FLORA software: semi-automatic LGE-CMR analysis tool for cardiac lesions identification and characterization.

PURPOSE: Today there is a growing interest in the quantification of late gadolinium enhancement (LGE) in ischemic and non-ischemic cardiac pathologies. We build an automatic self-made free software FLORA (For Late gadOlinium enhanced aReas clAssification) for the recognition, classification and quantification of LGE areas that allows to improve the observer's performances and that homogenizes the evaluations between different operators. MATERIAL AND METHODS: We have retrospectively selected 120 CMR exams: 40-ischemic with evident scar tissue on LGE sequences; 40-non-ischemic cardiomyopathy; 40-any myocardial alteration on CMR, especially on LGE sequences. FLORA's performance was compared to the radiologist's evaluation. RESULTS: FLORA identified both ischemic and non-ischemic myocardial lesions in almost all cases (80/80 and 79/80 for the double-Gaussian fit method and fixed-shift method, respectively, with sensitivity and specificity of 100%/98.8% and 55%/50%, respectively). The best results were obtained from the classification of ischemic myocardial damage, which was correctly identified in 85%-95% of cases. FLORA also increases the agreement between observers and allows a quantitative evaluation of transmurality. CONCLUSIONS: FLORA has proven to be an applicable tool that improves and facilitates the classification of LGE areas allowing their quantification.

Cardiac magnetic resonance in hypertrophic and dilated cardiomyopathies.

Cardiomyopathies are a heterogeneous entity. The progress in the field of genetics has allowed over the years to determine its origin more and more often. The classification of these pathologies has changed over the years; it has been updated with new knowledge. Imaging allows to define the phenotypic characteristics of the different forms of cardiomyopathy. Cardiac magnetic resonance (CMR) allows a morphological evaluation of the associated (and sometimes pathognomonic) cardiac findings of any form of cardiomyopathy. The tissue characterization sequences also make magnetic resonance imaging unique in its ability to detect changes in myocardial tissue. This review aims to define the features that can be highlighted by CMR in hypertrophic and dilated forms and the possible differential diagnoses. In hypertrophic forms, CMR provides: precise evaluation of wall thickness in all segments, ventricular function and size and evaluation of possible presence of areas of fibrosis as well as changes in myocardial tissue (measurement of T1 mapping and extracellular volume values). In dilated forms, cardiac resonance is the gold standard in the assessment of ventricular volumes. CMR highlights also the potential alterations of the myocardial tissue.

Masses in right side of the heart: spectrum of imaging findings.

Primary heart tumors are rare, benign tumors represent the majority of these. If a cardiac mass is found, the probability that it is a metastasis or a so-called "pseudo-mass" is extremely higher than a primary tumor. The detection of a heart mass during a transthoracic echocardiography (TE) is often unexpected. The TE assessment can be difficult, particularly if the mass is located at the level of the right chambers. Cardiac Computed Tomography (CCT) can be useful in anatomical evaluation and Cardiac Magnetic Resonance (CMR) for masses characterization as well. We provide an overview of right cardiac masses and their imaging futures.

Does evaluator experience have an impact on the diagnosis of lumbar spine instability in dynamic MRI? Interobserver agreement study.

OBJECTIVES: We aimed to evaluate interobserver agreement in the definition of spine instability among spine neuroradiologists with or without experience in dynamic magnetic resonance imaging (MRI). MATERIAL AND METHODS: Two expert neuroradiologists and two residents retrospectively evaluated the pre-operative dynamic MRI examinations of patients with vertebral instability. Segmental motion, defined as excessive (more than 3 mm) translational motion from supine to upright, was investigated in 103 subjects (309 segments) using kinetic MRI. Radiographic parameters which can help indicate segmental instability include disc degeneration, facet joint osteoarthritis, and ligament flavum hypertrophy. These three radiographic parameters were simultaneously evaluated, and the combinations corresponding to significant segmental instability at each level were determined. The agreement among the neuroradiologists was calculated using the kappa coefficient. All patients had neurosurgical intervention to stabilize the spine. RESULTS: Agreement was high among experienced and non-experienced neuroradiologists. Agreement was nearly perfect for spinal location of spinal instability. CONCLUSIONS: This study demonstrates that the experience of the evaluator has a low impact on the assessment of spinal instability if correct classification is used. The interobserver agreement confirms the usefulness and safety of kinetic MRI in the correct diagnosis of spinal instability even by less experienced evaluators.