High-resolution cardiac MRI may detect myocardial injuries after COVID-19 infection: Study
France: An accelerated HR-LGE technique can help diagnose COVID-related myocardial injuries, a recent study has found. According to the study, published in the European Journal of Radiology, undersampled free-breathing isotropic HR-LGE versus the conventional breath-held LR-LGE detected additional areas of late enhancement.
"The method allows for detailed characterization of myocardial injuries in acceptable scan times among patients with a history of COVID-19 infection without the need for repeated breath holds," the researchers wrote.
Late gadolinium enhancement (LGE) is a standard tool in cardiac MRI, widely used for diagnosing various myocardial diseases, primarily by detecting injured areas in the heart muscle. For instance, LGE can diagnose heart attacks. Previous studies have shown high-resolution free-breathing late gadolinium enhancement (HR-LGE) to be valuable for the diagnosis of acute coronary syndromes with non-obstructed coronary arteries. This implies that the method might be useful for detecting COVID-related myocardial injuries but is hampered by prolonged acquisition times.
Against the above background, Aurélien Bustin, Groupe Hospitalier Sud, CHU Bordeaux, Pessac, France, and colleagues aimed to introduce an accelerated HR-LGE technique for the diagnosis of COVID-related myocardial injuries.
To work towards their goal, Bustin and the team developed an undersampled navigator-gated HR-LGE (acquired resolution of 1.25mm3) sequence combined with advanced patch-based low-rank reconstruction and validated it in a phantom and in 23 patients with structural heart disease (test cohort; 15 men; 55±16 years).
Twenty patients with laboratory-confirmed COVID-19 infection associated with troponin rise (COVID cohort; 15 men; 46±24 years) prospectively underwent cardiovascular magnetic resonance (CMR) with the proposed sequence. Image sharpness, quality, signal intensity differences, and diagnostic value of free-breathing HR-LGE were compared against conventional breath-held low-resolution LGE (LR-LGE, voxel size 1.8x1.4x6mm).
The research yielded the following findings:
· Structures sharpness in the phantom showed no differences with the fully sampled image up to an undersampling factor of x3.8.
· In patients (N=43), this acceleration allowed for acquisition times of 7min21s±1min12s at 1.25mm3 resolution.
· Compared with LR-LGE, HR-LGE showed higher image quality and comparable signal intensity differences.
· In patients with structural heart disease, all LGE-positive segments on LR-LGE were also detected on HR-LGE (80/391) with 21 additional enhanced segments visible only on HR-LGE (101/391).
· In 4 patients with COVID-19 history, HR-LGE was definitely positive while LR-LGE was either definitely negative (1 microinfarction and 1 myocarditis) or inconclusive (2 myocarditis).
The researchers concluded, "In patients with a history of COVID-19 infection associated with troponin rise, the method allows for detailed characterization of myocardial injuries in acceptable scan times and without the need for repeated breath holds."
Reference:
The study titled, "High-resolution Free-breathing Late Gadolinium Enhancement Cardiovascular Magnetic Resonance to Diagnose Myocardial Injuries Following COVID-19 Infection," is published in the European Journal of Radiology.
DOI: https://www.ejradiology.com/article/S0720-048X(21)00441-1/fulltext
