title: Arrhythmogenic right ventricular dysplasia: ex vivo and in vivo fat detection with black-blood MR imaging.
abstract: OBJECTIVE
  To assess electrocardiographically gated spin-echo (SE) and double inversion-recovery fast SE magnetic resonance (MR) imaging in the depiction of intramyocardial fat in cadaveric heart specimens and patients with arrhythmogenic right ventricular dysplasia (ARVD).
  
  
  METHODS
  A phantom was used to determine the effective in-plane spatial resolution of SE and fast SE MR imaging protocols. Two cadavers with proved ARVD were imaged with identical sequences with spectrally selected fat suppression. Contrast-to-noise ratios (CNRs) of intramyocardial fat in the right ventricle (RV) were compared by using analysis of variance and Student t test with Bonferroni correction. Eleven patients with ARVD and 10 control subjects underwent fast SE MR imaging. Two blinded readers semiquantitatively evaluated images for fat conspicuity and image quality.
  
  
  RESULTS
  Fast SE MR imaging achieved better spatial resolution but lower CNR than that of gated SE imaging. CNRs in cadaveric specimens were higher for double R-R than for single R-R fast SE sequences for all section thicknesses (P <.0001). Absolute CNR values were higher for fat-suppressed fast SE sequences than for those without fat suppression. Cadaveric specimens demonstrated fatty infiltration from epicardium toward endocardium of the RV free wall. Intramyocardial fat was detected in eight of 11 (73%) patients with ARVD and in no control subjects (P <.001).
  
  
  CONCLUSIONS
  Intramyocardial fat detection in ARVD was better with fast SE MR imaging alone and combined with fat suppression than was gated SE MR imaging. When fast SE imaging is applied in vivo, however, breath-holding constraints limit the spatial resolution for RV fat detection.
authors.affiliation: Russell H. Morgan Dept of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, MRI-143 Nelson Basement, Baltimore, MD 21287, USA.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Castillo
authors.forename: Harikrishna
authors.initials: H
authors.lastname: Tandri
authors.forename: E Rene
authors.initials: ER
authors.lastname: Rodriguez
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
authors.forename: Julie
authors.initials: J
authors.lastname: Rutberg
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
authors.forename: João A C
authors.initials: JA
authors.lastname: Lima
authors.forename: David A
authors.initials: DA
authors.lastname: Bluemke
mesh_terms: D000273:Adipose Tissue / Q000473:pathology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000175:diagnosis* / Q000473:pathology; D004562:Electrocardiography; D005260:Female; D006352:Heart Ventricles / Q000473:pathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D066298:In Vitro Techniques; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D019047:Phantoms, Imaging