Fast, motion-free and diagnostic scar imaging using black-blood late gadolinium enhancement imaging in a one-shot approach

Presenting Author(s)

• 

  Victor de Villedon de Naide, MSc

  PhD student
  Bordeaux University - INSERM U1045
  Bordeaux, Aquitaine, France

Primary Author(s)

• 

  Victor de Villedon de Naide, MSc

  PhD student
  Bordeaux University - INSERM U1045
  Bordeaux, Aquitaine, France

Co-Author(s)

• SV

  Sane Viola

  Engineer
  IHU Liryc, Université de Bordeaux, France
• 

  Kalvin Narceau, MSc

  Phd student
  Bordeaux University - INSERM U1045
  Pessac, Aquitaine, France
• 

  Thaïs Genisson, MSc

  PhD student
  IHU Liryc, Université de Bordeaux
  Bordeaux, Aquitaine, France
• TR

  Théo Richard, MSc

  Engineer
  IHU LIRYC, Heart rhythm disease institute, Université de Bordeaux – INSERM U1045, Avenue du Haut Lévêque, 33604, Pessac, France
  Bordeaux, Aquitaine, France
• EB

  Ewan Barel

  Engineer
  IHU Liryc, Université de Bordeaux, France
• 

  Thomas Kuestner, PhD, MSc

  Professor
  Medical Image and Data Analysis (MIDAS.lab), Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, 72076 Tübingen, Germany
  Tübingen, Baden-Wurttemberg, Germany
• CB

  Claire Bazin

  MD
  Centre Hospitalier Universitaire de Bordeaux, France
• EG

  Edouard Gerbaud, MD, PhD

  Cardiac Intensive Care Unit, Groupe Hospitalier Sud, CHU de Bordeaux, Pessac, France, France
• PJ

  Pierre Jaïs, MD, PhD

  PROF/PhD
  Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux
  Bordeaux, Aquitaine, France
• MS

  Matthias Stuber, PhD

  Professor/Director
  CIBM/CHUV/UNIL
  Lausanne, Switzerland
• HC

  Hubert Cochet, MD, PhD

  Professor
  Bordeaux University - INSERM U1045
  Bordeaux, Aquitaine, France
• 

  Aurelien Bustin, FSCMR

  Research Associate
  Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, Pessac, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux – INSERM U1045, Avenue du Haut Lévêque, Pessac, France; Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
  Bordeaux, Aquitaine, France

Background: Myocardial scar imaging is essential for the diagnosis and management of patients with ischemic and non-ischemic cardiomyopathies. Conventional bright-blood LGE suffers from a lack of contrast at the blood-scar interface, particularly in the presence of subendocardial scars¹. Black-blood (BL) LGE overcomes this issue by nulling both myocardium and blood tissues^1,2. Traditional BL LGE techniques requires the acquisition of multiple single-shots images per slice position followed by image averaging ³. However, this approach is time consuming, necessitates multiple breath-holds, and remains prone to residual motion artifacts. This study investigates the feasibility and clinical performance of a prospective free-breathing one-shot BL LGE sequence.

Methods: A free-breathing BL 2D whole-heart ECG-triggered sequence acquires one single-shot LGE short-axis image per slice using a non-selective 180° inversion pulse, followed by a T1ρ preparation module³. A pause of one cardiac cycle between shots allows for a complete magnetization recovery (Fig.1).

8 patients (5 females, age 52-86yo) with known ischemic heart disease underwent 1.5T CMR (Siemens Aera) using conventional breath-held 2D PSIR⁴, breath-held five-shot BL and free-breathing one-shot BL, 12min post-injection of gadolinium (in random order). Dedicated TI-scouts were performed prior to each sequence.

Two readers manually segmented myocardial scars on all images. Intra- and inter-observer agreement were assessed using the Dice coefficient. Image quality was rated on a 4-point Likert scale (0: poor quality; 4: excellent quality), and presence of residual motion artifacts were noted. Signal intensities and acquisition times were compared. Scar mass (g) agreement between the two BL-LGE sequences was evaluated using ICCs (95% CI) and Bland–Altman analysis.

Results: Acquisition times were 3min6s±17s, 3min10s±17s, and 20s±3s for PSIR, five-, and one-shot BL, respectively (P< 0.001; Fig.2). Dice coefficients were higher for five- and one-shot BL than PSIR (intra: 77.8% vs. 76.3 vs. 68.2%; inter: 70.4 vs. 73.6% vs. 62.4%). Scar mass agreement between five- and one-shot BL was good (ICC=0.85 [0.37–0.97], bias -3.4±13.9g; Fig.3A). Intra-observer reproducibility was excellent for PSIR, five-, and one-shot BL (ICC=0.92 [0.67–0.98], 0.96 [0.80–0.99], and 0.97 [0.86–0.99], respectively), as was inter-observer reproducibility (ICC=0.99 [0.94–1.00], 0.89 [0.56–0.98], and 0.97 [0.85–0.99]). Excellent image quality (score 4) was observed in 27%, 18%, and 82% of PSIR, five-, and one-shot BL (Fig.3B), while motion artifacts occurred in 64%, 55%, and 0%, respectively. Signal intensities did not differ between five- and one-shot BL (p< 0.001;Fig.3C).

Conclusion: The proposed one-shot BL LGE sequence allows for rapid (< 30s), free-breathing and diagnostically accurate scar imaging, offering a more efficient and patient-friendly solution for patients with myocardial infarction. Further validation in a larger cohort is warranted.

Schematic overview of the proposed one-shot black-blood sequence. A non-selective 180° inversion pulse is followed by an adiabatic T1-rho preparation module, generating an ideal black-blood contrast. The second heartbeat allows magnetization to reach its steady state. Imaging parameters included: 5 signal averages, 1.5x1.5mm2 in-plane resolution, 8mm slice thickness, FA=60°, GRAPPA x2, ~160ms acquisition window, TE/TR=1.2/2.8ms, bandwidth=870Hz/pixel. A dedicated TI-scout was performed prior to LGE imaging. Abbreviations: FA, flip angle; IR, inversion recovery; TE, echo time; TI, inversion time; TR, repetition time.
Comparison of the proposed one-shot BL with reference techniques. A) Short-axis mid-ventricular images collected with PSIR (top row), five-shots BL (second row) and the proposed one-shot BL (bottom row) in four patients with myocardial infarction. The acquisition times needed to collect each image are shown. Yellow arrows represent incertitude in LGE delineation, while red arrows represent certitude. For each patient, acquisition time was normalized to 10 short-axis slices. The shortest acquisition time was highlighted in green, otherwise in red. For one patient (Female, 62 years-old, second column, from left to right), right-ventricular infarction could be detected with BL techniques, whereas PSIR imaging, in which the hyperenhancement was confounded with blood tissue. Abbreviations: AT, acquisition time; BL, black-blood; PSIR, phase-sensitive inversion recovery.
A) Comparison of scar mass assessed with five- and one-shot black-blood images through Bland-Altman analysis. B) Comparison of diagnostic confidence, following Likert scale, between PSIR, five- and one-shot black-blood images. C) Scar, remote myocardium, and blood signal intensities assessed in PSIR, five- and one-shot black-blood images. Abbreviations: PSIR, phase-sensitive inversion recovery.