Inappropriate inversion time selection for late gadolinium enhancement imaging. Bonekamp, D. & Zimmerman, S. L. In Fishman, E. K. & Zimmerman, S. L., editors, Pearls and Pitfalls in Cardiovascular Imaging: Pseudolesions, Artifacts, and Other Difficult Diagnoses, pages 146–149. Cambridge University Press, Cambridge, 2015. ![Inappropriate inversion time selection for late gadolinium enhancement imaging [link]](https://bibbase.org/img/filetypes/link.svg "link")
Paper doi abstract bibtex Imaging descriptionInappropriate selection of the inversion time (TI) in late gadolinium enhancement (LGE) cardiac MRI (CMR) examinations results in incomplete suppression of the myocardium. Most frequently encountered is the selection of a TI that is slightly too short, resulting in a subendocardial “ring of hypointensity” and a mid-myocardial zone of hyperintensity (Figures 47.1 and 47.2). These artifacts may mimic true mid-myocardial delayed enhancement that can be seen in pathologic conditions such as sarcoidosis or dilated cardiomyopathy (Figure 47.3). In a less commonly encountered clinical scenario, suppression of abnormal myocardium (amyloidosis is the prototypical example) will cause hypointensity of abnormal myocardium. This will result in the poor quality of delayed enhancement images that is a hallmark of patients with amyloidosis (Figure 47.4).ImportanceTwo potential pitfalls result from incorrect inversion time selection. First, incorrect nulling of the myocardium reduces the conspicuity of true myocardial delayed enhancement, potentially hiding underlying pathology, resulting in a falsenegative result. Second, incomplete nulling due to a short inversion time, if not recognized as artifact, can be erroneously interpreted as diffuse mid-myocardial LGE, leading to a falsepositive result. The interpreting radiologist must be familiar with the appearance of deviations of the TI selection, and be aware of underlying conditions, particularly amyloidosis, that can cause difficulty in selecting the correct TI time.Typical clinical scenarioTI is selected to provide maximal contrast between normal and abnormal myocardium by completely nulling any signal from normal myocardium. TI selection determines the sensitivity for the detection of myocardial damage. The actual TI time needed for normal myocardial suppression depends on multiple factors, including the time after contrast injection, renal elimination of contrast, patient size, cardiac output, contrast dose and contrast agent. A typical approach for TI selection is the use of a “TI scout” sequence, which is typically an ECG-gated post-contrast sequence with images acquired at multiple delay times after an initial 180 degree inversion pulse, resulting in different TI contrasts throughout the cardiac cycle.
@incollection{fishman_inappropriate_2015,
address = {Cambridge},
title = {Inappropriate inversion time selection for late gadolinium enhancement imaging},
isbn = {978-1-107-02372-7},
url = {https://www.cambridge.org/core/books/pearls-and-pitfalls-in-cardiovascular-imaging/inappropriate-inversion-time-selection-for-late-gadolinium-enhancement-imaging/BFD7916567C90706D4A4036789E9F361},
abstract = {Imaging descriptionInappropriate selection of the inversion time (TI) in late gadolinium enhancement (LGE) cardiac MRI (CMR) examinations results in incomplete suppression of the myocardium. Most frequently encountered is the selection of a TI that is slightly too short, resulting in a subendocardial “ring of hypointensity” and a mid-myocardial zone of hyperintensity (Figures 47.1 and 47.2). These artifacts may mimic true mid-myocardial delayed enhancement that can be seen in pathologic conditions such as sarcoidosis or dilated cardiomyopathy (Figure 47.3). In a less commonly encountered clinical scenario, suppression of abnormal myocardium (amyloidosis is the prototypical example) will cause hypointensity of abnormal myocardium. This will result in the poor quality of delayed enhancement images that is a hallmark of patients with amyloidosis (Figure 47.4).ImportanceTwo potential pitfalls result from incorrect inversion time selection. First, incorrect nulling of the myocardium reduces the conspicuity of true myocardial delayed enhancement, potentially hiding underlying pathology, resulting in a falsenegative result. Second, incomplete nulling due to a short inversion time, if not recognized as artifact, can be erroneously interpreted as diffuse mid-myocardial LGE, leading to a falsepositive result. The interpreting radiologist must be familiar with the appearance of deviations of the TI selection, and be aware of underlying conditions, particularly amyloidosis, that can cause difficulty in selecting the correct TI time.Typical clinical scenarioTI is selected to provide maximal contrast between normal and abnormal myocardium by completely nulling any signal from normal myocardium. TI selection determines the sensitivity for the detection of myocardial damage. The actual TI time needed for normal myocardial suppression depends on multiple factors, including the time after contrast injection, renal elimination of contrast, patient size, cardiac output, contrast dose and contrast agent. A typical approach for TI selection is the use of a “TI scout” sequence, which is typically an ECG-gated post-contrast sequence with images acquired at multiple delay times after an initial 180 degree inversion pulse, resulting in different TI contrasts throughout the cardiac cycle.},
urldate = {2021-06-18},
booktitle = {Pearls and {Pitfalls} in {Cardiovascular} {Imaging}: {Pseudolesions}, {Artifacts}, and {Other} {Difficult} {Diagnoses}},
publisher = {Cambridge University Press},
author = {Bonekamp, David and Zimmerman, Stefan L.},
editor = {Fishman, Elliot K. and Zimmerman, Stefan L.},
year = {2015},
doi = {10.1017/CBO9781139152228.048},
pages = {146--149},
