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Volume 18 Supplement 1

19th Annual SCMR Scientific Sessions

Real-time inversion recovery for infarct visualization during MR-guided interventions

Background

Real-time MR imaging is appealing for dynamic procedural guidance. Some MRI-guided procedures, such as catheter ablation or myocardial biopsy, may require the interventionist to visualize infarcted tissue in real-time in order to navigate devices relative to the lesion. Methods to interleave late gadolinium enhancement (LGE) images into a real-time imaging stream (1 in 5 frames) have been described previously for infarct visualization (1). Here, we implemented a real-time inversion recovery sequence to provide a stream of LGE images for procedural guidance, designed to rapidly toggle between high-frame rate "navigation mode" and lower-frame rate "infarct visualization mode".

Methods

Gadopenetate dimeglumine (Bayer Healthcare, Wayne, New Jersey) was administered intravenously (0.2 mmol/kg) to a swine model of myocardial infarction. Standard real-time imaging was used for "navigation mode" (bSSFP, TE/TR = 1.27/2.54 ms, flip angle = 45°, FOV = 300 mm, slice thickness = 6 mm, matrix = 192 x 144, GRAPPA factor = 2). In "infarct visualization mode", a non-selective inversion pre-pulse was performed before each real-time bSSFP acquisition. Inversion time (TI) was implemented as a real-time interactive parameter to enable optimal myocardial nulling, typical TI = 320 ms (approximately 25 minutes post-injection). The next inversion pulse immediately followed the image acquisition, with no additional time for signal recovery. A checkbox was used to switch between imaging modes on the fly.

Results

"Navigation mode" provided a temporal resolution of 244 ms/frame (4.1 frames/s), and was used for coarse navigation of devices requiring high frame-rate imaging. "Infarct visualization mode" provided a stream of myocardium-nulled LGE images with a temporal resolution of 444 ms/frame (2.3 frames/s) and was used for improved infarct delineation during fine device navigation relative to infarct location. Figure 1 demonstrates the real-time infarct visualization with a comparison to a high-resolution ECG-gated breath-held LGE images (2).

Figure 1
figure1

Comparison of standard real-time bSSFP images ("navigation mode") (A), real-time inversion recovery images ("infarct visualization mode") (B) and high-resolution ECG-gated breath-held LGE images (C) in two planes. Red arrowheads (B) indicate improved real-time infarct visualization compared to standard real-time imaging (A), and accurate infarct delieation compared to gold-standard late gadolinium enhancement images (C).

Conclusions

This imaging method provides real-time stream of LGE images that can be used to navigate devices relative to infarcted tissue, with only a small penalty in frame-rate. This sequence was designed with added flexibility to toggle between high frame-rate imaging and lower frame rate infarct visualization. This method will be useful for MRI-guided procedures such as catheter ablation and myocardial biopsy.

References

  1. 1.

    Guttman MA, Dick AJ, Raman VK, Arai AE,, Lederman RJ, McVeigh ER: Imaging of myocardial infarction for diagnosis and intervention using real-time interactive MRI without ECG-gating or breath-holding. Magn Reson Med. 2004, 52 (2): 354-361.

    PubMed Central  Article  PubMed  Google Scholar 

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    Kellman P, Arai AE, McVeigh ER, Aletras AH: Phase-sensitive inversion recovery for detecting myocardial infarction using gadolinium-delayed hyperenhancement. Magn Reson Med. 2002, 47 (2): 372-383.

    PubMed Central  Article  PubMed  Google Scholar 

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Correspondence to Adrienne E Campbell-Washburn.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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Campbell-Washburn, A.E., Rogers, T., Mazal, J.R. et al. Real-time inversion recovery for infarct visualization during MR-guided interventions. J Cardiovasc Magn Reson 18, P205 (2016). https://doi.org/10.1186/1532-429X-18-S1-P205

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Keywords

  • Late Gadolinium Enhancement
  • Catheter Ablation
  • Infarcted Tissue
  • Late Gadolinium Enhancement Image
  • Myocardial Biopsy