Available online 10 August 2022

Free-breathing black-blood late gadolinium enhancement cardiac MR images can be acquired in less than 2 min.

Non-rigid motion-compensated reconstruction enables free-breathing black-blood late gadolinium enhancement cardiac MR imaging.

Free-breathing black-blood late gadolinium enhancement cardiac MR imaging allows for improved detection of myocardial injuries.

Clinical guidelines recommend the use of bright-blood late gadolinium enhancement (BR-LGE) for the detection and quantification of regional myocardial fibrosis and scar. This technique, however, may suffer from poor contrast at the blood-scar interface, particularly in patients with subendocardial myocardial infarction. The purpose of this study was to assess the clinical performance of a two-dimensional black-blood LGE (BL-LGE) sequence, which combines free-breathing T1-rho-prepared single-shot acquisitions with an advanced non-rigid motion-compensated patch-based reconstruction.

Extended phase graph simulations and phantom experiments were performed to investigate the performance of the motion-correction algorithm and to assess the black-blood properties of the proposed sequence. Fifty-one patients (37 men, 14 women; mean age, 55 ± 15 [SD] years; age range: 19–81 years) with known or suspected cardiac disease prospectively underwent free-breathing T1-rho-prepared BL-LGE imaging with inline non-rigid motion-compensated patch-based reconstruction at 1.5T. Conventional breath-held BR-LGE images were acquired for comparison purposes. Acquisition times were recorded. Two readers graded the image quality and relative contrasts were calculated. Presence, location, and extent of LGE were evaluated.

BL-LGE images were acquired with full ventricular coverage in 115 ± 25 (SD) sec (range: 64–160 sec). Image quality was significantly higher on free-breathing BL-LGE imaging than on its breath-held BR-LGE counterpart (3.6 ± 0.7 [SD] [range: 2–4] vs. 3.9 ± 0.2 [SD] [range: 3–4]) (P <0.01) and was graded as diagnostic for 44/51 (86%) patients. The mean scar-to-myocardium and scar-to-blood relative contrasts were significantly higher on BL-LGE images (P < 0.01 for both). The extent of LGE was larger on BL-LGE (median, 5 segments [IQR: 2, 7 segments] vs. median, 4 segments [IQR: 1, 6 segments]) (P < 0.01), the method being particularly sensitive in segments with LGE involving the subendocardium or papillary muscles. In eight patients (16%), BL-LGE could ascertain or rule out a diagnosis otherwise inconclusive on BR-LGE.

Free-breathing T1-rho-prepared BL-LGE imaging with inline motion compensated reconstruction offers a promising diagnostic technology for the non-invasive assessment of myocardial injuries.

Gadolinium enhancement

Heart

Magnetic resonance imaging

Myocardial infarction

Motion

Alternating direction method of multipliers

Bright-blood late gadolinium-enhanced

Black-blood late-gadolinium-enhanced

Balanced steady-state free-precession

Cardiovascular magnetic resonance

Flow-independent dark-blood delayed enhancement

General matrix description

Normalized gradient squares

© 2022 The Author(s). Published by Elsevier Masson SAS on behalf of Société française de radiologie.