University of Chicago Medical Center, Chicago, Illinois.
University of California, Los Angeles, California.
Am J Cardiol. 2019 Apr 15;123(8):1329-1335. doi: 10.1016/j.amjcard.2019.01.018. Epub 2019 Jan 31.
Implantable cardioverter defibrillators (ICDs) have been a relative contraindication to cardiovascular magnetic resonance imaging. Although cardiovascular magnetic resonance provides valuable information regarding scar in patients with ventricular arrhythmias or cardiomyopathy, ICDs in these patients frequently cause artifacts hindering accurate interpretation of both cine and late gadolinium enhancement (LGE) images. We sought to quantify the frequency and severity of artifact on LGE images and assess whether a modified wideband LGE protocol could improve the diagnostic yield of scar identification in agreement with invasive electroanatomic mapping (EAM). Forty-nine patients with ICDs and ventricular tachycardia (VT) or cardiomyopathy underwent CMR (Philips 1.5T), including standard and wideband LGE imaging. A safety algorithm was followed throughout the protocol. Standard and wideband LGE short-axis images were graded using an artifact score on a per-slice basis. LGE on wideband images was compared with EAM in 27 of 49 patients who underwent VT ablation. There were no adverse patient- or device-related events. With standard LGE imaging, 84% of patients demonstrated some degree of hyperenhancement artifact, which persisted in 22% on wideband LGE but with much less extent. Wideband LGE imaging resulted in an increase from 48% to 94% diagnostic-quality slices, with a significant reduction in artifact score, and correlated with EAM in 21 of 27 patients (78%). In conclusion, assessment of standard LGE is markedly limited by artifact in patients with ICD. The use of wideband LGE significantly improves image quality and can accurately localize myocardial scar before VT ablation.
植入式心脏复律除颤器（ICD）一直是心血管磁共振成像的相对禁忌症。尽管心血管磁共振提供了有关室性心律失常或心肌病患者瘢痕的有价值的信息，但这些患者的 ICD 经常导致伪影，从而阻碍了电影和晚期钆增强（LGE）图像的准确解释。我们旨在量化 LGE 图像上伪影的频率和严重程度，并评估修改后的宽带 LGE 方案是否可以提高与侵入性电解剖映射（EAM）一致的瘢痕识别的诊断率。49 例 ICD 患者伴有室性心动过速（VT）或心肌病接受 CMR（Philips 1.5T）检查，包括标准和宽带 LGE 成像。整个方案均遵循安全算法。标准和宽带 LGE 短轴图像在切片的基础上使用伪影评分进行分级。在 27 例接受 VT 消融的患者中，将宽带图像上的 LGE 与 EAM 进行了比较。患者或设备均未发生不良事件。使用标准 LGE 成像，84％的患者表现出某种程度的高增强伪影，而在宽带 LGE 上则有 22％持续存在，但程度较轻。宽带 LGE 成像使诊断质量的切片从 48％增加到 94％，伪影评分显著降低，并且与 27 例患者中的 21 例（78％）的 EAM 相关。总之，在具有 ICD 的患者中，标准 LGE 的评估受到伪影的明显限制。宽带 LGE 的使用可以显著改善图像质量，并可以在 VT 消融前准确定位心肌瘢痕。
