Comparison of fast multi-slice and standard segmented techniques for detection of late gadolinium enhancement in ischemic and non-ischemic cardiomyopathy – a prospective clinical cardiovascular magnetic resonance trial

Abstract

BackgroundSegmented phase-sensitive inversion recovery (PSIR) cardiovascular magnetic resonance (CMR) sequences are reference standard for non-invasive evaluation of myocardial fibrosis using late gadolinium enhancement (LGE). Several multi-slice LGE sequences have been introduced for faster acquisition in patients with arrhythmia and insufficient breathhold capability.The aim of this study was to assess the accuracy of several multi-slice LGE sequences to detect and quantify myocardial fibrosis in patients with ischemic and non-ischemic myocardial disease.MethodsPatients with known or suspected LGE due to chronic infarction, inflammatory myocardial disease and hypertrophic cardiomyopathy (HCM) were prospectively recruited. LGE images were acquired 10–20 min after administration of 0.2 mmol/kg gadolinium-based contrast agent. Three different LGE sequences were acquired: a segmented, single-slice/single-breath-hold fast low angle shot PSIR sequence (FLASH-PSIR), a multi-slice balanced steady-state free precession inversion recovery sequence (bSSFP-IR) and a multi-slice bSSFP-PSIR sequence during breathhold and free breathing. Image quality was evaluated with a 4-point scoring system. Contrast-to-noise ratios (CNR) and acquisition time were evaluated. LGE was quantitatively assessed using a semi-automated threshold method. Differences in size of fibrosis were analyzed using Bland-Altman analysis.ResultsThree hundred twelve patients were enrolled (n = 212 chronic infarction, n = 47 inflammatory myocardial disease, n = 53 HCM) Of which 201 patients (67,4%) had detectable LGE (n = 143 with chronic infarction, n = 27 with inflammatory heart disease and n = 31 with HCM). Image quality and CNR were best on multi-slice bSSFP-PSIR. Acquisition times were significantly shorter for all multi-slice sequences (bSSFP-IR: 23.4 ± 7.2 s; bSSFP-PSIR: 21.9 ± 6.4 s) as compared to FLASH-PSIR (361.5 ± 95.33 s). There was no significant difference of mean LGE size for all sequences in all study groups (FLASH-PSIR: 8.96 ± 10.64 g; bSSFP-IR: 8.69 ± 10.75 g; bSSFP-PSIR: 9.05 ± 10.84 g; bSSFP-PSIR free breathing: 8.85 ± 10.71 g, p > 0.05).LGE size was not affected by arrhythmia or absence of breathhold on multi-slice LGE sequences.ConclusionsFast multi-slice and standard segmented LGE sequences are equivalent techniques for the assessment of myocardial fibrosis, independent of an ischemic or non-ischemic etiology. Even in patients with arrhythmia and insufficient breathhold capability, multi-slice sequences yield excellent image quality at significantly reduced scan time and may be used as standard LGE approach.Trial registrationISRCTN48802295 (retrospectively registered).

Comparison of 3D and 2D late gadolinium enhancement magnetic resonance imaging in patients with acute and chronic myocarditis

“…However, fibrosis in inflammatory disease has lower signal intensity compared with ischemic scars, with usually smaller amounts of fibrotic tissue in typically subepicardial location and lack of concomitant wall motion abnormalities [ 25 , 26 ]. Optimal image quality of LGE images is of utmost importance in order not to miss these subtle areas of fibrosis and the established multi breath-hold 2D LGE sequences are still preferably used in myocarditis protocols [ 27 – 29 ].…”

Cardiovascular Magnetic Resonance for the Differentiation of Left Ventricular Hypertrophy

“…Finally, there is active research into ‘fast’ MRI scans, with the expectation that this will translate into improved cost-effectiveness. Fast multi-slice sequences yield excellent LGE image quality for the assessment of myocardial fibrosis at significantly reduced scan time compared with conventional methods [ 127 ], while motion-corrected techniques continue to strive to improve acquisition efficiency for parametric mapping without compromising diagnostic accuracy [ 128 ]. Compressed sensing (CS), which enables image reconstruction from sparse data, has multiple CMR applications, and may soon become practical for clinical translation due to improvements in computer hardware [ 129 , 130 •].…”

Cardiovascular magnetic resonance: applications and practical considerations for the general cardiologist

“…In CAD, CMR identifies smaller infarcts routinely missed by lower resolution modalities (eg, SPECT) 15. Lower resolution, ‘single-shot’ CMR images may be acquired in seconds, detecting most areas of scarring/infarction 16. Infarct assessment (figures 4A-D) is pivotal in guiding patient selection for revascularisation (those with viable myocardium) and predicting adverse outcome 10 17.…”