High-resolution 3-dimensional late gadolinium enhancement scar imaging in surgically corrected Tetralogy of Fallot: clinical feasibility of volumetric quantification and visualization

Abstract

BackgroundThe extent of surgical scarring in Tetralogy of Fallot (TOF) may be a marker of adverse outcomes and provide substrate for ventricular arrhythmia. In this study we evaluate the feasibility of high resolution three dimensional (3D) late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) for volumetric scar quantification in patients with surgically corrected TOF.MethodsFifteen consecutive patients underwent 3D LGE imaging with 3 Tesla CMR using a whole-heart, respiratory-navigated technique. A novel, signal-histogram based segmentation technique was tested for the quantification and modeling of surgical scar. Total scar volume was compared to the gold standard manual expert segmentation. The feasibility of segmented scar fusion to matched coronary CMR data for volumetric display was explored.ResultsImage quality sufficient for 3D scar segmentation was acquired in fourteen patients. Mean patient age was 32.2 ± 11.9 years (range 21 to 57 years) with mean right ventricle (RV) ejection fraction (EF) of 53.9 ± 9.2% and mean RV end diastolic volume of 117.0 ± 41.5 mL/m2. The mean total scar volume was 11.1 ± 8.2 mL using semi-automated 3D segmentation with excellent correlation to manual expert segmentation (r = 0.99, bias = 0.89 mL, 95% CI -1.66 to 3.44). The mean segmentation time was significantly reduced using the novel semi-automated segmentation technique (10.1 ± 2.6 versus 45.8 ± 12.6 minutes). Excellent intra-observer and good inter-observer reproducibility was observed.Conclusion3D high resolution LGE imaging with semi-automated scar segmentation is clinically feasible among patients with surgically corrected TOF and shows excellent accuracy and reproducibility. This approach may offer a valuable clinical tool for risk prediction and procedural planning among this growing population.

Clinical evaluation of three‐dimensional late enhancement MRI

“…Previous investigations evaluating the reproducibility of methods assessed the feasibility of 3D scar imaging in selected patient groups with acute, subacute and chronic myocardial infarction as well as left atrial, right atrial, and right ventricular scar . These studies have shown that 3D LGE imaging is technically feasible, with a good diagnostic value.…”

Assessment of right ventricular systolic function in children with repaired tetralogy of Fallot by multiple‐view from single acoustic window with speckle tracking echocardiography

“…The reduction in RVLS was considered to be related to the RV dilatation and gradual formation of RV myocardial fibrosis in rTOF . The multi‐view reduction in RVLS was correspondent with the extension phenomenon of late gadolinium enhancement (LGE) CMR that RV fibrosis was not only seen at surgical sites ‐ the RVOT, but also in sites remote from RVOT which were vulnerable to ischemic insult …”

Review of Journal of Cardiovascular Magnetic Resonance 2014

“…LGE enhancement is associated with adverse clinical features in repaired tetralogy of Fallot (ToF) and RV scar is the substrate for ventricular arrhythmia. This study demonstrated high resolution 3D LGE at three Tesla findings in 15 patients using a whole heart, respiratory navigated technique and evaluated a semi-automated segmentation analysis [ 16 ]. Total right ventricular outflow tract scar volume using the semi-automated method was compared to manual segmentation as the gold standard in 15 patients with ToF.…”