}
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These artifacts may mimic true mid-myocardial delayed enhancement that can be seen in pathologic conditions such as sarcoidosis or dilated cardiomyopathy (Figure 47.3). In a less commonly encountered clinical scenario, suppression of abnormal myocardium (amyloidosis is the prototypical example) will cause hypointensity of abnormal myocardium. This will result in the poor quality of delayed enhancement images that is a hallmark of patients with amyloidosis (Figure 47.4).ImportanceTwo potential pitfalls result from incorrect inversion time selection. First, incorrect nulling of the myocardium reduces the conspicuity of true myocardial delayed enhancement, potentially hiding underlying pathology, resulting in a falsenegative result. Second, incomplete nulling due to a short inversion time, if not recognized as artifact, can be erroneously interpreted as diffuse mid-myocardial LGE, leading to a falsepositive result. The interpreting radiologist must be familiar with the appearance of deviations of the TI selection, and be aware of underlying conditions, particularly amyloidosis, that can cause difficulty in selecting the correct TI time.Typical clinical scenarioTI is selected to provide maximal contrast between normal and abnormal myocardium by completely nulling any signal from normal myocardium. TI selection determines the sensitivity for the detection of myocardial damage. The actual TI time needed for normal myocardial suppression depends on multiple factors, including the time after contrast injection, renal elimination of contrast, patient size, cardiac output, contrast dose and contrast agent. A typical approach for TI selection is the use of a “TI scout” sequence, which is typically an ECG-gated post-contrast sequence with images acquired at multiple delay times after an initial 180 degree inversion pulse, resulting in different TI contrasts throughout the cardiac cycle.","urldate":"2021-06-18","booktitle":"Pearls and Pitfalls in Cardiovascular Imaging: Pseudolesions, Artifacts, and Other Difficult Diagnoses","publisher":"Cambridge University Press","author":[{"propositions":[],"lastnames":["Bonekamp"],"firstnames":["David"],"suffixes":[]},{"propositions":[],"lastnames":["Zimmerman"],"firstnames":["Stefan","L."],"suffixes":[]}],"editor":[{"propositions":[],"lastnames":["Fishman"],"firstnames":["Elliot","K."],"suffixes":[]},{"propositions":[],"lastnames":["Zimmerman"],"firstnames":["Stefan","L."],"suffixes":[]}],"year":"2015","doi":"10.1017/CBO9781139152228.048","pages":"146–149","bibtex":"@incollection{fishman_inappropriate_2015,\n\taddress = {Cambridge},\n\ttitle = {Inappropriate inversion time selection for late gadolinium enhancement imaging},\n\tisbn = {978-1-107-02372-7},\n\turl = {https://www.cambridge.org/core/books/pearls-and-pitfalls-in-cardiovascular-imaging/inappropriate-inversion-time-selection-for-late-gadolinium-enhancement-imaging/BFD7916567C90706D4A4036789E9F361},\n\tabstract = {Imaging descriptionInappropriate selection of the inversion time (TI) in late gadolinium enhancement (LGE) cardiac MRI (CMR) examinations results in incomplete suppression of the myocardium. Most frequently encountered is the selection of a TI that is slightly too short, resulting in a subendocardial “ring of hypointensity” and a mid-myocardial zone of hyperintensity (Figures 47.1 and 47.2). These artifacts may mimic true mid-myocardial delayed enhancement that can be seen in pathologic conditions such as sarcoidosis or dilated cardiomyopathy (Figure 47.3). In a less commonly encountered clinical scenario, suppression of abnormal myocardium (amyloidosis is the prototypical example) will cause hypointensity of abnormal myocardium. This will result in the poor quality of delayed enhancement images that is a hallmark of patients with amyloidosis (Figure 47.4).ImportanceTwo potential pitfalls result from incorrect inversion time selection. First, incorrect nulling of the myocardium reduces the conspicuity of true myocardial delayed enhancement, potentially hiding underlying pathology, resulting in a falsenegative result. Second, incomplete nulling due to a short inversion time, if not recognized as artifact, can be erroneously interpreted as diffuse mid-myocardial LGE, leading to a falsepositive result. The interpreting radiologist must be familiar with the appearance of deviations of the TI selection, and be aware of underlying conditions, particularly amyloidosis, that can cause difficulty in selecting the correct TI time.Typical clinical scenarioTI is selected to provide maximal contrast between normal and abnormal myocardium by completely nulling any signal from normal myocardium. TI selection determines the sensitivity for the detection of myocardial damage. The actual TI time needed for normal myocardial suppression depends on multiple factors, including the time after contrast injection, renal elimination of contrast, patient size, cardiac output, contrast dose and contrast agent. A typical approach for TI selection is the use of a “TI scout” sequence, which is typically an ECG-gated post-contrast sequence with images acquired at multiple delay times after an initial 180 degree inversion pulse, resulting in different TI contrasts throughout the cardiac cycle.},\n\turldate = {2021-06-18},\n\tbooktitle = {Pearls and {Pitfalls} in {Cardiovascular} {Imaging}: {Pseudolesions}, {Artifacts}, and {Other} {Difficult} {Diagnoses}},\n\tpublisher = {Cambridge University Press},\n\tauthor = {Bonekamp, David and Zimmerman, Stefan L.},\n\teditor = {Fishman, Elliot K. and Zimmerman, Stefan L.},\n\tyear = {2015},\n\tdoi = {10.1017/CBO9781139152228.048},\n\tpages = {146--149},\n}\n\n","author_short":["Bonekamp, D.","Zimmerman, S. L."],"editor_short":["Fishman, E. K.","Zimmerman, S. 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