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Volume 18 Supplement 1

19th Annual SCMR Scientific Sessions

  • Walking poster presentation
  • Open Access

Equivalence of conventional and fast late gadolinium enhancement (LGE) techniques for quantitative evaluation of fibrosis in ischemic and non-ischemic cardiac disease - Save the Time!

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Journal of Cardiovascular Magnetic Resonance201618 (Suppl 1) :Q64

https://doi.org/10.1186/1532-429X-18-S1-Q64

  • Published:

Keywords

  • Myocardial Infarction
  • Standard Deviation
  • Myocarditis
  • Late Gadolinium Enhancement
  • Hypertrophic Cardiomyopathy

Background

Segmented single-slice/single-breath-hold 2D phase-sensitive inversion recovery (2D-PSIR) sequences are the gold standard for evaluation of myocardial fibrosis. Aim of this study was to assess the accuracy of novel free-breathing or single-breath-hold LGE sequences to detect and quantify myocardial fibrosis in patients with different entities.

Methods

Patients with myocardial infarction (n = 45), myocarditis (n = 25) or hypertrophic cardiomyopathy (HCM) (n = 15) were prospectively enrolled. After administration of gadolinium contrast agent, LGE images were acquired ECG-gated in short axis slices (slice thickness 7 mm, no gap) using 4 different LGE sequences: (1) conventional segmented 2D phase-sensitive inversion recovery in single-slice/single-breath-hold technique (2D-PSIR; gold standard; TR 744 ms, TE 5,17 ms, voxel size 1.4 × 1.4 × 7.0 mm), (2) single-breath-hold 3D-IR sequence (3D-IR bh; TR 924 ms, TE 1.06 ms, voxel size 1.9 × 1.9 × 7.0 mm), (3) single breath-hold 3D-SSFP sequence (3D-SSFP; TE 700 ms, TE 1.05 ms, voxel size 1.9 × 1.9 × 7.0 mm) and (4) non-breath-hold technique (3D-IR nbh). (Figure 1) For all techniques, inversion time was individually adjusted to null the remote myocardium. Myocardial fibrosis was quantitatively assessed using a semi-automated threshold method; positive LGE was defined as signal intensity 6 standard deviations (SD) above signal intensity of remote myocardium for myocardial infarction and 3 SD for myocarditis / HCM. Detection rates were determined as number of matching myocardial AHA segments with detected LGE in gold standard and each fast technique.
Figure 1
Figure 1

LGE images of three patients with chronic ischemis infarction (A-D), HCM (E-H) and acute myocarditis (I-L). Arrows indicate typical LGE localization. Horizontal rows display corresponding slices of LGE in the same patient using conventional segmented 2d-PSIR (A;E;I), 3D-IR (B;F;J), 3D-SSFP bh (C; G;K) and 3D-SSFP nbh 9D;H;L).

Results

Overall detection rates of fibrosis - compared to the gold standard - were not significantly lower for any of the fast LGE sequences: 3D-IR (83.06 ± 20.0%), 3D-SSFP bh (88.25 ± 18.5%), and 3D-SSFP nbh (86.48 ± 14.7%).

There was no significant difference in size of myocardial fibrosis between the segmented 2D-PSIR, the 3D-IR and 3D-SSFP sequence (Figure 2), independent of the underlying etiology. Correlation of infarct size in each fast sequence was significant towards gold standard, i.e. for myocardial infarction (3D-IR: r2 = 0.801; p = 0.01/3D-SSFP bh: r2 = 0.851; p = 0.01/3D-SSFP nbh: r2 = 0.834; p = 0.01), acute myocarditis (3D-IR: r2 = 0.788; p = 0.01/3D-SSFP bh: r2 = 0.949; p = 0.01/3D-SSFP nbh: r2 = 0.944; p = 0.01) or HCM (3D-IR: r2 = 0.904; p = 0.01/3D-SSFP bh: r2 = 0.905; p = 0.01/3D-SSFP nbh: r2 = 0.938; p = 0.01).

Figure 2

Acquisition times were significantly shorter for 3D-IR (23.2 s ± 8.2 s) and 3D-SSFP (21.8 s ± 7.2 s) as compared to 2D-PSIR (375.5 s ± 86.3 s).

Conclusions

Fast 3D-SSFP, 3D-IR and conventional segmented 2D-PSIR sequences are equivalent techniques for the assessment of myocardial fibrosis, independent of an ischemic or non-ischemic etiology. Due to the minimized acquisition time they shorten scan protocols by up to 6 minutes.

Authors’ Affiliations

(1)
Working Group on Cardiovascular MRI, Charité University Medicine and HELIOS Clinics, Berlin, Germany

Copyright

© Muehlberg 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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