Motion-corrected free-breathing LGE delivers high quality imaging and reduces scan time by half: an independent validation study
Int J Cardiovasc Imaging Original Paper Early Recent, May 18, 2019 10.1007/s10554-019-01620-x 本文由“天纳”临床学术信息人工智能系统自动翻译Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) sequences have evolved. Free-breathing motion-corrected (MOCO) LGE has potential advantages over breath-held (bh) LGE including minimal user input for the short axis (SAX) stack without breath-holds. It has previously been shown that MOCO-LGE delivers high image quality compared to bh-LGE. We sought to conduct an independent validation study to investigate real-world performance of bh-LGE versus MOCO-LGE in a high-throughput CMR center immediately after the introduction of the MOCO-LGE sequence and with elementary staff induction in its use. Four-hundred consecutive patients, referred for CMR and graded by clinical complexity, underwent CMR on either of two scanners (1.5 T, both Siemens) in a UK tertiary cardiac center. Scar imaging was by bh-LGE or MOCO-LGE (both with phase sensitive inversion recovery). Image quality, scan time, reader confidence and report reproducibility were compared between those scanned by bh-LGE versus MOCO-LGE. Readers had > 3 years CMR experience. Categorical variables were compared by χ2 or Fisher’s exact tests and continuous variables by unpaired Student’s t-test. Inter-rater agreement of LGE reports was by Cohen’s kappa. Image quality (low score = better) was better for MOCO-LGE (median, interquartile range [Q1–Q3]: 0 [0–0] vs. 2 [0–3], P < 0.0001). This persisted when just clinically complex patients were assessed (0 [0–1] vs. 2 [1–4] P < 0.0001). Readers were more confident in their MOCO-LGE rulings (P < 0.001) and reports more reproducible [bh-LGE vs. MOCO-LGE: kappa 0.76, confidence interval (CI) 0.7–0.9 vs. 0.82, CI 0.7–0.9]. MOCO-LGE significantly shortened LGE acquisition times compared to bh-LGE (for left ventricle SAX stack: 03:22 ± 01:14 vs 06:09 ± 01:47 min respectively, P < 0.0001). In a busy clinical service, immediately after its introduction and with elementary staff training, MOCO-LGE is demonstrably faster to bh-LGE, providing better images that are easier to interpret, even in the sickest of patients.晚期钆增强（LGE）心血管磁共振（CMR）序列已经进化。自由呼吸运动校正（MOCO）LGE比屏气（BH）LGE具有潜在的优势，包括对短轴（SAX）堆栈的最小用户输入，无需屏气。先前的研究表明，与BH LGE相比，MOCO-LGE具有较高的图像质量。我们试图在引入MOCO-LGE序列后立即在高通量CMR中心进行一项独立的验证研究，以调查BH LGE与MOCO-LGE在实际应用中的表现，并在使用中进行初级员工入职培训。在英国第三心脏中心的两台扫描仪（1.5t，两台西门子）中的任何一台上，连续400名患者接受了CMR检查，并根据临床复杂程度进行分级。瘢痕成像采用BH-LGE或MOCO-LGE（均具有相敏反转恢复）。比较了BH-LGE和MOCO-LGE扫描的图像质量、扫描时间、读者信心和报告再现性。读者有>3年的CMR经验。分类变量用χ2或Fisher精确检验进行比较，连续变量用未配对学生t检验进行比较。LGE报告的评级机构间协议由Cohen~q~sKappa提供。MOCO-LGE的图像质量（低分=更好）更好（中位数，四分位间距[q1–q3]：0[0–0]对2[0–3]，p<0.0001）。当仅仅对临床复杂患者进行评估时（0[0–1]对2[1–4]p<0.0001），这种情况持续存在。读者对他们的MOCO-LGE裁定更为自信（p<0.001），报告更具可重复性[bh-LGE与MOCO-LGE:kappa 0.76，置信区间（CI）0.7-0.9与0.82，CI 0.7-0.9]。与bh-lge相比，moco-lge显著缩短了lge采集时间（左心室SAX叠加：分别为03:22±01:14和06:09±01:47 min，p<0.0001）。在繁忙的临床服务中，在引入MOCO-LGE并进行初级员工培训后，MOCO-LGE明显比BH-LGE更快，提供了更好的图像，即使是最病态的患者也更容易理解。
