Top

Journal of Cardiovascular Magnetic Resonance

Published in:

Open Access 01-12-2018 | Research

Gray blood late gadolinium enhancement cardiovascular magnetic resonance for improved detection of myocardial scar

Authors: Ahmed S. Fahmy, Ulf Neisius, Connie W. Tsao, Sophie Berg, Elizabeth Goddu, Patrick Pierce, Tamer A. Basha, Long Ngo, Warren J. Manning, Reza Nezafat

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2018

Abstract

Background

Low scar-to-blood contrast in late gadolinium enhanced (LGE) MRI limits the visualization of scars adjacent to the blood pool. Nulling the blood signal improves scar detection but results in lack of contrast between myocardium and blood, which makes clinical evaluation of LGE images more difficult.

Methods

GB-LGE contrast is achieved through partial suppression of the blood signal using T₂ magnetization preparation between the inversion pulse and acquisition. The timing parameters of GB-LGE sequence are determined by optimizing a cost-function representing the desired tissue contrast. The proposed 3D GB-LGE sequence was evaluated using phantoms, human subjects (n = 45) and a swine model of myocardial infarction (n = 5). Two independent readers subjectively evaluated the image quality and ability to identify and localize scarring in GB-LGE compared to black-blood LGE (BB-LGE) (i.e., with complete blood nulling) and conventional (bright-blood) LGE.

Results

GB-LGE contrast was successfully generated in phantoms and all in-vivo scans. The scar-to-blood contrast was improved in GB-LGE compared to conventional LGE in humans (1.1 ± 0.5 vs. 0.6 ± 0.4, P < 0.001) and in animals (1.5 ± 0.2 vs. -0.03 ± 0.2). In patients, GB-LGE detected more tissue scarring compared to BB-LGE and conventional LGE. The subjective scores of the GB-LGE ability for localizing LV scar and detecting papillary scar were improved as compared with both BB-LGE (P < 0.024) and conventional LGE (P < 0.001). In the swine infarction model, GB-LGE scores for the ability to localize LV scar scores were consistently higher than those of both BB-LGE and conventional-LGE.

Conclusion

GB-LGE imaging improves the ability to identify and localize myocardial scarring compared to both BB-LGE and conventional LGE. Further studies are warranted to histologically validate GB-LGE.

Available only for authorised users

Kim RJ, Fieno DS, Parrish TB, Harris K, Chen EL, Simonetti O, Bundy J, Finn JP, Klocke FJ, Judd RM. Relationship of MRI delayed contrast enhancement to irreversible injury, infarct age, and contractile function. Circulation. 1999;100:1992–2002.CrossRefPubMed

Han Y, Peters DC, Kissinger KV, Goddu B, Yeon SB, Manning WJ, Nezafat R. Evaluation of papillary muscle function using cardiovascular magnetic resonance imaging in mitral valve prolapse. Am J Cardiol. 2010;106:243–8.CrossRefPubMedPubMedCentral

Tanimoto T, Imanishi T, Kitabata H, Nakamura N, Kimura K, Yamano T, Ishibashi K, Komukai K, Ino Y, Takarada S, et al. Prevalence and clinical significance of papillary muscle infarction detected by late gadolinium-enhanced magnetic resonance imaging in patients with ST-segment elevation myocardial infarction. Circulation. 2010;122:2281–7.CrossRefPubMed

Peters DC, Wylie JV, Hauser TH, Nezafat R, Han Y, Woo JJ, Taclas J, Kissinger KV, Goddu B, Josephson ME, et al. Recurrence of atrial fibrillation correlates with the extent of post-procedural late gadolinium enhancement: a pilot study. JACC Cardiovasc Imaging. 2009;2:308–16.CrossRefPubMedPubMedCentral

Look DC, Locker DR. Time saving in measurement of NMR and EPR relaxation times. Rev Sci Instrum. 1970;41:250–1.CrossRef

