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Phase-Sensitive Inversion Recovery Single-Shot Balanced Steady-State Free Precession for Detection of Myocardial Infarction During a Single Breathhold

Posted Nov 30, 2007 Updated Apr 7, 2023
By Armin Huber MD , Carmel Hayes PhD , Benedikt Spannagl MD , Johannes Rieber MD , Volker Klauss MD , Stefan Oswald Schoenberg MD , Maximilion Reiser MD , Bernd Jürgen Wintersperger MD
7 min read

Rationale and Objectives

We sought to show that phase-sensitive detection and a single-shot technique allow imaging of the heart for detection of myocardial infarction during a single breathhold without adaptation of the inversion time.

Materials and Methods

Thirty-five patients at 2 weeks to 3 months after Q-wave myocardial infarction were examined on a 1.5-T MR system 10 minutes after the administration of a double-dose extravascular contrast agent. In order to determine the optimal inversion recovery time (TI), a TI scout sequence was performed. An IR-turboFlash sequence with optimized TI was used as standard of reference. A phase-sensitive inversion recovery (PSIR) single-shot TrueFISP sequence, which allows imaging of nine slices during one breathhold (TR/TE/FA/BW: 2.2 ms/1.1 ms/60°, 8°/1220 Hz/Px) was used with a nominal TI of 200 ms. Spatial resolution was identical for both techniques: 1.3 mm × 1.8 mm × 8 mm. Infarct volumes, area of infarction on a selected slice, and scan time for imaging delayed contrast enhancement (DCE) were compared.

Results

The mean values for the time of imaging DCE were 10 minutes 43 seconds for the IR turboFLASH and 17 seconds ( P < .001) for the PSIR single-shot TrueFISP sequence. No significant difference was found for the mean values of the infarct volumes with 18.7 ml (IR turboFLASH) and 17.3 ml (PSIR single-shot TrueFISP). The values for the correlation coefficients of the infarct volumes and infarct areas of the two different techniques were r = 0.95 ( P < .004) and r = 0.97 ( P < .002). The regression equations were y = 0.76 + 0.92* x and y = 0.07 + 0.93* x , respectively.

Conclusions

PSIR single-shot TrueFISP allows for accurate identification of myocardial infarction during a single breathhold with reduction of scan time by a factor of 38.

Imaging myocardial infarction by MRI using the effect of delayed hyperenhancement is an established and accurate method (1−5). In patients with coronary artery disease and left ventricular dysfunction, the distinction between viable and nonviable myocardium by contrast-enhanced MRI allows the prediction of functional recovery after surgical or interventional revascularization ( ). In contrast to positron-emission tomography and single-photon-emission computed tomography ( ), delayed contrast-enhanced MRI has superior spatial resolution and can differentiate transmural from nontransmural myocardial infarction. The area of hyperenhancement shows a close correlation with histopathologically determined area of myocardial infarction (MI) in animal experiments ( ).

The most widely used pulse sequence type to depict late enhancing areas in the myocardium is inversion-recovery (IR) turboFLASH with magnitude reconstruction. This pulse sequence requires an individual adaptation of the inversion-recovery time (TI) to achieve optimal signal increase between infarcted and viable myocardium. At the optimal TI, the signal intensity of normal myocardium is nulled. Several breathholds can be necessary to determine the optimal TI value. An error in selection of the optimum null time leads to a reduction in contrast and may reduce the visible hyperenhanced area and therefore may cause an underestimation of the extent of the infarction ( ).

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Materials and methods

Patient Population

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MRI

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Image Evaluation

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Statistical Evaluation

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Results

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Figure 1, A , The scatter diagram reveals volumes of the infarctions acquired with the IR turboFLASH pulse sequence and with the PSIR single-shot TrueFISP pulse sequence. B , The Bland-Altman′s plot of infarct volumes of the two pulse sequence techniques (IR TrueFISP and IR turboFLASH) reveals one data point below the threshold, which is defined by two standard deviations.

Figure 2, A , The scatter diagram reveals areas of the infarctions on one selected slice, acquired with the IR turboFLASH pulse sequence and with the PSIR single-shot TrueFISP pulse sequence. B , The Bland-Altman′s plot of the areas of the infarction of the two pulse sequence techniques (PSIR single-shot TrueFISP and IR turboFLASH) reveals all data point within the threshold values, which are defined by two standard deviations.

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Figure 3, A 61-year-old man with occlusion of the right coronary artery and a transmural myocardial infarction. A , Two-chamber view acquired with a PSIR single-shot TrueFISP sequence reveals a transmural infarction in the inferior segment with involvement of the papillary muscle. B , Two-chamber view acquired with a segmented IR turboFLASH sequence reveals a transmural infarction in the inferior segment with involvement of the papillary muscle. C , Short-axis view acquired with a PSIR single-shot TrueFISP sequence reveals a transmural infarction in the inferior segment with involvement of the papillary muscle. D , Short-axis view acquired with an IR turboFLASH sequence reveals a transmural infarction in the inferior segment with involvement of the papillary muscle. In contrast to the single-shot image ( C ), a ghosting artifact can be identified on the segmented IR turboFLASH image, which is probably caused by a respiratory motion artifact.

Figure 4, A 67-year-old man with occlusion of the left anterior descending artery and a transmural myocardial infarction. A−C , Three short-axis images acquired with an IR turboFLASH sequence in a basal ( A ), midpapillary ( B ), and apical position ( C ) reveal a transmural myocardial infarction in the anteroseptal and anterior segments. Small hypointense areas are located in the subendocardial region of the infarction and indicate a possible microvascular obstruction. D−E , Short-axis images acquired with a PSIR single-shot TrueFISP sequence in a basal ( D ), midpapillary ( E ), and apical position ( F ) reveal the transmural infarction in the LAD territory with some hypointense areas within the infarction. Both pulse sequence techniques, the reference sequence ( A−D ) and the PSIR single-shot TrueFISP technique, reveal the myocardial infarction in a similar way concerning area of infarction, transmural extent of infarction, and dark zones within the infarction.

Figure 5, A 47-year-old patient with occlusion of the left anterior descending artery. A , Stack of short-axis images acquired with the IR turboFLASH sequence reveals a transmural infarction. The hyperintense infarcted myocardium is located in the anterior and anteroseptal segments. B , Short-axis images acquired with the PSIR single-shot TrueFISP sequence in the same positions as shown in A reveal a transmural infarction. Transmural extent, infarct area, and volume are similar compared to the images shown in A .

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Discussion

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Conclusion

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Academic Radiology, Volume 14, Issue 12
Journals General Radiology
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