Accuracy of ECV imaging for the detection of subendocardial infarction - comparison with black blood delayed enhancement and pathology

Background Delineation of diseased and normal tissue is fundamental to identifying cardiac pathology. Studies suggest that parametric extracellular volume fraction (ECV) imaging is superior to conventional delayed enhancement for detection of diffuse, global myocardial disease. Conversely, the sensitivity of ECV for the detection of focal disorders is unclear. This may be important for subendocardial disease since the standard methodology for ECV requires that “regions of interest.. have adequate margins of separation from tissue interfaces prone to partial volume averaging such as between myocardium and blood” [1]. We have developed a new, Flow-Independent Dark-blood DeLayed Enhancement technique (FIDDLE) that increases the conspicuity of subendocardial hyperenhancement, by making the blood pool black [2]. In this study, we compared ECV and FIDDLE for the detection of subendocardial infarction as verified by pathology.