Quantification of intramyocardial hemorrhage volume using magnetic resonance imaging with three-dimensional T1-weighted sequence in patients with ischemia-reperfusion injury : a semi-automated image processing technique

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Legends for Figures and Table

Fig. 1

Flowchart of the study protocol. Description from acquired images to various segmentation methods.

Fig. 2

Receiver operating characteristic (ROC) curve of CK and CK-MB for detecting patient with IMH. Both

of area under the curve (AUC) of the biomarkers show high sensitivity and specificity. The cutoff values

of CK and CK-MB are 2460 IU/L and 231 IU/L, respectively.

Fig. 3

Assessment of IMH volume using different quantification methods in acute myocardial infarction (AMI)

patient with IMH.

Short-axis 3D T1-MRI images in patients with AMI of segment 6. IMH size shows that 1SD is larger than

manual method and Otsu is considerably larger than manual method. Whereas, IMH size of 3SD, 4SD

and FWHM show smaller values than that obtained from manual method. IMH size of calculated by 2SD

is congruent to the values obtained by manual method.

Table 1

Patient Characteristics.

Values are mean ± standard deviation or median (IQR). Characteristics of all 33 patients are shown.

IMH = intramyocardial hemorrhage; STEMI = ST elevation myocardial infarction; CK = creatine kinase;

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CK-MB = creatine kinase MB; IQR = interquartile range; TIMI = thrombolysis in myocardial infarction;

PCI = percutaneous coronary intervention; EDV = end-diastolic volume; ESV = end-systolic volume; EF

= ejection fraction.

Table 2

Spearman rank-correlation coefficient, Bland-Altman analysis and ICC of different quantification

methods compared to the manual method for IMH measuring.

The myocardial weight is expressed in grams (g), computed slice-by-slice.

IMH = intramyocardial hemorrhage; FWHM = full width at half maximum; LOA = limits of agreement;

SSD = standard deviation of difference; ICC = intraclass correlation coefficients; CI = confidence

interval.

Table 3

Bland-Altman analysis and ICC for intra- and inter-observer variability of different quantification

methods for IMH measurement.

The myocardial weight is expressed in milligrams (mg), computed slice-by-slice.

IMH = intramyocardial hemorrhage; FWHM = full width at half maximum; LOA = limits of agreement;

SSD = standard deviation of difference; ICC = intraclass correlation coefficients; CI = confidence

interval.

Figures

Click here to access/download;Figure;Figures.pdf

Table

Click here to access/download;Table;Table1.docx

Table 1

Patient Characteristics.

All

Without IMH

With IMH

P value

(n = 33)

(n = 29)

(n = 4)

STEMI, n (%)

27 (82)

24 (83)

3 (75)

1.00

Age (years)

67 ± 11

67 ± 11

65 ± 11

0.47

Male, n (%)

27 (82)

23 (79)

4 (100)

1.00

23.6 ± 3.9

23.8 ± 4.1

23.1 ± 2.1

0.44

Systolic blood pressure (mmHg)

143.4 ± 28.2

143.2 ± 28.4

144.3 ± 30.7

0.87

Diastolic blood pressure (mmHg)

82.7 ± 21.7

81.6 ± 22.3

90.5 ± 17.0

0.19

Systemic hypertension, n (%)

25 (76)

21 (72)

4 (100)

0.55

Hyperlipidemia, n (%)

16 (48)

14 (48)

2 (50)

1.00

Diabetes mellitus, n (%)

11 (33)

11 (38)

0 (0)

0.28

Current smoker, n (%)

9 (27)

7 (24)

2 (50)

0.30

2487 ± 3051

1713 ± 1640

8093 ± 5146

<0.01

187 ± 161

152 ± 125

438 ± 185

<0.01

RCA

15 (45)

15 (52)

0 (0)

0.11

LAD

14 (42)

11 (38)

3 (75)

0.29

LCX

4 (12)

3 (10)

1 (25)

0.42

247 (131-1335)

247 (131-1440)

226 (137-564)

0.72

TIMI flow grade 0/1 pre-PCI, n (%)

21 (64)

18 (62)

3 (75)

1.00

TIMI flow grade 3 post PCI, n (%)

31 (94)

27 (93)

4 (100)

1.00

EDV (ml)

84.0 ± 24.1

82.4 ± 23.5

95.9 ± 28.6

0.39

ESV (ml)

38.1 ± 15.3

37.5 ± 14.5

42.1 ± 23.0

0.93

Clinical data

Body mass index (kg/m2)

Biochemical data

Peak CK (IU/L)

Peak CK-MB (IU/L)

Angiographic data

Culprit lesion, n (%)

Median (IQR) minutes from OTB

Echocardiographic data

EF (%)

56.9 ± 10.4

57.0 ± 10.8

56.1 ± 8.3

0.98

Values are mean ± standard deviation or median (IQR). Characteristics of all 33 patients are shown.

