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Background Phase‐sensitive inversion recovery (PSIR) is a powerful cardiac MRI method to assess myocardial viability, which can eliminate the background phase and preserve the sign of the desired magnetization during inversion recovery. Purpose/Hypothesis To shorten the acquisition time of myocardial viability imaging by introducing both simultaneous multislice (SMS) and parallel imaging (PI) into PSIR without additional acquisitions for calibration data. Study Type Prospective study. Subjects A high‐resolution phantom and three vials with doped solutions matching typical postcontrast T1 and T2 values of scar, healthy myocardium, and blood; 18 patients (six with known myocardial infarction) were included in this study. Field Strength/Sequence 3T/segmented fast spoiled gradient echo pulse sequence. Assessment Phantom and in vivo experiments were performed to compare the performance of conventional PSIR, SMS accelerated PSIR (SMS‐PSIR, 2× acceleration), and SMS as well as PI accelerated PSIR (SMS + PI‐PSIR, 4× acceleration). In phantom experiments, the error maps, local signal‐to‐noise ratio (SNR), and contrast‐to‐noise ratio (CNR) were calculated. In in vivo experiments, the image quality and artifact level of each study were qualitatively graded (by three radiologists). G‐factor maps were calculated. The infarct size presented as a percentage of the left ventricle was measured (full‐width half‐maximum). Acquisition time of each study was recorded. Statistical Test One‐way analysis of variance, Kruskal–Wallis test. Results In phantom experiments, SNR and CNR were well preserved for SMS‐PSIR, while they dropped for SMS + PI‐PSIR, as expected. In 15 subjects, the overall image quality scores were not significantly different among conventional PSIR (3.70 ± 1.06), SMS‐PSIR (3.78 ± 0.99), and SMS + PI‐PSIR (3.47 ± 0.94; P = 0.20). The artifact level scores were also comparable among conventional PSIR (3.67 ± 1.04), SMS‐PSIR (3.77 ± 1.03), and SMS + PI‐PSIR (3.45 ± 1.00; P = 0.22). SMS‐PSIR achieved negligible g‐factor noise amplification (1.04 ± 0.03) and SMS + PI‐PSIR showed higher g‐factors (2.83 ± 0.48). The infarct size was consistent among conventional PSIR (22.51 ± 25.05%) and SMS‐PSIR (22.98 ± 26.19%), as well as SMS + PI‐PSIR (22.93 ± 25.68%; P = 0.98). The acquisition time of two short‐axis slices for SMS‐PSIR (17.6 ± 1.7 sec, 16 heartbeats) and SMS + PI‐PSIR (9.8 ± 1.9 sec, 8 heartbeats) was 30% and 17% of that for conventional PSIR (56.2 ± 8.5 sec, 32 heartbeats), respectively. Data Conclusion SMS can be implemented in PSIR without additional reference scan. The image quality is comparable with conventional PSIR, while the acquisition time is much shorter. The proposed method is also compatible with PI to further reduce the scan time. Level of Evidence: 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;50:1964–1972.
Background Phase‐sensitive inversion recovery (PSIR) is a powerful cardiac MRI method to assess myocardial viability, which can eliminate the background phase and preserve the sign of the desired magnetization during inversion recovery. Purpose/Hypothesis To shorten the acquisition time of myocardial viability imaging by introducing both simultaneous multislice (SMS) and parallel imaging (PI) into PSIR without additional acquisitions for calibration data. Study Type Prospective study. Subjects A high‐resolution phantom and three vials with doped solutions matching typical postcontrast T1 and T2 values of scar, healthy myocardium, and blood; 18 patients (six with known myocardial infarction) were included in this study. Field Strength/Sequence 3T/segmented fast spoiled gradient echo pulse sequence. Assessment Phantom and in vivo experiments were performed to compare the performance of conventional PSIR, SMS accelerated PSIR (SMS‐PSIR, 2× acceleration), and SMS as well as PI accelerated PSIR (SMS + PI‐PSIR, 4× acceleration). In phantom experiments, the error maps, local signal‐to‐noise ratio (SNR), and contrast‐to‐noise ratio (CNR) were calculated. In in vivo experiments, the image quality and artifact level of each study were qualitatively graded (by three radiologists). G‐factor maps were calculated. The infarct size presented as a percentage of the left ventricle was measured (full‐width half‐maximum). Acquisition time of each study was recorded. Statistical Test One‐way analysis of variance, Kruskal–Wallis test. Results In phantom experiments, SNR and CNR were well preserved for SMS‐PSIR, while they dropped for SMS + PI‐PSIR, as expected. In 15 subjects, the overall image quality scores were not significantly different among conventional PSIR (3.70 ± 1.06), SMS‐PSIR (3.78 ± 0.99), and SMS + PI‐PSIR (3.47 ± 0.94; P = 0.20). The artifact level scores were also comparable among conventional PSIR (3.67 ± 1.04), SMS‐PSIR (3.77 ± 1.03), and SMS + PI‐PSIR (3.45 ± 1.00; P = 0.22). SMS‐PSIR achieved negligible g‐factor noise amplification (1.04 ± 0.03) and SMS + PI‐PSIR showed higher g‐factors (2.83 ± 0.48). The infarct size was consistent among conventional PSIR (22.51 ± 25.05%) and SMS‐PSIR (22.98 ± 26.19%), as well as SMS + PI‐PSIR (22.93 ± 25.68%; P = 0.98). The acquisition time of two short‐axis slices for SMS‐PSIR (17.6 ± 1.7 sec, 16 heartbeats) and SMS + PI‐PSIR (9.8 ± 1.9 sec, 8 heartbeats) was 30% and 17% of that for conventional PSIR (56.2 ± 8.5 sec, 32 heartbeats), respectively. Data Conclusion SMS can be implemented in PSIR without additional reference scan. The image quality is comparable with conventional PSIR, while the acquisition time is much shorter. The proposed method is also compatible with PI to further reduce the scan time. Level of Evidence: 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;50:1964–1972.
MRI represents an important tool for detection of the underlying cause and for risk stratification in many diseases associated with arrhythmias.
Fibrotic remodelling of the extracellular matrix is a healing mechanism necessary immediately after myocardial injury. However, prolonged increase in myocardial fibrotic activity results in stiffening of the myocardium and heralds adverse outcomes related to systolic and diastolic dysfunction, as well as arrhythmogenesis. Cardiac MRI provides a noninvasive phenotyping tool for accurate and easy detection and quantification of myocardial fibrosis by probing the retention of gadolinium-contrast agent in myocardial tissue. Late-gadolinium enhancement (LGE) cardiac MRI has been used extensively in a large number of studies for measurement of myocardial scarring. T1 mapping, a fairly new technique that can be used to identify the exact T1 value of the tissue, provides a direct measurement of the extracellular volume fraction of the myocardium. In contrast to LGE, T1 mapping can be used to measure diffuse myocardial fibrosis and differentiate between disease processes. In this Review, we describe the basic principles of imaging myocardial fibrosis using contrast-enhanced MRI and summarize its use for prognostic purposes.
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