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e-Article

Myocardial Scar Delineation Using Diffusion Tensor Magnetic Resonance Tractography
Document Type
article
Source
Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 7, Iss 3 (2018)
Subject
diffusion‐weighted imaging
magnetic resonance imaging
myocardial delayed enhancement
myocardial infarction
tractography
ventricular arrhythmia
Diseases of the circulatory (Cardiovascular) system
RC666-701
Language
English
ISSN
2047-9980
Abstract
BackgroundLate gadolinium enhancement (LGE) is the current standard for myocardial scar delineation. In this study, we introduce the tractographic propagation angle (PA), a metric of myofiber curvature (degrees/unit distance) derived from diffusion tensor imaging (DTI), and compare its use to LGE and invasive scar assessment by endocardial voltage mapping. Methods and ResultsDTI was performed on 7 healthy human volunteers, 5 patients with myocardial infarction, 6 normal mice, and 7 mice with myocardial infarction. LGE to delineate the infarct and border zones was performed with a 2‐dimensional inversion recovery gradient‐echo sequence. Ex vivo DTI was performed on 5 normal human and 5 normal sheep hearts. Endocardial electroanatomic mapping and subsequent ex vivo DTI was performed on 5 infarcted sheep hearts. PA in the normal human hearts varied smoothly and was generally 4 was the most accurate DTI‐derived measure of infarct size and demonstrated the greatest correlation with LGE (r=0.95). ConclusionsWe found a strong correlation between infarct size by PA and LGE in both mice and humans. There was also an inverse relationship between PA values and endocardial voltage. The use of PA may enable myocardial scar delineation and characterization of arrhythmogenic substrate without the need for exogenous contrast agents.