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DOI: 10.1148/radiol.2321030688
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(Radiology 2004;232:38-48.)
© RSNA, 2004

Cardiac Imaging

Arrhythmogenic Right Ventricular Dysplasia: Ex Vivo and in Vivo Fat Detection with Black-Blood MR Imaging1

Ernesto Castillo, MD, Harikrishna Tandri, MD, E. Rene Rodriguez, MD, Khurram Nasir, MD, Julie Rutberg, MS, Hugh Calkins, MD, João A. C. Lima, MD and David A. Bluemke, MD, PhD

1 From the Russell H. Morgan Dept of Radiology and Radiological Sciences (E.C., D.A.B.); Dept of Medicine, Div of Cardiology (H.T., K.N., J.R., H.C, J.A.C.L.); and Dept of Pathology (E.R.R), Johns Hopkins Univ School of Medicine, 600 N Wolfe St, MRI-143 Nelson Basement, Baltimore, MD 21287. Received May 19, 2003; revision requested July 31; revision received Oct 17; accepted Nov 25. The Johns Hopkins ARVD program is funded by a private grant from the Bogle Foundation. This study was supported in part by NIH research grant no. 1 UO1 HL65594–01A1. E.C. was supported by a research grant from the Fundación Ramón Areces, Madrid, Spain. Address correspondence to D.A.B (e-mail: dbluemke@jhmi.edu).

PURPOSE: To assess electrocardiographically gated spin-echo (SE) and double inversion-recovery fast SE magnetic resonance (MR) imaging in the depiction of intramyocardial fat in cadaveric heart specimens and patients with arrhythmogenic right ventricular dysplasia (ARVD).

MATERIALS AND METHODS: A phantom was used to determine the effective in-plane spatial resolution of SE and fast SE MR imaging protocols. Two cadavers with proved ARVD were imaged with identical sequences with spectrally selected fat suppression. Contrast-to-noise ratios (CNRs) of intramyocardial fat in the right ventricle (RV) were compared by using analysis of variance and Student t test with Bonferroni correction. Eleven patients with ARVD and 10 control subjects underwent fast SE MR imaging. Two blinded readers semiquantitatively evaluated images for fat conspicuity and image quality.

RESULTS: Fast SE MR imaging achieved better spatial resolution but lower CNR than that of gated SE imaging. CNRs in cadaveric specimens were higher for double R-R than for single R-R fast SE sequences for all section thicknesses (P < .0001). Absolute CNR values were higher for fat-suppressed fast SE sequences than for those without fat suppression. Cadaveric specimens demonstrated fatty infiltration from epicardium toward endocardium of the RV free wall. Intramyocardial fat was detected in eight of 11 (73%) patients with ARVD and in no control subjects (P < .001).

CONCLUSION: Intramyocardial fat detection in ARVD was better with fast SE MR imaging alone and combined with fat suppression than was gated SE MR imaging. When fast SE imaging is applied in vivo, however, breath-holding constraints limit the spatial resolution for RV fat detection.

© RSNA, 2004

Index terms: Arrhythmogenic right ventricular dysplasia, 523.1935, 523.86 • Heart, cardiomyopathy, 523.1935, 523.86 • Myocardium, MR, 511.121411, 511.121413, 523.121415 • Test objects




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