Ischemic Late Gadolinium Enhancement

Abstract

Appearance: The classic appearance of ischemic myocardial late gadolinium enhancement (LGE) is subendocardial hyperenhancement in the distribution of a major coronary artery (Fig. 1). The thickness or transmurality of the LGE is variable and may extend across the entire myocardial wall. Occasionally, the LGE contains a dark nonenhancing core.Explanation: Ischemic LGE is due to acute myocardial infarction (MI) or chronic scar from remote infarct and is seen on inversion recovery late gadolinium magnetic resonance (MR) imaging. New techniques to detect LGE with improved speed and quality have been developed. 1 While research exploring the utility of intravascular gadolinium based contrast agents (GBCA), such as gadofosveset (Vasovist, ABLAVAR) is ongoing, cardiac MR is currently routinely performed with administration of standard extracellular GBCAs, e.g. Gd-DTPA (Magnevist) or Gd-BOPTA (Multihance). LGE is a phenomenon related to the distribution of the extracellular GBCAs. Upon intravenous injection of an extracellular GBCA, myocardium enhances when gadolinium chelate contrast material diffuses passively throughout the extracellular space. 2The authors declare no conflicts of interest. myocardium, which helps distinguish true LGE from normal blood pool in myocardium containing large trabeculations. 6 Reference to myocardial thickness on SSFP images also helps differentiate microvascular obstruction located within the myocardium from thrombus that resides in the adjacent ventricular cavity.