Journal Article

Clinical value of dark-blood late gadolinium enhancement cardiovascular magnetic resonance without additional magnetization preparation

Botnar, René M., Holtackers, Robert J., Nazir, Muhummad Sohaib, Chiribiri, Amedeo, Ntalas, Ioannis, Rahman, Haseeb, Van De Heyning, Caroline M., Rashid, Imran

2019

Overview

Background For two decades, bright-blood late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) has been considered the reference standard for the non-invasive assessment of myocardial viability. While bright-blood LGE can clearly distinguish areas of myocardial infarction from viable myocardium, it often suffers from poor scar-to-blood contrast, making subendocardial scar difficult to detect. Recently, we proposed a novel dark-blood LGE approach that increases scar-to-blood contrast and thereby improves subendocardial scar conspicuity. In the present study we sought to assess the clinical value of this novel approach in a large patient cohort with various non-congenital ischemic and non-ischemic cardiomyopathies on both 1.5 T and 3 T CMR scanners of different vendors. Methods Three hundred consecutive patients referred for clinical CMR were randomly assigned to a 1.5 T or 3 T scanner. An entire short-axis stack and multiple long-axis views were acquired using conventional phase sensitive inversion recovery (PSIR) LGE with TI set to null myocardium (bright-blood) and proposed PSIR LGE with TI set to null blood (dark-blood), in a randomized order. The bright-blood LGE and dark-blood LGE images were separated, anonymized, and interpreted in a random order at different time points by one of five independent observers. Each case was analyzed for the type of scar, per-segment transmurality, papillary muscle enhancement, overall image quality, observer confidence, and presence of right ventricular scar and intraventricular thrombus. Results Dark-blood LGE detected significantly more cases with ischemic scar compared to conventional bright-blood LGE (97 vs 89, p  = 0.008), on both 1.5 T and 3 T, and led to a significantly increased total scar burden (3.3 ± 2.4 vs 3.0 ± 2.3 standard AHA segments, p  = 0.015). Overall image quality significantly improved using dark-blood LGE compared to bright-blood LGE (81.3% vs 74.0% of all segments were of highest diagnostic quality, p  = 0.006). Furthermore, dark-blood LGE led to significantly higher observer confidence (confident in 84.2% vs 78.4%, p  = 0.033). Conclusions The improved detection of ischemic scar makes the proposed dark-blood LGE method a valuable diagnostic tool in the non-invasive assessment of myocardial scar. The applicability in routine clinical practice is further strengthened, as the present approach, in contrast to other recently proposed dark- and black-blood LGE techniques, is readily available without the need for scanner adjustments, extensive optimizations, or additional training.

• Publisher: BioMed Central,BioMed Central Ltd,Elsevier
• Subject: Adult / Aged / Angiology / Cardiology / Cardiomyopathies - diagnostic imaging / Cardiomyopathies - pathology / Care and treatment / Cicatrix - diagnostic imaging / Cicatrix - pathology / Contrast Media - administration & dosage / Coronary heart disease / Dark-blood / Female / Gadolinium / Humans / Imaging / Late enhancement / Late gadolinium enhancement / LGE / Magnetic resonance imaging / Magnetic Resonance Imaging, Cine / Male / Medicine / Medicine & Public Health / Middle Aged / Myocardial Ischemia - diagnostic imaging / Myocardial Ischemia - pathology / Myocardial scar / Myocardium - pathology / Observer Variation / Organometallic Compounds - administration & dosage / Patient outcomes / Predictive Value of Tests / Radiology / Reproducibility of Results / Subendocardial scar / Tissue Survival