Left Ventricular Late Gadolinium Enhancement Assessment for MR

Purpose	Automate late gadolinium enhancement assessment
Tag(s)
Panel	Cardiac
Define-AI ID	18040008
Originator	Akos Szemes
Panel Chair	Carlo De Cecco
Panel Reviewers	Cardiac Panel
License	Creative Commons 4.0
Status	Published

                               

Value Proposition

Late gadolinium enhancement (LGE) can be observed in several myocardial pathologies, including different stages of myocardial infarction (MI), myocarditis, and certain cardiomyopathies. The clinical assessment of LGE is primarily qualitative, with descriptions of the location and number of affected segments, or semiquantitative, such as LGE transmurality. Although latter techniques allow for fast interpretation, the accurate quantification of MI has become necessary to systematically analyze the association of MI size with short- and long-term effects, associated complications, and general prognoses. It has been shown that the size of MI correlates with ejection fraction, predicts segmental functional outcome after revascularization, prognosticates recovery of left ventricular function, and shows association with the occurrence of spontaneous ventricular arrhythmias. Automated LGE quantification would save time and eliminate subjectivity from the analysis.

Narrative(s)

All patients undergoing contrast-enhanced cardiovascular magnetic resonance imaging (CMR) examinations should have automated quantification of LGE if data are available, which should then be automatically populated into the radiology report or a report supplement.

Workflow Description

A patient receives contrast-enhanced MRI of the heart, with LGE acquisition included. An algorithm retrieves input from the imaging data set, relevant EMR data (including age, sex, and body surface area [BSA; m2]), and user-selected quantification methods (standard deviation [SD] based: 2 or 5 SD and full width at half maximum). The algorithm automatically segments the borders of the LV endocardium and LV epicardium on LGE data sets and identifies the base and apex of the heart; the LV myocardium (the area between the epicardium and endocardium) automatically segmented to identify normal and enhanced myocardium based on the quantification method selected. The algorithm then detects affected myocardium segments based on the 17-segment American Heart Association model and determines transmurality in these segments (<25%, 25-50%, 51-75%, and >75%). With this information, the algorithm calculates absolute myocardial mass (LVM; mL and g), total LGE volume (mL), LGE percentage (%LVM), segmental LGE volume (mL), LGE percentage (%), and BSA-indexed LVM (g/m2). The measurements are returned and automatically populated into the report. Segmental assessment is visualized on a color-coded polar map also indicating coronary artery territories. The algorithm flags abnormal LVM values.

Procedures(s): Contrast enhanced cardiac MRI with LGE acquisition

View(s): {short-axis LGE images, long-axis 4-chamber LGE images, long-axis 2-chamber LGE images, long-axis left ventricular outflow tract LGE images}

 

Sex at Birth: {Male, Female}

 

Age: [0,90]

 

Body Surface Area: varied

 

Comorbidities: {Congenital heart disease, ventricular septal defects}

 

Intervention: {Congenital heart disease repair, mitral valve replacements, coronary artery bypass graft, alcohol ablation in hypertrophic cardiomyopathy, etc}

 

Contrast: contrast-enhanced MRI

Inputs

DICOM Study

Procedure	Contrast-enhanced cardiac MRI with LGE acquisition
Views	CMR: short-axis LGE images, long-axis 4-chamber LGE images, long-axis 2-chamber LGE images, long-axis LVOT LGE images
Data Type	DICOM
Modality	CMR
Body Region	Chest
Anatomic Focus	Heart

Primary Outputs

 

Number of segments with LGE

RadElement ID	RDE225
Definition	Number of segments with LGE based on the AHA model
Data Type	Numeric
Value Set
Units

 

List of Segments with LGE

RadElement ID	RDE226
Definition	List of segments with LGE (displayed on polar map)
Data Type	Segmentation value according to AHA segmentation
Value Set	1-basal anterior 2-basal anteroseptal 3-basal inferoseptal 4-basal inferior 5-basal inferolateral 6-basal anterolateral 7-mid anterior 8-mid anteroseptal 9-mid inferoseptal 10-mid inferior 11-mid inferolateral 12-mid anterolateral 13-apical anterior 14-apical septal 15-apical inferior 16-apical lateral 17-apex
Units	N/A

 

Transmurality of LGE

RadElement ID	RDE227
Definition	Transmurality of LGE in each segment (displayed on polar map)
Data Type	Numeric
Value Set
Units	Percentage

 

Total LGE Volume

RadElement ID	RDE228
Definition	Volume of LGE in the LV (mL)
Data Type	Numeric
Value Set
Units	mL

 

Total Percentage of LGE

RadElement ID	RDE229
Definition	Total percentage of LGE in the LV (%)
Data Type	Numeric
Value Set	[0,100]
Units	Percentage

 

Segmental Volume of LGE

RadElement ID	RDE230
Definition	Volume of LGE based on the AHA model (displayed on polar map)
Data Type	Numeric
Value Set
Units	mL

 

Segmental Percentage of LGE

RadElement ID	RDE231
Definition	Percentage of LGE based on the AHA model (displayed on polar map)
Data Type	Numeric
Value Set	[0,100]
Units	Percentage

Secondary Outputs

Myocardial Mass (mL)

RadElement ID	RDE232
Definition	Myocardial mass (ml)
Data Type	Numeric
Value Set
Units	mL

 

Myocardial Mass (g)

RadElement ID	RDE233
Definition	Myocardial mass (ml)
Data Type	Numeric
Value Set
Units	mL

 

Indexed Myocardial Mass

RadElement ID	RDE234
Definition	Myocardial Mass Indexed to body surface area (g/m2)
Data Type	Numeric
Value Set
Units	mL

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