Late Gadolinium Enhancement
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2022 ◽  
Vol 14 (1) ◽  
pp. 36
W. Boukefoussa ◽  
C. Di Lena ◽  
I. Limouzineau ◽  
G. Jarry ◽  
L. Leborgne ◽  

Camilla Torlasco ◽  
Silvia Castelletti ◽  
Davide Soranna ◽  
Valentina Volpato ◽  
Stefano Figliozzi ◽  

Background Long scanning times impede cardiac magnetic resonance (CMR) clinical uptake. A “one‐size‐fits‐all” shortened, focused protocol (eg, only function and late‐gadolinium enhancement) reduces scanning time and costs, but provides less information. We developed 2 question‐driven CMR and stress‐CMR protocols, including tailored advanced tissue characterization, and tested their effectiveness in reducing scanning time while retaining the diagnostic performances of standard protocols. Methods and Results Eighty three consecutive patients with cardiomyopathy or ischemic heart disease underwent the tailored CMR. Each scan consisted of standard cines, late‐gadolinium enhancement imaging, native T1‐mapping, and extracellular volume. Fat/edema modules, right ventricle cine, and in‐line quantitative perfusion mapping were performed as clinically required. Workflow was optimized to avoid gaps. Time target was <30 minutes for a CMR and <35 minutes for a stress‐CMR. CMR was considered impactful when its results drove changes in diagnosis or management. Advanced tissue characterization was considered impactful when it changed the confidence level in the diagnosis. The quality of the images was assessed. A control group of 137 patients was identified among scans performed before February 2020. Compared with standard protocols, the average scan duration dropped by >30% (CMR: from 42±8 to 28±6 minutes; stress‐CMR: from 50±10 to 34±6 minutes, both P <0.0001). Independent on the protocol, CMR was impactful in ≈60% cases, and advanced tissue characterization was impactful in >45% of cases. Quality grading was similar between the 2 protocols. Tailored protocols did not require additional staff. Conclusions Tailored CMR and stress‐CMR protocols including advanced tissue characterization are accurate and time‐effective for cardiomyopathies and ischemic heart disease.

2021 ◽  
Zheng Zhang ◽  
Xing Chen ◽  
Qing Wan ◽  
Haiyan Wang ◽  
Na Qi ◽  

Abstract PurposeRespiratory motion causes mismatches between PET images of the myocardium and the corresponding cardiac MR images in cardiac integrated PET/MR. The mismatch may affect the attenuation correction and the diagnosis of non-ischemic cardiomyopathies. In this study, we present a two-stage cardiac PET and MR Late Gadolinium Enhancement (LGE) co-registration method, which seeks to improve diagnostic accuracy of non-ischemic cardiomyopathies via better image co-registration using an integrated whole-body PET/MR system.MethodsThe proposed PET and LGE two-stage co-registration method was evaluated through comparison with one-stage direct co-registration and no-registration. One hundred and ninety-one slices of LGE and forty lesions were studied. Two trained nuclear medicine physicians independently assessed the displacement between LGE and PET to qualitatively evaluate the co-registration quality. The changes of the mean SUV in the normal myocardium and the LGE-enhanced lesions before and after image co-registration were measured to quantitatively evaluate the accuracy and value of image co-registration.ResultsThe two-stage method had an improved image registration score (4.93±0.89) compared with the no-registration method (3.49±0.84, p value <0.001) and the single-stage method (4.23±0.81, p value <0.001). Furthermore, the two-stage method led to increased SUV value in the myocardium (3.87±2.56) compared with the no-registration method (3.14±1.92, p value <0.001) and the single-stage method (3.32±2.16, p value <0.001). The mean SUV in the LGE lesion significantly increased from 2.51±2.09 to 2.85±2.35 (p value<0.001) after the two-stage co-registration.ConclusionThe proposed two-stage registration method significantly improved the co-registration between PET and LGE in integrated PET/MR imaging. The technique may improve diagnostic accuracy of non-ischemic cardiomyopathies via better image co-registration.Registered No.DF-2020-085, 2020.04.30

2021 ◽  
Vol 10 (4) ◽  
pp. 225-229
Christian Mahnkopf ◽  
Younghoon Kwon ◽  
Nazem Akoum

Atrial fibrosis is an important component of the arrhythmic substrate in AF. Evidence suggests that atrial fibrosis also plays a role in increasing the risk of stroke in patients with the arrhythmia. Patients with embolic stroke of undetermined source (ESUS), who are suspected to have AF but are rarely shown to have it, frequently demonstrate evidence of atrial fibrosis; measured using late-gadolinium enhancement MRI, this manifests as atrial remodelling encompassing structural, functional and electrical properties. In this review, the authors discuss the available evidence linking atrial disease, including fibrosis, with the risk of ischaemic stroke in AF, as well as in the ESUS population, in whom it has been linked to recurrent stroke and new-onset AF. They also discuss the implications of this association on future research that may elucidate the mechanism of stroke and stroke prevention strategies in the AF and ESUS populations.

2021 ◽  
Vol 8 ◽  
Jie Wang ◽  
Laura Bravo ◽  
Jinquan Zhang ◽  
Wen Liu ◽  
Ke Wan ◽  

Objectives: To identify significant radiomics features derived from late gadolinium enhancement (LGE) images in participants with hypertrophic cardiomyopathy (HCM) and assess their prognostic value in predicting sudden cardiac death (SCD) endpoint.Method: The 157 radiomic features of 379 sequential participants with HCM who underwent cardiovascular magnetic resonance imaging (MRI) were extracted. CoxNet (Least Absolute Shrinkage and Selection Operator (LASSO) and Elastic Net) and Random Forest models were applied to optimize feature selection for the SCD risk prediction and cross-validation was performed.Results: During a median follow-up of 29 months (interquartile range, 20–42 months), 27 participants with HCM experienced SCD events. Cox analysis revealed that two selected features, local binary patterns (LBP) (19) (hazard ratio (HR), 1.028, 95% CI: 1.032–1.134; P = 0.001) and Moment (1) (HR, 1.212, 95%CI: 1.032–1.423; P = 0.02) provided significant prognostic value to predict the SCD endpoints after adjustment for the clinical risk predictors and late gadolinium enhancement. Furthermore, the univariately significant risk predictor was improved by the addition of the selected radiomics features, LBP (19) and Moment (1), to predict SCD events (P &lt; 0.05).Conclusion: The radiomics features of LBP (19) and Moment (1) extracted from LGE images, reflecting scar heterogeneity, have independent prognostic value in identifying high SCD risk patients with HCM.

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