Abstract
Objective3D late gadolinium enhancement (LGE) imaging is a promising non-invasive technique for the assessment of atrial fibrosis. However, current techniques result in prolonged and unpredictable scan times and high rates of non-diagnostic images. The purpose of this study was to compare the performance of a recently proposed accelerated respiratory motion-compensated 3D water/fat LGE technique with conventional 3D LGE for atrial wall imaging.Materials and methods18 patients (age: 55.7±17.1 years) with atrial fibrillation underwent conventional diaphragmatic navigator gated inversion recovery (IR)-prepared 3D LGE (dNAV) and proposed image-navigator motion-corrected water/fat IR-prepared 3D LGE (iNAV) imaging. Images were assessed for image quality and presence of fibrosis by three expert observers. The scan time for both techniques was recorded.ResultsImage quality scores were improved with the proposed compared to the conventional method (iNAV: 3.1 ± 1.0 vs. dNAV: 2.6 ± 1.0, p = 0.0012, with 1: Non-diagnostic to 4: Full diagnostic). Furthermore, scan time for the proposed method was significantly shorter with a 59% reduction is scan time (4.5 ± 1.2 min vs. 10.9 ± 3.9 min, p < 0.0001). The images acquired with the proposed method were deemed as inconclusive less frequently than the conventional images (expert 1/expert 2: 4/7 dNAV and 2/4 iNAV images inconclusive).DiscussionThe motion-compensated water/fat LGE method enables atrial wall imaging with diagnostic quality comparable to the current conventional approach with a significantly shorter scan of about 5 min.
Highlights
Late gadolinium enhanced (LGE) cardiac magnetic resonance (MR) imaging is a promising non-invasive tool for the comprehensive assessment of atrial morphology and fibrosis in patients with atrial fibrillation [1–3]
The water/fat image navigators (iNAVs) 3D LGE acquisition was successfully completed in all eighteen subjects with an average scan time of 4.5 ± 1.2 min, which was significantly shorter than the time required for conventional diaphragmatic navigator-gated (dNAV) 3D LGE imaging (10.9 ± 3.9 min, p < 0.001)
Motion-induced artefacts can be observed in the dNAV-based image which are of similar intensity to the LGE areas and could potentially be misinterpreted as fibrosis, whereas the iNAV-based approach does not present evident remaining respiratory motion artefacts
Summary
Late gadolinium enhanced (LGE) cardiac magnetic resonance (MR) imaging is a promising non-invasive tool for the comprehensive assessment of atrial morphology and fibrosis in patients with atrial fibrillation [1–3]. Magnetic Resonance Materials in Physics, Biology and Medicine agent in the blood and improves fibrosis-to-blood pool contrast. These sequences can produce diagnostic quality images in subjects with regular breathing patterns, low respiratory efficiency in subjects with irregular breathing often lead to poor image quality, due to residual motion artefacts and/or signal variations arising from heart rate variability and contrast agent washout during long scans [10, 11]. While gadolinium dose and imaging timing protocols have been optimized to maximize the contrast between atrial LGE and atrial blood pool while nulling signal arising from healthy atrial wall, prolonged and unpredictable acquisition times of up to 15 min result in further image quality degradation due to gadolinium washout during the scan. An average ~ 23% of atrial LGE scans are reported as non-diagnostic in several studies (range 13.5–40.6% [2, 4, 5, 7, 10, 13, 14]), which in addition to the time-consuming protocol required for atrial wall LGE imaging has hindered its wide adoption in the clinical routine
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