Diagnosis of Acute Myocarditis Using Texture-Based Cardiac Magnetic Resonance, with CINE Imaging as a Novel Tissue Characterization Technique
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Cardiac MR
2.3. Image Segmentation and Texture Analysis
2.4. Statistical Analysis
3. Results
3.1. Reproducibility Measurements
3.2. Group Comparisons and Correlation Analysis
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristic | Clinically Suspected AM (n = 20) | CMR-Verified AM (n = 10) | Non CMR-Verified AM (n = 10) | p-Value |
---|---|---|---|---|
Age (years) | 28 (28) | 25 (10) | 49 (24) | 0.001 ‡ |
No. of men | 18 | 9 | 9 | 1 |
Height (cm) | 180 (8) | 177 (19) | 181 (4) | 0.44 |
Weight (kg) | 81 (22) | 78 (34) | 86 (18) | 0.33 |
Symptom † | ||||
Fever | 5 | 4 | 1 | - |
Fatigue | 3 | 1 | 2 | - |
Chest pain | 19 | 10 | 9 | - |
Dyspnea | 3 | 1 | 2 | - |
Recent infection | 14 | 10 | 4 | - |
No. of diagnostic criteria for clinically suspected AM ¶ | 3.0 (1.8) | 3.5 (1.0) | 3.0 (1.0) | 0.29 |
Pathologic ECG finding † | ||||
Sinus rhythm | 20 | 10 | 10 | - |
AV conduction abnormality | 1 | 0 | 1 | - |
ST-segment elevation | 7 | 4 | 3 | - |
ST-segment depression | 3 | 1 | 2 | - |
T-wave inversion | 6 | 3 | 3 | - |
Pathologic blood result † | ||||
TNT/TNI | 30 (538) | 606 (1407) § | 24 (40) | 0.001 ‡ |
NT-proBNP | 278 (487) | 424 (314) § | 17 (140) § | 0.003 ‡ |
CRP | 16 (35) | 34 (60) § | 7 (16) | 0.07 |
Cardiovascular risk factor † | ||||
Hypertension | 2 | 1 | 1 | - |
Hyperlipidaemia | 0 | 0 | 0 | - |
Diabetes | 0 | 0 | 0 | - |
Smoker | 0 | 0 | 0 | - |
Obesity | 1 | 0 | 1 | - |
CMR findings | ||||
LV iEDV (mL) | 91 (19) | 91 (13) | 86 (37) | 0.10 |
LV iESV (mL) | 37 (13) | 38 (10) | 35 (23) | 0.17 |
LV iSV (mL) | 50 (12) | 53 (10) | 46 (16) | 0.08 |
LV EF (%) | 59 (6) | 59 (5) | 59 (8) | 0.39 |
T2w findings † | 10 | 10 * | 0 | - |
LGE findings † | 10 | 10 | 0 | - |
Texture Category | Texture Feature | Number of Features |
---|---|---|
Histogram | Mean, variance, skewness, kurtosis, percentiles (1%, 10%, 50%, 90%, 99%). | 9 |
Absolute gradient (4 bits/pixel) | Gradient mean, variance, skewness, kurtosis, non-zeros. | 5 |
Run-length matrix (computed for four angles (vertical, horizontal, 45°, and 135°); 6 bits/pixel) | Run-length non-uniformity, gray-level non-uniformity, long run emphasis, short run emphasis, fraction of image in runs. | 20 |
Co-occurrence matrix (computed for four directions ((x,0), (0,x), (x,x), (x,−x)) at five interpixel distances (x = 1–5); 6 bits/pixel) | Angular second moment, contrast, correlation, entropy, sum entropy, sum of squares, sum average, sum variance, inverse different moment, difference entropy, difference variance. | 220 |
Autoregressive model | Teta 1 to 4, sigma. | 5 |
Wavelet transform (calculated for four subsampling factors (n = 1–4); 8 bits/pixel) | Energy of wavelet coefficients in low-frequency sub-bands, horizontal high-frequency sub-bands, vertical high-frequency sub-bands, and diagonal high-frequency sub-bands. | 16 |
