Diagnostic pearls and potential pitfalls of free-breathing motion-corrected late gadolinium enhancement: a head-to-head comparative study

Objective To compare the free-breathing motion-corrected (MOCO) sequence with the segmented breath-hold (BH) sequence in subjects undergoing late gadolinium enhancement (LGE) scans of Cardiac MRI. Materials and Methods Retrospectively enrolled 71 consecutive subjects underwent MOCO-LGE and BH-LGE sequences in random order. Semi-quantitative image quality (IQ) scores, image contrast-to-noise ratios (CNRs), myocardial scar size, and thickness of pericardial effusion were evaluated. Result Compared to BH-LGE images, MOCO-LGE images showed improved CNR of the scar to the remote myocardium (11.46 [6.43,16.82] vs. 7.94 [4.36,12.65], p < 0.001) as well as higher IQ scores (4.25 ± 0.60 vs. 3.70 ± 0.88, p < 0.001). More subepicardial scar was seen in MOCO-LGE than BH-LGE images (83.6% vs. 43.3%, p < 0.001) in lateral wall, and larger scar size was measured by MOCO-LGE than BH-LGE images by using 3-standard deviation (SD) method (24.39 [16.90,33.02] vs. 15.62 [10.67,24.76], p < 0.001) and 5-SD method (8.44 [4.89, 13.53] vs. 4.30 [1.63,8.21], p < 0.001). More and thicker epicardial effusions were seen in MOCO-LGE than BH-LGE images (81.7% vs. 60.6%, p = 0.001, and 9.16 ± 4.44 mm vs. 6.24 ± 4.16 mm, p < 0.001). Conclusion MOCO-LGE images demonstrate superior quality compared to BH-LGE images. However, MOCO-LGE images have a tendency to overestimate the extent of subepicardial scar and pericardial effusion. Advances in knowledge Our study demonstrates that MOCO-LGE images tend to overestimate the extent of subepicardial scar and pericardial effusion in comparison to BH-LGE images, suggesting potential diagnostic misconceptions and an area for improvement.