Introduction
Late gadolinium enhancement (LGE) tissue characterization by cardiovascular magnetic resonance (CMR) has widespread applications so demand on image quality has grown [1, 2]. Breath-held (bh), inversion recovery (IR) electrocardiography (ECG)-gated, segmented spoiled gradient echo (GRE) readout was the gold standard sequence [3]. To improve speed and quality, new techniques emerged. These include phase sensitive IR (PSIR) [4], single shot LGE [5, 6], and motion corrected (MOCO) averaging with free-breathing [7, 8].心血管磁共振（CMR）对晚期钆增强（LGE）组织的表征有着广泛的应用，因此对图像质量的要求也越来越高[1，2]。屏气（BH），倒置恢复（IR）心电图（ECG）门控，分段破坏梯度回波（GRE）读数是金标准序列[3]。为了提高速度和质量，出现了新的技术。其中包括相位敏感红外（psir）[4]、单次发射LGE[5，6]和自由呼吸运动校正（moco）平均值[7，8]。During traditional spoiled GRE bh-LGE sequences, a single image slice is acquired over a long breathhold (typically 12–16 heartbeats). If, instead of low flip angle spoiled GRE readout, steady-state free precession (SSFP) readouts are used, k-space can be acquired faster with increased signal-to-noise. This permitted single shot imaging and, for example, whole left ventricular (LV) coverage in a single bh [5]. However, trade off is needed so these approaches led to a combination of lower spatial resolution and longer read-outs with consequent reduced scar: remote myocardial contrast, even with PSIR [6]. One solution to improve this would be to use parallel imaging but it makes the images noisy. An alternative would be the development of single shot PSIR–SSFP LGE with parallel imaging and MOCO averaging, restoring both image resolution (matrix size) and signal-to-noise [1, 7, 8] with potential major advantages in clinical practice. Additionally, free-breathing CMR has advantages for patients, particularly the more unwell—it can potentially eliminate motion-related artifact and is faster to acquire [9] since pauses between bh slices are eliminated. Eliminating the need for bh voice commands brings benefits to patients with a language barrier, with hearing impairment, or to those than cannot stay awake. The strengths of MOCO-LGE were first described in a landmark clinical study 6 years ago [2], but in this time there have been no further replication studies and the promising research sequence, available only to selected centers, failed to mature to product sequence. We felt the need to remind the CMR community about the clinical utility, efficiency and easy-of-use of MOCO-LGE.在传统的坏掉的gre bh-lge序列中，通过长时间屏气（通常是12-16次心跳）获取单个图像切片。如果使用稳态自由进动（SSFP）读数而不是低翻转角损坏的GRE读数，则K空间可以随着信噪比的增加而更快地获得。这允许单次放射学成像，例如单次BH中的整个左心室（LV）覆盖[5]。然而，需要权衡，因此这些方法会导致低空间分辨率和更长的读出时间与随之减少的瘢痕相结合：远程心肌对比，即使是PSIR[6]。改善这一点的一个解决方案是使用并行成像，但它会使图像变得嘈杂。另一种选择是开发具有并行成像和MOCO平均的单镜头PSIR–SSFP LGE，恢复图像分辨率（矩阵大小）和信噪比[1、7、8]，在临床实践中具有潜在的主要优势。此外，自由呼吸的CMR对患者有好处，尤其是它越不舒服，就有可能消除运动相关的伪影，而且由于消除了BH切片之间的停顿，所以获得[9]的速度更快。消除对bh语音命令的需求，对语言障碍、听力障碍或不能保持清醒的患者都有好处。MOCO-LGE的优势在6年前的一项具有里程碑意义的临床研究[2]中首次得到描述，但在这一时期，没有进一步的复制研究，只有选定的中心才能获得的有前景的研究序列未能成熟到产品序列。我们认为有必要提醒CMR社区MOCO-LGE的临床效用、效率和易用性。In consecutive patients referred for CMR in a high-throughput tertiary center, we sought to compare the clinical performance of a freshly introduced free-breathing single shot PSIR–SSFP with parallel imaging MOCO-LGE sequence against that of conventional bh segmented PSIR–fast low-angle shot (FLASH) LGE (bh-LGE).在高通量第三中心连续转诊为CMR的患者中，我们试图比较新引进的自由呼吸单发PSIR–SSFP与平行成像MOCO-LGE序列的临床表现，与传统的BH分段PSIR–快速低角射（闪光）LGE（BH LGE）序列的临床表现。
