Wideband black- and bright-blood late gadolinium enhancement imaging in patients with implantable cardiac devices at 1.5T for improved visualization and localization of myocardial injury

Abstract Aims Late gadolinium enhancement (LGE) imaging in patients with implantable cardiac devices is often degraded by device-related artefacts. Wideband phase-sensitive inversion-recovery (PSIR) mitigates these artefacts but suffers from low scar-blood contrast, limiting detection of subendocardial and small focal scars. Therefore, a novel wideband SPOT sequence combining co-registered wideband black- and bright-blood LGE to improve scar-blood contrast and localization, with wideband inversion recovery and wideband T2 preparation for artefact reduction, was implemented at 1.5T. Methods and Results Wideband SPOT was compared with wideband PSIR, conventional PSIR and conventional SPOT in an animal and 18 patients with devices and known myocardial lesions. Patient analyses included qualitative assessment of image quality, artefact severity, diagnostic confidence, and LGE segment detection; quantitative measurements of left ventricular (LV) volume, scar volume, and scar size; agreement analysis between wideband SPOT and wideband PSIR; and reproducibility analysis. In the animal, wideband SPOT reduced device-related artefacts and enabled accurate scar localization consistent with histology. In patients, wideband SPOT and wideband PSIR yielded similar image and artefact reduction (P>0.05), but wideband SPOT reduced diagnostic uncertainty by 24% (P=0.080). Inter-observer agreement for qualitative scores was moderate to good (ICC 0.54–0.83, P<0.001). Quantitative LV and scar measurements demonstrated excellent correlation (r>0.9, P<0.01) and good-to-excellent reproducibility (ICC 0.85–0.98, P<0.001) between techniques. Conclusion Compared with wideband PSIR, wideband SPOT showed a trend toward enhanced scar detection, identifying additional scarred segments while maintaining similar overall scar burden. It also improved inter-observer agreement, preserved anatomical reference, and reduced device artefacts, which may improve diagnostic confidence and risk stratification.