Optimization of late gadolinium enhancement cardiovascular magnetic resonance imaging of post-ablation atrial scar: a cross-over study.
Optimization of late gadolinium enhancement cardiovascular magnetic resonance imaging of post-ablation atrial scar: a cross-over study.
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DOI：
10.1186/s12968-018-0449-8
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发表时间：
2018-05-03
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影响因子：
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通讯作者：
Razavi R
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作者：
Chubb H;Aziz S;Karim R;Sohns C;Razeghi O;Williams SE;Whitaker J;Harrison J;Chiribiri A;Schaeffter T;Wright M;O'Neill M;Razavi R
心血管磁共振（CMR）成像可用于可视化消融后心房疤痕（PAAS），三维晚期钆增强（3D LGE）是慢性疤痕成像中使用最广泛的技术。 PAAS 的检测提供了对消融效果的独特非侵入性洞察，并可能有助于指导进一步的消融手术。然而，有证据表明 CMR 通常无法检测到 PAAS，这意味着存在显着的灵敏度问题，并且领先中心之间的成像参数有所不同。因此，需要建立检测 PAAS 的最佳成像参数。 40 名接受 AF 肺静脉隔离手术的受试者对心房疤痕进行了详细的 CMR 评估：消融前进行一次扫描，消融后 3 个月进行两次扫描（间隔 48 小时）。每次扫描都包括注射钆造影剂 (GBCA) 后 10、20 和 30 分钟的心电图和呼吸导航 3D LGE 采集。第一次术后扫描在 1.5 T 扫描仪上进行，具有标准采集参数，包括双剂量 (0.2 mmol/kg) Gadovist 和 4 mm 切片厚度。随后，10 名患者接受了与对照相同的扫描，另外 30 名患者则使用减少的单剂量 GBCA (n = 10)、半切片厚度 (n = 10) 或 3 T 扫描仪 (n = 10) 进行成像。评估表观信噪比 (aSNR)、对比噪声比 (aCNR) 和成像质量（李克特量表，3 名独立观察者）。手动分割后评估 PAAS 位置和面积（%PAAS 疤痕）。然后将每个时间点具有标准化 %PAAS 的心房壳与消融病变位置进行比较，以评估疤痕勾画的质量。总共收购了 271 项 3D 收购（最多 280 项，占 96.7%）。成像质量的李克特量表具有较高的观察者间和观察者内组内相关系数（分别为 0.89 和 0.96），并且在 3 T 和半层厚度上显示出较低的整体成像质量。 aCNR 和疤痕轮廓的质量随着时间的推移显着增加。单次 GBCA 剂量减少后，aCNR 较高 (p = 0.005)。 3D LGE CMR 心房疤痕成像经过定性和定量评估，随着 GBCA 给药时间的推移而改善，一些指标在 20 至 30 分钟内持续改善。 GBCA 注射后至少 20 分钟应进行成像，并应考虑使用单剂量造影剂。试验登记处 - 英国国家研究道德服务中心 08/H0802/68 – 2008 年 9 月 30 日。本文的在线版本 (10.1186/s12968-018-0449-8) 包含补充材料，可供授权用户使用。
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. 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. 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). 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 registry- United Kingdom National Research Ethics Service 08/H0802/68 – 30th September 2008. The online version of this article (10.1186/s12968-018-0449-8) contains supplementary material, which is available to authorized users.