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. 2022 Jun;127(6):589-601.
doi: 10.1007/s11547-022-01491-8. Epub 2022 Apr 18.

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

Silvia Pradella  1   2 , Lorenzo Nicola Mazzoni  3   4 , Mayla Letteriello  1 , Paolo Tortoli  4 , Silvia Bettarini  4 , Cristian De Amicis  1 , Giulia Grazzini  5 , Simone Busoni  4 , Pierpaolo Palumbo  2   6 , Giacomo Belli  4 , Vittorio Miele  1
Affiliations

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

Silvia Pradella et al. Radiol Med. 2022 Jun.

Abstract

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.

Keywords: Cardiac radiology; Ischemic cardiomyopathies; Late gadolinium enhancement (LGE); Magnetic resonance imaging (MRI); Non-ischemic cardiomyopathies; Quantification software.

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