Optimization of myocardial nulling in pediatric cardiac MRI

Abstract

Current protocols to determine optimal nulling time in late enhancement imaging using adult techniques may not apply to children. To determine the optimal nulling time in anesthetised children, with the hypothesis that this occurs earlier than in adults. Sedated cardiac MRI was performed in 12 children (median age: 12months, range: 1-60months). After gadolinium administration, scout images at 2, 3, 4 and 10min and phase sensitive inversion recovery (PSIR) images from 5 to 10min were obtained. Signal-to-noise ratio (SNR) and inversion time (TI) were determined. Quality of nulling was assessed according to a grading score by three observers. Data was analysed using linear regression, Kruskal-Wallis and quadratic-weighted kappa statistics. One child with a cardiomyopathy had late enhancement. Good agreement in nulling occurred for scout images at 2 (κ = 0.69) and 3 (κ = 0.66) min and moderate agreement at 4min (κ = 0.57). Agreement of PSIR images was moderate at 7min (κ = 0.44) and poor-fair at other times. There were significant correlations between TI and scout time (r = 0.61, P < 0.0001), and SNR and kappa (r = 0.22, P = 0.017). Scout images at 2-4min can be used to determine the TI with little variability. Image quality for PSIR images was highest at 7min and SNR optimal at 7-9min. TI increases with time and should be adjusted frequently during imaging. Thus, nulling times in children differ from nulling times in adults when using standard adult techniques.