Late Gadolinium Enhancement Cardiac Magnetic Resonance Imaging: From Basic Concepts to Emerging Methods

Abstract

Background Late gadolinium enhancement (LGE) is a widely used cardiac magnetic resonance imaging (MRI) technique to diagnose a broad range of ischemic and non-ischemic cardiomyopathies. Since its development and validation against histology already more than two decades ago, the clinical utility of LGE and its span of applications have increased considerably.

Methods In this review we will present the basic concepts of LGE imaging and its diagnostic and prognostic value, elaborate on recent developments and emerging methods, and finally discuss future prospects.

Results Continuous developments in 3 D imaging methods, motion correction techniques, water/fat-separated imaging, dark-blood methods, and scar quantification improved the performance and further expanded the clinical utility of LGE imaging.

Conclusion LGE imaging is the current noninvasive reference standard for the assessment of myocardial viability. Improvements in spatial resolution, scar-to-blood contrast, and water/fat-separated imaging further strengthened its position.

Key Points: 

• LGE MRI is the reference standard for the noninvasive assessment of myocardial viability

• LGE MRI is used to diagnose a broad range of non-ischemic cardiomyopathies in everyday clinical practice.

• Improvements in spatial resolution and scar-to-blood contrast further strengthened its position

• Continuous developments improve its performance and further expand its clinical utility

Citation Format

• Holtackers RJ, Emrich T, Botnar RM et al. Late Gadolinium Enhancement Cardiac Magnetic Resonance Imaging: From Basic Concepts to Emerging Methods. Fortschr Röntgenstr 2022; 194: 491 – 504

Zusammenfassung

Hintergrund Das Late-Gadolinium-Enhancement (LGE) ist eine weit verbreitete Methode in der kardialen Magnetresonanztomografie (MRT) um ein breites Spektrum an ischämischen und nicht-ischämischen Kardiomyopathien zu diagnostizieren. Die klinische Anwendung und Nutzen haben sich seit der Entwicklung und histologischen Validierung des LGE vor mehr als zwei Jahrzehnten erheblich gesteigert.

Methoden In dieser Übersichtsarbeit wird das Grundprinzip der LGE-Bildgebung und der diagnostische und prognostische Wert vorgestellt, aktuelle Entwicklungen und neue Methoden erläutert und Zukunftsperspektiven diskutiert.

Ergebnisse Kontinuierliche Weiterentwicklungen bei 3D-Bildgebungsmethoden, Bewegungskorrekturtechniken, wasser-/ fettgetrennter Bildgebung, Dark-Blood-Methoden und Narbenquantifizierung haben die Leistung und den klinischen Nutzen der LGE-Bildgebung weiter verbessert.

Schlussfolgerung Die LGE-Bildgebung ist der aktuelle nichtinvasive Referenzstandard für die Beurteilung der Myokardvitalität. Verbesserungen bei der räumlichen Auflösung, dem Narben-Blut-Kontrast und der wasser-/fettgetrennten Bildgebung haben diese Position weiter gestärkt.

Kernaussagen:

• LGE-MRT ist der Referenzstandard für die nichtinvasive Beurteilung der Myokardvitalität.

• Das LGE wird in der täglichen klinischen Praxis zur Diagnose eines breiten Spektrums nicht-ischämischer Kardiomyopathien eingesetzt.

• Verbesserungen der räumlichen Auflösung und des Narben- Blut-Kontrastes haben diese Position weiter gestärkt.

• Kontinuierliche Weiterentwicklungen verbessern die Leistung und erweitern den klinischen Nutzen.

Key words

cardiac - heart - tissue characterization - MR imaging

Publication History

Received: 14 October 2021

Accepted: 21 November 2021

Article published online:
23 February 2022

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