Abstract
BackgroundLow 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.MethodsGB-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.ResultsGB-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.ConclusionGB-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.
Highlights
Low scar-to-blood contrast in late gadolinium enhanced (LGE) MRI limits the visualization of scars adjacent to the blood pool
We recently proposed a dark-blood LGE (DB-LGE) sequence by inserting the T2 magnetization preparation pulse between the inversion pulse and image acquisition [13, 14] to achieve simultaneous nulling of the blood pool and the myocardium
We present a 3D gray-blood LGE (GB-LGE) sequence based on our previous Dark blood (DB)-LGE sequence [13, 14] by introducing a parameter optimization approach that allows flexible adjustment of tissue contrast
Summary
Low scar-to-blood contrast in late gadolinium enhanced (LGE) MRI limits the visualization of scars adjacent to the blood pool. Flow-independent approaches have been proposed to null the blood signal based on T1 differences among the blood, scar, and normal myocardium This includes using nonselective dual inversion recovery [8] and blood signal nulling using phase-sensitive LGE [9]. We recently proposed a dark-blood LGE (DB-LGE) sequence by inserting the T2 magnetization preparation pulse between the inversion pulse and image acquisition [13, 14] to achieve simultaneous nulling of the blood pool and the myocardium. This technique was subsequently used in combination with phase-sensitive inversion recovery (PSIR) [15]. The technique was validated using canine model as a reference standard and human subject data [17]
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