Methods
Patient population
Four hundred consecutive consenting patients underwent CMR with either bh-LGE (n = 200) or MOCO-–LGE (n = 200), and a further 11 consenting patients underwent both (to permit Fig. 1). Patients were scanned on either of two 1.5 Tesla (T) magnets with standard contrast dose at the Barts Heart Centre, London, between July 2015 and December 2015. This period was immediately after the installation of the new MOCO-LGE sequence on scanners and followed elementary radiographer training in its use. We excluded patients with conventional contraindications to CMR and those with glomerular filtration rates < 30 mL/min. All participants provided written informed consent for imaging and clinical data to be used as part of the Barts Cardiovascular Registry. Clinical and comorbidity data were extracted from local electronic patient record systems. In-patient or out-patient status at the time of CMR was ascertained per patient. A composite score to represent clinical complexity (min 0–max 15) was estimated through the assignment of 1 point for each of the following clinically relevant variables if present: age ≥ 75 years , dementia, stroke, atrial fibrillation (AF), New York Heart Association functional classes III or IV, left ventricular ejection fraction < 35%, pericardial effusion, pleural effusion, ascites, severe anemia (hemoglobin < 8 g/dL), chronic kidney disease (glomerular filtration rate < 45 mL/min /1.73 m2 or creatinine > 200 mg/dL), in-patient status, high alcohol intake ( ≥ 14 units of alcohol /week), and recreational drug use.四百名连续同意的患者接受了bh-lge（n 200）或moco-lge（n 200）的CMR，另外11名同意的患者接受了这两种方法（允许图1）。患者于2015年7月至2015年12月在伦敦巴特斯心脏中心用标准对比剂对两块1.5特斯拉（T）磁铁中的任何一块进行扫描。这段时间是在扫描仪上安装新的MOCO-LGE序列之后，随后接受了初级放射技师的使用培训。我们排除了有CMR常规禁忌症和肾小球滤过率30 ml/min的患者。所有参与者都提供了成像和临床数据的书面知情同意书，作为BATS心血管登记的一部分。从本地电子病历系统中提取临床和共病数据。每名患者在CMR时的住院或门诊状态都是确定的。通过以下临床相关变量（如存在）分配1分来评估代表临床复杂性（最小0–最大15）的综合评分：年龄≥75岁、痴呆、中风、房颤（AF）、纽约心脏协会功能三级或四级、左心室射血分数<35%，心包积液，胸腔积液，腹水，严重贫血（血红蛋白<8 g/dl），慢性肾病（肾小球滤过率<45 ml/min/1.73 m2或肌酐>200 mg/dl），住院状态，高酒精摄入（≥14单位酒精/周），和休闲药物使用。Fig. 1Example matched images from 11 selected patients who underwent both bh-LGE (top) and MOCO-LGE (bottom) showcasing the type of artifacts encountered. In the setting of arrhythmia or inability to breath hold, MOCO-LGE offers improved image quality. bh-LGE breath-held late gadolinium enhancement, MOCO motion correction
CMR protocol
