Fast 3-Breath-Hold 3-Dimensional Tagging Cardiac Magnetic Resonance in Patients with Hypertrophic Myocardial Diseases: A Feasibility Study

Abstract

Tagging CMR has been established as the standard reference for measurement of myocardial strain. The current 2D tagging technique requires multiple breath-holds to cover the whole heart and cannot show the 3D motions of the left ventricle. We performed fast 3-breath-hold 3D tagging with localized tagging preparation and complementary spatial modulation of magnetization in 10 patients with hypertrophic myocardial diseases and 6 normal volunteers. The left wall motion was observed at any view angle, which allowed for the identification of regional and global hypokinesis using the fast 3D tagging. Although a decrease in the circumferential strain and LGE were observed at the basal septum in hypertrophic cardiomyopathy, they were not located together in each patient. In hypertensive heart disease, the decrease in circumferential strain was observed more widely than LGE, and the summed strain of all segments was significantly decreased. The decrease in strain and LGE were observed diffusely in cardiac amyloidosis. In conclusion, fast 3-breath-hold 3D tagging is feasible for the regional and global strain analysis. The location of reduced circumferential strain is not necessarily the same as that of LGE and is related to the global cardiac function in patients with hypertrophic myocardial diseases.

Three-dimensional Cardiac MR Imaging: Related Techniques and Clinical Applications

“… 16 The navigator gating technique is also applied to 2–4 breath-hold 3D LGE or 3D tagging to maintain an identical diaphragmatic position between the breath-holds. 17 …”

“…Spatial excitation allows for images with a limited, smaller field-of-view (FOV) while avoiding phase wrapping artifacts. 17 , 20 , 31 In particular, spatial excitation is used for the second tagging preparation in 3D tagging, which allows for a half FOV without a wrapping-around artifact. 17 , 32 …”

“…In 3D tagging, the navigator gating technique is used to maintain an identical diaphragmatic position during the breath-holds. 12 , 17 Echo-planar readout and the second tagging preparation using a spatial localized pulse are applied to reduce the scan time significantly. 31 , 32 The 3D tagging can provide the 3D presentation of the entire left ventricle with grid tags ( Fig.…”

“…8b ), and has shown that the circumferential strain at the mid septal and posterior segments and apical segments in hypertensive cardiomyopathy is predominantly decreased, irrespective of the presence or absence of LGE. 17 …”

Cardiac MR Imaging of Hypertrophic Cardiomyopathy: Techniques, Findings, and Clinical Relevance

“… 18 The hypertrophied myocardial region with LGE tends to show decreased wall motion on tagging, 32 while the disconcordance between LGE and decreased circumferential strain is observed using 3D tagging. 33 It is unknown whether the tagging has considerable advantages over cine SSFP and LGE MR imaging for identification of early-stage HCM and for risk stratification.…”