Oisin Jude Flanagan MBBCh, MRCPI, Presenter: Nothing to Disclose

Shivraman Giri PhD, Abstract Co-Author: Employee, Siemens AG

Bruce Spottiswoode, Abstract Co-Author: Employee, Siemens AG

Sven Zuehlsdorff PhD, Abstract Co-Author: Employee, Siemens AG

Xiaoming Bi PhD, Abstract Co-Author: Nothing to Disclose

Maria Carr, Abstract Co-Author: Nothing to Disclose

Michael Markl PhD, Abstract Co-Author: Nothing to Disclose

Jad Marwan Bou Ayache MD, Abstract Co-Author: Nothing to Disclose

Marcos Paulo Ferreira Botelho MD, Abstract Co-Author: Nothing to Disclose

Jeremy Douglas Collins MD, Abstract Co-Author: Consultant, B. Braun Melsungen AG

Robert R. Edelman MD, Abstract Co-Author: Research support, Siemens AG Royalties, Siemens AG

James Christopher Carr MD, Abstract Co-Author: Research Grant, Astellas Group Research support, Siemens AG Speaker, Siemens AG Advisory Board, Guerbet SA

To improve image quality and diagnostic confidence in characterizing non-ischemic delayed enhancement (DE) sequences in all patients, including those with irregular cardiac rhythms and poor breath-holding ability.

28 consecutive out-patients (11F, 17M age 25-84 years, mean 62.2) with possible non-ischemic cardiomyopathy were referred for cardiac MRI on a 1.5T system (MAGNETOM Aera, Siemens AG, Erlangen, Germany). Two standard PSIR sequences of free breathing single shot steady state free precession (FB single shot SSFP) and breath hold (BH) turboflash (TF) were performed as well as a prototype sequence FB MOCO SSFP. This latter sequence used respiratory motion compensation based on nonrigid image registration and motion corrected averaging to enhance SNR. The anonymized Images were independently graded by two blinded experienced cardiovascular radiologists for image quality (1 to 5), diagnostic confidence (1 to 3), the presence of DE (using a 16 segment model). Each segment was analysed for location of DE (subendocardial, midmyocardial or subepicardial) and finally for segmental artiefact.

15 of 28 patients showed non-ischemic DE. Image quality for FB single shot SSFP, BH TF and FB MOCO SSFP were 3.80, 3.15 and 3.87 respectively. Diagnostic confidence was 2.63, 2.35 and 2.70 and the number of segments degraded by artefact was 41, 112 and 34. Total DE segments detected were 92, 119 and 112 in an approximate distribution of 68% subendocardial, 24% midmyocardial and 3% subepicardial across all three techniques.

FB MOCO SSFP had higher image quality and diagnostic confidence and less artifact than both FB single shot SSFP and BH TF. It detected more DE than FB single shot SSFP. BH TF detected the most DE but with the lowest image quality and diagnostic confidence and the most artefact. This suggests that in non-ischemic cardiomyopathy, FB MOCO SSFP is overall superior to FB single shot SSFP and superior to BH TF in the large number of cases where BH TF images are poor.

As increasingly sicker patients undergo cardiac MRI, robust motion corrected images are needed to combat thir poor breatholding and fast or irrgular rhythms. This sequence provides this and will be increasingly important over time.

Flanagan, O, Giri, S, Spottiswoode, B, Zuehlsdorff, S, Bi, X, Carr, M, Markl, M, Bou Ayache, J, Botelho, M, Collins, J, Edelman, R, Carr, J, “Heart of Brightness” – Delayed Enhancement Detection using Motion Corrected (MOCO) Phase Sensitive Inversion Recovery (PSIR) Imaging in Non-ischemic Cardiomyopathy.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045723.html