Basic Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Sep 28, 2018; 10(9): 100-107
Published online Sep 28, 2018. doi: 10.4329/wjr.v10.i9.100
Optimized cardiac magnetic resonance imaging inversion recovery sequence for metal artifact reduction and accurate myocardial scar assessment in patients with cardiac implantable electronic devices
El-Sayed H Ibrahim, Mason Runge, Jadranka Stojanovska, Prachi Agarwal, Maryam Ghadimi-Mahani, Anil Attili, Thomas Chenevert, Chiel den Harder, Frank Bogun
El-Sayed H Ibrahim, Department of Radiology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
Mason Runge, Jadranka Stojanovska, Prachi Agarwal, Maryam Ghadimi-Mahani, Anil Attili, Thomas Chenevert, Frank Bogun, Department of Radiology, University of Michigan, Ann Arbor, MI 48109, United States
Chiel den Harder, Department of Medical Physics, Leiden University Medical Center, Leiden 2333ZA, The Netherlands
Author contributions: Ibrahim EH and Stojanovska J designed research; Ibrahim EH, Stojanovska J, Agarwal P, Ghadimi-Mahani M and Attili A performed research; Ibrahim EH, Stojanovska J and Bogun F analyzed data; Runge M, Chenevert T, den Harder C and Bogun F contributed with analytic tools; Ibrahim E wrote the paper.
Institutional review board statement: The study is approved by the University of Michigan Institutional Review Board.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors do not have conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: El-Sayed H Ibrahim, PhD, Associate Professor, Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, United States. eibrahim@mcw.edu
Telephone: +1-414-9554663 Fax: +1-414-9556314
Received: April 26, 2018
Peer-review started: April 26, 2018
First decision: May 22, 2018
Revised: July 12, 2018
Accepted: July 14, 2018
Article in press: July 16, 2018
Published online: September 28, 2018
Processing time: 155 Days and 20 Hours
Abstract

Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) is the gold standard for imaging myocardial viability. An important application of LGE CMR is the assessment of the location and extent of the myocardial scar in patients with ventricular tachycardia (VT), which allows for more accurate identification of the ablation targets. However, a large percentage of patients with VT have cardiac implantable electronic devices (CIEDs), which is a relative contraindication for cardiac magnetic resonance imaging due to safety and image artifact concerns. Previous studies showed that these patients can be safely scanned on 1.5 T scanners provided that an adequate imaging protocol is adopted. Nevertheless, imaging patients with a CIED result in metal artifacts due to the strong frequency off-resonance effects near the device; therefore, the spins in the surrounding myocardium are not completely inverted, and thus give rise to hyperintensity artifacts. These artifacts obscure the myocardial scar tissue and limit the ability to study the correlation between the myocardial scar structure and the electro-anatomical map during catheter ablation. In this study, we developed a modified inversion recovery technique to alleviate the CIED-induced metal artifacts and improve the diagnostic image quality of LGE images in patients with CIEDs without increasing scan time or requiring additional hardware. The developed technique was tested in phantom experiments and in vivo scans, which showed its capability for suppressing the hyperintensity artifacts without compromising myocardium nulling in the resulting LGE images.

Keywords: Magnetic resonance imaging; Heart; Late gadolinium enhancement; Viability imaging; Inversion recovery; Cardiac implantable electronic devices

Core tip: Late gadolinium-enhancement magnetic resonance imaging is the gold standard for imaging myocardial viability, especially for assessing location and extent of myocardial scar in patients with ventricular-tachycardia, which allows for more identification of the ablation targets. However, large percentages of these patients have cardiac-implantable electronic devices, which results in hyperintensity artifacts that obscure the myocardial scar. In this study, we developed a modified technique to alleviate the metal-induced image artifacts without increasing scan time or requiring additional hardware. The developed technique was tested in phantom and in-vivo scans, which showed its capability for suppressing the hyperintensity artifacts and improving diagnostic image quality.