Myocardial late gadolinium enhancement using delayed 3D IR-FLASH in the pediatric population: feasibility and diagnostic performance compared to single-shot PSIR-bSSFP

Figures

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  Fig. 1. Examples of image quality ratings for conventional single-shot PSIR-bSSFP LGE and 3D HR LGE sequences. 1 poor with no clear distinction of myocardial margins; 2 fair with blurred myocardial edges; 3 good with clear myocardial margins; 4 very good with sharp myocardial margins. 3D 3-dimensional, HR high-resolution, LGE late gadolinium enhancement, PSIR phase-sensitive inversion recovery, bSSFP balanced steady-state free precession

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  Fig. 2. Box-and-whisker plots of image quality ratings and signal intensity ratios between conventional single-shot PSIR-bSSFP LGE and 3D HR-LGE sequences in a cohort of routine clinical pediatric patients (n = 102). Boxes show the 25th and 75th quartile ranges with median denoted by the black solid horizontal line, whiskers representing 1.5 × the quartile range, and dots representing data points beyond the whiskers

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  Fig. 3. Box-and-whisker plots showing number of LV and RV segments with identified LGE on conventional single-shot PSIR-bSSFP LGE and 3D HR-LGE sequences in the cohort of pediatric patients with positive LV LGE (n = 24) and RV LGE (n = 27). Boxes show the 25th and 75th quartile ranges with median denoted by the black solid horizontal line, whiskers representing 1.5 × the quartile range, and dots representing data points beyond the whiskers. LV left ventricular, RV right ventricular

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  Fig. 4. Comparison of 3D HR-LGE and conventional single-shot PSIR-bSSFP LGE sequences performed without sedation in a 14-year-old patient with myocarditis, showing patchy mid-ventricular LGE (solid and empty arrowheads). 3D HR-LGE sequences show better signal and spatial delineation of the LGE

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  Fig. 5. Comparison of 3D HR-LGE and conventional single-shot PSIR-bSSFP LGE sequences performed without sedation in a 15-year-old patient with Kawasaki disease, showing subendocardial LGE of the of the basal to mid left ventricle in the left main coronary artery territory (solid and empty arrowheads). 3D HR-LGE sequences show better signal and spatial delineation of the LGE

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  Fig. 6. Comparison of 3D HR-LGE and conventional single-shot PSIR-bSSFP LGE sequences performed free-breathing under general anaesthesia in a 4-year-old patient with hypoplastic left heart syndrome, showing circumferential LV endocardial fibroelastosis (solid arrowheads) and focal LGE of an RV papillary muscle (empty arrowheads). Both endocardial fibroelastosis and papillary muscle LGE are not clearly identifiable on the single-shot PSIR-bSSFP sequence

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  Fig. 7. Comparison of 3D HR-LGE and conventional single-shot PSIR-bSSFP LGE sequences performed without sedation in an 11-year-old patient with Takayasu arteritis status-post left coronary artery bypass graft and right coronary artery stent, showing LGE of the basal RV free-wall and subendocardial LV free-wall (solid white arrowheads) along with LGE of the LV anterolateral papillary muscle (black arrowheads). 3D HR-LGE shows all areas of LGE better than single-shot PSIR-bSSFP