Myocardial Late Gadolinium Enhancement: Accuracy of T1 Mapping–based Synthetic Inversion-Recovery Imaging

Abstract

Purpose:To compare the accuracy of detection and quantification of myocardial late gadolinium enhancement (LGE) with a synthetic inversion-recovery (IR) approach with that of conventional IR techniques. Materials and Methods:This prospective study was approved by the institutional review board and compliant with HIPAA. Results:Seventeen of the 43 patients (39%) had LGE patterns consistent with myocardial infarction. The sensitivity and specificity of synthetic magnitude and phase-sensitive IR techniques in the detection of LGE were 90% and 95%, respectively, with patient-based analysis and 94% and 99%, respectively, with segment-based analysis. The area of LGE measured with synthetic IR techniques showed excellent agreement with that of conventional techniques (4.35 cm 2 6 1.88 and 4.14 cm 2 6 1.62 for synthetic magnitude and phase-sensitive IR, respectively, compared with 4.25 cm 2 6 1.92 and 4.22 cm 2 6 1.86 for conventional magnitude and phase-sensitive IR, respectively; P . .05). Interreader agreement was excellent for the detection (k . 0.81) and quantification (bias range, 20.34 to 0.40; P . .05) of LGE. Conclusion:The accuracy of the T1 map-based synthetic IR approach in the detection and quantification of myocardial LGE in patients with previous myocardial infarction was similar to that of conventional IR techniques. The use of T1 mapping to derive synthetic LGE images may reduce imaging times and operator dependence in future T1 mapping protocols with full left ventricular coverage.q RSNA, 2015

Synthetic late gadolinium enhancement cardiac magnetic resonance for diagnosing myocardial scar

“…Even though the acquisitions were after one another, the LGE acquisition of an entire LV short-axis stack and long axis views takes around 10-15 minutes, thus inherently the post-contrast T1 map acquisitions were delayed. However, in the study by Varga-Szemes et al [8] the LGE and synthetic inversion recovery technique were acquired immediately after each other, suggesting that it is not only the systematic timing of acquisition in this study that accounts for the differences in results. Further limitations are related to the study cohort and study design.…”

“…Post-contrast T1 mapping using MOLLI has been shown to have a high diagnostic accuracy to diagnose chronic MI compared to LGE [11]. This is supported recently by T1 mapping based synthetic inversion recovery imaging which has showed high sensitivity and specificity in detection and quantification of focal ischemic fibrosis [8]. This study focused primarily on patients with previous myocardial infarction and did not study patient with non-ischemic fibrosis.…”

“…In addition, post-contrast T1 can be used to generate synthetic LGE (SynLGE) images with an image contrast similar to conventional LGE. The accuracy of T1 map-based synthetic inversion recovery has been tested in detection of patients with previous myocardial infarction [8]. However, this evaluation has been limited to detection of focal myocardial fibrosis of ischemic origin.…”

Contrast agents for cardiovascular magnetic resonance imaging: an overview

“…35,36 This phenomenon is due to neovessels formation in the endothelial lesions during the atherosclerotic cascade. Given the growing importance of LGE in assessing damaged myocardium, 37 research and development of such agents has been very intense. A recent example is gadofosveset (MS-325) 8,38 which is currently used in patients 39 with carotid artery stenosis for the detection of vulnerable plaque features.…”

Quantification of both the area-at-risk and acute myocardial infarct size in ST-segment elevation myocardial infarction using T1-mapping

“…Refinements of the T1 Modified Look-Locker Inversion recovery (MOLLI) prototype using IR images at different TIs initially designed to improve motion correction [ 11 ], can also create “synthetic” IR LGE images, namely magnitude-reconstructed IR (MagIR), phase-sensitive IR (PSIR) outputs. These synthetic read-outs have recently been shown to accurately detect chronic MI size in a small cohort of 17 patients [ 12 ]. To date, no studies have assessed the performance of post-contrast T1 mapping and synthetic LGE in quantifying MI size with full left ventricular (LV) coverage in a cohort of reperfused STEMI patients.…”