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Three-Dimensional Phase-Sensitive Inversion-Recovery Turbo FLASH Sequence for the Evaluation of Left Ventricular Myocardial Scar

¹ Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave., Ste. 1600, Chicago, IL 60611.
² MR Research and Development, Siemens Medical Solutions USA, Inc., Chicago, IL.

OBJECTIVE. The purpose of this study was to evaluate a new free-breathing 3D phase-sensitive inversion-recovery (PSIR) turbo FLASH pulse sequence for the detection of left ventricular myocardial scar.

SUBJECTS AND METHODS. Patients with suspected myocardial scar were examined on a 1.5-T MR scanner for myocardial late enhancement after the administration of gadopentetate dimeglumine using a segmented 2D PSIR turbo FLASH sequence followed by a navigator-gated 3D PSIR turbo FLASH sequence. Image quality was scored by two independent readers using a 4-point Likert scale (0 = poor, nondiagnostic; 1 = fair, diagnostics may be impaired; 2 = good, some artifacts but not interfering in diagnostics; 3 = excellent, no artifacts). Scars were compared quantitatively in volume and graded qualitatively on the basis of size (area) and location.

RESULTS. Thirty-three patients were scanned using both techniques. In 25 patients, the quality of the 3D PSIR images was acceptable. Scars were detected in 12 patients. Hyperenhanced scar volumes (p = 0.43), qualitative analysis of scar area (p = 0.78), and scar location (p = 0.68) were similar for both techniques. More small hyperenhanced scars, corresponding mostly to nonischemic distribution patterns, were detected using 3D PSIR than 2D PSIR. Although 2D and 3D results were found to be highly correlated for scar volume, Bland-Altman analysis indicated a systematic smaller infarct volume on the 2D PSIR scans (R² = 0.84).

CONCLUSION. Free-breathing 3D PSIR turbo FLASH imaging is a promising technique for the assessment of left ventricular scar particularly for scar quantification and the detection of small nonischemic scars in the myocardium.

Keywords: ischemic cardiomyopathies • myocardial late enhancement • navigator gating • nonischemic cardiomyopathies • phase-sensitive inversion-recovery imaging • PSIR

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