Improved border sharpness of post-infarct scar by a novel self-navigated free-breathing high-resolution 3D whole-heart inversion recovery magnetic resonance approach

Abstract

The border zone of post-infarction myocardial scar as identified by late gadolinium enhancement (LGE) has been identified as a substrate for arrhythmias and consequently, high-resolution 3D scar information is potentially useful for planning of electrophysiological interventions. This study evaluates the performance of a novel high-resolution 3D self-navigated free-breathing inversion recovery magnetic resonance pulse sequence (3D-SN-LGE) vs. conventional 2D breath-hold LGE (2D-LGE) with regard to sharpness of borders (S) of post-infarction scar. Patients with post-infarction scar underwent two magnetic resonance examinations for conventional 2D-LGE and high-resolution 3D-SN-LGE acquisitions (both 15 min after 0.2 mmol/kg Gadobutrol IV) at 1.5T. In the prototype 3D-SN-LGE sequence, each ECG-triggered radial steady-state-free-precession read-out segment is preceded by a non-slice-selective inversion pulse. Scar volume and S were assessed on 2D-LGE and matching reconstructed high-resolution 3D-SN-LGE short-axis slices. In 16 patients (four females, 58 ± 10y) all scars visualized by 2D-LGE could be identified on 3D-SN-LGE (time between 2D-LGE and 3D-SN-LGE 48 ± 53 days). A good agreement of scar volume by 3D-SN-LGE vs. 2D-LGE was found (Bland-Altman: -3.7 ± 3.4 ml, correlation: r = 0.987, p < 0.001) with a small difference in scar volume (20.5 (15.8, 35.2) ml vs. 24.5 (20.0, 41.9)) ml, respectively, p = 0.002] and a good intra- and interobserver variability (1.1 ± 4.1 and -1.1 ± 11.9 ml, respectively). S of border "scar to non-infarcted myocardium" was superior on 3D-SN-LGE vs. 2D-LGE: 0.180 ± 0.044 vs. 0.083 ± 0.038, p < 0.001. Detection and quantification of myocardial scar by 3D-SN-LGE is feasible and accurate in comparison to 2D-LGE. The high spatial resolution of the 3D sequence improves delineation of scar borders.

Magnetic resonance imaging guidance for the optimization of ventricular tachycardia ablation

“… 32 3D free-breathing self-navigating MR sequences have recently been described to overcome the errors associated with respiratory navigator placement and irregular breathing patterns enabling high-resolution visualization of scar distribution and superior delineation of scar borders. 33 A new technique to reconstruct a high resolution image from multiple low resolution views of the same volume (super-resolution reconstruction) has also shown a good agreement with the bipolar voltage range of scar BZ. 34 Further developments in these techniques may allow faster imaging with higher spatial resolution and advance the ability of clinical MRI protocols to identify areas of scar critical for re-entrant VT circuits.…”

Cardiovascular Magnetic Resonance to Predict Appropriate Implantable Cardioverter Defibrillator Therapy in Ischemic and Nonischemic Cardiomyopathy Patients Using Late Gadolinium Enhancement Border Zone

“…However, the different LGE sequences have shown good agreement in patients with ICM [33]. The algorithms used could also have performed even better in higher-resolution data sets [34]. …”

Quantitative analysis of late gadolinium enhancement in hypertrophic cardiomyopathy: comparison of diagnostic performance in myocardial fibrosis between gadobutrol and gadopentetate dimeglumine

“…While the application of gadobutrol in cardiac late imaging is limited, there are still some published studies about use of gadobutrol in other DCE CMRI studies [26][27][28][29] . In our study, the usage of gadobutrol with corrected relaxation dosage and gadopentetate dimeglumine with standard dosage was more advantageous in cardiac delayed imaging.…”