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Updated: Mar 12, 2026
Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
Published on: June 11, 2019
Clinical evaluation of three-dimensional late enhancement MRI
Konstantinos Bratis1, Markus Henningsson1, Chrisanthos Grigoratos2
1Division of Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom.
Purpose:
To assess the diagnostic value of three-dimensional late enhancement (3D-LGE) for the detection of myocardial necrosis in a routine clinical setting. 3D-LGE has been proposed as a novel magnetic resonance (MR) technique for the accurate detection of myocardial scar in both the ventricles and atria. Its performance in clinical practice has been poorly examined.
Materials And Methods:
Fifty-seven patients referred for cardiac MR examination including scar imaging were prospectively enrolled. Gadolinium enhanced single breathhold 3D T1-weighted gradient-echo inversion recovery sequence and a conventional 2D-LGE sequence were performed using a 1.5 Tesla clinical MR imaging system. The presence, pattern and transmurality of LGE, diagnostic accuracy and level of diagnostic confidence as well as image quality (median quality, mean LGE signal intensity, sharpness, virtual scan time) were graded on a 4-point scale.
Results:
Interpretable images were obtained in 52/57 2D-LGE and in 47/57 3D high-resolution exams. LGE was detected in 10 patients with ischemic pattern, 9 with nonischemic pattern, while it was absent in 28, resulting in a total of 47 complete datasets. The detection of global and segmental LGE as well as its transmural extent were similar for both techniques (P = 0.65, P = 0.305, and P = 0.15, respectively). Image quality (median quality, LGE/ myocardial and LGE/ blood pool sharpness) was similar for both techniques (P = 0.740, P = 0.34, and P = 1.00, respectively), but LGE signal intensity was higher with 2D (P = 0.020).
Conclusion:
3D-LGE diagnostic and quality scores were comparable to 2D-LGE in a routine clinical setting. Further technical refinement is required for 3D LGE to offer a reliable alternative for high quality scar imaging.
Level Of Evidence:
2 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;45:1675-1683.
Insights
Three-dimensional late gadolinium enhancement (3D-LGE) shows diagnostic value comparable to 2D-LGE for detecting myocardial scar. While 3D-LGE quality is similar, further technical improvements are needed for it to be a reliable alternative in clinical practice.
Area of Science:
- Cardiovascular Imaging
- Magnetic Resonance Imaging
Background:
- Three-dimensional late gadolinium enhancement (3D-LGE) is a novel magnetic resonance (MR) technique for detecting myocardial scar in the ventricles and atria.
- Its clinical performance in routine practice remains underexamined.
Purpose of the Study:
- To evaluate the diagnostic accuracy and image quality of 3D-LGE compared to conventional 2D-LGE for myocardial necrosis detection in a clinical setting.
Main Methods:
- Fifty-seven patients underwent cardiac MR with both 3D-LGE and 2D-LGE sequences using a 1.5 Tesla system.
- Presence, pattern, transmurality, diagnostic accuracy, confidence, and image quality parameters were assessed and graded.
Main Results:
- Interpretable images were obtained in 47/57 (3D-LGE) and 52/57 (2D-LGE) patients.
- Both techniques showed similar detection rates and transmural extent of LGE (P > 0.05).
- Image quality was comparable, though 2D-LGE had higher LGE signal intensity (P=0.020).
Conclusions:
- 3D-LGE demonstrates comparable diagnostic performance and image quality to 2D-LGE in routine clinical settings.
- Further technical advancements are necessary for 3D-LGE to become a superior alternative for scar imaging.
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