AUTHOR=Gonzalez de Alba Cesar , Moghari Mehdi H. , Browne Lorna P. , Friesen Richard M. , Fonseca Brian , Malone LaDonna J. 

TITLE=Feasibility of gray-blood late gadolinium enhancement evaluation in young patients with congenital and acquired heart disease

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=10

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1269412

DOI=10.3389/fcvm.2023.1269412

ISSN=2297-055X

ABSTRACT=<sec><title>Background</title><p>Late gadolinium enhancement (LGE) sequences have become common in pediatric cardiovascular magnetic resonance (CMR) to assess for myocardial fibrosis. Bright-blood late gadolinium enhancement (BB-LGE) by conventional phase-sensitive inversion recovery (PSIR) is commonly utilized, but similar inversion time (TI) value of fibrosis and left ventricular (LV) blood pool can make subendocardial areas difficult to assess. A gray-blood LGE (GB-LGE) technique has been described, targeting nulling of the LV blood pool and demonstrating improvement in ischemic scar detection over BB-LGE in adult patients. We sought to evaluate the feasibility of the GB-LGE technique in a young population with congenital and acquired heart disease and compare its ability to detect subendocardial scar to conventional BB-LGE.</p></sec><sec><title>Methods</title><p>Seventy-six consecutive patients referred for clinical CMR underwent both BB-LGE and GB-LGE on 1.5 T and 3 T scanners. Conventional PSIR sequences were obtained with TI to null the myocardium (BB-LGE) in short-axis and horizontal long-axis stacks. Same PSIR stacks were immediately repeated with TI to null the blood pool (GB-LGE). Both sequences were reviewed separately a week apart by two readers, blinded to the initial clinical interpretation. Studies were analyzed for overall image quality, confidence in scar detection, confidence in detection of LGE, LGE class, inter- and intra-observer agreement for the presence of scar, and intraclass correlation coefficient (ICC) for total scar burden.</p></sec><sec><title>Results</title><p>Overall confidence in myocardial scar detection by BB-LGE or GB-LGE as well as grading of image quality were not statistically different [(<italic>p</italic> = 1 and <italic>p</italic> = 1) and (<italic>p</italic> = 0.53, <italic>p</italic> = 0.18), respectively]. There was very good inter-observer agreement for the presence of scar on BB-LGE (<italic>K</italic> = 0.88, 95% CI 0.77–0.99) and GB-LGE (<italic>K</italic> = 0.84, 95% CI 0.7–0.96), as well as excellent intra-observer agreement for both readers (<italic>K</italic> = 0.93, 95% CI 0.87–0.99; and <italic>K</italic> = 0.81, 95% CI 0.69–0.95). Interclass correlation coefficient for total scar burden was excellent for BB-LGE (ICC = 0.98, 95% CI 0.96–0.99) and GB-LGE (ICC = 0.94, 95% CI 0.91–0.97).</p></sec><sec><title>Conclusions</title><p>The GB-LGE technique is feasible in the pediatric population with congenital and acquired heart disease. It can detect subendocardial/ischemic scar similar to conventional bright-blood PSIR sequences in the pediatric population.</p></sec>