Single-shot blood-nulled PSIR LGE with fixed inversion time for rapid and reliable scar detection in cardiac MRI.

OBJECTIVES

To compare conventional segmented white-blood (WB) late gadolinium enhancement (LGE) with fixed-inversion-time (TI) single-shot dark-blood (DB) LGE for myocardial scar assessment in patients with suspected ischemic or non-ischemic cardiomyopathy.

MATERIAL AND

METHODS

In this prospective single-center study, consecutive patients undergoing cardiac magnetic resonance (CMR) between May 2023 and January 2024 for suspected ischemic or non-ischemic cardiomyopathy received both segmented WB LGE and single-shot DB LGE at 1.5 T. Segmented WB imaging used manually optimized TIs, single-shot DB imaging used a fixed TI of 160 ms. Short-axis stacks were assessed for presence, localization, transmurality, and pattern of LGE using the American Heart Association 17-segment model, Visual Presence Score (VPS; 0-17), and Visual Transmurality Score (VTS; 0-68).

RESULTS

Sixty-six patients (mean age 46 ± 16 years; 38% female) were included, with equal numbers referred for suspected ischemic and non-ischemic cardiomyopathy (n = 33 each). Final CMR diagnoses were ischemic heart disease in 11 patients (17%), non-ischemic cardiomyopathy in 25 (38%), mixed etiology in 3 (5%), and normal CMR in 27 (41%). Single-shot DB LGE required 95% less acquisition time (19 s vs. 375 s; p < 0.001). LGE was detected in 26 patients (39%) by both techniques; no discordant classifications. VPS and VTS showed excellent agreement between WB and DB (VPS: 5.5 ± 3.2 vs. 5.2 ± 3.2; VTS: 14.5 ± 10.9 vs. 13.7 ± 10.2; Spearman's ρ ≥ 0.95).

CONCLUSION

Fixed-TI single-shot DB LGE provides scar detectability and characterization comparable to conventional segmented WB LGE with minimal additional acquisition time, and may be used as a rapid complementary sequence.