title: Improved border sharpness of post-infarct scar by a novel self-navigated free-breathing high-resolution 3D whole-heart inversion recovery magnetic resonance approach.
abstract: The border zone of post-infarction myocardial scar as identified by late gadolinium enhancement (LGE) has been identified as a substrate for arrhythmias and consequently, high-resolution 3D scar information is potentially useful for planning of electrophysiological interventions. This study evaluates the performance of a novel high-resolution 3D self-navigated free-breathing inversion recovery magnetic resonance pulse sequence (3D-SN-LGE) vs. conventional 2D breath-hold LGE (2D-LGE) with regard to sharpness of borders (SBorder) of post-infarction scar. Patients with post-infarction scar underwent two magnetic resonance examinations for conventional 2D-LGE and high-resolution 3D-SN-LGE acquisitions (both 15 min after 0.2 mmol/kg Gadobutrol IV) at 1.5T. In the prototype 3D-SN-LGE sequence, each ECG-triggered radial steady-state-free-precession read-out segment is preceded by a non-slice-selective inversion pulse. Scar volume and SBorderwere assessed on 2D-LGE and matching reconstructed high-resolution 3D-SN-LGE short-axis slices. In 16 patients (four females, 58 ± 10y) all scars visualized by 2D-LGE could be identified on 3D-SN-LGE (time between 2D-LGE and 3D-SN-LGE 48 ± 53 days). A good agreement of scar volume by 3D-SN-LGE vs. 2D-LGE was found (Bland-Altman: -3.7 ± 3.4 ml, correlation: r = 0.987, p < 0.001) with a small difference in scar volume (20.5 (15.8, 35.2) ml vs. 24.5 (20.0, 41.9)) ml, respectively, p = 0.002] and a good intra- and interobserver variability (1.1 ± 4.1 and -1.1 ± 11.9 ml, respectively). SBorderof border "scar to non-infarcted myocardium" was superior on 3D-SN-LGE vs. 2D-LGE: 0.180 ± 0.044 vs. 0.083 ± 0.038, p < 0.001. Detection and quantification of myocardial scar by 3D-SN-LGE is feasible and accurate in comparison to 2D-LGE. The high spatial resolution of the 3D sequence improves delineation of scar borders.
authors.affiliation: Division of Cardiology and Cardiac MR Center, University Hospital Lausanne, Lausanne, Switzerland.
authors.forename: Tobias
authors.initials: T
authors.lastname: Rutz
authors.affiliation: Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland.|Department of Radiology, University Hospital and University of Lausanne, Lausanne, Switzerland.
authors.forename: Davide
authors.initials: D
authors.lastname: Piccini
authors.affiliation: Department of Radiology, University Hospital and University of Lausanne, Lausanne, Switzerland.
authors.forename: Simone
authors.initials: S
authors.lastname: Coppo
authors.affiliation: Department of Radiology, University Hospital and University of Lausanne, Lausanne, Switzerland.
authors.forename: Jerome
authors.initials: J
authors.lastname: Chaptinel
authors.affiliation: Department of Radiology, University Hospital and University of Lausanne, Lausanne, Switzerland.
authors.forename: Giulia
authors.initials: G
authors.lastname: Ginami
authors.affiliation: Division of Cardiology and Cardiac MR Center, University Hospital Lausanne, Lausanne, Switzerland.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Vincenti
authors.affiliation: Department of Radiology, University Hospital and University of Lausanne, Lausanne, Switzerland.|Center for Biomedical Imaging, Lausanne, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Stuber
authors.affiliation: Division of Cardiology and Cardiac MR Center, University Hospital Lausanne, Lausanne, Switzerland. Jurg.schwitter@chuv.ch.
authors.forename: Juerg
authors.initials: J
authors.lastname: Schwitter
mesh_terms: D000368:Aged; D002921:Cicatrix / Q000000981:diagnostic imaging*; D003287:Contrast Media / Q000008:administration & dosage; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging*; D009206:Myocardium / Q000473:pathology*; D015588:Observer Variation; D009942:Organometallic Compounds / Q000008:administration & dosage; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012119:Respiration
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C090600:gadobutrol
keywords: 3D self-navigation; Free-breathing; Inversion recovery MRI; Scar imaging; Whole heart