Highly effective fat suppression in clinical T1-weighted imaging of ischemic and non-ischemic heart disease with DeSPAIR

Complete fat suppression is highly desirable for inversion recovery (IR) imaging of both ischemic and nonischemic heart disease. It allows for improved visualization of scar without confounding fat signal, and for assessment of fatty infiltrations, which both appear bright on T1-weighted contrast-enhanced images. For example, arrhythmogenic right ventricular dysplasia (ARVD) is characterized by fibrofatty replacement of the right ventricular (RV) myocardium. Screening tests are critical as patients may be asymptomatic, but at increased risk for sudden cardiac death. Such tests must differentiate myocardial fibrosis from fatty infiltrations, as fatty infiltrations without RV fibrosis have been observed in healthy subjects. Standard fat saturation works poorly in clinical protocols, prompting us to design a double Spectral Selection Attenuated Inversion Recovery (double SPAIR, DeSPAIR) module that completely nulls fat signal in IR sequences. In 22 patients with ischemic and non-ischemic heart disease, we demonstrate excellent performance of this technique compared to standard fat saturation.