All CMR scans were performed on one of two Magnetom Aera platforms (Siemens Medical Solutions, Erlangen, Germany) using an 18-channel phased-array anterior cardiac coil. The examination included standard bh segmented cine imaging with SSFP in the short axis (SAX) [10] (8 mm slice thickness with 2 mm gap) and 2-, 3-, and 4-chamber orientations. Real-time cines replaced segmented SSFP cines in patients with arrhythmias or breath-holding difficulties. LV volumes were measured as previously described [11]. The LGE protocol comprised separate 2-, 3-, and 4-chamber acquisitions, and an LV SAX stack (8 mm slice thickness with 2 mm gap) ensuring full LV coverage.所有CMR扫描均在两个磁电机AERA平台（西门子医疗解决方案公司，德国Erlangen）中的一个平台上使用18通道相控阵前心脏线圈进行。检查包括在短轴（SAX）【10】（8 mm层厚，2 mm间隙）和2腔、3腔和4腔方向上使用SSFP进行的标准BH分段电影成像。实时电影取代分段SSFP电影心律失常或屏气困难患者。如前所述测量左心室容积[11]。LGE协议包括单独的2腔、3腔和4腔采集，以及一个LV SAX堆栈（8 mm层厚，2 mm间隙），确保完全的LV覆盖。
bh-LGE
Segmented PSIR–FLASH bh-LGE (standard Siemens Product) was performed 5–10 min after a 0.1 mmol/kg intravenous bolus of gadoteric acid (Dotarem; Guerbet, France). All reconstructions were with PSIR [4]. This sequence acquires IR and proton density (PD)-weighted data every other heartbeat (every third heartbeat for faster heart rates > 90 beats /min). Typical parameters were: an adiabatic 180° inversion pulse every second R-R, field of view (FOV) ~ 360 × 270 mm, acquisition matrix ~ 256 × 138, spatial resolution ~ 1.4 × 2.1 mm (8 mm slice thickness), repetition time/echo time (TR/TE) 8.2/3.17 ms, flip angle 23°, 23 lines per acquisition window, inversion time (TI) starting at ≈ 300 ms (adjusted for nulling non-infarcted myocardium), imaging window 189 ms, pixel bandwidth 140 Hz, no parallel image acceleration. Typical bhs were 14 heartbeats in duration.在静脉注射0.1 mmol/kg的钆酸（Dotarem；Guerbet，France）后5-10 min进行分段psir-flash bh-lge（标准西门子产品）。所有重建均采用psir[4]。这个序列每隔一次心跳（每三次心跳，心率更快>90次/分钟）获取红外和质子密度（PD）加权数据。典型参数为：每秒R-R的绝热180°倒置脉冲、视场（FOV）窗口，反转时间（ti）从≈300 ms开始（调整为无梗塞心肌），成像窗口189 ms，像素带宽140 Hz，无平行图像加速。典型的心率持续时间为14次心跳。
MOCO-LGE
Single shot PSIR–SSFP free-breathing respiratory MOCO-LGE [8] (research sequence) was performed at the same post contrast delay and contrast dose and using similar typical TIs, slice thickness and FOV. The matrix and spatial resolution were however slightly higher 256 × 144 and 1.4 × 1.9 mm (8 mm slice thickness). Other parameters were TR/TE 2.8/1.18 ms, pixel bandwidth 1085 Hz, generalized autocalibrating partial parallel acquisition (GRAPPA) = 2, flip angle 50°. Each acquisition had eight repeated measurements per slice with each measurement every second R-R interval (every third for faster heart rates > 90 bpm) for a duration of 16 heartbeats (or 24 heartbeats for faster heart rates > 90 bpm). Non-rigid image registration corrected respiratory motion between repeated measurements [1, 7, 8]. The details can be found in reference [9]. The MOCO-LGE sequence is similar to the standard Siemens product (currently available on the Vida and Sola) but is implemented in the Gadgetron streaming reconstruction software framework [12] which provides on-the-fly reconstruction for increased speed. At the end of acquiring a SAX stack of slices, the complete reconstruction with MOCO averaging is completed in less than 10 s.在对比后延迟和对比剂量相同的情况下，采用相同的典型TIS、切片厚度和FOV，进行单次PSIR–SSFP自由呼吸MOCO-LGE[8]（研究序列）。然而，基质和空间分辨率略高于256__144和1.4__1.9_mm（8_mm层厚）。其他参数为Tr/Te 2.8/1.18_ms，像素带宽1085_Hz，广义自动校准部分并行采集（grappa）=2，翻转角度50°。每一次采集有8次重复测量，每一次测量每秒钟R-R间隔（每三分之一用于更快的心率>90 bpm），持续16次心跳（或24次心跳用于更快的心率>90 bpm）。非刚性图像配准校正了重复测量之间的呼吸运动[1，7，8]。详情见参考文献[9]。MOCO-LGE序列类似于标准的西门子产品（目前在VIDA和SOLA上可用），但在Gadgetron流式重建软件框架[12]中实现，该框架提供实时重建以提高速度。在获取一个SAX切片堆栈的末尾，用moco平均值完成的完整重建在不到10_s内完成。
