to measure lesion size after acute myocardial infarction (AMI) using native T1/T2 mapping, T2-weighted (T2w) imaging, contrast-enhanced late gadolinium enhancement (LGE), post-contrast T1 mapping and extracellular volume (ECV) quantification. Methods Lesion size was independently quantified by 2 experienced observers in total of 120 consecutive CMRs obtained in 30 patients within the first 6 months after AMI using native and contrast-enhanced sequences. Lesion sizes were quantified using a threshold method (cutoff >2SD of remote normal myocardium) on basal, midventricular and apical short-axis left ventricular slices. Lesion size is given as the mean of both observers. Bland-Altman analysis was performed to determine the agreement between the two observers. Non-parametric Levene's test was used to compare the variances of the relative differences. Statistical analysis was performed using GraphPad Prism 6. Results The relative median difference of the native CMR techniques were -1.95% (-12.7% and 9.8%) for T2w, -5.3% (-19.6% and 14.8%) for native T1 and -4.0% (-23.9% and 9.9%) for native T2 (Fig. 1). Results for contrast-enhanced CMR imaging were: 2.9% (-4.5% and 10.5%) for LGE, 7.5% (-2.4% and 21.5%) for post-contrast T1 and -2.9% (-11.4% and 9%) for ECV measurement. Bland Altman analysis revealed a better agreement for all post-contrast sequences indicted by lower limits of agreement compared to native sequences (Figure 1). The increased variability of native imaging was caused by higher interobserver differences in small lesions with sizes between 0-15 %LV compared to lager lesions >15 %LV. This bias was not observed for post-contrast imaging. Figure 1 The Bland-Altman graphs show the relative differences and limits of agreement for measurement of lesion size using the indicated sequences. Conclusions In general, there was a good agreement between the two observers to measure lesion size after AMI, but all post-contrast sequences had a better agreement compared to the native sequences. The low agreement of native imaging was mainly caused by higher interobserver differences in small lesions with lesion sizes between 0-15 %LV compared to lager lesions >15 %LV.

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          Author and article information

          J Cardiovasc Magn Reson
          J Cardiovasc Magn Reson
          Journal of Cardiovascular Magnetic Resonance
          BioMed Central (London )
          27 January 2016
          27 January 2016
          : 18
          Issue : Suppl 1 Issue sponsor : Publication of this supplement was funded by the Society for Cardiovascular Magnetic Resonance.
          [1 ]grid.13648.380000000121803484Diagnostic and Interventional Radiology, University Hospital Eppendorf, Hamburg, Germany
          [2 ]grid.13648.380000000121803484General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
          [3 ]Institute of Applied Sciences, Wedel, Germany
          [4 ]Phillips Research Laboratory, Hamburg, Germany
          © Tahir et al. 2016

          This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

          19th Annual SCMR Scientific Sessions
          Los Angeles, CA, USA
          27-30 January 2016
          Poster Presentation
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          © The Author(s) 2016

          Cardiovascular Medicine


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