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J Cardiovasc Magn Reson. 2017 Nov 21;19(1):91. doi: 10.1186/s12968-017-0407-x.

Prospective comparison of novel dark blood late gadolinium enhancement with conventional bright blood imaging for the detection of scar.

Author information

1
Cardiac MRI Unit, Royal Free Hospital, University College London, Rowland Hill Street, London, NW3 2PF, UK.
2
Hatter Cardiovascular Institute, University College London, London, UK.
3
National Heart, Lung and Blood Institute, National Institutes of health, Bethesda, Maryland, USA.
4
National Amyloidosis Centre, University College London, Royal Free Campus, London, UK.
5
Department of Cardiology, Royal Free Hospital, London, UK.
6
Barts Heart Centre, St. Bartholomew's Hospital, London, UK.
7
Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore.
8
National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore.
9
Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore.
10
The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK.
11
Cardiac MRI Unit, Royal Free Hospital, University College London, Rowland Hill Street, London, NW3 2PF, UK. m.fontana@ucl.ac.uk.
12
National Amyloidosis Centre, University College London, Royal Free Campus, London, UK. m.fontana@ucl.ac.uk.

Abstract

BACKGROUND:

Conventional bright blood late gadolinium enhancement (bright blood LGE) imaging is a routine cardiovascular magnetic resonance (CMR) technique offering excellent contrast between areas of LGE and normal myocardium. However, contrast between LGE and blood is frequently poor. Dark blood LGE (DB LGE) employs an inversion recovery T2 preparation to suppress the blood pool, thereby increasing the contrast between the endocardium and blood. The objective of this study is to compare the diagnostic utility of a novel DB phase sensitive inversion recovery (PSIR) LGE CMR sequence to standard bright blood PSIR LGE.

METHODS:

One hundred seventy-two patients referred for clinical CMR were scanned. A full left ventricle short axis stack was performed using both techniques, varying which was performed first in a 1:1 ratio. Two experienced observers analyzed all bright blood LGE and DB LGE stacks, which were randomized and anonymized. A scoring system was devised to quantify the presence and extent of gadolinium enhancement and the confidence with which the diagnosis could be made.

RESULTS:

A total of 2752 LV segments were analyzed. There was very good inter-observer correlation for quantifying LGE. DB LGE analysis found 41.5% more segments that exhibited hyperenhancement in comparison to bright blood LGE (248/2752 segments (9.0%) positive for LGE with bright blood; 351/2752 segments (12.8%) positive for LGE with DB; pā€‰<ā€‰0.05). DB LGE also allowed observers to be more confident when diagnosing LGE (bright blood LGE high confidence in 154/248 regions (62.1%); DB LGE in 275/324 (84.9%) regions (pā€‰<ā€‰0.05)). Eighteen patients with no bright blood LGE were found to have had DB LGE, 15 of whom had no known history of myocardial infarction.

CONCLUSIONS:

DB LGE significantly increases LGE detection compared to standard bright blood LGE. It also increases observer confidence, particularly for subendocardial LGE, which may have important clinical implications.

KEYWORDS:

Bright blood; Dark blood; Inversion recovery; Late gadolinium enhancement; Myocardial infarction; PSIR

PMID:
29162123
PMCID:
PMC5696884
DOI:
10.1186/s12968-017-0407-x
[Indexed for MEDLINE]
Free PMC Article

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