Late Gadolinium Enhancement MRI for Patients with Implantable Cardiac Devices

描述(申请人提供)：晚期Gd增强(LGE)心脏MRI在心肌疾病的诊断和治疗中起着重要作用。它是临床上的“黄金” 非侵入性心肌组织定征的标准“。使用LGE MRI评估心肌瘢痕的存在/缺失、位置、大小和模式通常是准确诊断和鉴别各种形式的非缺血性心肌病的唯一非侵入性手段，包括心肌炎、致心律失常性右室发育不良、淀粉样变性和结节病。LGE MRI在指导导管消融方面也发挥着越来越大的作用，导管消融是室性心动过速(VT)和复发ICD治疗的一种广泛使用的治疗程序。在这种手术中，LGE MRI对心肌瘢痕的位置、大小和透壁性的评估可以更准确地识别致心律失常的基质和消融部位，从而有可能减少手术时间和提高成功率。尽管LGE MRI具有重要的作用，但由于之前植入了心脏装置，许多患者没有接受心脏MRI检查。最近的报道表明，对于大多数节律不依赖于设备的患者，植入设备的患者的MRI可以安全地进行。然而，LGE图像对这些患者的诊断价值往往受到设备生成器产生的重大成像伪影的严重限制，设备生成器是一个主要植入患者胸部左侧的金属盒子。该装置发生器导致心肌组织内的多kHz非共振，通常会导致极其明亮的信号伪影，使得在这些受影响的区域无法进行疤痕评估。在此，我们提出了一种新的宽带多光谱LGE MRI技术的假设、技术创新和临床评估，该技术可以常规使用来显著减少植入心脏装置的患者的LGE成像伪影。该项目的完成将导致临床部署一套用于LGE成像的MRI脉冲序列和重建方法，并在一组使用心脏设备的患者中成功验证。

DESCRIPTION (provided by applicant): Late gadolinium enhancement (LGE) cardiac MRI plays an important role in diagnosis and treatment of myocardial diseases. It is the clinical "gold standard" in for non-invasive myocardial tissue characterization. Assessment of presence/absence, location, size and pattern of myocardial scar using LGE MRI is often the only non-invasive means of accurately diagnosing and differentiating various forms of non-ischemic cardiomyopathy, including myocarditis, arrhythmogenic right ventricular dysplasia, amyloidosis, and sarcoidosis. LGE MRI also plays an increasing role in guiding catheter ablations, a widely used treatment procedure for ventricular tachycardia (VT) and recurrent ICD therapies. For this procedure, the assessment of myocardial scar location, size and transmurality provided by LGE MRI allows more accurate identification of arrhythmogenic substrate and ablation sites, thereby potentially decreasing procedure time and increasing success rate. Despite the important role of LGE MRI, many of the patients do not undergo cardiac MRI due to prior implantation of cardiac devices. Recent reports suggest that MRI of patients with implanted devices can be performed safely for most patients whose rhythms are not device dependent. The diagnostic value of the LGE images for these patients, however, is often severely limited by significant imaging artifacts that arise from the device generator, a metal box that is implanted predominantly on the left side of the patient's chest. The device generator results in multi-kHz off-resonance within myocardial tissue and typically causes extremely bright signal artifacts, making scar assessment impossible in these affected regions. Herein, we propose hypotheses, technical innovations, and clinical evaluation of a new wideband multi-spectral LGE MRI technique that can be used routinely to significantly reduce LGE imaging artifacts in patients with implanted cardiac devices. Completion of the project will result in the clinical deployment of a set of MRI pulse sequences and reconstruction methods for LGE imaging and successful validation in a cohort of patients with cardiac devices.