Abstract
BackgroundLate gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) represents the gold standard for assessment of myocardial viability. The purpose of this study was to investigate the clinical potential of Compressed SENSE (factor 5) accelerated free-breathing three-dimensional (3D) whole heart LGE with high isotropic spatial resolution (1.4 mm3 acquired voxel size) compared to standard breath-hold LGE imaging.MethodsThis was a retrospective, single-center study of 70 consecutive patients (45.8 ± 18.1 years, 27 females; February–November 2019), who were referred for assessment of left ventricular myocardial viability and received free-breathing and breath-hold LGE sequences at 1.5 T in clinical routine. Two radiologists independently evaluated global and segmental LGE in terms of localization and transmural extent. Readers scored scans regarding image quality (IQ), artifacts, and diagnostic confidence (DC) using 5-point scales (1 non-diagnostic—5 excellent/none). Effects of heart rate and body mass index (BMI) on IQ, artifacts, and DC were evaluated with ordinal logistic regression analysis.ResultsGlobal LGE (n = 33) was identical for both techniques. Using free-breathing LGE (average scan time: 04:33 ± 01:17 min), readers detected more hyperenhanced lesions (28.2% vs. 23.5%, P < .05) compared to breath-hold LGE (05:15 ± 01:23 min, P = .0104), pronounced at subepicardial localization and for 1–50% of transmural extent. For free-breathing LGE, readers graded scans with good/excellent IQ in 80.0%, with low-impact/no artifacts in 78.6%, and with good/high DC in 82.1% of cases. Elevated BMI was associated with increased artifacts (P = .0012) and decreased IQ (P = .0237). Increased heart rate negatively influenced artifacts (P = .0013) and DC (P = .0479) whereas IQ (P = .3025) was unimpaired.ConclusionsIn a clinical setting, free-breathing Compressed SENSE accelerated 3D high isotropic spatial resolution whole heart LGE provides good to excellent image quality in 80% of scans independent of heart rate while enabling improved depiction of small and particularly non-ischemic hyperenhanced lesions in a shorter scan time than standard breath-hold LGE.
Highlights
Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) represents the gold standard for assessment of myocardial viability
The purpose of this study was to investigate the clinical potential of Compressed SENSitivity Encoding (SENSE) accelerated free-breathing 3D whole heart LGE with high isotropic spatial resolution compared to standard breath-hold LGE imaging for assessment of left ventricular (LV) viability
Thereof, 18 (35.3%) patients were examined for evaluation of potential myocarditis, nine (17.6%) of structural heart disease, seven (13.7%) of sarcoidosis, six (11.8%) of dilated cardiomyopathy (DCM), five (9.8%) of hypertrophic cardiomyopathy (HCM), three (5.8%) of amyloidosis, two (3.9%) of chemotherapy-induced cardiomyopathy, and one patient (2.0%) of Anderson-Fabry disease
Summary
Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) represents the gold standard for assessment of myocardial viability. The recent development of three-dimensional (3D) imaging allows data acquisition of the entire heart in a single scan without interslice gaps [3, 13] In this context, accelerated and extended breath-hold approaches have been proposed [14, 15]. These techniques are associated with similar constraints on SNR and spatial resolution as 2D LGE since they can only provide highly anisotropic readouts [14, 15]. They are hampered by long breath-hold duration, widely unsuitable for clinical routine [15, 16]. Drawbacks like susceptibility to varying heart rate and respiratory motion as well as changing accumulation of contrast agent in injured myocardium with inadequate nulling of healthy tissue question their feasibility and usefulness in clinical routine [27, 28]
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