What is the mid-wall linear high intensity “lesion” on cardiovascular magnetic resonance late gadolinium enhancement?

Background: Knowledge of the normal myocardial-myocyte orientation could theoretically allow the definition of relevant quantitative biomarkers in clinical routine to diagnose heart pathologies. A whole heart diffusion tensor template representative of the global myofiber organization over species is therefore crucial for comparisons across populations. In this study, we developed a template-based and tractography framework to resolve the global myofiber arrangement of large mammalian hearts. To demonstrate the potential application of the proposed method, a novel description of sub-regions in the intraventricular septum is presented. Methods: Three explanted sheep (ovine) hearts (size ~12×8×6 cm3 , heart weight ~ 150 g ) were perfused with contrast agent and fixative and imaged in a 9.4T magnet. A group-wise registration of high-resolution anatomical and diffusion-weighted images were performed to generated anatomical and diffusion tensor templates. Diffusion tensor metrics (eigenvalues, eigenvectors, fractional anisotropy...) were computed to provide a quantitative and spatially-resolved analysis of cardiac microstructure. Then tractography was performed using deterministic and probabilistic algorithms and used for different purposes: i) Visualization of myofiber architecture, ii) Segmentation of sub-area depicting the same fiber organization, iii) Seeding and Tract Editing. Finally, dissection was performed to confirm the existence of macroscopic structures identified in the diffusion tensor template. Results: The template creation takes advantage of high-resolution anatomical and diffusion-weighted images obtained at an isotropic resolution of 150 μm and 600 μm respectively, covering ventricles and atria and providing information on the normal myocardial architecture. The diffusion metric distributions from the template were found close to the one of the individual samples validating the registration procedure. Small new sub-regions exhibiting spatially sharp variations in fiber orientation close to the junctions of the septum and ventricles were identified. Each substructure was defined and represented using streamlines. The existence of a bundle of fibers in the posterior junction was validated by anatomical dissection. A complex structural organization of the anterior junction in comparison to the posterior junction was evidenced by the high-resolution acquisition. Conclusions: A new framework combining cardiac template generation and tractography was applied on the whole sheep heart. The framework can be used for anatomical investigation, characterization of microstructure and visualization of myofiber orientation across samples. Finally, a novel description of the ventricular junction in large mammalian hearts was proposed.

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“…The "Y" pattern, depicted in Fig. 7B, is also associated with the location of the anterior-septal perforator arteries recently mentioned in [69].…”

Section: Discussionsupporting

confidence: 53%

A groupwise registration and tractography framework for cardiac myofiber architecture description by diffusion MRI: an application to the ventricular junctions

Magat

Yon

Bihan-Poudec

et al. 2021

Preprint

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“…The global myofiber organization was found closely linked to the surrounding structure including the pulmonary and the aorta. The “Y” pattern, depicted in Fig 7B , is also associated with the location of the anterior-septal perforator arteries recently mentioned in [ 72 ] referred as ventricular myocardial extensions [ 73 ]. Finally, visual inspection and streamline connectivity of the anterior junction suggest that most fibers end in the anterior wall while a strong connectivity fiber is visible in the posterior wall.…”

Section: Discussionmentioning

confidence: 95%

A groupwise registration and tractography framework for cardiac myofiber architecture description by diffusion MRI: An application to the ventricular junctions

et al. 2022

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Background Knowledge of the normal myocardial–myocyte orientation could theoretically allow the definition of relevant quantitative biomarkers in clinical routine to diagnose heart pathologies. A whole heart diffusion tensor template representative of the global myofiber organization over species is therefore crucial for comparisons across populations. In this study, we developed a groupwise registration and tractography framework to resolve the global myofiber arrangement of large mammalian sheep hearts. To demonstrate the potential application of the proposed method, a novel description of sub-regions in the intraventricular septum is presented. Methods Three explanted sheep (ovine) hearts (size ~12×8×6 cm3, heart weight ~ 150 g) were perfused with contrast agent and fixative and imaged in a 9.4T magnet. A group-wise registration of high-resolution anatomical and diffusion-weighted images were performed to generate anatomical and diffusion tensor templates. Diffusion tensor metrics (eigenvalues, eigenvectors, fractional anisotropy …) were computed to provide a quantitative and spatially-resolved analysis of cardiac microstructure. Then tractography was performed using deterministic and probabilistic algorithms and used for different purposes: i) Visualization of myofiber architecture, ii) Segmentation of sub-area depicting the same fiber organization, iii) Seeding and Tract Editing. Finally, dissection was performed to confirm the existence of macroscopic structures identified in the diffusion tensor template. Results The template creation takes advantage of high-resolution anatomical and diffusion-weighted images obtained at an isotropic resolution of 150 μm and 600 μm respectively, covering ventricles and atria and providing information on the normal myocardial architecture. The diffusion metric distributions from the template were found close to the one of the individual samples validating the registration procedure. Small new sub-regions exhibiting spatially sharp variations in fiber orientation close to the junctions of the septum and ventricles were identified. Each substructure was defined and represented using streamlines. The existence of a fiber-bundles in the posterior junction was validated by anatomical dissection. A complex structural organization of the anterior junction in comparison to the posterior junction was evidenced by the high-resolution acquisition. Conclusions A new framework combining cardiac template generation and tractography was applied on the whole sheep heart. The framework can be used for anatomical investigation, characterization of microstructure and visualization of myofiber orientation across samples. Finally, a novel description of the ventricular junction in large mammalian sheep hearts was proposed.

