Fused whole-heart coronary and myocardial scar imaging using 3-T CMR. Implications for planning of cardiac resynchronization therapy and coronary revascularization.
OBJECTIVE
The aim of this study was to demonstrate the feasibility of providing spatially matched, 3-dimensional (3D) myocardial scar and coronary imaging for the purpose of fused volumetric image display in patients undergoing cardiac resynchronization therapy (CRT) or coronary artery revascularization (CAR).


BACKGROUND
Clinical success in coronary vascular-based interventions is mitigated by the presence of scar in related myocardium. Pre-procedural fused volumetric imaging of both myocardial scar and coronary vasculature may benefit pre-procedural planning and patient selection in populations referred for CRT or CAR.


METHODS
A total of 55 studies were performed in patients referred for either CRT (n = 42) or CAR (n = 13). Coronary-enhanced and scar-enhanced imaging was performed on a 3-T cardiac magnetic resonance scanner using the same cardiac-gated, 3D, free-breathing cardiac magnetic resonance technique during and 20 minutes following slow gadolinium infusion. Matched image datasets were fused and volume-rendered to simultaneously display coronary anatomy and myocardial scar. Visual scoring of coronary artery, coronary vein, and myocardial scar image quality (score 0 to 4) was performed. The clinical impact of imaging was also scored using a physician survey.


RESULTS
Mean age was 57 ± 14 years. Combined 3D coronary and scar imaging was successful in 49 studies (89%). A quality score ≥ 2 was obtained for 97% of proximal- and mid-coronary artery and vein segments. The mean quality score of 3D scar imaging was 2.8 ± 1.0 and was scored as ≥ 2 in 86% of patients with myocardial scar. All patients with a scar quality score ≥ 2 achieved successful image fusion. Transmural scar was present below ≥ 1 planned target vessel in 9 patients (39%) planned for CRT and 8 patients (62%) planned for CAR. Physician surveys demonstrated incremental clinical impact in 67% of patients.


CONCLUSIONS
Three-dimensional myocardial scar and coronary imaging with fused volumetric display is clinically feasible and may be valuable for the planning of vascular-based interventions when regional myocardial scar is pertinent to therapeutic success.
White
James A
JA
Division of Cardiology, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada. jwhite@imaging.robarts.ca
Fine
Nowell
N
Gula
Lorne J
LJ
Yee
Raymond
R
Al-Admawi
Mohammed
M
Zhang
Qi
Q
Krahn
Andrew
A
Skanes
Allan
A
MacDonald
Anna
A
Peters
Terry
T
Drangova
Maria
M
D000328:Adult; D000368:Aged; D058406:Cardiac Resynchronization Therapy; D002921:Cicatrix / Q000473:pathology*; D003287:Contrast Media; D023921:Coronary Stenosis / Q000628:therapy; D003331:Coronary Vessels / Q000473:pathology; D005240:Feasibility Studies; D005260:Female; D019786:Gadolinium DTPA; D006333:Heart Failure / Q000628:therapy; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D009206:Myocardium / Q000473:pathology*; D018579:Patient Selection; D011379:Prognosis; D016896:Treatment Outcome
D003287:Contrast Media; D019786:Gadolinium DTPA