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Non-selective double inversion recovery pre-pulse for flow-independent black blood myocardial viability imaging

Introduction

MRI late gadolinium enhancement (LGE) using the inversion-recovery (IR) sequence is the current gold standard for assessing myocardial viability. Although it achieves high contrast between infarct and normal myocardium, there is often poor infarct-to-blood contrast. Flow-dependent and diffusion-prepared black-blood LGE techniques have previously been described.[1, 2] Recently a quadruple-inversion recovery pre-pulse was introduced for T1-independent flow suppression in carotid plaque imaging[3]. We introduced a modification to this pre-pulse aiming to achieve flow-independent signal suppression over a wide user-defined T1-range and to improve sub-endocardial infarct detection in LGE myocardial viability imaging.

Methods

NS-DIR pre-pulse

A non-selective double-inversion recovery (NS-DIR) sequence with two time delays, TI1 and TI2, was implemented on a 3 T Philips Achieva MR-scanner (Philips-Healthcare, Best, NL). TI1 and TI2 were optimized in MATLAB simulations by minimizing M Z NS-DIR over several user-defined T1-ranges for a given heart rate.

Phantom experiments

A T1-phantom containing 11 T1-samples (T1-range = 120 ms-1730 ms) was imaged with the NS-DIR pre-pulse using optimized TI1 and TI2 times. The signal-to-noise ratio (SNR) was calculated for each sample.

Patient Study

A 78-year-old man with previous myocardial infarctions was imaged with a 32-channel coil ~15 minutes after injection of 0.12 mmol/kg Gd-DOTA (Gadovist). Firstly a breath-hold 2D IR segmented gradient-echo (TFE) sequence was acquired in standard views. Imaging parameters included: spatial-resolution = 1.54 × 1.75 × 8 mm, TR/TE = 3.8 ms/2 ms, FA = 25°, TFE-factor = 25 and TI = 350 ms(chosen using LookLocker sequence).

Subsequently, identical planes were repeated with the IR replaced by the NS-DIR pre-pulse with imaging parameters maintained. TI1 = 411 ms and TI2 = 156 ms were used (optimized to minimize M Z NS-DIR for T1-range = 300-1400 ms, heart rate = 70 bpm).

Results

Simulations & Phantom experiments

M Z NS-DIR simulations (Fig. 1a) indicate excellent signal suppression over the desired T1-range for all heart rates with corresponding phantom studies in good agreement (Fig. 1b).

Figure 1
figure1

a) Simulated M z NS-DIR curves for TI 1 and TI 2 values optimized to minime M z NS-DIR for T 1 values between 300 and 1400 ms for difference heart rates. Figure 1b) The corresponding SNR values measured in phantom images using the same TI1 and TI2 settings and heart-rates are in good agreement with the simulations.

Patient Study

NS-DIR images demonstrate excellent signal suppression of blood and normal myocardium (Fig. 2a) while conventional IR-TFE images (Fig. 2b) display similar infarct and blood signal. Whilst both techniques demonstrate transmural anterior and inferior wall infarcts, the NS-DIR image depicts an apical, non-transmural sub-endocardial defect, which is difficult to distinguish from blood in the IR image.

Figure 2
figure2

A 78-year-old man with previous myocardial infarctions was imaged using a) the NS-DIR pre-pulse and b) the standard IR sequence. Arrows indicate transmural infarcts in the anterior and inferior walls and a non-transmural apical infarct which is better visualized with the NS-DIR pre-pulse.

Conclusion

We have developed a new flow-independent LGE sequence for improved contrast visualization. Simulations and phantom studies demonstrate excellent tissue suppression over a wide T1-range. Preliminary patient data suggests improved visualization of small sub-endocardial defects. Further studies are warranted to investigate the clinical usefulness of this novel approach.

References

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Correspondence to Sarah A Peel.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Peel, S.A., Jansen, C., Toussaint, N. et al. Non-selective double inversion recovery pre-pulse for flow-independent black blood myocardial viability imaging. J Cardiovasc Magn Reson 12, P104 (2010). https://doi.org/10.1186/1532-429X-12-S1-P104

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Keywords

  • Late Gadolinium Enhancement
  • Carotid Plaque
  • Phantom Study
  • Normal Myocardium
  • Phantom Experiment