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Abstract
Background
Late gadolinium enhancement (LGE) imaging is the gold standard for noninvasive evaluation
of myocardial scar. In the clinical setting, the standard imaging protocol involves
a breath-held segmented inversion-prepared 2D Cartesian acquisition at a single location.
This breath-hold scan is repeated 10 -14 times to cover the entire left ventricle.
Although multislice 2D LGE has shown great diagnostic accuracy, the multiple breath-holds
increase the scan time to approximately 10min and patient fatigue which can result
in poor breath-holding and ghosting artifact. In this study, we propose to perform
the 3D LGE imaging in a single breath-hold using a stack of spiral trajectory.
Methods
Single breath-hold 3D stack of spiral LGE images covering the entire LV were acquired
in 27 subjects undergoing clinical scans following the conventional multisilce 2D
LGE on a Siemens 1.5T Avanto scanner. The 3D spiral LGE sequence consisted of 12 partitions
of a dual density spiral trajectory. Each spiral readout was 4ms long with 24 interleaves
to support 1.5x Nyquist in the center and 0.7x Nyquist in the edge of kspace. At each
cardiac cycle, 2 out of 24 interleaves were acquired for each partition resulting
in an acquisition window of approximately 160ms. All of the spirals were acquired
in a single 12 heart beat breath-hold. Other sequence parameters included: TR 7ms,
TE 1ms, TI 300~400ms, FA 20o, FOV 340mm, in-plane resolution 1.5mm, 12 slices, and
thickness 8mm. The images were reconstructed using SPIRiT. Image quality was rated
on a 5 point scale (1- very poor to 5 excellent) by two cardiologists.
Results
Figure 1 shows the typical negative 3D LGE images from a subject without any scar.
Figure 2 shows the multislice 2D LGE images (top two rows) and 3D LGE images (bottom
two rows) from patients undergoing a viability study. Both of the 2D and 3D LGE images
show a myocardial infarction in the inferior wall. Although the 3D LGE images were
acquired within one breath-hold, the SNR of the images were still adequate for diagnostic
purpose. The multislice 2D LGE scan time required approximately 10min while the 3D
LGE scan time took only 10s. The average image quality score was 3.7 from cardiologist
1 and 3.6 from cardiologist 2.
Figure 1
3D spiral LGE images from a subject without scar
Figure 2
Top two rows: multiple breath-hold 2D LGE images. Bottom two rows: single breath-hold
3D spiral LGE images. Arrows: the myocardial infarction in the inferior wall.
Conclusions
We demonstrate the successful application of single breath-hold 3D LGE imaging using
stack of spiral trajectories. As with the standard 2D multislice LGE images, 3D LGE
images are able to differentiate myocardial scar, while the scan time is dramatically
reduced. Such an approach will improve patient throughput in CMR.
Funding
K23 HL112910-01.
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