Contrast-enhanced Steady-state Free Precession in the Assessment of Hypertrophic Obstructive Cardiomyopathy after Alcohol Septal Ablation

Abstract

Purpose: We evaluated the feasibility of contrast-enhanced steady-state free precession (ceSSFP) in the assessment of myocardial injury and obstruction of the left ventricular outflow tract (LVOT) in patients with hypertrophic obstructive cardiomyopathy (HOCM) after alcohol septal ablation (ASA).Methods: Twelve patients with HOCM underwent 16 magnetic resonance (MR) examinations following ASA. Precontrast SSFP, ceSSFP and late gadolinium enhancement (LGE) imaging were performed with a 1.5-tesla imager. ceSSFP was performed 3 to 7 min after gadolinium injection. We visually and quantitatively evaluated the signal patterns of the myocardium after ASA on SSFP and LGE MR imaging. We observed the LVOT using ceSSFP in the 3-chamber view.Results: We could visualize ASA-induced myocardial infarction (MI) in all 16 studies by LGE and ceSSFP but in only 6 studies (37.5%) by precontrast SSFP. Contrast was higher between MI and remote myocardium with LGE than ceSSFP (P < 0.01). ASA-induced hypointense regions were well visualized by the 2 sequences after contrast in the 7 patients who underwent MR imaging within 7 weeks of ASA and in a few patients after 80 weeks from ASA. The ceSSFP allowed comparable visualization of the jet flow crossing the LVOT to that derived from echocardiographic data.Conclusion: Contrast-enhanced steady-state free precession allows assessment of myocardial injury as well as of the left ventricular outflow tract after alcohol septal ablation in a single scan without penalty in scan time and cine imaging contrast.

Three-dimensional Cardiac MR Imaging: Related Techniques and Clinical Applications

“… 10 The use of gadolinium can improve the image contrast on SSFP. 29 , 30 Image blurring is also observed in 3D cine imaging with a high reduction factor ( Fig. 6c ).…”

“… 14 , 15 Gadolinium increases the SNR of not only T 1 -weighted gradient-echo imaging but also SSFP imaging because of reduced longitudinal relaxation time. 5 , 29 , 30 Therefore, gadolinium-based contrast agents can be used in the 3D cine cardiac MR imaging.…”

Cardiac MR Imaging of Hypertrophic Cardiomyopathy: Techniques, Findings, and Clinical Relevance

“…20 ). 62 Therefore, cardiac MR imaging is useful for treatment planning and follow-up in patients with HCM with LVOT obstruction.…”