Dark-Blood Delayed Enhancement Cardiac Magnetic Resonance of Myocardial Infarction.

Journal Article (Journal Article)

OBJECTIVES: This study introduced and validated a novel flow-independent delayed enhancement technique that shows hyperenhanced myocardium while simultaneously suppressing blood-pool signal. BACKGROUND: The diagnosis and assessment of myocardial infarction (MI) is crucial in determining clinical management and prognosis. Although delayed enhancement cardiac magnetic resonance (DE-CMR) is an in vivo reference standard for imaging MI, an important limitation is poor delineation between hyperenhanced myocardium and bright LV cavity blood-pool, which may cause many infarcts to become invisible. METHODS: A canine model with pathology as the reference standard was used for validation (n = 22). Patients with MI and normal controls were studied to ascertain clinical performance (n = 31). RESULTS: In canines, the flow-independent dark-blood delayed enhancement (FIDDLE) technique was superior to conventional DE-CMR for the detection of MI, with higher sensitivity (96% vs. 85%, respectively; p = 0.002) and accuracy (95% vs. 87%, respectively; p = 0.01) and with similar specificity (92% vs, 92%, respectively; p = 1.0). In infarcts that were identified by both techniques, the entire length of the endocardial border between infarcted myocardium and adjacent blood-pool was visualized in 33% for DE-CMR compared with 100% for FIDDLE. There was better agreement for FIDDLE-measured infarct size than for DE-CMR infarct size (95% limits-of-agreement, 2.1% vs. 5.5%, respectively; p < 0.0001). In patients, findings were similar. FIDDLE demonstrated higher accuracy for diagnosis of MI than DE-CMR (100% [95% confidence interval [CI]: 89% to 100%] vs. 84% [95% CI: 66% to 95%], respectively; p = 0.03). CONCLUSIONS: The study introduced and validated a novel CMR technique that improves the discrimination of the border between infarcted myocardium and adjacent blood-pool. This dark-blood technique provides diagnostic performance that is superior to that of the current in vivo reference standard for the imaging diagnosis of MI.

Full Text

Duke Authors

Cited Authors

  • Kim, HW; Rehwald, WG; Jenista, ER; Wendell, DC; Filev, P; van Assche, L; Jensen, CJ; Parker, MA; Chen, E-L; Crowley, ALC; Klem, I; Judd, RM; Kim, RJ

Published Date

  • December 2018

Published In

Volume / Issue

  • 11 / 12

Start / End Page

  • 1758 - 1769

PubMed ID

  • 29248655

Pubmed Central ID

  • PMC5993564

Electronic International Standard Serial Number (EISSN)

  • 1876-7591

Digital Object Identifier (DOI)

  • 10.1016/j.jcmg.2017.09.021


  • eng

Conference Location

  • United States