Abstract 334: Observer Performance With State-of-the-Art T2 Weighted Sequences -T2p-singleshot SSFP, TSESSFP(ACUTE), IR-TSE (TIRM) and BLADE- for the Detection of Acute Myocardial Injury
Purpose: To assess the diagnostic performance of different T2 weighted (T2w) imaging sequences for the detection of acute myocardial injury (AMI) by cardiac magnetic resonance (CMR).
Materials and Methods: A total of 39 patients with acute myocardial injury (30 with reperfused Acute Myocardial Infarction (AMI) and 9 with acute myocarditis), underwent a complete CMR imaging study 2–5 days after hospital admission. Reading of all available data (cine, T2, EGE + LGE, x-ray coronary angiography) was performed independently by an experienced radiologist to determine abnormal segments (reference reading). Presence of high/low signal intensity within the myocardial wall was assessed by 2 blinded observers using four sequences:
a free breathing single-shot T2 prepared SSFP with (N) and without dedicated normalization (U) for spatially variable coil sensitivity;
a breath hold T2 weighted ACUTE (N) and (U)
a breath hold T2 dark blood IR-TSE sequence
a free breathing high resolution T2 dark blood BLADE sequence using navigators technique.
Readers graded their confidence in the presence of any hyper/hyposignal within AHA myocardial segments according to a 5-points rating scale (0: absence up to 4: clear hypo/hyperintensity). Observer performance was assessed to identify the overall performance of each T2w sequence.
Results: Receiver Operating Characteristic (ROC) analysis showed that
normalized T2p ssSSFP had the best diagnostic performance (area under the ROC curve (Az) = 0.88±0.01; P=0.003), followed by normalized T2 ACUTE (Az=0.82±0.02), un-normalized T2 ACUTE (Az=0.80±0.03), unnormalized T2p ssSSFP (Az=0.77±0.02), and T2 DB TIRM (Az=0.76±0.02) and T2 DB BLADE (Az =0.69±0.03)
all sequences had similar diagnostic performance for microvascular obstruction (P=0.47)
in acute myocardial injured patients the diagnostic performance is not influenced significantly depending on the myocardial injured territory location.
Conclusion: Blindly and directly comparing four different T2w sequences, normalized T2 ssSSFP has the best diagnostic performance for the diagnosis of acute myocardial injury.