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Optimization of late gadolinium enhancement cardiovascular magnetic resonance imaging of post-ablation atrial scar: a cross-over study

BACKGROUND: Cardiovascular magnetic resonance (CMR) imaging may be used to visualize post-ablation atrial scar (PAAS), and three-dimensional late gadolinium enhancement (3D LGE) is the most widely employed technique for imaging of chronic scar. Detection of PAAS provides a unique non-invasive insigh...

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Autores principales: Chubb, Henry, Aziz, Shadman, Karim, Rashed, Sohns, Christian, Razeghi, Orod, Williams, Steven E., Whitaker, John, Harrison, James, Chiribiri, Amedeo, Schaeffter, Tobias, Wright, Matthew, O’Neill, Mark, Razavi, Reza
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5932811/
https://www.ncbi.nlm.nih.gov/pubmed/29720202
http://dx.doi.org/10.1186/s12968-018-0449-8
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author Chubb, Henry
Aziz, Shadman
Karim, Rashed
Sohns, Christian
Razeghi, Orod
Williams, Steven E.
Whitaker, John
Harrison, James
Chiribiri, Amedeo
Schaeffter, Tobias
Wright, Matthew
O’Neill, Mark
Razavi, Reza
author_facet Chubb, Henry
Aziz, Shadman
Karim, Rashed
Sohns, Christian
Razeghi, Orod
Williams, Steven E.
Whitaker, John
Harrison, James
Chiribiri, Amedeo
Schaeffter, Tobias
Wright, Matthew
O’Neill, Mark
Razavi, Reza
author_sort Chubb, Henry
collection PubMed
description BACKGROUND: Cardiovascular magnetic resonance (CMR) imaging may be used to visualize post-ablation atrial scar (PAAS), and three-dimensional late gadolinium enhancement (3D LGE) is the most widely employed technique for imaging of chronic scar. Detection of PAAS provides a unique non-invasive insight into the effects of the ablation and may help guide further ablation procedures. However, there is evidence that PAAS is often not detected by CMR, implying a significant sensitivity problem, and imaging parameters vary between leading centres. Therefore, there is a need to establish the optimal imaging parameters to detect PAAS. METHODS: Forty subjects undergoing their first pulmonary vein isolation procedure for AF had detailed CMR assessment of atrial scar: one scan pre-ablation, and two scans post-ablation at 3 months (separated by 48 h). Each scan session included ECG- and respiratory-navigated 3D LGE acquisition at 10, 20 and 30 min post injection of a gadolinium-based contrast agent (GBCA). The first post-procedural scan was performed on a 1.5 T scanner with standard acquisition parameters, including double dose (0.2 mmol/kg) Gadovist and 4 mm slice thickness. Ten patients subsequently underwent identical scan as controls, and the other 30 underwent imaging with a reduced, single, dose GBCA (n = 10), half slice thickness (n = 10) or on a 3 T scanner (n = 10). Apparent signal-to-noise (aSNR), contrast-to-noise (aCNR) and imaging quality (Likert Scale, 3 independent observers) were assessed. PAAS location and area (%PAAS scar) were assessed following manual segmentation. Atrial shells with standardised %PAAS at each timepoint were then compared to ablation lesion locations to assess quality of scar delineation. RESULTS: A total of 271 3D acquisitions (out of maximum 280, 96.7%) were acquired. Likert scale of imaging quality had high interobserver and intraobserver intraclass correlation coefficients (0.89 and 0.96 respectively), and showed lower overall imaging quality on 3 T and at half-slice thickness. aCNR, and quality of scar delineation increased significantly with time. aCNR was higher with reduced, single, dose of GBCA (p = 0.005). CONCLUSION: 3D LGE CMR atrial scar imaging, as assessed qualitatively and quantitatively, improves with time from GBCA administration, with some indices continuing to improve from 20 to 30 min. Imaging should be performed at least 20 min post-GBCA injection, and a single dose of contrast should be considered. TRIAL REGISTRATION: Trial registry- United Kingdom National Research Ethics Service 08/H0802/68 – 30th September 2008. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12968-018-0449-8) contains supplementary material, which is available to authorized users.
