Comparison of fast and standard segmented techniques for detection of late gadolinium enhancement in acute myocardial infarction: a prospective clinical cardiovascular magnetic resonance trial.

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.