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Accuracy of ECV imaging for the detection of subendocardial infarction - comparison with black blood delayed enhancement and pathology
© Jenista et al. 2016
- Published: 27 January 2016
- Coronary Occlusion
- DeLayed Enhancement
- Gadolinium Administration
- Black Blood
- Transmural Infarct
Delineation of diseased and normal tissue is fundamental to identifying cardiac pathology. Studies suggest that parametric extracellular volume fraction (ECV) imaging is superior to conventional delayed enhancement for detection of diffuse, global myocardial disease. Conversely, the sensitivity of ECV for the detection of focal disorders is unclear. This may be important for subendocardial disease since the standard methodology for ECV requires that "regions of interest.. have adequate margins of separation from tissue interfaces prone to partial volume averaging such as between myocardium and blood" . We have developed a new, Flow-Independent Dark-blood DeLayed Enhancement technique (FIDDLE) that increases the conspicuity of subendocardial hyperenhancement, by making the blood pool black . In this study, we compared ECV and FIDDLE for the detection of subendocardial infarction as verified by pathology.
Canines (n = 7) underwent variable coronary occlusion to create a range of infarct sizes including 2 sham operated controls. CMR was performed 2-5 days after MI followed immediately by excision and TTC staining to provide a gold standard histopathology reference. ECV was calculated using T1-maps generated with MOLLI sequence (SIEMENS WIP 448B) before and after gadolinium administration (0.2 mmol/kg). FIDDLE images were acquired in identical slice locations 10-20 minutes after gadolinium administration. FIDDLE and ECV analysis were performed separately, blinded to subject identity and pathology. ECV was calculated as previously reported . 26 patients with enzymatically confirmed MI, and 10 normal volunteers with no history of CAD, and a low Framingham risk were enrolled. Imaging and analysis was identical to that for canines. Subendocardial infarction was defined as <50% transmural.
Diagnostic performance of ECV and FIDDLE in canines and patients.
Overall - Animals
Subendocardial (<50% transmurality by pathology)
Transmural (>50% transmurality by pathology)
Overall - Patients
Subendocardial (<50% transmurality by FIDDLE)
Transmural (>50% transmurality by FIDDLE)
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