Author + information
- Received July 5, 2017
- Revision received September 6, 2017
- Accepted September 25, 2017
- Published online December 3, 2018.
- Han W. Kim, MDa,b,
- Wolfgang G. Rehwald, PhDc,
- Elizabeth R. Jenista, PhDa,b,
- David C. Wendell, PhDa,b,
- Peter Filev, MDa,
- Lowie van Assche, MDa,
- Christoph J. Jensen, MDa,
- Michele A. Parker, MSa,b,
- Enn-ling Chen, PhDa,b,
- Anna Lisa C. Crowley, MDa,b,
- Igor Klem, MDa,b,
- Robert M. Judd, PhDa,b,d and
- Raymond J. Kim, MDa,b,d,∗ ()
- aDuke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina
- bDivision of Cardiology, Duke University Medical Center, Durham, North Carolina
- cSiemens Medical Solutions, Malvern, Pennsylvania
- dDepartment of Radiology, Duke University Medical Center, Durham, North Carolina
- ↵∗Address for correspondence:
Dr. Raymond J. Kim, Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, DUMC-3934, Trent Drive, Durham, North Carolina.
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.
This study was funded by U.S. National Institutes of Health grant NIH-NHLBI R01-HL64726, to Dr. R.J. Kim. Drs. R.J. Kim and Judd are patent holders for delayed enhancement MRI through Northwestern University. Dr. R.J. Kim is a patent holder for flow-independent dark-blood delayed enhancement MRI through Duke University. Dr. Rehwald is an employee of Siemens Medical Solutions. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 5, 2017.
- Revision received September 6, 2017.
- Accepted September 25, 2017.
- 2018 American College of Cardiology Foundation
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