Image quality and reader confidence analysis
Quality of bh-LGE and MOCO-LGE images was evaluated by Reader-1 (IL, cardiologist with > 3 years’ CMR experience), blinded—as far as possible—to LGE technique using cvi42 post-processing software (Version 5.1.1, Circle Cardiovascular Imaging, Inc., Calgary, Canada). We adapted an established quality scoring method [13] and assessed 10 criteria, of which the first 9 refer to the LV SAX LGE stack. Every criterion was scored from 0 (excellent) to 3 (worst) to obtain a final composite score (Table 1). The total minimum attainable score was 0 for perfect image quality, and the maximum score 31 for worst image quality. Incorrect TI was not included as both approaches offered PSIR reconstruction. Reader confidence in LGE diagnoses was measured using three well-established methods as previously described [14] and detailed in Fig. 2.BH-LGE和MOCO-LGE图像的质量由Reader-1（IL，心脏病专家，具有>3年的CMR经验）评估，使用CVI42后处理软件（加拿大卡尔加里Circle心血管成像公司5.1.1版）尽可能盲于LGE技术。我们采用了既定的质量评分方法[13]并评估了10个标准，其中前9个标准指的是LV SAX LGE堆栈。每个标准从0分（优秀）到3分（最差），得到最终的综合得分（表1）。完美图像质量的总最低可获得分数为0，最差图像质量的最大可获得分数为31。不正确的TI不包括在内，因为这两种方法都提供了PSIR重建。读者对LGE诊断的信心是使用三种成熟的方法测量的，如前所述[14]和图2所示。Table 1
LGE criterion
0
1
2
3
Max
LV coveragea
Full coverage
–
Apex not covered
Base or ≥ 1 slice missing
5
Wrap
No
1 Slice
2 Slices
≥ 3 Slices
3
Respiratory ghost (motion artefact)
No
1 Slice
2 Slices
≥ 3 Slices
3
Cardiac ghost (motion artefact)
No
1 Slice
2 Slices
≥ 3 Slices
3
Blurring/mis-trigger
No
1 Slice
2 Slices
≥ 3 Slices
3
Metallic artifacts
No
1 Slice
2 Slices
≥ 3 Slices
3
Signal loss (coil inactive)b
Activated
–
Not activated
–
2
Slice thicknessc
≤ 10 mm
11–15 mm
–
> 15 mm
3
Inter-slice gapc
< 3 mm
3–4 mm
–
> 4 mm
3
Correct LV long axisd
≥ 3
2
1
None
3
Total LGE score
31
LGE late gadolinium enhancement, LV left ventricle
aFor ‘LV coverage’, maximum (and worst) possible rating for this criterion was 5; inadequate apical coverage (2 points); inadequate basal coverage; ≥ 1 additional slice(s) missing (3 points)
bIf relevant coils had not been activated resulting in signal loss, 2 points were given, otherwise 0
cSlice thickness and slice gap were fixed for our protocols so all study patients scored 0 for this criterion
dFor ‘Correct long axis’ 3 points were given if all long axis slices were missing (4-, 3-, and 2-chamber), 2 points if 2 long axis images were missing, 1 point if 1 long axis was missing
