Gray blood late gadolinium enhancement cardiovascular magnetic resonance for improved detection of myocardial scar

Abstract

BackgroundLow scar-to-blood contrast in late gadolinium enhanced (LGE) MRI limits the visualization of scars adjacent to the blood pool. Nulling the blood signal improves scar detection but results in lack of contrast between myocardium and blood, which makes clinical evaluation of LGE images more difficult.MethodsGB-LGE contrast is achieved through partial suppression of the blood signal using T2 magnetization preparation between the inversion pulse and acquisition. The timing parameters of GB-LGE sequence are determined by optimizing a cost-function representing the desired tissue contrast. The proposed 3D GB-LGE sequence was evaluated using phantoms, human subjects (n = 45) and a swine model of myocardial infarction (n = 5). Two independent readers subjectively evaluated the image quality and ability to identify and localize scarring in GB-LGE compared to black-blood LGE (BB-LGE) (i.e., with complete blood nulling) and conventional (bright-blood) LGE.ResultsGB-LGE contrast was successfully generated in phantoms and all in-vivo scans. The scar-to-blood contrast was improved in GB-LGE compared to conventional LGE in humans (1.1 ± 0.5 vs. 0.6 ± 0.4, P < 0.001) and in animals (1.5 ± 0.2 vs. -0.03 ± 0.2). In patients, GB-LGE detected more tissue scarring compared to BB-LGE and conventional LGE. The subjective scores of the GB-LGE ability for localizing LV scar and detecting papillary scar were improved as compared with both BB-LGE (P < 0.024) and conventional LGE (P < 0.001). In the swine infarction model, GB-LGE scores for the ability to localize LV scar scores were consistently higher than those of both BB-LGE and conventional-LGE.ConclusionGB-LGE imaging improves the ability to identify and localize myocardial scarring compared to both BB-LGE and conventional LGE. Further studies are warranted to histologically validate GB-LGE.Electronic supplementary materialThe online version of this article (10.1186/s12968-018-0442-2) contains supplementary material, which is available to authorized users.

Usefulness of TI-scout images in the assessment of late gadolinium enhancement in children

“…However, there are limitations in detection of the lesions, particularly in areas of the myocardium adjacent to the blood pool and epicardial fat with standard LGE imaging. To overcome such limitations, the signal from the blood pool was completely or partially suppressed with or without T2 preparation between the inversion pulse and signal readout [ 4 – 7 ]. Although both complete and partial suppression techniques are helpful, neither technique is completely satisfactory.…”

Accelerated high-resolution free-breathing 3D whole-heart T2-prepared black-blood and bright-blood cardiovascular magnetic resonance

“…6 . Alternatively, a grey-blood PSIR technique can be used, which is optimized to null the blood pool, leading to a gray appearance of the blood in the PSIR image, and hence, offering better contrast between myocardium and blood pool [ 36 , 37 ]. Nevertheless, the ability of the proposed method to discriminate between ischemic and non-ischemic cardiomyopathies needs to be evaluated and will also be the subject of future studies.…”

Molecular Imaging to Monitor Left Ventricular Remodeling in Heart Failure

“…Delayed hyperintensity in the myocardium and signal from blood is hard to distinguish. To improve contrast between infarct scar and blood in LGE, a T 2 preparation was added between inversion pulse and image acquisition [34]. Cons of the LGE technique include the inability to show the quality of the scar, emphasis on extracellular water content, and failure to detect diffuse fibrosis and global changes in the myocardium after the injury [15,35].…”