title: Improved dark blood late gadolinium enhancement (DB-LGE) imaging using an optimized joint inversion preparation and T2magnetization preparation.
abstract: OBJECTIVE
  To develop a dark blood-late gadolinium enhancement (DB-LGE) sequence that improves scar-blood contrast and delineation of scar region.
  
  
  METHODS
  The DB-LGE sequence uses an inversion pulse followed by T2magnetization preparation to suppress blood and normal myocardium. Time delays inserted after preparation pulses and T2-magnetization-prep duration are used to adjust tissue contrast. Selection of these parameters was optimized using numerical simulations and phantom experiments. We evaluated DB-LGE in 9 swine and 42 patients (56 ± 14 years, 33 male). Improvement in scar-blood contrast and overall image quality was subjectively evaluated by two independent readers (1 = poor, 4 = excellent). The signal ratios among scar, blood, and myocardium were compared.
  
  
  RESULTS
  Simulations and phantom studies demonstrated that simultaneous nulling of myocardium and blood can be achieved by selecting appropriate timing parameters. The scar-blood contrast score was significantly higher for DB-LGE (P < 0.001) with no significant difference in overall image quality (P > 0.05). Scar-blood signal ratios for DB-LGE versus LGE were 5.0 ± 2.8 versus 1.5 ± 0.5 (P < 0.001) for patients, and 2.2 ± 0.7 versus 1.0 ± 0.4 (P = 0.0023) for animals. Scar-myocardium signal ratios were 5.7 ± 2.9 versus 6.3 ± 2.6 (P = 0.35) for patients, and 3.7 ± 1.1 versus 4.1 ± 2.0 (P = 0.60) for swine.
  
  
  CONCLUSIONS
  The DB-LGE sequence simultaneously reduces normal myocardium and blood signal intensity, thereby enhancing scar-blood contrast while preserving scar-myocardium contrast. Magn Reson Med 79:351-360, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
authors.affiliation: Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.|Biomedical Engineering Department, Cairo University, Giza, Egypt.
authors.forename: Tamer A
authors.initials: TA
authors.lastname: Basha
authors.affiliation: Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Maxine C
authors.initials: MC
authors.lastname: Tang
authors.affiliation: Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Connie
authors.initials: C
authors.lastname: Tsao
authors.affiliation: Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.|Harvard-Thorndike Electrophysiology Institute, Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Cory M
authors.initials: CM
authors.lastname: Tschabrunn
authors.affiliation: Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.|Harvard-Thorndike Electrophysiology Institute, Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Elad
authors.initials: E
authors.lastname: Anter
authors.affiliation: Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.|Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Warren J
authors.initials: WJ
authors.lastname: Manning
authors.affiliation: Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Reza
authors.initials: R
authors.lastname: Nezafat
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D001769:Blood / Q000000981:diagnostic imaging*; D003287:Contrast Media / Q000737:chemistry*; D005260:Female; D005682:Gadolinium / Q000737:chemistry*; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009203:Myocardial Infarction / Q000000981:diagnostic imaging*; D009206:Myocardium / Q000473:pathology; D019047:Phantoms, Imaging; D015203:Reproducibility of Results; D013552:Swine
chemical_list: D003287:Contrast Media; D005682:Gadolinium
keywords: dark blood scar imaging; late gadolinium enhancement; myocardial scar