Abstract
For almost 20 years, late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) has been the reference standard for the non-invasive assessment of myocardial viability. Since the blood pool often appears equally bright as the enhanced scar regions, detection of subendocardial scar patterns can be challenging. Various novel LGE methods have been proposed that null or suppress the blood signal by employing additional magnetization preparation mechanisms. This review aims to provide a comprehensive overview of these dark-blood LGE methods, discussing the magnetization preparation schemes and findings in phantom, preclinical, and clinical studies. Finally, conclusions on the current evidence and limitations are drawn and new avenues for future research are discussed. Dark-blood LGE methods are a promising new tool for non-invasive assessment of myocardial viability. For a mainstream adoption of dark-blood LGE, however, clinical availability and ease of use are crucial.
Highlights
Late gadolinium enhancement (LGE), sometimes referred to as late enhancement (LE) or delayed enhancement (DE), is a widely used cardiovascular magnetic resonance (CMR) technique to distinguish macroscopic scarring and myocardial infarction (MI) from normal myocardium
This study showed that using LGE, even small regions of scar tissue of only 2% of the mean left ventricular (LV) mass could be identified that were linked with a sevenfold increase in major cardiac events
This review aims to provide a comprehensive overview of current dark-blood LGE methods
Summary
Late gadolinium enhancement (LGE), sometimes referred to as late enhancement (LE) or delayed enhancement (DE), is a widely used cardiovascular magnetic resonance (CMR) technique to distinguish macroscopic scarring and myocardial infarction (MI) from normal myocardium. Their approach was evaluated in a cohort of 61 patients which showed that subendocardial MI was observed best when nulling the blood pool completely Their CNR measurements, performed on a subset of 30 patients, showed increased scar-to-blood contrast compared to conventional LGE, at the cost of scarto-myocardium contrast. As these BIR-4 RF pulses hardly affect the blood pool, in contrast to the scar tissue, blood and scar magnetization levels are already separated before the 180o inversion RF pulse. A dedicated noise scan without RF pulses was performed in each patient to enable accurate SNR and CNR measurements, showing a 99% increase in scar-to-blood contrast for blood-nulled LGE compared to conventional myocardium-nulled LGE, regardless of which method was used first. Mostly desired for improved detection of subendocardial scar areas, dark-blood LGE methods may be beneficial for visualizing scar patterns in papillary muscles and thin-walled structures, such as the atria and RV
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