Farrelly C, Rehwald W, Salerno M, Davarpanah A, Keeling AN, Jacobson JT. Improved detection of subendocardial hyperenhancement in myocardial infarction using dark blood-pool delayed enhancement MRI. AJR Am J Roentgenol. 2011;196:339–48.CrossRefPubMed

Yarnykh VL, Yuan C. T1-insensitive flow suppression using quadruple inversion-recovery. Magn Reson Med. 2002;48:899–905.CrossRefPubMed

Peel SA, Morton G, Chiribiri A, Schuster A, Nagel E, Botnar RM. Dual inversion-recovery MR imaging sequence for reduced blood signal on late gadolinium-enhanced images of myocardial scar. Radiology. 2012;264:242–9.CrossRefPubMed

Holtackers RJ, Chiribiri A, Schneider T, Higgins DM, Botnar RM. Dark-blood late gadolinium enhancement without additional magnetization preparation. J Cardiovasc Magn Reson. 2017;19:64.CrossRefPubMedPubMedCentral

10.

Liu C-Y, Wieben O, Brittain JH, Reeder SB. Improved delayed enhanced myocardial imaging with T2-prep inversion recovery magnetization preparation. J Magn Reson Imaging. 2008;28:1280–6.CrossRefPubMed

11.

Muscogiuri G, Rehwald WG, Schoepf UJ, Suranyi P, Litwin SE, De Cecco CN, Wichmann JL, Mangold S, Caruso D, Fuller SR, et al. T (Rho) and magnetization transfer and INvErsion recovery (TRAMINER)-prepared imaging: a novel contrast-enhanced flow-independent dark-blood technique for the evaluation of myocardial late gadolinium enhancement in patients with myocardial infarction. J Magn Reson Imaging. 2017;45:1429–37.CrossRefPubMed

12.

Kim HW, Rehwald WG, Wendell DC, Jenista E, Van Assche L, Jensen CJ. Flow-Independent Dark-blood DeLayed Enhancement (FIDDLE): validation of a novel black blood technique for the diagnosis of myocardial infarction. J Cardiovasc Magn Reson. 2016;18:O55.CrossRefPubMedCentral

13.

Basha TA, Tang MC, Tsao C, Tschabrunn CM, Anter E, Manning WJ, Nezafat R. Improved dark blood late gadolinium enhancement (DB-LGE) imaging using an optimized joint inversion preparation and T2 magnetization preparation. Magn Reson Med. 2018;79:351–60.CrossRefPubMed

14.

Basha T, Roujol S, Kissinger KV, Goddu B, Manning WJ, Nezafat R. Black blood late gadolinium enhancement using combined T2 magnetization preparation and inversion recovery. J Cardiovasc Magn Reson. 2015;17:O14.CrossRefPubMedCentral

15.

Kellman P, Xue H, Olivieri LJ, Cross RR, Grant EK, Fontana M, Ugander M, Moon JC, Hansen MS. Dark blood late enhancement imaging. J Cardiovasc Magn Reson. 2016;18:77.CrossRefPubMedPubMedCentral

16.

Francis R, Kellman P, Kotecha T, Baggiano A, Norrington K, Martinez-Naharro A, Nordin S, Knight DS, Rakhit RD, Lockie T, Hawkins PN, Moon JC, Hausenloy DJ, Xue H, Hansen MS, Fontana M. Prospective comparison of novel dark blood late gadolinium enhancement with conventional bright blood imaging for the detection of scar. J Cardiovasc Magn Reson. 2017;19:91.CrossRefPubMedPubMedCentral

17.

Kim HW, Rehwald WG, Jenista ER, Wendell DC, Filev P, Assche L, Jensen CJ, Parker MA, Chen E, Crowley ALC, Klem I, Judd RM, Kim RJ. Dark blood delayed-enhancement MRI of myocardial infarction. JACC Cardiovasc Imaging. 2017; https://doi.org/10.1016/j.jcmg.2017.09.021.

18.

Giri S, Chung Y-C, Merchant A, Mihai G, Rajagopalan S, Raman SV, Simonetti OP. T2 quantification for improved detection of myocardial edema. J Cardiovasc Magn Reson. 2009;11:56.CrossRefPubMedPubMedCentral

19.

