PMID- 28835250 OWN - NLM STAT- MEDLINE DCOM- 20180604 LR - 20240117 IS - 1532-429X (Electronic) IS - 1097-6647 (Print) IS - 1097-6647 (Linking) VI - 19 IP - 1 DP - 2017 Aug 23 TI - Dark-blood late gadolinium enhancement without additional magnetization preparation. PG - 64 LID - 10.1186/s12968-017-0372-4 [doi] LID - 64 AB - BACKGROUND: This study evaluates a novel dark-blood late gadolinium enhancement (LGE) cardiovascular magnetic resonance imaging (CMR) method, without using additional magnetization preparation, and compares it to conventional bright-blood LGE, for the detection of ischaemic myocardial scar. LGE is able to clearly depict myocardial infarction and macroscopic scarring from viable myocardium. However, due to the bright signal of adjacent left ventricular blood, the apparent volume of scar tissue can be significantly reduced, or even completely obscured. In addition, blood pool signal can mimic scar tissue and lead to false positive observations. Simply nulling the blood magnetization by choosing shorter inversion times, leads to a negative viable myocardium signal that appears equally as bright as scar due to the magnitude image reconstruction. However, by combining blood magnetization nulling with the extended grayscale range of phase-sensitive inversion-recovery (PSIR), a darker blood signal can be achieved whilst a dark myocardium and bright scar signal is preserved. METHODS: LGE was performed in nine male patients (63 +/- 11y) using a PSIR pulse sequence, with both conventional viable myocardium nulling and left ventricular blood nulling, in a randomized order. Regions of interest were drawn in the left ventricular blood, viable myocardium, and scar tissue, to assess contrast-to-noise ratios. Maximum scar transmurality, scar size, circumferential scar angle, and a confidence score for scar detection and maximum transmurality were also assessed. Bloch simulations were performed to simulate the magnetization levels of the left ventricular blood, viable myocardium, and scar tissue. RESULTS: Average scar-to-blood contrast was significantly (p < 0.001) increased by 99% when nulling left ventricular blood instead of viable myocardium, while scar-to-myocardium contrast was maintained. Nulling left ventricular blood also led to significantly (p = 0.038) higher expert confidence in scar detection and maximum transmurality. No significant changes were found in scar transmurality (p = 0.317), normalized scar size (p = 0.054), and circumferential scar angle (p = 0.117). CONCLUSIONS: Nulling left ventricular blood magnetization for PSIR LGE leads to improved scar-to-blood contrast and increased expert confidence in scar detection and scar transmurality. As no additional magnetization preparation is used, clinical application on current MR systems is readily available without the need for extensive optimizations, software modifications, and/or additional training. FAU - Holtackers, Robert J AU - Holtackers RJ AUID- ORCID: 0000-0003-1809-313X AD - Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom. rob.holtackers@mumc.nl. AD - Department of Radiology, Maastricht University Medical Centre, Maastricht, the Netherlands. rob.holtackers@mumc.nl. FAU - Chiribiri, Amedeo AU - Chiribiri A AD - Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom. FAU - Schneider, Torben AU - Schneider T AD - Philips, Guildford, Surrey, United Kingdom. FAU - Higgins, David M AU - Higgins DM AD - Philips, Guildford, Surrey, United Kingdom. FAU - Botnar, Rene M AU - Botnar RM AD - Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom. AD - Pontificia Universidad Catolica de Chile, Escuela de Ingenieria, Santiago, Chile. LA - eng GR - RG/12/1/29262/BHF_/British Heart Foundation/United Kingdom PT - Comparative Study PT - Journal Article DEP - 20170823 PL - England TA - J Cardiovasc Magn Reson JT - Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance JID - 9815616 RN - 0 (Contrast Media) RN - 0 (Organometallic Compounds) RN - 1BJ477IO2L (gadobutrol) SB - IM MH - Aged MH - Cicatrix/*diagnostic imaging/pathology MH - Contrast Media/*administration & dosage MH - Humans MH - Image Interpretation, Computer-Assisted MH - Magnetic Resonance Imaging/*methods MH - Male MH - Middle Aged MH - Myocardial Infarction/blood/*diagnostic imaging/pathology MH - Myocardium/*pathology MH - Organometallic Compounds/*administration & dosage MH - Predictive Value of Tests MH - Reproducibility of Results PMC - PMC5568308 OTO - NOTNLM OT - Dark blood OT - Delayed enhancement OT - Late enhancement OT - Late gadolinium enhancement OT - Myocardial infarction OT - Myocardial scar OT - Phase-sensitive inversion-recovery COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: Participants provided written informed consent for the study inclusion and additional imaging. The study was conducted according to the Declaration of Helsinki and Good Clinical Practice guidelines and was approved by the Guy's and St Thomas' Research Ethics Committee (approval number 15/NS/0030). CONSENT FOR PUBLICATION: Not applicable. COMPETING INTERESTS: TS and DMH are employees of Philips Healthcare. The other authors declare that they have no competing interests. PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Dr. Robert Judd served as a guest editor for this manuscript. EDAT- 2017/08/25 06:00 MHDA- 2018/06/05 06:00 PMCR- 2017/08/23 CRDT- 2017/08/25 06:00 PHST- 2017/04/03 00:00 [received] PHST- 2017/07/11 00:00 [accepted] PHST- 2017/08/25 06:00 [entrez] PHST- 2017/08/25 06:00 [pubmed] PHST- 2018/06/05 06:00 [medline] PHST- 2017/08/23 00:00 [pmc-release] AID - S1097-6647(23)01098-0 [pii] AID - 372 [pii] AID - 10.1186/s12968-017-0372-4 [doi] PST - epublish SO - J Cardiovasc Magn Reson. 2017 Aug 23;19(1):64. doi: 10.1186/s12968-017-0372-4.