PMID- 29554919 OWN - NLM STAT- MEDLINE DCOM- 20190314 LR - 20240213 IS - 1532-429X (Electronic) IS - 1097-6647 (Print) IS - 1097-6647 (Linking) VI - 20 IP - 1 DP - 2018 Mar 19 TI - The reproducibility of late gadolinium enhancement cardiovascular magnetic resonance imaging of post-ablation atrial scar: a cross-over study. PG - 21 LID - 10.1186/s12968-018-0438-y [doi] LID - 21 AB - BACKGROUND: Cardiovascular magnetic resonance (CMR) imaging has been used to visualise post-ablation atrial scar (PAAS), generally employing a three-dimensional (3D) late gadolinium enhancement (LGE) technique. However the reproducibility of PAAS imaging has not been determined. This cross-over study is the first to investigate the reproducibility of the technique, crucial for both future research design and clinical implementation. METHODS: Forty subjects undergoing first time ablation for atrial fibrillation (AF) had detailed CMR assessment of PAAS. Following baseline pre-ablation scan, two scans (separated by 48 h) were performed at three months post-ablation. Each scan session included 3D LGE acquisition at 10, 20 and 30 min post administration of gadolinium-based contrast agent (GBCA). Subjects were allocated at second scan post-ablation to identical imaging parameters ('Repro', n = 10), 3 T scanner ('3 T', n = 10), half-slice thickness ('Half-slice', n = 10) or half GBCA dose ('Half-gad', n = 10). PAAS was compared to baseline scar and then reproducibility was assessed for two measures of thresholded scar (% left atrial (LA) occupied by PAAS (%LA PAAS) and Pulmonary Vein Encirclement (PVE)), and then four measures of non-thresholded scar (point-by-point assessment of PAAS, four normalisation methods). Thresholded measures of PAAS were evaluated against procedural outcome (AF recurrence). RESULTS: A total of 271 3D acquisitions (out of maximum 280, 96.7%) were acquired. At 20 and 30 min, inter-scan reproducibility was good to excellent (coefficient of variation at 20 min and 30 min: %LA PAAS 0.41 and 0.20; PVE 0.13 and 0.04 respectively for 'Repro' group). Changes in imaging parameters, especially reduced GBCA dose, reduced inter-scan reproducibility, but for most measures remained good to excellent (ICC for %LA PAAS 0.454-0.825, PVE 0.618-0.809 at 30 min). For non-thresholded scar, highest reproducibility was observed using blood pool z-score normalisation technique: inter-scan ICC 0.759 (absolute agreement, 'Repro' group). There was no significant relationship between indices of PAAS and AF recurrence. CONCLUSION: PAAS imaging is a reproducible finding. Imaging should be performed at least 20 min post-GBCA injection, and a blood pool z-score should be considered for normalisation of signal intensities. The clinical implications of these findings remain to be established in the absence of a simple correlation with arrhythmia outcome. TRIAL REGISTRATION: United Kingdom National Research Ethics Service 08/H0802/68 - 30th September 2008. FAU - Chubb, Henry AU - Chubb H AUID- ORCID: 0000-0002-2859-3536 AD - School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK. henry.chubb@kcl.ac.uk. FAU - Karim, Rashed AU - Karim R AD - School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK. FAU - Roujol, Sebastien AU - Roujol S AD - School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK. FAU - Nunez-Garcia, Marta AU - Nunez-Garcia M AD - PhySense, Department of Information and Communication Technologies Department, Universitat Pompeu Fabra, Barcelona, Spain. FAU - Williams, Steven E AU - Williams SE AD - School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK. AD - Department of Cardiology, St Thomas' Hospital, London, UK. FAU - Whitaker, John AU - Whitaker J AD - School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK. FAU - Harrison, James AU - Harrison J AD - School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK. AD - Department of Cardiology, St Thomas' Hospital, London, UK. FAU - Butakoff, Constantine AU - Butakoff C AD - PhySense, Department of Information and Communication Technologies Department, Universitat Pompeu Fabra, Barcelona, Spain. FAU - Camara, Oscar AU - Camara O AD - PhySense, Department of Information and Communication Technologies Department, Universitat Pompeu Fabra, Barcelona, Spain. FAU - Chiribiri, Amedeo AU - Chiribiri A AD - School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK. AD - Department of Cardiology, St Thomas' Hospital, London, UK. FAU - Schaeffter, Tobias AU - Schaeffter T AD - School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK. FAU - Wright, Matthew AU - Wright M AD - School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK. AD - Department of Cardiology, St Thomas' Hospital, London, UK. FAU - O'Neill, Mark AU - O'Neill M AD - School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK. AD - Department of Cardiology, St Thomas' Hospital, London, UK. FAU - Razavi, Reza AU - Razavi R AD - School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK. LA - eng GR - WT_/Wellcome Trust/United Kingdom GR - MC_PC_16048/MRC_/Medical Research Council/United Kingdom PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20180319 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 - Atrial Fibrillation/diagnostic imaging/physiopathology/*surgery MH - Catheter Ablation/*adverse effects MH - Cicatrix/*diagnostic imaging/etiology/pathology/physiopathology MH - Contrast Media/*administration & dosage MH - Cross-Over Studies MH - Female MH - Heart Atria/*diagnostic imaging/pathology/physiopathology/*surgery MH - Humans MH - *Magnetic Resonance Imaging, Cine MH - Male MH - Middle Aged MH - Myocardium/pathology MH - Organometallic Compounds/*administration & dosage MH - Predictive Value of Tests MH - Recurrence MH - Reproducibility of Results MH - Time Factors MH - Treatment Outcome PMC - PMC5858144 OTO - NOTNLM OT - Atrial fibrillation OT - Atrium OT - Cardiac magnetic resonance imaging OT - Catheter ablation OT - Late gadolinium enhancement OT - Optimization COIS- CONSENT FOR PUBLICATION: Patient information sheet and consent form included provision for consent for publication (08/H0802/68). All data presented in this article is non-identifiable. COMPETING INTERESTS: The 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. EDAT- 2018/03/21 06:00 MHDA- 2019/03/15 06:00 PMCR- 2018/03/19 CRDT- 2018/03/21 06:00 PHST- 2017/07/12 00:00 [received] PHST- 2018/02/19 00:00 [accepted] PHST- 2018/03/21 06:00 [entrez] PHST- 2018/03/21 06:00 [pubmed] PHST- 2019/03/15 06:00 [medline] PHST- 2018/03/19 00:00 [pmc-release] AID - S1097-6647(23)00558-6 [pii] AID - 438 [pii] AID - 10.1186/s12968-018-0438-y [doi] PST - epublish SO - J Cardiovasc Magn Reson. 2018 Mar 19;20(1):21. doi: 10.1186/s12968-018-0438-y.