Wright GA, Hu BS, Macovski A. Estimating oxygen saturation of blood in vivo with MR imaging at 1.5 T. J Magn Reson Imaging. 1991;1:275–83.CrossRefPubMed

20.

Nocedal J, Wright SJ. Numerical Optimization. New York: Springer; 2006.

21.

Messroghli DR, Radjenovic A, Kozerke S, Higgins DM, Sivananthan MU, Ridgway JP. Modified look-locker inversion recovery (MOLLI) for high-resolution T1 mapping of the heart. Magn Reson Med. 2004;52:141–6.CrossRefPubMed

22.

Levitt MH, Freeman R, Frenkiel T. Broadband heteronuclear decoupling. J Magn Reson. 1982;47:328–30.

23.

Moghari MH, Chan RH, Hong-Zohlman SN, Shaw JL, Goepfert LA, Kissinger KV, Goddu B, Josephson ME, Manning WJ, Nezafat R. Free-breathing cardiac MR with a fixed navigator efficiency using adaptive gating window size. Magn Reson Med. 2012;68:1866–75.CrossRefPubMedPubMedCentral

24.

Kellman P, Arai AE, Mcveigh ER, Aletras AH. Phase-sensitive inversion recovery for detecting myocardial infarction using gadolinium-delayed hyperenhancement. Magn Reson Med. 2002;47:372–83.CrossRefPubMedPubMedCentral

25.

Akçakaya M, Basha TA, Goddu B, Goepfert LA, Kissinger KV, Tarokh V, Manning WJ, Nezafat R. Low-dimensional-structure self-learning and thresholding: regularization beyond compressed sensing for MRI reconstruction. Magn Reson Med. 2011;66:756–67.CrossRefPubMedPubMedCentral

26.

Akçakaya M, Rayatzadeh H, Basha TA, Hong SN, Chan RH, Kissinger KV, Hauser TH, Josephson ME, Manning WJ, Nezafat R. Accelerated late gadolinium enhancement cardiac MR imaging with isotropic spatial resolution using compressed sensing: initial experience. Radiology. 2012;264:691–9.CrossRefPubMedPubMedCentral

27.

Basha TA, Akçakaya M, Liew C, Tsao CW, Delling FN, Addae G, Ngo L, Manning WJ, Nezafat R. Clinical performance of high-resolution late gadolinium enhancement imaging with compressed sensing. J Magn Reson Imaging. 2017;46:1829–38.CrossRefPubMed

Title: Gray blood late gadolinium enhancement cardiovascular magnetic resonance for improved detection of myocardial scar
Authors: Ahmed S. Fahmy
Ulf Neisius
Connie W. Tsao
Sophie Berg
Elizabeth Goddu
Patrick Pierce
Tamer A. Basha
Long Ngo
Warren J. Manning
Reza Nezafat
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Journal of Cardiovascular Magnetic Resonance / Issue 1/2018
Electronic ISSN: 1532-429X
DOI: https://doi.org/10.1186/s12968-018-0442-2

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Gray blood late gadolinium enhancement cardiovascular magnetic resonance for improved detection of myocardial scar

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2018

Atherosclerosis T1-weighted characterization (CATCH): evaluation of the accuracy for identifying intraplaque hemorrhage with histological validation in carotid and coronary artery specimens

Non-contrast assessment of microvascular integrity using arterial spin labeled cardiovascular magnetic resonance in a porcine model of acute myocardial infarction

Association between myocardial extracellular volume and strain analysis through cardiovascular magnetic resonance with histological myocardial fibrosis in patients awaiting heart transplantation

A multi-band double-inversion radial fast spin-echo technique for T2 cardiovascular magnetic resonance mapping of the heart

The growth and evolution of cardiovascular magnetic resonance: a 20-year history of the Society for Cardiovascular Magnetic Resonance (SCMR) annual scientific sessions

Guidelines for training in cardiovascular magnetic resonance (CMR)