PMID- 30252987
OWN - NLM
STAT- MEDLINE
DCOM- 20200720
LR  - 20200720
IS  - 1522-2586 (Electronic)
IS  - 1053-1807 (Linking)
VI  - 49
IP  - 3
DP  - 2019 Mar
TI  - REPAIRit: Improving Myocardial Nulling and Ghosting Artifacts of 3D 
      Navigator-Gated Late Gadolinium Enhancement Imaging During Arrhythmia.
PG  - 688-699
LID - 10.1002/jmri.26284 [doi]
AB  - BACKGROUND: Cardiac 3D navigator-gated late gadolinium enhancement (LGE) imaging 
      is important for assessment of left atrial fibrosis, but the image quality is 
      often degraded due to arrhythmia. PURPOSE: To investigate a novel 3D LGE sequence 
      with improved myocardial nulling and reduced ghosting artifacts during 
      arrhythmia. STUDY TYPE: Prospective. POPULATION: Arrhythmia patients (n = 14). 
      SEQUENCE: The proposed technique, REPAIRit (Regrowth Equalization Pulse for 
      Arrhythmias in Inversion Recovery with automatic inversion time calculation), 
      inserts a saturation pulse with a dynamic flip angle into the 3D LGE sequence to 
      minimize arrhythmia-induced signal fluctuations. Using ShMOLLI (shortened 
      modified Look-Locker imaging) to estimate myocardial T(1) , REPAIRit 
      automatically calculates the optimal inversion time (TI) based on Bloch 
      equations. ASSESSMENT: REPAIRit LGE and the standard LGE were compared with 
      simulations, phantom imaging, and patient studies. Patient images were assessed 
      quantitatively, based on ghost-to-noise ratio (GNR), blood signal-to-noise ratio 
      (SNRb), myocardial signal-to-noise ratio (SNRm), and blood-to-myocardium 
      contrast-to-noise ratio (CNR), and qualitatively on a 4-point scale. Patients 
      were subgrouped based on the presence of arrhythmia to assess the image quality 
      difference. STATISTICAL TESTS: The two LGE sequences were compared by Student's 
      t-test and Wilcoxon signed-rank test. The two patient-subgroups were compared 
      using Welch's t-test and Wilcoxon rank-sum test. RESULTS: In 14 analyzed 
      patients, REPAIRit LGE significantly lowered GNR (1.25 +/- 0.41 vs. 1.42 +/- 0.42, 
      P = 0.04), reduced SNRm (1.90 +/- 0.60 vs. 3.16 +/- 1.66, P = 0.01), improved 
      ghosting artifact scores (2.5 +/- 0.6 vs. 2.2 +/- 0.9, P = 0.03), myocardial nulling 
      scores (2.7 +/- 0.5 vs. 2.3 +/- 0.7, P = 0.02), and atrial quality scores (2.8 +/- 0.3 
      vs. 2.4 +/- 0.8, P = 0.03) compared with the standard LGE. Comparing patients with 
      arrhythmia (n = 6) to those without (n = 8) during the scan, the former had lower 
      left ventricular (LV) myocardial T(1) s (430 +/- 26 msec vs. 469 +/- 39 msec, 
      P = 0.06) but similar blood T(1) s (318 +/- 55 msec vs. 316 +/- 27 msec, P = 0.96), 
      and significantly lower blood SNR (5.2 +/- 1.8 vs. 9.2 +/- 3.0, P = 0.01) and 
      significantly worse image quality (P = 0.01 for REPAIRit and P = 0.03 for 
      standard). DATA CONCLUSION: REPAIRit improves myocardial nulling and reduces 
      ghosting artifacts of 3D LGE under arrhythmia. LEVEL OF EVIDENCE: 2 Technical 
      Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:688-699.
CI  - (c) 2018 International Society for Magnetic Resonance in Medicine.
FAU - Hu, Chenxi
AU  - Hu C
AD  - Department of Radiology and Biomedical Imaging, Yale School of Medicine, New 
      Haven, Connecticut, USA.
FAU - Huber, Steffen
AU  - Huber S
AD  - Department of Radiology and Biomedical Imaging, Yale School of Medicine, New 
      Haven, Connecticut, USA.
AD  - Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School 
      of Medicine, New Haven, Connecticut, USA.
FAU - Latif, Syed R
AU  - Latif SR
AD  - Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School 
      of Medicine, New Haven, Connecticut, USA.
FAU - Santacana-Laffitte, Guido
AU  - Santacana-Laffitte G
AD  - Department of Radiology and Biomedical Imaging, Yale School of Medicine, New 
      Haven, Connecticut, USA.
FAU - Mojibian, Hamid R
AU  - Mojibian HR
AD  - Department of Radiology and Biomedical Imaging, Yale School of Medicine, New 
      Haven, Connecticut, USA.
AD  - Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School 
      of Medicine, New Haven, Connecticut, USA.
FAU - Baldassarre, Lauren A
AU  - Baldassarre LA
AD  - Department of Radiology and Biomedical Imaging, Yale School of Medicine, New 
      Haven, Connecticut, USA.
AD  - Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School 
      of Medicine, New Haven, Connecticut, USA.
FAU - Peters, Dana C
AU  - Peters DC
AD  - Department of Radiology and Biomedical Imaging, Yale School of Medicine, New 
      Haven, Connecticut, USA.
LA  - eng
GR  - R01HL122560/National Institutes of Health (NIH)/International
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20180925
PL  - United States
TA  - J Magn Reson Imaging
JT  - Journal of magnetic resonance imaging : JMRI
JID - 9105850
RN  - 0 (Contrast Media)
RN  - AU0V1LM3JT (Gadolinium)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Arrhythmias, Cardiac/*diagnostic imaging
MH  - Artifacts
MH  - *Cardiac Imaging Techniques
MH  - Contrast Media/chemistry
MH  - Female
MH  - Gadolinium/*chemistry
MH  - Heart/diagnostic imaging
MH  - Humans
MH  - Image Enhancement/methods
MH  - Image Interpretation, Computer-Assisted/methods
MH  - Imaging, Three-Dimensional/methods
MH  - *Magnetic Resonance Imaging
MH  - Male
MH  - Middle Aged
MH  - Myocardium/*metabolism/pathology
MH  - Phantoms, Imaging
MH  - Prospective Studies
MH  - Signal-To-Noise Ratio
EDAT- 2018/09/27 06:00
MHDA- 2020/07/21 06:00
CRDT- 2018/09/26 06:00
PHST- 2018/05/05 00:00 [received]
PHST- 2018/07/20 00:00 [revised]
PHST- 2018/07/23 00:00 [accepted]
PHST- 2018/09/27 06:00 [pubmed]
PHST- 2020/07/21 06:00 [medline]
PHST- 2018/09/26 06:00 [entrez]
AID - 10.1002/jmri.26284 [doi]
PST - ppublish
SO  - J Magn Reson Imaging. 2019 Mar;49(3):688-699. doi: 10.1002/jmri.26284. Epub 2018 
      Sep 25.