Purpose/ Objective

Bright-blood late gadolinium enhancement (LGE) MRI has been considered the reference standard in the non-invasive assessment of myocardial viability for almost two decades now. Its ability to clearly depict areas of myocardial infarction from viable myocardium is well established, making LGE a widely accepted component of standard clinical CMR protocols. By nulling the magnetization level of viable myocardium, its dark appearance can easily be distinguished from the bright appearance of scar tissue. However, as the adjacent LV blood pool can have similar T1 values at 10 min post-injection with almost equally bright signal, the border between scar and blood can be difficult to delineate. In particular patients with thin subendocardial scarring patterns in this border zone are susceptible to this limitation, where the apparent volume of scar tissue can be significantly reduced, or even completely obscured. Furthermore, blood pool signal can mimic scar tissue and lead to false positive observations. This makes subendocardial scar patterns difficult to detect and clearly delineate using conventional bright-blood LGE. Various novel LGE methods have been proposed, using additional magnetization preparation schemes to improve scar-to-blood contrast and thus subendocardial scar visibility. However, these methods are often not widely available and require software/scanner adjustments, extensive optimizations, and/or additional training. Following this activity, learns will understand how to perform the proposed dark-blood LGE approach without additional magnetization preparation. And taht this can be done by adjusting your standard LGE sequence as follows: Perform a Look-Locker / TI scout with a 2 heartbeat interval (if not already used); Find the inversion time where LV blood pool is nulled instead of myocardium; Set this inversion time in the LGE sequence; Enable phase-sensitive inversion-recovery (PSIR) for the LGE sequence (if not already used); and After scanning, use PSIR image for analysis

Accreditation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit (s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Instructions for Claiming CME

• Attend the sessions in full for which credit is sought
• Complete the post-activity evaluation
• A certificate of completion will be available once the evaluation is submitted

Financial Disclosures
The planners and faculty for this activity did not have any relationships to disclose.

Disclosure of Commercial Support
SCMR received funding to support this activity from the following organizations:

Bibliography
Please see the bibliography at the end of the journal article.