Dark-Blood Late Gadolinium Enhancement MRI Is Noninferior to Bright-Blood LGE in Non-Ischemic Cardiomyopathies

Abstract

(1) Background and Objectives: Dark-blood late gadolinium enhancement has been shown to be a reliable cardiac magnetic resonance (CMR) method for assessing viability and depicting myocardial scarring in ischemic cardiomyopathy. The aim of this study was to evaluate dark-blood LGE imaging compared with conventional bright-blood LGE for the detection of myocardial scarring in non-ischemic cardiomyopathies. (2) Materials and Methods: Patients with suspected non-ischemic cardiomyopathy were prospectively enrolled in this single-centre study from January 2020 to March 2023. All patients underwent 1.5 T CMR with both dark-blood and conventional bright-blood LGE imaging. Corresponding short-axis stacks of both techniques were analysed for the presence, distribution, pattern, and localisation of LGE, as well as the quantitative scar size (%). (3) Results: 343 patients (age 44 ± 17 years; 124 women) with suspected non-ischemic cardiomyopathy were examined. LGE was detected in 123 of 343 cases (36%) with excellent inter-reader agreement (κ 0.97–0.99) for both LGE techniques. Dark-blood LGE showed a sensitivity of 99% (CI 98–100), specificity of 99% (CI 98–100), and an accuracy of 99% (CI 99–100) for the detection of non-ischemic scarring. No significant difference in total scar size (%) was observed. Dark-blood imaging with mean 5.35 ± 4.32% enhanced volume of total myocardial volume, bright-blood with 5.24 ± 4.28%, p = 0.84. (4) Conclusions: Dark-blood LGE imaging is non-inferior to conventional bright-blood LGE imaging in detecting non-ischemic scarring. Therefore, dark-blood LGE imaging may become an equivalent method for the detection of both ischemic and non-ischemic scars.

Quantification of myocardial scar of different etiology using dark- and bright-blood late gadolinium enhancement cardiovascular magnetic resonance

“…Inherently, the measurements may have subjectivity as illustrated by the inter-observer variability, in particular in the NICM and HCM groups. Although the external validity of the present findings is less robust given this single-center nature of this study with a relatively small number of patients for each subgroup, studies at other centers investigating the quantification of ischemic 16 and non-ischemic 33 scar using dark-blood LGE compared to conventional bright-blood LGE found similar results. Finally, high-resolution 3D LGE imaging is increasingly used for accurate substrate detection in the work-up for ablation therapy and implantable cardioverter-defibrillator (ICD) implantation.…”

Lightweight preprocessing and template matching facilitate streamlined ischemic myocardial scar classification

“…At the same time, CMR imaging has sustained its relevance in cardiovascular research, with the prevalence of recent studies demonstrating continued research interest in advancing the diagnostic capabilities and roles of CMR imaging for heart conditions. 19,20 Clinically, CMR images derived from contrast-enhanced CMR imaging is the current standard, with CMR images primarily being manually examined by clinicians to classify IMS. However, the manual classification of IMS in CMR images faces challenges.…”

The Multi-Faceted Utility of Cardiovascular Magnetic Resonance Imaging: Editorial on Special Issue “Advances in Cardiovascular Magnetic Resonance”

“…Brendel et al evaluated the diagnostic performance of dark-blood LGE compared to that of conventional bright-blood LGE in detecting non-ischemic myocardial scarring [8]. The study included 343 patients with suspected non-ischemic cardiomyopathy who underwent both dark-blood and bright-blood LGE imaging.…”