- Poster presentation
- Open Access
The validity of a free breathing motion corrected phase sensitive inversion recovery sequence in the detection of delayed myocardial enhancement in non-ischemic heart disease
© Flanagan et al.; licensee BioMed Central Ltd. 2014
- Published: 16 January 2014
- Steady State Free Precession
- Free Breathing
- Diagnostic Confidence
- Delayed Enhancement
- Gold Standard Technique
Breath-hold (BH) segmented TURBO FLASH (TFL) is currently used as the gold standard technique to evaluate delayed enhancement (DE) of the myocardium, typically with a phase sensitive inversion recovery (PSIR) approach (1). However, many patients are unable to perform adequate breath-holding resulting in poor image quality and limited diagnostic yield. Free breathing (FB) single shot steady state free precession (SSFP) is used as an alternative approach however respiratory motion artifact with resultant blurring may affect visualization of smaller myocardial scars. FB motion corrected (MOCO) single shot SSFP with averaging (2) has been shown to be equal or superior in detecting myocardial infarction (3), particularly in vulnerable patients. For FB MOCO sequences to replace current BH techniques in the detection of DE, they must be sensitive to the detection of both ischemic and non-ischemic patterns of delayed enhancement.
16 consecutive patients, with suspected cardiomyopathy, who underwent cardiac MRI on a 1.5T system (MAGNETOM Aera, Siemens, Erlangen, AG) were imaged with FB PSIR SSFP, BH PSIR TFL and FB PSIR MOCO SSFP. Images were graded by an experienced cardiovascular physician for image quality (scale of 1 to 5), the presence of DE, localisation (sub endocardium, mid myocardium and sup epicardium), number of segments showing DE (0-17) and diagnostic confidence (scale of 1 to 3).
Results of image quality and diagnostic confidence in all patients and in the subgroup of patients with non-ischemic delayed enhancement.
Average Image quality
1=very poor and not analyzable, 2=poor, 3=acceptable, 4=good,
Average Diagnostic confidence;
Total (n = 16)
Non-ischemic DE (n = 6)
All patients with DE on either FB SSFP or BH TFL were identified on FB MOCO. More DE segments were identified on FB MOCO than either FB SSFP or BH TFL. FB MOCO provided equal or superior image quality and diagnostic confidence. While some variation with BH TRUFI and BH TFL was identified, image quality and diagnostic confidence was higher for FB MOCO than FB SSFP and BH TFL, which both showed low diagnostic confidence in these cases. While further study with larger numbers is required to validate these findings, initial experience suggests that FB MOCO is equal or superior to FB SSFP and BH TFL in detecting non-ischemic DE and could replace them in clinical practice.
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