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“…The LLGE in the anterior septum was noted to be similar to the anterior septal perforator artery on coronary CT in its shape and running, and the ratio of LLGE (60.3%) was higher than that reported in previous studies (49.5%) [11]. The correlation between the length of the septal perforator artery on CCTA and the length of LLGE on LGE was also more signi cant, indicating that the two were close in length.…”

Section: Discussionmentioning

confidence: 46%

“…The de nitions of LLGE + were as follows: (1) In the anterior septum or lateral wall, the linear high-intensity signal could be clearly seen in the epicardium or mid-wall of the myocardium, and (2) LLGE observable at 10 mm or more in the anterior septum and lateral wall. Based on previous studies, 15 mm was set as the cut-off value to exclude the possibility of artifacts [11]. In this study, LGE images were obtained by the PSIR technique with higher resolution, so 10 mm was used as the criterion for determining LLGE.…”

Section: Image Analysismentioning

confidence: 99%

“…Recent studies suggested that LGE in the basal septum may represent an artery or vein. Nakamura et al [11] reported that a linear high-intensity lesion in the basal anterior septum could be observed in the shortaxis view on LGE. Compared to the maximum intensity projection (MIP) images of coronary computed tomography angiography (CCTA), the linear high-intensity signal may represent the anterior septal perforator artery.…”

Section: Introductionmentioning

confidence: 99%

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Linear Late Gadolinium Enhancement In The Basal Anterior Septum And Lateral Wall May Represent The Anterior Septal Perforator Artery And Circumflex Artery, Respectively: A CMR And CCTA Comparison Study

Ma¹,

Shang²,

Hu³

et al. 2021

Preprint

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Purpose: The purpose of this paper was to verify that the linear high-intensity signal on late gadolinium enhancement-cardiac magnetic resonance (LGE-CMR) may represent the contrast enhancement of vessels rather than scars or fibrosis, and to assess whether this linear high-intensity signal will affect the quantification of myocardial fibrosis in patients with hypertrophic cardiomyopathy (HCM).Methods: A total of 58 patients who underwent both coronary computed tomography angiography (CCTA) and LGE-CMR in our hospital were ultimately enrolled. The definitions of positive linear LGE (LLGE+) were as follows: (1) LLGE in the basal anterior septum or lateral wall, and (2) LLGE observable at 10 mm or more. All other patients were regarded as negative LLGE (LLGE-). In LLGE+ patients, the length of the LLGE located in the anterior septum and lateral wall was compared with the length of the septal perforator artery and the circumflex artery on CCTA, respectively. For nine patients with HCM, the LGE% was measured before and after removal of LLGE.Results: Among the 58 patients, 40 of whom showed LLGE+ and 18 of whom showed LLGE-. For patients with LLGE in the anterior septum, there was a strong correlation between LLGE and anterior septal perforator arteries in length (r=0.887, p<0.001). For patients with LLGE in the lateral wall, LLGE also correlated well with the circumflex arteries in length (r=0.962, p<0.001). In nine patients with HCM, the LGE% decreased significantly after the removal of LLGE (18.6 [14.15 - 27.5] vs. 12.4 [9.8 - 17.5], p<0.05).Conclusions: The LLGE in the anterior septum and lateral wall may represent contrast enhancement of the anterior septal perforator artery and the circumflex artery, respectively. This LLGE may overestimate the extent of myocardial fibrosis in patients with hypertrophic cardiomyopathy.

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What is the mid-wall linear high intensity “lesion” on cardiovascular magnetic resonance late gadolinium enhancement?

Cited by 10 publications

References 26 publications

A groupwise registration and tractography framework for cardiac myofiber architecture description by diffusion MRI: an application to the ventricular junctions

A groupwise registration and tractography framework for cardiac myofiber architecture description by diffusion MRI: an application to the ventricular junctions

A groupwise registration and tractography framework for cardiac myofiber architecture description by diffusion MRI: An application to the ventricular junctions

Linear Late Gadolinium Enhancement In The Basal Anterior Septum And Lateral Wall May Represent The Anterior Septal Perforator Artery And Circumflex Artery, Respectively: A CMR And CCTA Comparison Study

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