{
  "abstract": "Coronary artery disease is the leading cause of death worldwide and it is well demonstrated that even small regions of myocardial infarction are associated with large increases in major adverse cardiac events. Furthermore, regional functional recovery following revascularisation is shown to be highly dependent on infarct transmurality, and so in these patients, accurate detection and quantification of scar is essential.Late gadolinium enhancement cardiovascular magnetic resonance imaging is the gold standard for identifying and quantifying myocardial scar and fibrosis with conventional ‘bright-blood’ inversion recovery sequence being the most widely used approach. There are limitations with this sequence however, as scar can be difficult to accurately delineate from the adjacent high signal blood pool, potentially leading to under/overestimation or even total obscuration of scar.Holtackers et al proposed a novel dark-blood approach without using any additional magnetization preparation mechanism and without the need for scanner software adjustments or additional training.At our institution, this novel dark blood late gadolinium enhancement sequence was introduced on a 1.5 T Siemens scanner as part of the standard viability protocol. This paper presents a series of cases illustrating the value of this technique in practice, including improved detection and quantification of subtle subendocardial scar and its importance in identifying papillary muscle infarction. These examples demonstrate how black-blood imaging can increase diagnostic confidence and complement conventional bright-blood late gadolinium sequences in cardiac viability assessment (figures 1–3). What is the main rationale for implementing a dark-blood late gadolinium enhancement (LGE) sequence?A. To reduce scan time during routine CMR viability assessment.B. To improve detection and delineation of subtle myocardial scar, particularly subendocardial infarction.C. To eliminate the need for gadolinium contrast administration.D. To replace cine imaging for assessment of ventricular function.E. To allow imaging at 3T only.Abstract 8 Figure 3Mid LV 2D short axis spot images bright-blood (left) & dark-blood (right); showing subendocardial infarct along the mid inferior segment, better visualized on dark-blood imaging(right)Abstract 8 Figure 2Basal and Mid LV 2D short axis spot images bright-blood (left) & dark-blood (right); showing very small focal infarct seen along the basal anterolateral segment, only well visualized on dark-blood imaging (top right). In addition, focal infarct of anterolateral papillary muscles is seen in the mid LV sections, best seen on dark-blood imaging (bottom right)Abstract 8 Figure 1Basal LV 2D short axis spot images bright-blood(left) & dark-blood (right) showing wall thinning and transmural infarct along the lateral segments. However, subendocardial enhancement is noted along the basal septal wall, only well appreciated on dark-blood sequence(right)Correct Answer: B.",
  "authors": [
    {
      "affiliations": [
        "Radiology Department, Royal Stoke University Hospital"
      ],
      "name": "Lucy Cosbey"
    },
    {
      "affiliations": [
        "Radiology Department, Royal Stoke University Hospital"
      ],
      "name": "Tooba Kareem"
    },
    {
      "affiliations": [
        "Cardiology Department, Royal Stoke University Hospital"
      ],
      "name": "Anikethana Appaji"
    },
    {
      "affiliations": [
        "Radiology Department, Royal Stoke University Hospital"
      ],
      "name": "Samavia Raza"
    }
  ],
  "title": "8 Improved detection of sub-endocardial infarction with dark-blood LGE: early experiences at our institution",
  "uid": "882a97dd-f036-5978-b66e-7378c2841832"
}