2021/9 - Dark-blood late gadolinium enhancement cardiovascular magnetic resonance for improved detection of subendocardial scar: a review of current techniques [Journal Club]-From Live Event: "Dark-blood late gadolinium enhancement cardiovascular magnetic resonance for improved detection of

From Live Event: "Dark-blood late gadolinium enhancement cardiovascular magnetic resonance for improved detection of

Pdf Summary

This review summarizes “dark-blood” late gadolinium enhancement (LGE) cardiovascular magnetic resonance methods designed to improve detection of myocardial scar, especially subendocardial infarction, which can be hard to see with standard bright-blood LGE because the blood pool and scar may appear equally bright.<br /><br />For nearly 20 years, conventional LGE has been the non-invasive reference standard for assessing myocardial viability, scar extent, and transmurality. However, its main limitation is reduced scar-to-blood contrast. Dark-blood approaches address this by suppressing or nulling blood signal using different preparation mechanisms: T2 preparation, magnetization transfer, spin-locking, multiple inversion pulses, or simply adjusting inversion timing in phase-sensitive inversion recovery (PSIR) sequences.<br /><br />The review compares key methods and their strengths/weaknesses. Some techniques produce black-blood images, which maximize scar-to-blood contrast but may reduce scar-to-myocardium contrast and make thrombus detection harder. Others create gray-blood images, offering a balance between better scar visibility and preserved anatomical reference. PSIR-based methods without extra preparation are attractive because they are simpler and widely available, and they have shown improved scar detection and even histologic validation in animal studies.<br /><br />Overall, studies consistently show that dark-blood LGE improves confidence and sensitivity for ischemic scar detection, particularly for subtle subendocardial disease. Yet important limitations remain: many methods require extra parameters, pre-scans, or specialized software not routinely available on clinical scanners; some are sensitive to heart rate, field strength, or motion; and evidence for non-ischemic scar detection is still limited.<br /><br />The authors conclude that dark-blood LGE is a promising advance for myocardial scar imaging, but broader clinical adoption will depend on ease of use, availability, and further validation, especially for quantification and routine workflow integration.

Keywords

dark-blood LGE

late gadolinium enhancement

myocardial scar

subendocardial infarction

cardiovascular magnetic resonance

blood pool suppression

scar-to-blood contrast

phase-sensitive inversion recovery

ischemic scar detection

myocardial viability