CMR | Texture Feature | CMR-Verified AM | Non CMR-Verified AM | ICC | p-Value | R |
---|---|---|---|---|---|---|
T2w | WavEnLL_s_2 | 16,400 ± 1360 | 19,100 ± 1600 | 0.85 | 0.002 | −0.67 |
WavEnLL_s_3 | 12,500 ± 1690 | 16,900 ± 3570 | 0.88 | 0.008 | −0.62 | |
S_3__3_SumOfSqs | 113 ± 8 | 103 ± 5 | 0.88 | 0.012 | 0.59 | |
S_2__2_SumOfSqs | 111 ± 6 | 104 ± 4 | 0.81 | 0.012 | 0.59 | |
WavEnLL_s_4 | 8050 ± 1920 | 12,200 ± 3600 | 0.94 | 0.012 | −0.58 | |
S_1_1_SumAverg | 64.7 ± 0.8 | 63.8 ± 0.6 | 0.77 | 0.012 | 0.56 | |
S_2_2_SumAverg | 65.2 ± 1.2 | 63.8 ± 0.9 | 0.89 | 0.019 | 0.54 | |
S_4__4_SumOfSqs | 113 ± 9 | 102 ± 10 | 0.81 | 0.019 | 0.50 | |
Skewness | 0.37 ± 0.38 | −0.01 ± 0.3 | 0.89 | 0.031 | 0.49 | |
S_0_2_SumOfSqs | 110 ± 5 | 106 ± 4 | 0.81 | 0.021 | 0.48 | |
LGE | S_0_2_SumVarnc | 401 ± 46 | 306 ± 42 | 0.98 | <0.001 | 0.73 |
S_0_4_SumVarnc | 376 ± 73 | 233 ± 65 | 0.96 | <0.001 | 0.72 | |
S_0_5_SumVarnc | 372 ± 82 | 228 ± 66 | 0.97 | <0.001 | 0.69 | |
S_1__1_SumVarnc | 411 ± 28 | 258 ± 29 | 0.95 | <0.001 | 0.69 | |
S_0_1_SumVarnc | 424 ± 24 | 379 ± 23 | 0.98 | <0.001 | 0.68 | |
S_2_0_SumAverg | 65.6 ± 0.9 | 63.6 ± 1.3 | 0.78 | <0.001 | 0.68 | |
S_0_2_SumAverg | 65.9 ± 1.1 | 63.6 ± 1.4 | 0.77 | <0.001 | 0.68 | |
S_0_2_SumOfSqs | 114 ± 6 | 102 ± 7 | 0.89 | <0.001 | 0.66 | |
WavEnLL_s_2 | 17,700 ± 1540 | 21,200 ± 2320 | 0.91 | <0.001 | −0.66 | |
S_0_4_Correlat | 0.57 ± 0.21 | 0.18 ± 0.23 | 0.98 | <0.001 | 0.66 | |
CINE | S_0_1_Correlat | 0.84 ± 0.06 | 0.72 ± 0.07 | 0.98 | <0.001 | 0.70 |
S_0_2_Correlat | 0.61 ± 0.15 | 0.32 ± 0.15 | 0.99 | <0.001 | 0.70 | |
S_0_2_SumVarnc | 359 ± 50 | 274 ± 39 | 0.98 | <0.001 | 0.69 | |
S_0_1_Contrast | 34.0 ± 13.2 | 59.9 ± 13.9 | 0.97 | <0.001 | −0.68 | |
S_0_2_Contrast | 85.3 ± 31.8 | 141 ± 28 | 0.97 | <0.001 | −0.68 | |
S_1__1_Correlat | 0.73 ± 0.10 | 0.54 ± 0.11 | 0.98 | <0.001 | 0.67 | |
S_1__1_Contrast | 57.8 ± 20.3 | 94.9 ± 21.5 | 0.98 | <0.001 | −0.66 | |
S_0_1_SumVarnc | 405 ± 25 | 362 ± 25 | 0.89 | <0.001 | 0.66 | |
S_0_3_Correlat | 0.51 ± 0.19 | 0.20 ± 0.17 | <1.00 | <0.001 | 0.66 | |
Sigma | 0.35 ± 0.08 | 0.48 ± 0.08 | 0.98 | <0.001 | −0.65 |
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Papalini, E.I.; Polte, C.L.; Bobbio, E.; Lagerstrand, K.M. Diagnosis of Acute Myocarditis Using Texture-Based Cardiac Magnetic Resonance, with CINE Imaging as a Novel Tissue Characterization Technique. Diagnostics 2022, 12, 3187. https://doi.org/10.3390/diagnostics12123187
Papalini EI, Polte CL, Bobbio E, Lagerstrand KM. Diagnosis of Acute Myocarditis Using Texture-Based Cardiac Magnetic Resonance, with CINE Imaging as a Novel Tissue Characterization Technique. Diagnostics. 2022; 12(12):3187. https://doi.org/10.3390/diagnostics12123187
Chicago/Turabian StylePapalini, Evin I., Christian L. Polte, Emanuele Bobbio, and Kerstin M. Lagerstrand. 2022. "Diagnosis of Acute Myocarditis Using Texture-Based Cardiac Magnetic Resonance, with CINE Imaging as a Novel Tissue Characterization Technique" Diagnostics 12, no. 12: 3187. https://doi.org/10.3390/diagnostics12123187