VIsual STAndardized Quantification of LGE (VISTAQ), a contour-less method for late gadolinium enhancement quantification

Clicks: 18
ID: 326875
2026
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Ranked #20 of 72 articles by views in European Heart Journal - Imaging Methods and Practice

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Abstract
ABSTRACT Background Late gadolinium enhancement (LGE) quantification by cardiovascular magnetic resonance is central to risk stratification in hypertrophic cardiomyopathy (HCM), yet conventional techniques require contour tracing and region-of-interest (ROI) placement, which may reduce reproducibility and increase analysis time. We developed a novel visual standardized approach, the Visual Standardized Quantification of LGE (VISTAQ), that does not require myocardial contouring, arbitrary ROI positioning, or dedicated post-processing software. Methods In this multicenter, multivendor retrospective study, LGE images from 400 patients (100 prior myocardial infarction, 250 HCM, 50 other non-ischemic heart diseases) were analyzed. VISTAQ subdivides each myocardial segment into transmural mini-segments and classifies LGE visually using predefined criteria, expressing global LGE burden as the percentage of positive mini-segments. Reproducibility was assessed in 250 patients across different observer expertise levels using intraclass correlation coefficients (ICC) and Bland–Altman analysis. In 100 HCM patients, VISTAQ was compared with conventional methods (mean+2SD, +5SD, +6SD, FWHM, visual thresholding). Prognostic performance was evaluated in 250 HCM patients over a median 5-year follow-up. Results VISTAQ demonstrated excellent intra- and inter-observer reproducibility (ICC up to 0.98 and 0.97, respectively), consistent across disease subtypes. Compared with conventional techniques, VISTAQ showed similar ICC to FWHM but significantly lower net and absolute inter-observer differences (median absolute difference 1.3%). Mean+2SD markedly overestimated LGE, whereas mean+6SD slightly underestimated LGE compared with VISTAQ, mean+5SD, FWHM, and visual thresholding. Analysis time was substantially shorter with VISTAQ (median 105 vs. 375 seconds, p<0.0001). During follow-up, 21 hard cardiac events occurred in HCM population. An LGE threshold >10% predicted events with higher accuracy using VISTAQ (AUC 0.90; sensitivity 85%; specificity 94%) compared with mean+6SD (AUC 0.75; sensitivity 57%; specificity 93%). Conclusions VISTAQ provides highly reproducible, time-efficient LGE quantification without dedicated software and demonstrates non-inferior prognostic discrimination in HCM compared with conventional threshold-based techniques.
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Authors G D Aquaro, Roberto Licordari, Carmelo De Gori, Giancarlo Todiere, Umberto Ianni, Andrea Barison, Antonio De Luca, Alessandro Folgheraiter, C Grigoratos, Mattia Alberti, Lisa Fulceri, Marilena Lombardo, Raffaele De Caterina, Gianfranco Sinagra, Michele Emdin, Gianluca Di Bella
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Journal European Heart Journal - Imaging Methods and Practice
Year 2026
DOI
10.1093/ehjimp/qyag148
URL
https://doi.org/10.1093/ehjimp/qyag148
Keywords Keywords not found

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