Auto-Threshold quantification of late gadolinium enhancement in patients with acute heart disease

Purpose: To assess the Otsu-Auto-Threshold (OAT) for accuracy and reproducibility for sizing irreversible injury in late gadolinium enhancement (LGE) images of patients with acute heart disease. The OAT method automatically identifies high signal intensity areas using a cutoff derived from the signal intensity histogram and therefore is user-independent. Materials and Methods: LGE was performed in 28 patients with acute myocardial infarction (MI) and 30 patients with acute myocarditis. LGE mass was compared between OAT and thresholds using 2 standard deviations (SD), 3SD, and 5SD above remote myocardium, and full-width-at-half-maximum (FWHM). A separate, blinded visual assessment served as the standard of truth. Results: In patients with acute MI, OAT and 5SD did not differ (26.1 +/- 11.4 g vs. 25.4 +/- 11.1 g, P = 0.088), but thresholds of 2SD and 3SD overestimated LGE mass by 37% and 20%, respectively, and FWHM underestimated by 15%. In acute myocarditis, OAT was not different from a visual quantification, but thresholds of 2SD and 3SD overestimated LGE mass by 46% and 19%, respectively, and thresholds of 5SD and FWHM underestimated LGE mass by 17% and 26%, respectively. OAT and FWHM showed the best intraobserver and interobserver reproducibility. Conclusion: Automatic thresholding using OAT may serve as an accurate and reproducible method to quantify irreversible myocardial injury in acute heart disease. J. Magn. Reson. Imaging 2013;37:382390. (C) 2012 Wiley Periodicals, Inc.