Preliminary clinical application of free-breathing black-blood myocardial scar imaging in patients with cardiac implantable devices

Motivation: Breath-held wideband black-blood imaging enhances myocardial scar detection in ICD patients, offering better scar-to-blood contrast and reduced device-related artifacts compared to conventional PSIR imaging. However, this sequence is ineffective for severely ill patients who are unable to hold their breath. Goal(s): To improve myocardial lesion detection in ICD patients who cannot hold their breath. Approach: A 2D free-breathing wideband black-blood sequence with non-rigid motion correction was developed, incorporating wideband adiabatic inversion recovery and wideband T2 preparation, and was tested in 15 patients with cardiac implants. Results: Wideband pulses suppressed ICD artifacts. Motion correction improved scar sharpness, image entropy, and provided excellent scar depiction. Impact: Our findings support the clinical use of the proposed sequence for more accurate myocardial scar detection in patients with implantable cardiac devices, without long and tedious breath-holds, which could influence treatment decisions and improve outcomes by preventing sudden cardiac death.