Clinical value of dark-blood late gadolinium enhancement cardiovascular magnetic resonance without additional magnetization preparation

Abstract

Background For two decades, bright-blood late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) has been considered the reference standard for the non-invasive assessment of myocardial viability. While bright-blood LGE can clearly distinguish areas of myocardial infarction from viable myocardium, it often suffers from poor scar-to-blood contrast, making subendocardial scar difficult to detect. Recently, we proposed a novel dark-blood LGE approach that increases scar-to-blood contrast and thereby improves subendocardial scar conspicuity. In the present study we sought to assess the clinical value of this novel approach in a large patient cohort with various non-congenital ischemic and non-ischemic cardiomyopathies on both 1.5 T and 3 T CMR scanners of different vendors. Methods Three hundred consecutive patients referred for clinical CMR were randomly assigned to a 1.5 T or 3 T scanner. An entire short-axis stack and multiple long-axis views were acquired using conventional phase sensitive inversion recovery (PSIR) LGE with TI set to null myocardium (bright-blood) and proposed PSIR LGE with TI set to null blood (dark-blood), in a randomized order. The bright-blood LGE and dark-blood LGE images were separated, anonymized, and interpreted in a random order at different time points by one of five independent observers. Each case was analyzed for the type of scar, per-segment transmurality, papillary muscle enhancement, overall image quality, observer confidence, and presence of right ventricular scar and intraventricular thrombus. Results Dark-blood LGE detected significantly more cases with ischemic scar compared to conventional bright-blood LGE (97 vs 89, p = 0.008), on both 1.5 T and 3 T, and led to a significantly increased total scar burden (3.3 ± 2.4 vs 3.0 ± 2.3 standard AHA segments, p = 0.015). Overall image quality significantly improved using dark-blood LGE compared to bright-blood LGE (81.3% vs 74.0% of all segments were of highest diagnostic quality, p = 0.006). Furthermore, dark-blood LGE led to significantly higher observer confidence (confident in 84.2% vs 78.4%, p = 0.033). Conclusions The improved detection of ischemic scar makes the proposed dark-blood LGE method a valuable diagnostic tool in the non-invasive assessment of myocardial scar. The applicability in routine clinical practice is further strengthened, as the present approach, in contrast to other recently proposed dark- and black-blood LGE techniques, is readily available without the need for scanner adjustments, extensive optimizations, or additional training.

Clinical application of free-breathing 3D whole heart late gadolinium enhancement cardiovascular magnetic resonance with high isotropic spatial resolution using Compressed SENSE

“…However, no quantitative SNR comparison was carried out in the current work because of the iterative and wavelet denoising based reconstruction used for free-breathing LGE, which is dependent on the actual image content and results in different numbers of iterations or denoising steps for different images interfering with absolute SNR estimations. The visually reduced signal of the blood pool improved detection of subendocardial lesions in this study, mostly due to visually moderately increased differentiation between blood and injured myocardium, facilitating depiction of scars at this localization, comparable to dark-blood LGE [40,41].…”

Respiratory motion-compensated high-resolution 3D whole-heart T1ρ mapping

“…Myocardial infarction detection is important for the evaluation of post-infarction left ventricular remodelling [1]. Late gadolinium enhanced (LGE) cardiovascular magnetic resonance (CMR) imaging is widely used to detect scar, because of its high contrast between the infarcted region and the surrounding myocardium [2,3]. However, LGE imaging requires the administration of gadolinium-based contrast agents, which may be contraindicated in patients with severe renal impairment, due to poor renal clearance of the contrast agent [4].…”

2020 - State of our JCMR

“…The amount of late gadolinium enhancement outperforms current guideline-recommended criteria in the identification of patients with hypertrophic cardiomyopathy at risk of sudden cardiac death [9] Thompson et al Quantification of lung water in heart failure using cardiovascular magnetic resonance imaging [10] Dabir et al Multiparametric cardiovascular magnetic resonance imaging in acute myocarditis: a comparison of different measurement approaches [11] Holtackers et al Clinical value of dark-blood late gadolinium enhancement cardiovascular magnetic resonance without additional magnetization preparation [12] Shusterman et al High-energy external defibrillation and transcutaneous pacing during MRI: feasibility and safety [18] Thompson et al * Quantification of lung water in heart failure using cardiovascular magnetic resonance imaging [10] Walheim et al Multipoint 5D flow cardiovascular magnetic resonance-accelerated cardiac-and respiratory-motion resolved mapping of mean and turbulent velocities [19] website. Over 95% found value in the open-access format with 23% using JCMR as a source for CME and over 75% finding benefit of using the SCMR membership benefit for an 80% discount in the article publication fee (APC).…”

“…In late 2017, we introduced on-line CME credit for the benefit of our clinician readers. This program has been a great success and now includes over 30 manuscripts members including 6 in 2019 [7][8][9][10][11][12] (Table 3). See http:// scmr.peach newme dia.com/store /provi der/custo mpage .php?pagei d=20 for the entire listing.…”