Accurate late gadolinium enhancement prediction by early T1- based quantitative synthetic mapping

Area of Science:

• Cardiovascular Imaging
• Radiology
• Medical Physics

Background:

• Assessing myocardial scar is crucial for diagnosing and managing ischemic heart disease.
• Conventional late gadolinium enhancement (LGE) is the standard for scar imaging but requires a prolonged imaging delay.
• Stress-perfusion cardiac magnetic resonance (CMR) provides functional information but scar assessment typically necessitates a separate LGE sequence.

Purpose of the Study:

• To evaluate the efficacy of early synthetic gadolinium enhancement (ESGE) imaging, derived from post-contrast T1 mapping, in assessing myocardial scar.
• To compare the diagnostic performance of ESGE with conventional LGE imaging after adenosine stress-perfusion CMR.
• To determine if ESGE can shorten clinical acquisition times without compromising diagnostic accuracy.

Main Methods:

• Two hundred fourteen patients with suspected myocardial ischemia underwent adenosine stress-perfusion CMR.
• Myocardial infarct volume was quantified using both early synthetic (2-3 min post-gadolinium) and conventional (9 min post-gadolinium) imaging techniques.
• Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated on per-patient and per-subsegment bases.

Main Results:

• ESGE imaging demonstrated excellent correlation (r=0.997) and agreement with LGE imaging for quantifying myocardial scar.
• The median scar volume was comparable between ESGE (2.0 g) and LGE (2.2 g) imaging (p=0.39).
• ESGE achieved high diagnostic accuracy, with per-patient sensitivity, specificity, PPV, and NPV of 96%, 99%, 96%, and 99.5%, respectively, and similar high values in subsegment analysis.

Conclusions:

• Early synthetic gadolinium enhancement (ESGE) imaging is a highly accurate method for detecting and quantifying myocardial scar.
• ESGE, utilizing post-contrast T1 mapping after stress-perfusion CMR, shows excellent agreement with conventional LGE.
• This technique substantially shortens clinical acquisition time and avoids the need for additional gadolinium administration.