2023/04 - Revisiting how we perform late gadolinium enhancements CMR: insights gleaned over 25 years of clinical practice [Journal Club]-April JCMR Journal Club

Video Transcription

Video Summary

The webinar focused on best practices and practical tips for late gadolinium enhancement (LGE) cardiac MRI, led by Duke experts David Bendel and Han Kim. They reviewed the technique’s history, its role as the imaging reference standard for myocardial infarction and viability, and its value in non-ischemic cardiomyopathies and thrombus detection. Key technical points included choosing the correct inversion time (TI), using segmented versus single-shot imaging, and adapting protocols for difficult patients, especially those with breath-hold limitations or arrhythmias such as atrial fibrillation. They emphasized that consistent contrast dosing and timing improve image quality, and that blood-nulling or dark-blood techniques can improve detection of small subendocardial infarcts. Special cases discussed included amyloidosis, where blood should be nulled to reveal diffuse myocardial infiltration, and patients with cardiac devices, where wideband inversion pulses help reduce artifacts. The session also covered scar assessment, emphasizing semi-quantitative visual interpretation over purely quantitative methods, and highlighted ongoing developments such as automated TI selection, broader use of 3D imaging, and improved broadband pulses for 3T scanning.

Keywords

late gadolinium enhancement

cardiac MRI

myocardial infarction

inversion time

non-ischemic cardiomyopathy

dark-blood imaging

amyloidosis

cardiac devices

scar assessment