Petersen Antonia, Nagel Sebastian Niko, Hamm Bernd, Elgeti Thomas, Schaafs Lars-Arne
Department of Radiology, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Front Cardiovasc Med. 2022 Oct 20;9:977414. doi: 10.3389/fcvm.2022.977414. eCollection 2022.
Left bundle branch block (LBBB) is a ventricular conduction delay with high prevalence. Aim of our study is to identify possible recurring patterns of artefacts in late gadolinium enhancement (LGE) imaging in patients with LBBB who undergo cardiac magnetic resonance imaging (MRI) and to define parameters of mechanical dyssynchrony associated with artefacts in LGE images.
Fifty-five patients with LBBB and 62 controls were retrospectively included. Inversion time (TI) scout and LGE images were reviewed for artefacts. Dyssynchrony was identified using cardiac MRI by determining left ventricular systolic dyssynchrony indices (global, septal segments, and free wall segments) derived from strain analysis and features of mechanical dyssynchrony (apical rocking and septal flash).
Thirty-seven patients (67%) with LBBB exhibited inhomogeneous myocardial nulling in TI scout images. Among them 25 (68%) patients also showed recurring artefact patterns in the septum or free wall on LGE images and artefacts also persisted in 18 (72%) of those cases when utilising phase sensitive inversion recovery. Only the systolic dyssynchrony index of septal segments allowed differentiation of patient subgroups (artefact/no artefact) and healthy controls (given as median, median ± interquartile range); LBBB with artefact: 10.44% (0.44-20.44%); LBBB without artefact: 6.82% (-2.18-15.83%); controls: 4.38% (1.38-7.38%); < 0.05 with an area under the curve of 0.863 (81% sensitivity, 89% specificity). Septal flash and apical rocking were more frequent in the LBBB with artefact group than in the LBBB without artefact group (70 and 62% versus 33 and 17%; < 0.05).
Patients with LBBB show recurring artefact patterns in LGE imaging. Use of strain analysis and evaluation of mechanical dyssynchrony may predict the occurrence of such artefacts already during the examination and counteract misinterpretation.
左束支传导阻滞（LBBB）是一种患病率较高的心室传导延迟。我们研究的目的是确定接受心脏磁共振成像（MRI）的LBBB患者延迟钆增强（LGE）成像中伪影可能出现的重复模式，并定义与LGE图像中伪影相关的机械不同步参数。
回顾性纳入55例LBBB患者和62例对照者。对反转时间（TI）预扫描图像和LGE图像进行伪影评估。通过心脏MRI确定左心室收缩不同步指数（整体、室间隔节段和游离壁节段），并利用应变分析和机械不同步特征（心尖摆动和室间隔闪烁）来识别不同步。
37例（67%）LBBB患者在TI预扫描图像中表现出心肌信号不均匀衰减。其中25例（68%）患者在LGE图像的室间隔或游离壁上也出现了重复的伪影模式，并且在18例（72%）此类病例中，使用相位敏感反转恢复序列时伪影仍然存在。只有室间隔节段的收缩不同步指数能够区分患者亚组（有伪影/无伪影）和健康对照者（以中位数、中位数±四分位数间距表示）；有伪影的LBBB患者：10.44%（0.44 - 20.44%）；无伪影的LBBB患者：6.82%（-2.18 - 15.83%）；对照者：4.38%（1.38 - 7.38%）；P < 0.05，曲线下面积为0.863（敏感性81%，特异性89%）。有伪影的LBBB组中心间隔闪烁和心尖摆动比无伪影的LBBB组更常见（分别为70%和62%，对比33%和17%；P < 0.05）。
LBBB患者在LGE成像中表现出重复的伪影模式。使用应变分析和评估机械不同步可能在检查期间就能预测此类伪影的发生，并避免误判。