IMH = intramyocardial hemorrhage; STEMI = ST elevation myocardial infarction; CK = creatine kinase; CK-MB =

creatine kinase MB; IQR = interquartile range; TIMI = thrombolysis in myocardial infarction; PCI = percutaneous

coronary intervention; EDV = end-diastolic volume; ESV = end-systolic volume; EF = ejection fraction.

Table

Click here to access/download;Table;Table2.docx

Table 2

Spearman rank-correlation coefficient, Bland-Altman analysis and ICC of different quantification methods compared to

the manual method for IMH measuring.

Correlation analysis

Semi-

IMH volume (g)

automated

vs. Manual

method

measurements

Bland-Altman analysis

Bias

P value

ICC

SDD

(LOA)

(95% CI)

(8.07 g

(5.37 to 9.33))

19.96

1SD

0.90

0.63

<0.0001

(14.79 to 26.68)

(-0.62 to 2.42)

5.84

2SD

-0.01

0.85

<0.0001

(3.30 to 9.00)

(-0.51 to 0.49)

-0.21

0.91

<0.0001

(1.19 to 5.07)

(-0.71 to 0.30)

-0.28

0.84

<0.0001

(0.65 to 3.20)

(-0.89 to 0.32)

-0.37

0.54

<0.0001

(0.33 to 0.67)

(-1.17 to 0.44)

7.11

0.30

(109.97 to 136.55)

0.01

(0 – 0.31)

0.01

2.19

(2.82 to 11.40)

(0.02 – 0.71)

0.11

0.41

122.57

Otsu

(0.24 – 0.84)

0.46

0.31

0.46

FWHM

(0.75 – 0.90)

0.67

0.26

1.90

4SD

(0 – 0.56)

0.84

0.26

3.00

3SD

0.28

0.78

(0 – 0.06)

The myocardial weight is expressed in grams (g), computed slice-by-slice.

IMH = intramyocardial hemorrhage; FWHM = full width at half maximum; LOA = limits of agreement; SSD = standard

deviation of difference; ICC = intraclass correlation coefficients; CI = confidence interval.

Table

Click here to access/download;Table;Table3.docx

Table 3

Bland-Altman analysis and ICC for intra- and inter-observer variability of different quantification methods for IMH

measurement.

Intra-observer

Method

Bias

Inter-observer

ICC

Bias

SDD

(LOA)

-11

Manual

91

(-189 to 167)

-113

1SD

299

(-698 to 472)

-22

2SD

48

(-118 to 72)

-4

3SD

(-15 to 7)

-0.8

4SD

(-14 to 12)

-0.5

FWHM

(-4 to 3)

-615

Otsu

880

(-2339 to 1109)

ICC

SDD

(95% CI)

(LOA)

0.97

50

0.95

121

(0.93 – 0.99)

(-187 to 288)

0.92

-204

(-615 to 207)

0.99

-52

(-180 to 76)

1.00

-18

(-81 to 45)

1.00

-10

(-40 to 21)

0.99

-0.9

(-4 to 3)

0.91

-522

(0.99 – 1.00)

0.96

531

(-1563 to 519)

(0.97 – 1.00)

1.00

(0.97 – 1.00)

(0.97 – 1.00)

0.99

15

(1.00 – 1.00)

(0.91 – 0.99)

0.99

32

(1.00 – 1.00)

(0.71 – 0.99)

0.98

65

(0.98 – 1.00)

(0.87 – 0.98)

0.96

210

(0.81 – 0.97)

(0.79 – 0.96)

(95% CI)

(0.70 – 0.99)

The myocardial weight is expressed in milligrams (mg), computed slice-by-slice.

IMH = intramyocardial hemorrhage; FWHM = full width at half maximum; LOA = limits of agreement; SSD = standard

deviation of difference; ICC = intraclass correlation coefficients; CI = confidence interval.

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