Korean J Radiol.  2018 Jun;19(3):372-380. 10.3348/kjr.2018.19.3.372.

Single-Dose Gadoterate Meglumine for 3T Late Gadolinium Enhancement MRI for the Assessment of Chronic Myocardial Infarction: Intra-Individual Comparison with Conventional Double-Dose 1.5T MRI

• Lim J
• Park EA
• Song YS
• Lee W

• KMID: 2410807
• DOI: http://doi.org/10.3348/kjr.2018.19.3.372

Abstract

OBJECTIVE
To intra-individually compare 3T magnetic resonance (MR) images obtained with one dose gadoterate meglumine to 1.5T MR using conventional double dose for assessment of chronic myocardial infarction.
MATERIALS AND METHODS
Sixteen patients diagnosed with chronic myocardial infarctions were examined on single-dose 3T MR within two weeks after undergoing double-dose 1.5T MR. Representative short-axis images were acquired at three points after administration of gadoterate meglumine. Contrast-to-noise ratios between infarcted and normal myocardium (CNRinfarct-normal) and between infarct and left ventricular cavity (CNRinfarct-LVC) were calculated and compared intra-individually at each temporal scan. Additionally, two independent readers assessed relative infarct size semi-automatically and inter-observer reproducibility was evaluated using intraclass correlation coefficient.
RESULTS
While higher CNRinfarct-normal was revealed at single-dose 3T at only 10 minutes scan (p = 0.047), the CNRinfarct-LVC was higher at single-dose 3T MR at each temporal scan (all, p < 0.05). Measurement of relative infarct size was not significantly different between both examinations for both observers (all, p > 0.05). However, inter-observer reproducibility was higher at single-dose 3T MR (all, p < 0.05).
CONCLUSION
Single-dose 3T MR is as effective as double-dose 1.5T MR for delineation of infarcted myocardium while being superior in detection of infarcted myocardium from the blood cavity, and provides better reproducibility for infarct size quantification.

Keyword

Chronic myocardial infarction; Magnetic resonance imaging; Gadolinium contrast agent; Late gadolinium enhancement

MeSH Terms

Gadolinium*
Humans
Magnetic Resonance Imaging*
Meglumine*
Myocardial Infarction*
Myocardium
Gadolinium
Meglumine

Figure

• 

  Fig. 1 Assessment of SIs, contrast-to-noise ratios and relative infarct area on magnitude images.A, B. SIs were determined in circular ROIs placed in remote normal (blue circle) and infarcted myocardium (red circle), and LV cavity (yellow circle). Noise was derived from ROI located in background air (white circle). C. Assessment of relative infarct area of LGE using semiautomatic analysis software. Small blue circle indicates reference myocardium as normal remote myocardium. Green and red circles indicate outer and inner contours of left ventricular myocardium, respectively. Relative infarct size was quantified by identifying myocardial area with LGE, overlaid with yellow, by means of threshold of 6 SDs above mean SI of remote, non-enhanced myocardium. LGE = late gadolinium enhancement, LV = left ventricular, ROIs = regions of interest, SDs = standard deviations, SIs = signal intensities

• 

  Fig. 2 Subendocardial infarction observed in septal, inferior and lateral wall in 71-year-old man.LGE short axis images obtained using double dosage of gadolinium at 1.5T (upper row) and single dosage of gadolinium at 3T (lower row). There was difficulty in delineating border between subendocardial infarction and LV cavity as bright blood cavity obscures subendocardial infarction at 1.5T MR. To contrary, visualization of hyper-enhancement in subendocardium was much more improved at 3T MR using single dose. MR = magnetic resonance

• 

  Fig. 3 Subendocardial infarction observed in inferior and lateral wall in 59-year-old man.LGE short axis images obtained using double dosage of gadolinium at 1.5T MR (upper row) and single dosage of gadolinium at 3T (lower row). Greater signal difference between LV cavity and subendocardial infarcted region on 3T MR using single dosage enabled better delineation of infarcted myocardium compared to 1.5T MR using double dosage.

• 

  Fig. 4 Bland-Altman analysis of relative infarct area measured by observers 1 (A) and 2 (B).Center line represents mean of differences, top line shows upper 95% limit of agreement, and bottom line shows lower 95% limit of agreement, with mean difference between long- and short-axis measurements (± 1.96 times SD).

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