Background and Objectives:
Bright-blood (BB) and dark-blood (DB) late gadolinium enhancement (LGE) are established cardiac magnetic resonance (CMR) methods for assessing myocardial viability and scarring. This study aimed to evaluate single-shot DB-LGE compared with conventional BB-LGE for detecting myocardial scarring in patients with suspected cardiomyopathies.
Materials and Methods:
In this prospective single-center study, patients with suspected ischemic or non-ischemic cardiomyopathy were enrolled between May 2023 and January 2024. All underwent 1.5 T CMR with both single-shot DB-LGE and conventional BB-LGE. For DB-LGE, a fixed inversion time (TI) of 160 ms was applied, whereas BB-LGE was performed with manually adapted TI values according to a preceding TI-scout (range 250–350 ms). Corresponding short-axis stacks were visually analysed for presence, distribution, pattern, and localization of LGE, as well as transmurality per AHA segment. A Visual Presence Score (VPS) was defined as the number of LGE-positive segments (0–17). A Visual Transmurality Score (VTS) was calculated by summing transmurality grades per segment (0 = none, 1 = <25%, 2 = 26–50%, 3 = 51–75%, 4 = >76%), yielding a score of 0–68.
Results:
Overall, 66 patients (46 ± 16 years; 25 female) were examined by a dedicated CMR protocol. Acquisition time was significantly shorter for DB-LGE compared with BB-LGE (15 s vs. 366 s, p<0.001). On a per-patient basis, LGE was detected in 26 cases (41%) by both techniques, with no false positives or negatives. Accordingly, DB-LGE demonstrated a sensitivity and specificity of 100% for scar detection. LGE pattern was classified as patchy in 8 BB vs. 11 DB cases (p=0.083) and as linear in 17 BB vs. 15 DB cases (p=0.157). Mean VPS among LGE-positive patients was 5.2 (DB) vs. 5.5 (BB), and mean VTS was 13.7 (DB) vs. 14.5 (BB), both showing excellent correlation between techniques (Spearman’s rho = 0.99, p<0.001).
Conclusions:
Single-shot DB-LGE seems to be non-inferior to conventional BB-LGE for detecting ischemic and non-ischemic myocardial scars. Given its much shorter acquisition time, single-shot DB-LGE might be used 1) in patients in which very short acquisition times are necessary, or 2) might be added to a conventional image acquisition CMR protocol for comprehensive scar characterization.
