3D whole-heart phase sensitive inversion recovery CMR for simultaneous black-blood late gadolinium enhancement and bright-blood coronary CMR angiography

Background: Phase sensitive inversion recovery (PSIR) applied to late gadolinium enhancement (LGE) imaging is widely used in clinical practice. However, conventional 2D PSIR LGE sequences provide sub-optimal contrast between scar tissue and blood pool, rendering the detection of subendocardial infarcts and scar segmentation challenging. Furthermore, the acquisition of a low flip angle reference image doubles the acquisition time without providing any additional diagnostic information. The purpose of this study was to develop and test a novel 3D whole-heart PSIR-like framework, named BOOST, enabling simultaneous black-blood LGE assessment and bright-blood visualization of cardiac anatomy. Methods: The proposed approach alternates the acquisition of a 3D volume preceded by a T-2-prepared Inversion Recovery (T(2)Prep-IR) module (magnitude image) with the acquisition of a T-2-prepared 3D volume (reference image). The two volumes (T(2)Prep-IR BOOST and bright-blood T(2)Prep BOOST) are combined in a PSIR-like reconstruction to obtain a complementary 3D black-blood volume for LGE assessment (PSIR BOOST). The black-blood PSIR BOOST and the bright-blood T(2)Prep BOOST datasets were compared to conventional clinical sequences for scar detection and coronary CMR angiography (CMRA) in 18 patients with a spectrum of cardiovascular disease (CVD). Results: Datasets from 12 patients were quantitatively analysed. The black-blood PSIR BOOST dataset provided statistically improved contrast to noise ratio (CNR) between blood and scar when compared to a clinical 2D PSIR sequence (15.8 +/- 3.3 and 4.1 +/- 5.6, respectively). Overall agreement in LGE depiction was found between 3D black-blood PSIR BOOST and clinical 2D PSIR acquisitions, with 11/12 PSIR BOOST datasets considered diagnostic. The bright-blood T(2)Prep BOOST dataset provided high quality depiction of the proximal coronary segments, with improvement of visual score when compared to a clinical CMRA sequence. Acquisition time of BOOST (similar to 10 min), providing information on both LGE uptake and heart anatomy, was comparable to that of a clinical single CMRA sequence. Conclusions: The feasibility of BOOST for simultaneous black-blood LGE assessment and bright-blood coronary angiography was successfully tested in patients with cardiovascular disease. The framework enables free-breathing multi-contrast whole-heart acquisitions with 100% scan efficiency and predictable scan time. Complementary information on 3D LGE and heart anatomy are obtained reducing examination time.