Purpose To compare a new free-breathing 3D late gadolinium enhancement (LGE) cardiovascular magnetic resonance with conventional 2D LGE in patients with prior myocardial infarction.
Methods Patients with prior myocardial infarction were studied using a segmented 2D Phase-Sensitive Inversion-Recovery (PSIR) turbo FLASH sequence followed by a navigator-gated 3D PSIR turbo FLASH sequence on a 1.5T MR scanner for myocardial late enhancement after the administration of gadopentetate dimeglumine. All images were evaluated by two independent cardiovascular radiologists. Overall image quality was graded. The hyperenhanced myocardial scars were compared quantitatively in volume and scored qualitatively on the basis of size (area) and location.
Results 24 patients were successfully scanned using both approaches. Image quality was considered diagnostic for analysis in 23 cases, and this group underwent qualitative and quantitative scar analyses. 2D and 3D results were found to be highly correlated for hyperenhanced scar area and scar location. There was a high correlation between the hyperenhanced lesions volumes determined by 2D PSIR and 3D PSIR (R2=0.86). The average hyperenhancement lesion score (maximum possible score, 68) between both readers based on scar area per patient was 31.85 (range, 8.5–48) for 3D PSIR and 26.91 (range, 8.5–44.5) for 2D PSIR (p<0.01). The average hyperenhancement lesion score based on scar location (maximum possible score, 34) per patient was 19.46 (range, 3.5–28.5) for 3D PSIR and 16.89 (range, 4.5–26) for 2D PSIR (p<0.01). The mean scar volume over all cases was 31.41 ml (range, 8.6–63.8) for 3D PSIR and 23.42 ml (range, 7.4–44.6) for 2D PSIR (p<0.01).
Conclusion Free-breathing 3D PSIR turbo FLASH provides a promising approach for accurate scar quantification and detection of left ventricular myocardial scar particularly for patients who cannot perform repeated breath-holding.