Improved myocardial scar visualization using free-breathing motion-corrected wideband black-blood late gadolinium enhancement imaging in patients with implantable cardiac devices

Name: 7T MRI Seminar: 7T Spinal Cord MRI: current landscape and feedback from the Marseille site
Start: 2025-03-20
End: 2025-03-20
Location: CHUV Radiology, room BH07 147 demo1 and online

AUTHORS: Gut P., Cochet H., Caluori G., El-Hamrani D., Constantin M., Vlachos K., Sridi S., Antiochos P., Schwitter J., Masi A., Sacher F., Jaïs P., Stuber M., Bustin A.

Diagnostic and Interventional Imaging, : , 12 December 2024

ABSTRACT

Purpose

The purpose of this study was to introduce and evaluate a novel 2D wideband black-blood (BB) LGE sequence, incorporating wideband inversion recovery, wideband T2 preparation, and non-rigid motion correction (MOCO) reconstruction, to improve myocardial scar detection and address artifacts associated with implantable cardioverter defibrillators (ICDs).

Materials and methods

The wideband MOCO free-breathing BB-LGE sequence was tested on a sheep with ischemic scar and in 22 patients with cardiac disease, including 15 with cardiac implants, at 1.5T. Wideband MOCO free-breathing BB-LGE sequence was compared with conventional and wideband breath-held PSIR-LGE and conventional and wideband breath-held BB-LGE techniques. Image sharpness, entropy, and scar-to-blood, scar-to-myocardium, and blood-to-myocardium contrast were analyzed and reconstruction times were measured. Two expert readers assessed the image quality, ICD artifact severity, and the diagnostic confidence with scar extent. Finally, for the animal study, a histology of the heart was performed to confirm the presence and localization of scar tissue.

Results

In the animal, wideband MOCO free-breathing BB-LGE were reconstructed in 0.6 s and demonstrated a 200 % improvement in scar-to-blood contrast compared to wideband breath-held PSIR-LGE, with significant improvement in image sharpness and reduction in entropy. It also effectively minimized ICD artifacts and accurately detected scars. In patients, wideband MOCO free-breathing BB-LGE were reconstructed in 1.5 ± 0.4 (standard deviation) s per slice. Seventeen patients (17/22; 77%) with myocardial scars were confidently diagnosed with wideband MOCO free-breathing BB-LGE, compared to 11 (11/22; 50 %) with wideband breathheld PSIR-LGE (P < 0.01).

Conclusion

Free-breathing wideband T2-prepared black-blood LGE imaging, combined with motion-corrected reconstruction, offers a promising diagnostic approach for the evaluation of myocardial lesions in patients with ICDs.