Tissue Characterization

1356179 - Quantification of myocardial scar of different etiology using dark-blood and bright-blood late gadolinium enhancement MRI

Friday, January 27, 2023

10:20 AM – 11:00 AM

Location: Pacific Jewel

Presenting Author(s)

Rob Holtackers, PhD

MR Physicist
Maastricht University Medical Centre, Netherlands

Primary Author(s)

Rob Holtackers, PhD

MR Physicist
Maastricht University Medical Centre, Netherlands

Co-Author(s)

LJ

Lamis Jada

PhD student
King's College London, United Kingdom
CV

Caroline M. Van De Heyning, MD, PhD

Consultant cardiologist
Antwerp University Hospital
Edegem, Belgium
René M. Botnar, PhD

Professor
King's College London
London, England, United Kingdom
JW

Joachim E. WIldberger, MD, PhD

Professor of Radiology
Maastricht University Medical Center, Netherlands
Reza Razavi, MD

Professor of Paediatric Cardiovascular Science
King's College London
London, England, United Kingdom
Amedeo Chiribiri, MD PhD FHEA FSCMR

Professor of Cardiovascular Imaging; Consultant Cardiologist
King's College London
London, England, United Kingdom

Disclosure(s):

Rob Holtackers, PhD: No financial relationships to disclose

René M. Botnar, PhD: No financial relationships to disclose

Amedeo Chiribiri, MD PhD FHEA FSCMR: No relevant disclosure to display

Background: Dark-blood late gadolinium enhancement (LGE) has been shown to allow for improved visualization and more accurate quantification of areas of ischemic scar compared to standard bright-blood LGE.^1,2 Recently, the performance of various semi-automated quantification techniques has been evaluated for the assessment of infarct size using both dark-blood LGE and conventional bright-blood LGE, with histopathology as reference standard.³ In this study, we evaluated various semi-automated scar quantification methods in different groups of patients, including those with ischemic heart disease (IHD), non-ischemic cardiomyopathy (NICM), and hypertrophic cardiomyopathy (HCM), using both bright-blood and dark-blood LGE.

Methods: A total of 62 patients referred for clinical CMR were included. All patients had a confirmed diagnosis of either MI (n=21), NICM or previous myocarditis (n=21), or HCM (n=20), and underwent CMR on a 1.5T scanner including both bright- and dark-blood LGE using a standard PSIR sequence. Both LGE methods used identical sequence settings as per clinical protocol, apart from the inversion time parameter, which was set differently.⁴ The order of acquisition of both LGE methods was randomized. All short-axis LGE images were manually segmented for epicardial and endocardial borders. The extent of LGE was then measured visually by manual planimetry, and semi-automatically by signal thresholding (2-6 SDs) and the full-width at half-maximum method. All LGE datasets were independently and randomly assessed while the operator was blinded to patients’ characteristics.

Results: Table 1 summarizes the demographics and CMR characteristics of the study population. For all quantification methods in the IHD group, except the 6-SD method, dark-blood LGE detected significantly more LV enhancement compared to bright-blood LGE (p< 0.05 for all methods). For both bright-blood and dark-blood LGE, the 6-SD method correlated best with manual quantification (16.9% vs 17.1% and 20.1 vs 20.4%, respectively). For the NICM group, no significant differences between both LGE methods were found for any of the quantification methods (p >0.05 for all methods). For bright-blood LGE the 5-SD method correlated best with manual quantification (9.3% vs 11.00), while for dark-blood LGE the 4-SD method correlated best (12.6% vs 11.5%). Similarly, for the HCM group, no significant differences between both LGE methods were found for any of the quantification methods (p >0.05 for all methods). For bright-blood LGE the 6-SD method correlated best with manual quantification (10.9% vs 12.2), while for dark-blood LGE the 5-SD method correlated best (13.2% vs 11.5%). Figure 1 shows the mean of %LV enhancement across the used quantification methods in bright-blood LGE and dark-blood LGE.

Conclusion: Dark-blood LGE might be able to safely replace the use of bright-blood LGE, while providing similar quantitative results in patients with NICM and HCM, and a more accurate assessment of the scar burden in patients with IHD.