Department of Cardiovascular Imaging, Groupe Hospitalier Sud, CHU Bordeaux, 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.
Department of Cardiovascular Imaging, Groupe Hospitalier Sud, CHU Bordeaux, Pessac, France.
Eur J Radiol. 2021 Nov;144:109960. doi: 10.1016/j.ejrad.2021.109960. Epub 2021 Sep 20.
High-resolution free-breathing late gadolinium enhancement (HR-LGE) was shown valuable for the diagnosis of acute coronary syndromes with non-obstructed coronary arteries. The method may be useful to detect COVID-related myocardial injuries but is hampered by prolonged acquisition times. We aimed to introduce an accelerated HR-LGE technique for the diagnosis of COVID-related myocardial injuries.
An undersampled navigator-gated HR-LGE (acquired resolution of 1.25 mm) sequence combined with advanced patch-based low-rank reconstruction was developed and validated in a phantom and in 23 patients with structural heart disease (test cohort; 15 men; 55 ± 16 years). Twenty patients with laboratory-confirmed COVID-19 infection associated with troponin rise (COVID cohort; 15 men; 46 ± 24 years) prospectively underwent cardiovascular magnetic resonance (CMR) with the proposed sequence in our center. Image sharpness, quality, signal intensity differences and diagnostic value of free-breathing HR-LGE were compared against conventional breath-held low-resolution LGE (LR-LGE, voxel size 1.8x1.4x6mm).
Structures sharpness in the phantom showed no differences with the fully sampled image up to an undersampling factor of x3.8 (P > 0.5). In patients (N = 43), this acceleration allowed for acquisition times of 7min21s ± 1min12s at 1.25 mm resolution. Compared with LR-LGE, HR-LGE showed higher image quality (P = 0.03) and comparable signal intensity differences (P > 0.5). In patients with structural heart disease, all LGE-positive segments on LR-LGE were also detected on HR-LGE (80/391) with 21 additional enhanced segments visible only on HR-LGE (101/391, P < 0.001). In 4 patients with COVID-19 history, HR-LGE was definitely positive while LR-LGE was either definitely negative (1 microinfarction and 1 myocarditis) or inconclusive (2 myocarditis).
Undersampled free-breathing isotropic HR-LGE can detect additional areas of late enhancement as compared to conventional breath-held LR-LGE. In patients with history of COVID-19 infection associated with troponin rise, the method allows for detailed characterization of myocardial injuries in acceptable scan times and without the need for repeated breath holds.
高分辨率自由呼吸晚期钆增强（HR-LGE）已被证明对诊断非阻塞性冠状动脉急性冠脉综合征有价值。该方法可能有助于检测与 COVID 相关的心肌损伤，但由于采集时间延长而受到阻碍。我们旨在引入一种加速 HR-LGE 技术来诊断与 COVID 相关的心肌损伤。
开发并验证了一种欠采样导航门控 HR-LGE（采集分辨率为 1.25mm）序列，结合先进的基于补丁的低秩重建，在体模和 23 例结构性心脏病患者（试验队列；15 名男性；55±16 岁）中进行了验证。20 例实验室确诊的 COVID-19 感染伴肌钙蛋白升高的患者（COVID 队列；15 名男性；46±24 岁）前瞻性地在我院中心接受了拟议序列的心血管磁共振（CMR）检查。与传统的屏气低分辨率 LGE（LR-LGE，体素大小为 1.8x1.4x6mm）相比，比较了自由呼吸 HR-LGE 的图像清晰度、质量、信号强度差异和诊断价值。
在体模中，结构清晰度在采样因子高达 x3.8 时与完全采样图像无差异（P>0.5）。在患者（N=43）中，这种加速允许在 1.25mm 分辨率下采集 7 分 21 秒±1 分 12 秒的时间。与 LR-LGE 相比，HR-LGE 显示出更高的图像质量（P=0.03）和相当的信号强度差异（P>0.5）。在结构性心脏病患者中，LR-LGE 上的所有 LGE 阳性节段也在 HR-LGE 上检测到（80/391），而 HR-LGE 上仅检测到 21 个增强节段（101/391，P<0.001）。在 4 例有 COVID-19 病史的患者中，HR-LGE 呈阳性，而 LR-LGE 要么呈阴性（1 例微梗死和 1 例心肌炎），要么不确定（2 例心肌炎）。
与传统的屏气低分辨率 LGE 相比，欠采样的自由呼吸各向同性 HR-LGE 可检测到晚期增强的附加区域。在伴有肌钙蛋白升高的 COVID-19 感染病史的患者中，该方法可在可接受的扫描时间内对心肌损伤进行详细特征描述，且无需重复屏气。
