Accurate Automatic Papillary Muscle Identification for Quantitative Left Ventricle Mass Measurements in Cardiac Magnetic Resonance Imaging

Rationale and Objectives: We sought to evaluate the automatic detection of the papillary muscle and to determine its influence on quantitative left ventricular (LV) mass assessment. Materials and Methods: Twenty-eight Yorkshire-Landrace swine and 10 volunteers underwent cardiac magnetic resonance imaging (CMR) of the left ventricle. The variability in measurements of LV papillary muscles traced automatically and manually were compared to intra- and interobserver variabilities. CMR-derived LV mass with the papillary muscle included or excluded from LV mass measurements was compared to true mass at autopsy of the Yorkshire-Landrace swine. Results: Automatic LV papillary muscle mass from all subjects correlated well with manually derived LV papillary muscle mass measurements (r = 0.84) with no significant bias between both measurements (mean difference ± SD, 0.0 ± 1.5 g; P = .98). The variability in results related to the contour detection method used was not statistically significant different compared to intra- and interobserver variabilities (P = .08 and P = .97, respectively). LV mass measurements including the papillary muscle showed significantly less underestimation (-10.6 ± 7.1 g) with the lowest percentage variability (6%) compared to measurements excluding the papillary muscles (mean underestimation, -15.1 ± 7.4 g percentage variability, 7%). Conclusion: The automatic algorithm for detecting the papillary muscle was accurate with variabilities comparable to intra- and interobserver variabilities. LV mass is determined most accurately when the papillary muscles are included in the LV mass measurements. Taken together, these observations warrant the inclusion of automatic contour detection of papillary muscle mass in studies that involve the determination of LV mass.

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