Fig. 2Reader confidence estimation methods used in this study. a Basic analytic method: C0 and C1 denote pre- and post-test confidence on a 0% to 100% scale, irrespective of whether the pre- and post-test diagnosis matched or not. b Retained diagnosis method: removes from consideration cases in which the post-test diagnosis differs from the pretest diagnosis and only considers reads with unchanged (or “retained”) diagnoses and ci–iii Omary method: considers all cases and estimates C1 minus C0 except for the situation where diagnoses differ and C0 is < 50%, in which case C1 is calculated as: C1 − (100 – C0)
Scan timings
Acquisition times for LGE imaging were semi-automatically derived from the digital imaging and communications in medicine (DICOM) time stamps on the first and last image of each module using an in-house Matlab (Mathworks, Natick, US) script.使用内部matlab（mathworks，natick，us）脚本，从每个模块的第一个和最后一个图像上的数字成像和医学通信（DICOM）时间戳半自动得出LGE成像的采集时间。
LGE reporting
Prior to commencing review of an LGE dataset, Reader-1 reviewed the CMR referral letter and clinical details in the electronic health record, and predicted the likelihood of finding pathological LGE as well as the pretest confidence in the ensuing LGE diagnosis (0–100%). Next, the LGE data was reported (as presence/absence of LGE ± pattern, Fig. 3) and a post-test confidence (0–100%) for this LGE ruling provided. To determine inter-rater reproducibility of LGE reports, the entire analysis (n = 400) was repeated by a blinded Reader-2 (VC) with equivalent CMR experience.在开始审查LGE数据集之前，reader-1审查了电子健康记录中的CMR转介信和临床细节，并预测了发现病理性LGE的可能性以及对随后的LGE诊断的预测试信心（0-100%）。接下来，报告了LGE数据（如存在/不存在LGE模式，图3），并提供了该LGE裁定的测试后置信度（0–100%）。为了确定LGE报告的内部再现性，盲读卡器2（VC）重复了整个分析（n=400），具有同等CMR经验。Fig. 3Example MOCO-LGE images illustrating the variety of LGE patterns observed in the sampled cohort. a Subendocardial chronic myocardial infarction, b transmural chronic myocardial infarction, c mid-wall enhancement in patient with dilated cardiomyopathy, d basal lateral wall subepicardial enhancement in a patient with previous myocarditis, e patchy anteroseptal scar in a patient with hypertrophic cardiomyopathy and f trace of superior and inferior right ventricular insertion points. Other abbreviations as in Fig. 1
Statistical analysis
Statistical analysis was performed in R (version 3.0.1, The R Foundation for Statistical Computing). Descriptive data are expressed as mean ± standard deviation except where otherwise stated. Distribution of data was assessed on histograms and using Shapiro–Wilk test. Categorical variables were compared using χ2 or Fisher’s exact tests. Continuous variables were compared using unpaired Student’s t-test. Inter-rater agreement of LGE reports was calculated using the Cohen’s kappa statistic. A two-sided P value < 0.05 was considered significant.统计分析在R（版本3.0.1，R统计计算基础）中进行。除非另有说明，否则描述性数据表示为平均±标准偏差。数据分布通过柱状图和夏皮罗-威尔克检验进行评估。分类变量采用χ2或Fisher精确检验进行比较。使用未配对学生t检验比较连续变量。使用Cohen的Kappa统计数据计算了LGE报告的评级机构间一致性。双侧p值<0.05被认为是显著的。
Results
Patient characteristics
