Three-dimensional phase-sensitive inversion recovery sequencing in the evaluation of left ventricular myocardial scars in ischemic and non-ischemic cardiomyopathy: comparison to three-dimensional inversion recovery sequencing.

BACKGROUND: Late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) is a useful technique for detecting myocardial fibrosis. LGE images are typically acquired using the inversion recovery (IR) method. Recently, phase-sensitive inversion recovery (PSIR) technology has been developed. The purpose of this study was to evaluate free-breathing 3D PSIR sequencing in comparison with breath-held 3D IR sequencing for the detection of myocardial fibrosis.

METHODS: One hundred twenty-three patients with suspected ischemic cardiac disease (n=27) or non-ischemic cardiomyopathy (hypertrophic cardiomyopathy, n=29; dilated cardiomyopathy, n=22; sarcoidosis, n=21; arrhythmia, n=9; myocarditis, n=4; amyloidosis, n=3; and others, n=8) were evaluated by LGE-MRI, which was performed first with the IR sequence and then with the PSIR sequence, using a 3T MRI scanner. Image quality was scored by two independent readers using a four-point scale. The 3D LGE volume was analyzed quantitatively and compared between both sequencing methods.

RESULTS: There was no significant difference in overall image quality (p=0.19). LGE was detected in 73 patients, who were evaluated visually. Ultimately, 58 patients with acceptable image quality were enrolled in further quantitative analyses (volume assessment). Although quantification of LGE volume revealed a strong correlation between both methods, larger LGE volumes were detected with PSIR compared to IR in patients suspected of non-ischemic cardiomyopathy (39.5 ± 25.9 cm(3) for PSIR and 32.8 ± 23.9 cm(3) for IR, p<0.001). The LGE volume did not differ significantly in patients suspected of ischemic cardiac disease (17.9 ± 12.7 cm(3) for PSIR and 17.5 ± 11.1cm(3) for IR, p=0.34).

CONCLUSIONS: 3D PSIR is suitable for detection of LGE and may be an option in cases with IR images of unacceptable quality but overestimates LGE volume in non-ischemic cardiomyopathy.