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

Pauline Gut; Hubert Cochet; Panagiotis Antiochos; Guido Caluori; Baptiste Durand; Marion Constantin; Konstantinos Vlachos; Kalvin Narceau; Ambra Masi; Jürg Schwitter; Frederic Sacher; Pierre Jaïs; Matthias Stuber; Aurélien Bustin

doi:10.1016/j.diii.2024.12.001

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

Diagn Interv Imaging. 2024 Dec 12:S2211-5684(24)00275-4. doi: 10.1016/j.diii.2024.12.001. Online ahead of print.

Authors

Affiliations

¹ IHU LIRYC, Heart Rhythm Disease Institute, Université de Bordeaux, INSERM U1045, 33604, Pessac, France; Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; Faculty of Biology and Medicine, University of Lausanne, 1011 Lausanne, Switzerland.
² Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33604 Pessac, France.
³ Cardiovascular Department, Division of Cardiology, University Hospital of Lausanne and University of Lausanne, 1011 Lausanne, Switzerland.
⁴ IHU LIRYC, Heart Rhythm Disease Institute, Université de Bordeaux, INSERM U1045, 33604, Pessac, France.
⁵ IHU LIRYC, Heart Rhythm Disease Institute, Université de Bordeaux, INSERM U1045, 33604, Pessac, France; Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33604 Pessac, France.
⁶ Faculty of Biology and Medicine, University of Lausanne, 1011 Lausanne, Switzerland; Cardiovascular Department, Division of Cardiology, University Hospital of Lausanne and University of Lausanne, 1011 Lausanne, Switzerland.
⁷ IHU LIRYC, Heart Rhythm Disease Institute, Université de Bordeaux, INSERM U1045, 33604, Pessac, France; Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33604 Pessac, France.
⁸ IHU LIRYC, Heart Rhythm Disease Institute, Université de Bordeaux, INSERM U1045, 33604, Pessac, France; Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; CIBM Center for Biomedical Imaging, 1011 Lausanne, Switzerland.
⁹ IHU LIRYC, Heart Rhythm Disease Institute, Université de Bordeaux, INSERM U1045, 33604, Pessac, France; Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33604 Pessac, France. Electronic address: [email protected].

PMID: 39667998
DOI: 10.1016/j.diii.2024.12.001

Abstract

Purpose: The purpose of this study was to introduce and evaluate a novel two-dimensional 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 1.5 T. 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, histopathological assessment 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 breath-held 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.

Keywords: Black blood imaging; Cardiac magnetic resonance imaging; Implantable cardioverter defibrillator; Motion artifacts; Myocardial infarction.