Rationale and Objectives
To compare free-breathing three-dimensional (3D) phase-sensitive inversion recovery (PSIR) with breath-holding two-dimensional (2D) IR sequences to determine which is better for detecting and characterizing myocardial late gadolinium enhancement (LGE) in hypertrophic cardiomyopathy (HCM) patients.
Materials and Methods
Thirty HCM patients clinically underwent 3.0 T cardiac magnetic resonance imaging that included 3D-PSIR and 2D-IR. The amount of LGE lesions was calculated and expressed as %LGE of the myocardial mass, and the average of the %LGE value reported by two observers was recorded as the final %LGE. We also counted the number of LGE lesions and recorded their location. The myocardium-LGE contrast, margin sharpness, artifacts, and overall image quality were graded on a 4-point grading scale (1 = poor, 2 = fair, 3 = good, 4 = excellent).
Results
The mean %LGE on 2D-IR was 24.7 ± 0.6, 17.5 ± 0.6, and 8.5 ± 0.3, respectively, for the basal, mid-, and apical myocardium; the corresponding values were 24.2 ± 0.4, 20.0 ± 0.4, and 7.7 ± 0.3 on 3D-PSIR (2D-IR versus 3D-PSIR, P = .87). On 2D IR and 3D-PSIR images, 13, 52, and 53, and 9, 74, and 33 LGE lesions were detected in the subendocardial, midwall, subepicardial area, respectively. The myocardium-LGE contrast and overall image quality were significantly higher on 3D-PSIR than 2D-IR images ( P < .001); the sequences did not differ significantly with respect to margin sharpness and artifact.
Conclusion
Three-dimensional PSIR sequence yields higher image contrast, better image quality, and greater detection ability for LGE lesions than 2D-IR sequence.
Cardiovascular magnetic resonance (CMR) imaging at 1.5- and 3.0-T machines yields high spatial and contrast resolution and is now accepted as a valuable tool for the evaluation of many cardiac diseases . It is particularly useful for the assessment of cardiomyopathies because it can depict different myocardial enhancement patterns on inversion-recovery (IR) late gadolinium-enhanced (LGE) images . Patients with hypertrophic cardiomyopathy (HCM) have a genetically anomalous, usually hypercontractile and asymmetric, myocardium that may obstruct output and result in sudden cardiac death. The estimated incidence of HCM is 1 in 500 in the general population . Evidence has emerged that myocardial fibrosis is a relatively early manifestation of HCM and that it may have a pathophysiological role in sudden cardiac death . Adabag et al found that LGE was an independent risk factor for HCM that was reflected in a 7.3-fold increase in the RR interval during nonsustained ventricular tachycardia, a potential risk factor for sudden death . LGE CMR imaging can depict the peculiar pattern of fibrosis whose increase is observed in patients at risk for major cardiac events . Therefore, the evaluation of the distribution and extent of LGE is clinically important for risk stratification and the management of HCM patients.
At LGE-CMR studies, two-dimensional (2D) IR images are conventionally acquired under breath-holding and an optimal inversion recovery time (TI) must be selected. Myocardial fibrosis is located in the area of hypertrophy; it can be patchy with multiple foci or distributed diffusely . As small or patchy LGE lesions can be missed on conventional 2D IR images because of noncontiguous slice coverage attributable to misregistration between breath holds, three-dimensional (3D) phase-sensitive IR (PSIR) under free breathing has been proposed as a technique to detect LGE lesions . Advantages of this technique include the consistent contrast and appearance over a relatively wide range of TI . The introduction of 3.0-T MR machines has been increasing in the clinical settings; however, there were no reports that evaluated the potentials of PSIR sequence for diagnosis of cardiomyopathy at a 3.0-T machine.
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Materials and methods
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Patient Population
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MR Imaging
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Quantitative Evaluation
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Visual Evaluation
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Statistical Analysis
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Results
Quantitative Evaluation
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Visual Evaluation
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Table 1
Scores for the Visual Evaluation of LGE Lesions on 2D IR and 3D PSIR Images
2D IR 3D PSIR_P_ Value Contrast 2.3 ± 0.7 3.2 ± 0.5 <.001 Sharpness 2.4 ± 0.6 2.7 ± 0.6 .14 Artifact 2.2 ± 0.7 2.5 ± 0.7 .20 Overall 2.3 ± 0.6 2.8 ± 0.7 .006
2D, two-dimensional; 3D, three-dimensional; IR, inversion recovery; PSIR, phase-sensitive inversion recovery.
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Discussion
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