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spelling pubmed-59328112018-05-09 Optimization of late gadolinium enhancement cardiovascular magnetic resonance imaging of post-ablation atrial scar: a cross-over study Chubb, Henry Aziz, Shadman Karim, Rashed Sohns, Christian Razeghi, Orod Williams, Steven E. Whitaker, John Harrison, James Chiribiri, Amedeo Schaeffter, Tobias Wright, Matthew O’Neill, Mark Razavi, Reza J Cardiovasc Magn Reson Research BACKGROUND: Cardiovascular magnetic resonance (CMR) imaging may be used to visualize post-ablation atrial scar (PAAS), and three-dimensional late gadolinium enhancement (3D LGE) is the most widely employed technique for imaging of chronic scar. Detection of PAAS provides a unique non-invasive insight into the effects of the ablation and may help guide further ablation procedures. However, there is evidence that PAAS is often not detected by CMR, implying a significant sensitivity problem, and imaging parameters vary between leading centres. Therefore, there is a need to establish the optimal imaging parameters to detect PAAS. METHODS: Forty subjects undergoing their first pulmonary vein isolation procedure for AF had detailed CMR assessment of atrial scar: one scan pre-ablation, and two scans post-ablation at 3 months (separated by 48 h). Each scan session included ECG- and respiratory-navigated 3D LGE acquisition at 10, 20 and 30 min post injection of a gadolinium-based contrast agent (GBCA). The first post-procedural scan was performed on a 1.5 T scanner with standard acquisition parameters, including double dose (0.2 mmol/kg) Gadovist and 4 mm slice thickness. Ten patients subsequently underwent identical scan as controls, and the other 30 underwent imaging with a reduced, single, dose GBCA (n = 10), half slice thickness (n = 10) or on a 3 T scanner (n = 10). Apparent signal-to-noise (aSNR), contrast-to-noise (aCNR) and imaging quality (Likert Scale, 3 independent observers) were assessed. PAAS location and area (%PAAS scar) were assessed following manual segmentation. Atrial shells with standardised %PAAS at each timepoint were then compared to ablation lesion locations to assess quality of scar delineation. RESULTS: A total of 271 3D acquisitions (out of maximum 280, 96.7%) were acquired. Likert scale of imaging quality had high interobserver and intraobserver intraclass correlation coefficients (0.89 and 0.96 respectively), and showed lower overall imaging quality on 3 T and at half-slice thickness. aCNR, and quality of scar delineation increased significantly with time. aCNR was higher with reduced, single, dose of GBCA (p = 0.005). CONCLUSION: 3D LGE CMR atrial scar imaging, as assessed qualitatively and quantitatively, improves with time from GBCA administration, with some indices continuing to improve from 20 to 30 min. Imaging should be performed at least 20 min post-GBCA injection, and a single dose of contrast should be considered. TRIAL REGISTRATION: Trial registry- United Kingdom National Research Ethics Service 08/H0802/68 – 30th September 2008. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12968-018-0449-8) contains supplementary material, which is available to authorized users. BioMed Central 2018-05-03 /pmc/articles/PMC5932811/ /pubmed/29720202 http://dx.doi.org/10.1186/s12968-018-0449-8 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Chubb, Henry
Aziz, Shadman
Karim, Rashed
Sohns, Christian
Razeghi, Orod
Williams, Steven E.
Whitaker, John
Harrison, James
Chiribiri, Amedeo
Schaeffter, Tobias
Wright, Matthew
O’Neill, Mark
Razavi, Reza
Optimization of late gadolinium enhancement cardiovascular magnetic resonance imaging of post-ablation atrial scar: a cross-over study
title Optimization of late gadolinium enhancement cardiovascular magnetic resonance imaging of post-ablation atrial scar: a cross-over study
title_full Optimization of late gadolinium enhancement cardiovascular magnetic resonance imaging of post-ablation atrial scar: a cross-over study
title_fullStr Optimization of late gadolinium enhancement cardiovascular magnetic resonance imaging of post-ablation atrial scar: a cross-over study
title_full_unstemmed Optimization of late gadolinium enhancement cardiovascular magnetic resonance imaging of post-ablation atrial scar: a cross-over study
title_short Optimization of late gadolinium enhancement cardiovascular magnetic resonance imaging of post-ablation atrial scar: a cross-over study
title_sort optimization of late gadolinium enhancement cardiovascular magnetic resonance imaging of post-ablation atrial scar: a cross-over study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5932811/
https://www.ncbi.nlm.nih.gov/pubmed/29720202
http://dx.doi.org/10.1186/s12968-018-0449-8
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