Poskaite Paulina, Kremser Christian, Pamminger Mathias, Troger Felix, Reiter Gert, Reinstadler Sebastian J, Metzler Bernhard, Rehwald Wolfgang G, Kim Raymond J, Mayr Agnes
University Clinic of Radiology, Medical University of Innsbruck, A-6020, Innsbruck, Austria.
Research and Development, Siemens Healthcare Diagnostics GmbH, A-8054, Graz, Austria.
Eur Radiol. 2025 Jun;35(6):3030-3041. doi: 10.1007/s00330-024-11192-7. Epub 2024 Dec 5.
To prospectively compare image quality and infarct sizing methods between magnetization-transfer "flow-independent dark-blood delayed enhancement" (MT-FIDDLE) and standard "bright-blood"-late gadolinium enhancement (LGE) cardiac-magnetic-resonance (CMR) sequence.
"Bright-blood"-LGE and MT-FIDDLE sequence were acquired in 110 patients at 4 days (n = 33), 4 months (n = 39) and 12 months (n = 38) after acute ST-elevation myocardial infarction (STEMI). Subjective image quality, including confidence in infarct segmentation and blood-pool bordering, were each rated on a 4-point Likert scale. Objective image quality was assessed by the detectability index (DI). Infarct volumes derived via full-width at half-maximum (FWHM) and different number of standard deviations ("n-SD") methods on MT-FIDDLE images were compared with FWHM and reference 5-SD results from "bright-blood-LGE images.
Overall subjective median image quality was excellent for both LGE sequences. Qualitative analysis revealed a significantly higher confidence in infarct segmentation and in blood-pool bordering for MT-FIDDLE as compared to "bright-blood"-LGE (all p < 0.001). Infarct volumes assessed by the FWHM technique on MT-FIDDLE and "bright-blood"-LGE showed excellent agreement overall (Concordance correlation coefficient, CCC = 0.96). The 3-SD technique for MT-FIDDLE showed the best agreement with the 5-SD method for "bright-blood"-LGE overall (CCC = 0.94), as well as in the subgroup with excellent confidence in infarct segmentation on "bright-blood"-LGE (CCC = 0.96). DI of scar versus LV blood-pool was higher for MT-FIDDLE (8.9 ± 5.5) compared to "bright-blood"-LGE sequence (2.0 ± 1.5; p < 0.001).
MT-FIDDLE significantly optimizes the discrimination between myocardial infarction and adjacent blood-pool in STEMI patients. As compared to the established 5-SD technique on "bright-blood"-LGE, the 3-SD method on MT-FIDDLE results in consistent infarct volumes.
Question Does magnetization-transfer "flow-independent dark-blood delayed enhancement" (MT-FIDDLE) offer any benefits over standard "bright-blood"-late gadolinium enhancement (LGE) cardiac-magnetic-resonance (CMR) for identifying STEMI infarct borders? Findings MT-FIDDLE image quality was higher than LGE CMR and measured infarct volume comparability to the standard 5-SD-threshold-technique. Clinical relevance MT-FIDDLE facilitates the assessment of myocardial infarctions at the subendocardial border, improving the discrimination between myocardial infarction and adjacent blood-pool in STEMI patients.
前瞻性比较磁化传递“血流无关黑血延迟强化”（MT-FIDDLE）与标准“亮血”晚期钆增强（LGE）心脏磁共振（CMR）序列的图像质量和梗死灶测量方法。
对110例急性ST段抬高型心肌梗死（STEMI）患者在发病4天（n = 33）、4个月（n = 39）和12个月（n = 38）时分别进行“亮血”-LGE和MT-FIDDLE序列检查。主观图像质量，包括对梗死灶分割和血池边界的信心，均采用4分李克特量表进行评分。客观图像质量通过可检测性指数（DI）进行评估。将MT-FIDDLE图像上通过半高宽（FWHM）和不同标准差数量（“n-SD”）方法得出的梗死灶体积与“亮血”-LGE图像上的FWHM和参考5-SD结果进行比较。
两种LGE序列的总体主观图像质量中位数均为优秀。定性分析显示，与“亮血”-LGE相比，MT-FIDDLE在梗死灶分割和血池边界方面的信心显著更高（所有p < 0.001）。MT-FIDDLE和“亮血”-LGE上通过FWHM技术评估的梗死灶体积总体一致性良好（一致性相关系数，CCC = 0.96）。MT-FIDDLE的3-SD技术与“亮血”-LGE的5-SD方法总体一致性最佳（CCC = 0.94），在“亮血”-LGE上对梗死灶分割信心优秀的亚组中也是如此（CCC = 0.96）。MT-FIDDLE的瘢痕与左心室血池的DI（8.9 ± 5.5）高于“亮血”-LGE序列（2.0 ± 1.5；p < 0.001）。
MT-FIDDLE显著优化了STEMI患者中心肌梗死与相邻血池之间的区分。与“亮血”-LGE上既定的5-SD技术相比，MT-FIDDLE上的3-SD方法得出的梗死灶体积一致。
问题 磁化传递“血流无关黑血延迟强化”（MT-FIDDLE）在识别STEMI梗死灶边界方面是否比标准“亮血”晚期钆增强（LGE）心脏磁共振（CMR）有任何优势？ 发现 MT-FIDDLE图像质量高于LGE CMR，且测量的梗死灶体积与标准5-SD阈值技术具有可比性。 临床意义 MT-FIDDLE有助于评估心内膜下边界的心肌梗死，改善STEMI患者中心肌梗死与相邻血池之间的区分。
