Standardized image post-processing of cardiovascular magnetic resonance T1-mapping reduces variability and improves accuracy and consistency in myocardial tissue characterization.

Background: Myocardial T1-mapping is increasingly used in multicentre studies and trials. Inconsistent image analysis introduces variability, hinders differentiation of diseases, and results in larger sample sizes. We present a systematic approach to standardize T1-map analysis by human operators to improve accuracy and consistency.

Methods: We developed a multi-step training program for T1-map post-processing. The training dataset contained 42 left ventricular (LV) short-axis T1-maps (normal and diseases; 1.5 and 3 Tesla). Contours drawn by two experienced human operators served as reference for myocardial T1 and wall thickness (WT). Trainees (n = 26) underwent training and were evaluated by: (a) qualitative review of contours; (b) quantitative comparison with reference T1 and WT.

Results: The mean absolute difference between reference operators was 8.4 ± 6.3 ms (T1) and 1.2 ± 0.7 pixels (WT). Trainees' mean discrepancy from reference in T1 improved significantly post-training (from 8.1 ± 2.4 to 6.7 ± 1.4 ms; p < 0.001), with a 43% reduction in standard deviation (SD) (p = 0.035). WT also improved significantly post-training (from 0.9 ± 0.4 to 0.7 ± 0.2 pixels, p = 0.036), with 47% reduction in SD (p = 0.04). These experimentally-derived thresholds served to guide the training process: T1 (±8 ms) and WT (±1 pixel) from reference.

Conclusion: A standardized approach to CMR T1-map image post-processing leads to significant improvements in the accuracy and consistency of LV myocardial T1 values and wall thickness. Improving consistency between operators can translate into 33-72% reduction in clinical trial sample-sizes. This work may: (a) serve as a basis for re-certification for core-lab operators; (b) translate to sample-size reductions for clinical studies; (c) produce better-quality training datasets for machine learning.