Li Jinshui, Kong Huihui, Wang Zhaozhao, Yuan Ying, An Jing, He Yi
Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Siemens Shenzhen Magnetic Resonance, MR Collaboration NE Asia, Shenzhen, China.
Quant Imaging Med Surg. 2025 Jun 6;15(6):5769-5780. doi: 10.21037/qims-24-2308. Epub 2025 Jun 3.
Segmented phase-sensitive inversion recovery (PSIR) turbo fast low-angle shot (FLASH) has become the reference standard sequence for late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) imaging. However, it has a long scanning time, requires multiple breath holds, and is prone to motion artifacts. This study aimed to compare the accuracy of two fast LGE sequences with FLASH PSIR in acute myocardial infarction (AMI) detection and quantification of LGE.
We prospectively recruited consecutive AMI patients who underwent clinical contrast-enhanced CMR with three different LGE sequences at Beijing Friendship Hospital. The overall image quality (IQ) score and contrast-to-noise ratio (CNR) were used to comprehensively evaluate IQ. LGE and microvascular obstruction (MVO) were qualitatively and quantitatively assessed.
A total of 110 AMI patients (90 males, 58.61±10.9 years) were included in our analyses. Of these, 100 patients (84 males, 58.6±10.9 years) presented LGE (+), and 60 patients developed MVO. Participants were divided into three groups according to the LGE results, namely LGE (-), LGE (+) without MVO, and LGE (+) with MVO. The overall IQ score and CNR for the two fast sequences [single-shot true fast imaging with steady-state precession (TrueFISP PSIR), PSIR motion-corrected, free-breathing single-shot balanced steady-state free precession (moco bSSFP)] were significantly higher than those for the FLASH PSIR (P<0.001). On visual assessment, the number of layers (P=0.20 and 0.22, respectively) and segments (P=0.09 and 0.32, respectively) for LGE displayed no difference and showed excellent matching with those of FLASH PSIR. There were no significant differences in LGE mass (P=0.61 and 0.83, respectively) and MVO mass (P=0.15 and 0.55, respectively) between the FLASH PSIR and the two fast sequences.
In clinical practice, these two rapid sequences can achieve good IQ, as well as accurate localization and quantification of LGE when acquired during a single breath hold or in a free-breathing state. We recommend them as the preferred LGE CMR sequence for AMI patients.
分段相敏反转恢复（PSIR）快速低角度激发（FLASH）已成为延迟钆增强（LGE）心脏磁共振（CMR）成像的参考标准序列。然而，其扫描时间长，需要多次屏气，且容易出现运动伪影。本研究旨在比较两种快速LGE序列与FLASH PSIR在急性心肌梗死（AMI）检测及LGE定量方面的准确性。
我们前瞻性地招募了在北京友谊医院接受三种不同LGE序列临床对比增强CMR检查的连续AMI患者。采用整体图像质量（IQ）评分和对比噪声比（CNR）综合评估图像质量。对LGE和微血管阻塞（MVO）进行定性和定量评估。
共有110例AMI患者（90例男性，年龄58.61±10.9岁）纳入分析。其中，100例患者（84例男性，年龄58.6±10.9岁）出现LGE（+），60例患者发生MVO。根据LGE结果将参与者分为三组，即LGE（-）组、无MVO的LGE（+）组和有MVO的LGE（+）组。两种快速序列[单次激发稳态进动真快速成像（TrueFISP PSIR）、PSIR运动校正自由呼吸单次激发平衡稳态自由进动（moco bSSFP）]的整体IQ评分和CNR均显著高于FLASH PSIR（P<0.001）。视觉评估显示，LGE的层数（分别为P=0.20和0.22）和节段数（分别为P=0.09和0.32）无差异，且与FLASH PSIR的层数和节段数匹配良好。FLASH PSIR与两种快速序列在LGE质量（分别为P=0.61和0.83）和MVO质量（分别为P=0.15和0.55）方面无显著差异。
在临床实践中，这两种快速序列在单次屏气或自由呼吸状态下采集时，能够获得良好的图像质量，以及准确的LGE定位和定量。我们推荐将它们作为AMI患者LGE CMR的首选序列。
