Division of Cardiology, Department of Pediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada.
Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
J Cardiovasc Magn Reson. 2023 Jan 23;25(1):2. doi: 10.1186/s12968-023-00917-0.
This study compares three-dimensional (3D) high-resolution (HR) late gadolinium enhancement (LGE; 3D HR-LGE) imaging using a respiratory navigated, electrocardiographically-gated inversion recovery gradient echo sequence with conventional LGE imaging using a single-shot phase-sensitive inversion recovery (PSIR) balanced steady-state free precession (bSSFP; PSIR-bSSFP) sequence for routine clinical use in the pediatric population.
Pediatric patients (0-18 years) who underwent clinical cardiovascular magnetic resonance (CMR) with both 3D HR-LGE and single-shot PSIR-bSSFP LGE between January 2018 and June 2020 were included. Image quality (0-4) and detection of LGE in the left ventricle (LV) (per 17 segments), in the right ventricle (RV) (per 3 segments), as endocardial fibroelastosis (EFE), at the hinge points, and at the papillary muscles was analyzed by two blinded readers for each sequence. Ratios of the mean signal intensity of LGE to normal myocardium (LGE:Myo) and to LV blood pool (LGE:Blood) were recorded. Data is presented as median (1st-3rd quartiles). Wilcoxon signed rank test and chi-square analyses were used as appropriate. Inter-rater agreement was analyzed using weighted κ-statistics.
102 patients were included with median age at CMR of 8 (1-13) years-old and 44% of exams performed under general anesthesia. LGE was detected in 55% of cases. 3D HR LGE compared to single-shot PSIR-bSSFP had longer scan time [4:30 (3:35-5:34) vs 1:11 (0:47-1:32) minutes, p < 0.001], higher image quality ratings [3 (3-4) vs 2 (2-3), p < 0.001], higher LGE:Myo [23.7 (16.9-31.2) vs 5.0 (2.9-9.0), p < 0.001], detected more segments of LGE in both the LV [4 (2-8) vs 3 (1-7), p = 0.045] and RV [1 (1-1) vs 1 (0-1), p < 0.001], and also detected more cases of LGE with 13/56 (23%) of patients with LGE only detectable by 3D HR LGE (p < 0.001). 3D HR LGE specifically detected a greater proportion of RV LGE (27/27 vs 17/27, p < 0.001), EFE (11/11 vs 5/11, p = 0.004), and papillary muscle LGE (14/15 vs 4/15, p < 0.001). Inter-rater agreement for the recorded variables ranged from 0.42 to 1.00.
3D HR LGE achieves greater image quality and detects more LGE than conventional single-shot PSIR-bSSFP LGE imaging, and should be considered an alternative to conventional LGE sequences for routine clinical use in the pediatric population.
本研究比较了三种不同的影像学方法，分别是使用呼吸导航、心电图门控反转恢复梯度回波序列的三维（3D）高分辨率（HR）晚期钆增强（LGE；3D HR-LGE）成像，以及常规使用单次激发相位敏感反转恢复（PSIR）平衡稳态自由进动（bSSFP；PSIR-bSSFP）序列的 LGE 成像，用于儿科人群的常规临床使用。
纳入了 2018 年 1 月至 2020 年 6 月期间进行临床心血管磁共振（CMR）检查且同时接受了 3D HR-LGE 和单次激发 PSIR-bSSFP LGE 检查的儿科患者（0-18 岁）。两位盲法阅片者分别对两种序列的图像质量（0-4 分）和左心室（LV）（17 个节段）、右心室（RV）（3 个节段）、心内膜弹力纤维增生症（EFE）、心瓣膜和乳头肌的 LGE 检出情况进行了评估。记录 LGE 与正常心肌（LGE:Myo）和 LV 血池（LGE:Blood）的平均信号强度比值。数据以中位数（第 1-3 四分位数）表示。采用 Wilcoxon 符号秩检验和卡方分析。采用加权κ统计量分析组内一致性。
共纳入 102 例患者，CMR 检查时的中位年龄为 8（1-13）岁，44%的检查在全身麻醉下进行。55%的病例中检测到 LGE。与单次激发 PSIR-bSSFP 相比，3D HR-LGE 的扫描时间更长[4:30（3:35-5:34）vs 1:11（0:47-1:32）分钟，p<0.001]，图像质量评分更高[3（3-4）vs 2（2-3），p<0.001]，LGE:Myo 更高[23.7（16.9-31.2）vs 5.0（2.9-9.0），p<0.001]，LV 和 RV 的 LGE 节段数也更多[LV：4（2-8）vs 3（1-7），p=0.045；RV：1（1-1）vs 1（0-1），p<0.001]，并且还能检测到更多的 LGE 病例，有 13/56（23%）的患者只有 3D HR-LGE 才能检测到 LGE（p<0.001）。3D HR-LGE 还能特异性地检测到更多的 RV LGE（27/27 vs 17/27，p<0.001）、EFE（11/11 vs 5/11，p=0.004）和乳头肌 LGE（14/15 vs 4/15，p<0.001）。记录的变量的组内一致性范围为 0.42 至 1.00。
与常规的单次激发 PSIR-bSSFP LGE 成像相比，3D HR-LGE 能获得更高的图像质量并能检测到更多的 LGE，因此应考虑将其作为儿科人群常规临床使用的 LGE 序列的替代方法。
