Hopital Universitaire de Genève, Genève, Switzerland.
J Magn Reson Imaging. 2011 Dec;34(6):1374-87. doi: 10.1002/jmri.22783. Epub 2011 Oct 3.
To compare-theoretically and experimentally-clinically available two-dimensional/three-dimensional (2D/3D), breathhold and non-breathhold, inversion-recovery (IR) gradient-echo (GRE) sequences used to differentiate between nonviable injured and normal myocardium with late gadolinium-enhanced techniques (IR-GRE2D sequence is used as a reference), and to evaluate their respective clinical benefit.
Six breathhold (2D-IR-GRE, 3D-IR-GRE, balanced steady-state free precession 2D-IR-bSSFP and 3D-IR-bSSFP, phase-sensitive 2D-PSIR-GRE, and 2D-PSIR-bSSFP) and two non-breathhold late gadolinium-enhanced techniques (single-shot 2D-ssbSSFP and 2D-PSIR-ssbSSFP) were consecutively performed in 32 coronary artery disease patients with chronic myocardial infarction. Qualitative assessment and manual planimetry were performed by two independent observers. Quantitative assessment was based on percentage signal intensity elevation between injured and normal myocardium and contrast-to-noise ratio. Theoretical simulations were compared with experimental measurements performed on phantoms with various concentrations of gadolinium.
The 3D-IR-GRE image quality appeared better than the other 2D and 3D sequences, showing better delineation of complex nontransmural lesions, with significantly higher percentage signal intensity and contrast-to-noise ratio. PSIR techniques appeared more limited in differentiating sub-endocardial lesions and intracavity blood pool, but in all other cases were comparable to the other techniques. Single-shot PSIR-ssbSSFP appeared to be a valuable alternative technique when breathhold cannot be achieved.
We recommend 3D-IR-GRE as the method of choice for late gadolinium-enhanced cardiac magnetic resonance imaging in clinical practice.
通过理论和临床比较，评估对比剂增强心脏磁共振成像中，二维/三维（2D/3D）、屏气/非屏气、反转恢复（IR）梯度回波（GRE）序列在鉴别存活性心肌损伤与正常心肌方面的作用，这些序列包括临床应用的二维/三维 IR-GRE 序列（将其作为参考序列），并评估这些序列的临床获益。
在 32 例慢性心肌梗死的冠心病患者中，连续进行了 6 种屏气（2D-IR-GRE、3D-IR-GRE、平衡稳态自由进动 2D-IR-bSSFP 和 3D-IR-bSSFP、相位敏感 2D-PSIR-GRE 和 2D-PSIR-bSSFP）和 2 种非屏气（单次激发 2D-ssbSSFP 和 2D-PSIR-ssbSSFP）对比剂增强技术检查。由两位独立观察者进行定性评估和手动勾画。定量评估基于损伤心肌与正常心肌之间的信号强度百分比升高和对比噪声比。理论模拟与不同浓度钆对比剂的体模实验测量进行了比较。
3D-IR-GRE 图像质量优于其他 2D 和 3D 序列，能够更好地显示复杂的非穿透性病变，信号强度百分比和对比噪声比显著更高。PSIR 技术在鉴别心内膜下病变和心腔内血液池方面似乎更有限，但在其他所有情况下，与其他技术相当。当无法屏气时，单次激发 PSIR-ssbSSFP 似乎是一种有价值的替代技术。
我们建议在临床实践中，将 3D-IR-GRE 作为对比剂增强心脏磁共振成像的首选方法。
