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BioMed Research International
Volume 2015 (2015), Article ID 232649, 9 pages
Research Article

Importance of Reference Muscle Selection in Quantitative Signal Intensity Analysis of T2-Weighted Images of Myocardial Edema Using a T2 Ratio Method

1CMR Centre, Montreal Heart Institute, University of Montreal, Montreal, QC, Canada H1T 1C8
2Department of Radiological, Onchological and Pathological Sciences, Sapienza, University of Rome, 00161 Rome, Italy
3Stephenson CMR Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada T2N 2T9
4Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada S7N 5B4
5King Abdulaziz Cardiac Center, Riyadh 11426, Saudi Arabia
6Department of Diagnostic Imaging, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada T2N 2T9

Received 7 August 2014; Revised 2 February 2015; Accepted 11 March 2015

Academic Editor: Volker Rasche

Copyright © 2015 Iacopo Carbone et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objectives. The purpose of our study was to identify the suitability of various skeletal muscles as reference regions for calculating the T2 SI ratio for a semiautomated quantification of the extent of myocardial edema with T2-weighted images. Methods. Thirty-four patients with acute myocardial infarction (MI) were enrolled. The extent of myocardial edema was determined by T2 SI ratio map, using 4 different muscles as reference: major and minor pectoralis, serratus anterior, teres minor-infraspinatus, and subscapularis. The size of myocardial edema as visually quantified was used as the standard of truth. The control group consisted of 15 patients with chronic MI. Intra- and interobserver variability were assessed. Results. Due to poor image quality four patients were excluded from the analysis. In acute MI patients, serratus anterior muscle showed the strongest correlation with the visual analysis (; ) and low inter- and intraobserver variability, while the other muscles resulted in a significant interobserver variability. In contrast, the use of other muscles as a reference led to overestimating edema size. Conclusions. In acute MI patients, serratus anterior resulted to be the most reliable and reproducible muscle for measuring the extent of myocardial edema.