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Volume 18 Supplement 1

19th Annual SCMR Scientific Sessions

  • Poster presentation
  • Open Access

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

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  • 1,
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Journal of Cardiovascular Magnetic Resonance201618 (Suppl 1) :P205

https://doi.org/10.1186/1532-429X-18-S1-P205

  • Published:

Keywords

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

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
Figure 1

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.

Authors’ Affiliations

(1)
Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA

References

  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 CentralView ArticlePubMedGoogle Scholar
  2. 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 CentralView ArticlePubMedGoogle Scholar

Copyright

© Campbell-Washburn et al. 2016

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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