Clinical and demographic characteristics of patients are summarized in Table 2. One-hundred and thirty three patients (33%) were clinically complex. Bh-LGE and MOCO-LGE populations were similar across most clinicodemographic characteristics including their burden of AF/flutter (16% vs 22%, P = 0.368), except that patients imaged by MOCO-LGE were slightly older, with lower ejection fractions, and more clinically complex (scores for bh-LGE and MOCO-LGE groups: 0.41 ± 0.84 vs 0.72 ± 1.15, respectively, P = 0.003).表2总结了患者的临床和人口统计学特征。一百三十三名患者（33%）临床表现复杂。bh-lge和moco-lge人群在大多数临床影像学特征上相似，包括他们的房颤/颤振负担（16%对22%，P=0.368），但moco-lge成像的患者年龄稍大，射血分数较低，临床复杂度较高（bh-lge和moco-lge组得分：0.41 0.84对0.72）。1.15，分别为p=0.003）。Table 2
Variable
MOCO-LGE (n = 200)
bh-LGE (n = 200)
P Value
Demographics
Female (%)
85 (43)
72 (36)
0.219
Age (y)
55 ± 16
50 ± 15
0.001
Ethnicity
White (%)
120 (60)
108 (54)
0.543
Black (%)
16 (8)
36 (18)
0.096
Mixed/multiple (%)
2 (1)
4 (2)
0.622
Asian, Asian British (%)
46 (23)
40 (20)
0.698
Other
16 (8)
12 (6)
0.698
Clinical characteristics
Body mass index (kg/m2)
29 ± 6
28 ± 6
0.096
Diabetes mellitus (%)
50 (25)
40 (20)
0.434
Hypertension (%)
138 (69)
112 (56)
0. 032
Dyslipidaemia
102 (51)
82 (41)
0.120
Current cigarette smoking
102 (51)
70 (35)
0.113
History of atrial fibrillation or flutter
44 (22)
32 (16)
0.368
Inpatient status
20 (10)
12 (6)
0.183
Prior coronary revascularization
30 (15)
32 (16)
0.887
Acute myocardial infarction
4 (2)
8 (4)
0.503
Prior myocardial infarction
60 (30)
48 (24)
0.342
Clinical complexity score
0.72 ± 1.15
0.41 ± 0.84
0.003
Laboratory characteristics
Creatinine (mg/dL)
84 ± 29
85 ± 31
0.739
Glomerular filtration rate (mL/min/1.73 m2)
86 ± 26
85 ± 25
0.695
Clinical indication for CMR
Known or suspected cardiomyopathy
41 (21)
54 (27)
0.580
Possible CAD/stress perfusion
106 (53)
95 (48)
0.317
Myocarditis (new or follow up)
9 (5)
14 (7)
0.389
Evaluation for arrhythmia substrate
11 (6)
8 (4)
0.639
Family screening
5 (2)
3 (1)
0.723
Adult congenital heart disease
4 (2)
7 (3)
0.543
Mass or thrombus
3 (1)
2 (1)
1.000
Other
21 (10)
17 (9)
0.610
Data reported as mean ± standard deviation, counts (%) or median (interquartile ranges 1–3). Other abbreviations as in Table 1
Significant P values highlighted in bold
bh breath-held, MI myocardial infarction, MOCO motion-corrected, CAD coronary artery disease, CMR cardiovascular magnetic resonance, y years
Global scan protocol evaluation
Eight (4%) and 6 (3%) patients from the bh-LGE and MOCO-LGE groups respectively received realtime cines corroborating the slightly higher complexity of the MOCO-LGE cohort. There were no other systematic differences in acquisition (e.g. the LV SAX cine stack acquisitions were similar: bh-LGE 03:47 ± 01:21 min vs. MOCO-LGE 03:58 ± 01:40 min, P = 0.227), Table 3).来自bh-lge组和moco-lge组的8名（4%）和6名（3%）患者分别接受实时电影，证实moco-lge组的复杂性稍高。在采集方面没有其他系统性差异（例如，左心室SAX电影堆栈采集相似：bh lge 03:47±01:21 min vs.moco-lge 03:58±01:40 min，p=0.227），表3）。全文超过5万字符微信字数限制无法显示全文扫描左侧二维码查看全文
Motion-corrected free-breathing LGE delivers high quality imaging and reduces scan time by half: an independent validation study
Int J Cardiovasc Imaging Original Paper Early Recent, May 18, 2019 10.1007/s10554-019-01620-x
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