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

Abstract

Objectives

Early synthetic gadolinium enhancement (ESGE) imaging from post-contrast T1 mapping after adenosine stress-perfusion cardiac magnetic resonance (CMR) was compared to conventional late gadolinium enhancement (LGE) imaging for assessing myocardial scar.

Methods

Two hundred fourteen consecutive patients suspected of myocardial ischaemia were referred for stress-perfusion CMR. Myocardial infarct volume was quantified on a per-subsegment basis in both synthetic (2–3 min post-gadolinium) and conventional (9 min post-gadolinium) images by two independent observers. Sensitivity, specificity, PPV and NPV were calculated on a per-patient and per-subsegment basis.

Results

Both techniques detected 39 gadolinium enhancement areas in 23 patients. The median amount of scar was 2.0 (1.0–3.1) g in ESGE imaging and 2.2 (1.1–3.1) g in LGE imaging (p=0.39). Excellent correlation (r=0.997) and agreement (mean absolute difference: -0.028±0.289 ml) were found between ESGE and LGE images. Sensitivity, specificity, PPV and NPV of ESGE imaging were 96 (78.9–99.9), 99 (97.1–100.0)%, 96 (76.5–99.4) and 99.5 (96.6–99.9) in patient-based and 99 (94.5–100.0), 100 (99.9–100.0)%, 97.0 (91.3–99.0) and 100.0 (99.8–100.0) in subsegment-based analysis.

Conclusion

ESGE based on post-contrast T1 mapping after adenosine stress-perfusion CMR imaging shows excellent agreement with conventional LGE imaging for assessing myocardial scar, and can substantially shorten clinical acquisition time.

Key Points

• Synthetic gadolinium enhancement images can be used for detection of myocardial scar.

• Early synthetic gadolinium enhancement images can substantially shorten clinical acquisition time.

• ESGE has high diagnostic accuracy as compared to conventional late gadolinium enhancement.

• Quantification of myocardial scar with ESGE closely correlates with conventional LGE.

• ESGE after stress perfusion CMR avoids need for additional gadolinium administration.