Contrast-enhanced Steady-state Free Precession in the Assessment of Hypertrophic Obstructive Cardiomyopathy after Alcohol Septal Ablation.
OBJECTIVE
We evaluated the feasibility of contrast-enhanced steady-state free precession (ceSSFP) in the assessment of myocardial injury and obstruction of the left ventricular outflow tract (LVOT) in patients with hypertrophic obstructive cardiomyopathy (HOCM) after alcohol septal ablation (ASA).


METHODS
Twelve patients with HOCM underwent 16 magnetic resonance (MR) examinations following ASA. Precontrast SSFP, ceSSFP and late gadolinium enhancement (LGE) imaging were performed with a 1.5-tesla imager. ceSSFP was performed 3 to 7 min after gadolinium injection. We visually and quantitatively evaluated the signal patterns of the myocardium after ASA on SSFP and LGE MR imaging. We observed the LVOT using ceSSFP in the 3-chamber view.


RESULTS
We could visualize ASA-induced myocardial infarction (MI) in all 16 studies by LGE and ceSSFP but in only 6 studies (37.5%) by precontrast SSFP. Contrast was higher between MI and remote myocardium with LGE than ceSSFP (P < 0.01). ASA-induced hypointense regions were well visualized by the 2 sequences after contrast in the 7 patients who underwent MR imaging within 7 weeks of ASA and in a few patients after 80 weeks from ASA. The ceSSFP allowed comparable visualization of the jet flow crossing the LVOT to that derived from echocardiographic data.


CONCLUSIONS
Contrast-enhanced steady-state free precession allows assessment of myocardial injury as well as of the left ventricular outflow tract after alcohol septal ablation in a single scan without penalty in scan time and cine imaging contrast.
Department of Radiology, Nippon Medical School.
Yasuo
Y
Amano
Fumi
F
Yamada
Mitsunobu
M
Kitamura
Masaki
M
Tachi
Kumiko
K
Mine
Shinichiro
S
Kumita
Morimasa
M
Takayama
D055011:Ablation Techniques / Q000379:methods*; D000368:Aged; D000369:Aged, 80 and over; D002312:Cardiomyopathy, Hypertrophic / Q000601:surgery*; D003287:Contrast Media; D000431:Ethanol / Q000627:therapeutic use*; D005240:Feasibility Studies; D005260:Female; D005682:Gadolinium; D006346:Heart Septum / Q000601:surgery; D006352:Heart Ventricles; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007091:Image Processing, Computer-Assisted / Q000379:methods; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis; D011183:Postoperative Complications / Q000175:diagnosis; D012189:Retrospective Studies; D016277:Ventricular Function, Left / Q000502:physiology; D014694:Ventricular Outflow Obstruction / Q000175:diagnosis
D003287:Contrast Media; D000431:Ethanol; D005682:Gadolinium