Abstract
BackgroundCardiovascular-MR (CMR) is the gold standard for quantifying myocardial infarction using late gadolinium enhancement (LGE) technique. Both 2D- and 3D-LGE-sequences are used in clinical practise and in clinical and experimental studies for infarct quantification. Therefore the aim of this study was to investigate if image acquisitions with 2D- and 3D-LGE show the same infarct size in patients and ex vivo.MethodsTwenty-six patients with previous myocardial infarction who underwent a CMR scan were included. Images were acquired 10-20 minutes after an injection of 0.2 mmol/kg gadolinium-based contrast agent. Two LGE-sequences, 3D-inversion recovery (IR) and 2D-phase-sensitive (PS) IR, were used in all patients to quantify infarction size. Furthermore, six pigs with reperfused infarction in the left anterior descending artery (40 minutes occlusion and 4 hours of reperfusion) were scanned with 2D- and 3D-LGE ex vivo. A high resolution T1-sequence was used as reference for the infarct quantification ex vivo. Spearman’s rank-order correlation, Wilcoxon matched pairs test and bias according to Bland-Altman was used for comparison of infarct size with different LGE-sequences.ResultsThere was no significant difference between the 2D- and 3D-LGE sequence in left ventricular mass (LVM) (2D: 115 ± 25 g; 3D: 117 ± 24 g: p = 0.35). Infarct size in vivo using 2D- and 3D-LGE showed high correlation and low bias for both LGE-sequences both in absolute volume of infarct (r = 0.97, bias 0.47 ± 2.1 ml) and infarct size as part of LVM (r = 0.94, bias 0.16 ± 2.0%). The 2D- and 3D-LGE-sequences ex vivo correlated well (r = 0.93, bias 0.67 ± 2.4%) for infarct size as part of the LVM. The IR LGE-sequences overestimated infarct size as part of the LVM ex vivo compared to the high resolution T1-sequence (bias 6.7 ± 3.0%, 7.3 ± 2.7% for 2D-PSIR and 3D-IR respectively, p < 0.05 for both).ConclusionsInfarct quantification with 2D- and 3D-LGE gives similar results in vivo with a very low bias. IR LGE-sequences optimized for in vivo use yield an overestimation of infarct size when used ex vivo.
Highlights
Cardiovascular-MR (CMR) is the gold standard for quantifying myocardial infarction using late gadolinium enhancement (LGE) technique
There was no significant difference in mean left ventricular mass (LVM) between the 2D- and 3D-LGE sequence (2D-Phase sensitive inversion recovery (PSIR): 115 ± 25 g: 3D-inversion recovery (IR): 117 ± 24 g: p = 0.35)
All patients were in sinus rhythm during imaging and the heart rates were similar for both acquisitions (2D-PSIR: ± 2 beats/min; 3D-IR ± 2 beats/min, r = 0.97, bias = -0.08 ± 2.2, p = 0.85)
Summary
Cardiovascular-MR (CMR) is the gold standard for quantifying myocardial infarction using late gadolinium enhancement (LGE) technique Both 2D- and 3D-LGE-sequences are used in clinical practise and in clinical and experimental studies for infarct quantification. Because the 2D-LGE sequences requires a relative long acquisition time a three-dimensional inversion recovery (3D-IR) GRE sequence has been developed to shorten the scanning time with multiple slices being acquired in a single breathold [10]. Both 2D- and 3D-LGE-sequences are used in clinical practice and in clinical and experimental studies for infarct quantification both in vivo and ex vivo. The aim of this study was 1) to investigate the agreement between 2D-PSIR and a 3D-IR for measurement of infarct size in patients and 2) to compare 2D-PSIR and 3D-IR with a reference high resolution T1w sequence in an experimental infarct model
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