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. 2018 Nov;29(11):1556-1562.
doi: 10.1111/jce.13709. Epub 2018 Sep 25.

Acute noncontrast T1-weighted magnetic resonance imaging predicts chronic radiofrequency ablation lesions

Eugene G Kholmovski  1   2 , Josh Silvernagel  3   4 , Nathan Angel  3   4 , Sathya Vijayakumar  1   2 , Samuel Thomas  5 , Derek Dosdall  3   6   7 , Rob MacLeod  3   7 , Nassir F Marrouche  1   4 , Ravi Ranjan  3   4   7
Affiliations

Acute noncontrast T1-weighted magnetic resonance imaging predicts chronic radiofrequency ablation lesions

Eugene G Kholmovski et al. J Cardiovasc Electrophysiol. 2018 Nov.

Abstract

Background: Magnetic resonance imaging (MRI) has been used to visualize radiofrequency (RF) ablation lesions but the relationship between volumes that enhance in acute MRI and the chronic lesion size is unknown.

Objectives: The main goal was to use noncontrast (native) T1-weighted (T1w) MRI and late gadolinium enhancement (LGE)-MRI to visualize lesions acutely and chronically and correlate the acute area of enhancement with chronic lesion size in histology.

Materials and methods: In a canine (n = 9) model RF ablation lesions were created in both ventricles. Native T1w MRI and LGE-MRI were acquired acutely after the ablation procedure. After 8 weeks, another set of RF ablations was performed, and the MRI study was repeated. Volume and depth of enhancement in native T1w MRI and LGE-MRI acquired after the initial ablation procedure were correlated with chronic lesion volume and depth in histology.

Results: Thirty-three lesions were analyzed. Native T1w MRI visualized the acute lesions but not the chronic lesions. LGE-MRI showed both acute and chronic lesions. Acute native T1w MRI volume (average of 102.1 ± 48.5 mm3 ) and depth (4.9 ± 1.2 mm) correlated well with chronic histological volume (105.9 ± 51.8 mm3 ) and depth (4.8 ± 1.3 mm) with R2 of 0.881 (P < 0.001) and 0.874 (P < 0.001), respectively. Acute LGE-MRI had a significantly higher volume of enhancement of 499.7 ± 214.4 mm3 (P < 0.001) and depth of 7.5 ± 1.8 mm ( P < 0.001) when compared with chronic histological lesion volume and depth.

Conclusions: Native T1w MRI acquired acutely after RF ablation is a good predictor of chronic lesion size. Acute LGE-MRI significantly overestimates the chronic lesion size.

Keywords: LGE-MRI; cardiac magnetic resonance image; catheter ablation; lesion visualization; noncontrast MRI.

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Conflict of interest statement

Eugene Kholmovski reports equity interest in Marrek Inc; consultant to Marrek Inc.

Figures

Figure 1:
Figure 1:
Comparison between pathology samples from 2 animals and the corresponding T2w, T1w and LGE images acquired after the repeat ablation procedure. The pathology clearly demonstrates acute and chronic RF lesions. Red arrows indicate acute lesions and green arrows mark the chronic lesions. Acute lesions consist of lesion core and surrounding hemorrhage ring. Enhancement in native T1w and T2w images is only observed in the area of acute lesions. T2w enhancement extends far beyond the ablation regions. In T1w images, the acute lesions are visualized as discrete hyper-intense regions with shape and size similar to lesion cores observed in the pathology. The LGE-MRI shows a much larger area of enhancement for acute lesions as compared to chronic lesions.
Figure 2:
Figure 2:
The top panel - Correlation of enhancement volume in acute T1w MRI with histological lesion volume. The bottom panel - Bland-Altman plot for T1w enhancement and histological volumes.
Figure 3:
Figure 3:
Correlation of lesion depth in acute native T1w MRI with histological lesion depth.
Figure 4:
Figure 4:
Correlation of enhancement volume in acute and chronic LGE-MRI with histological lesion volume. The acute LGE-MRI drastically over estimates the lesion volume with a factor of 3.6. Chronic LGE-MRI is a better predictor of lesion volume with a factor of 1.4.
Figure 5.
Figure 5.
Representative examples of RF lesion visualization by acute T1w, T2w, LGE-MRI and chronic LGE-MRI. Enhancement regions in the acute T1w are similar to the corresponding enhancement regions in the chronic LGE-MRI. Acute T2w imaging shows much larger areas of enhancement as does the acute LGE-MRI as compared to the acute T1w or the chronic LGE-MRI.
Figure 6.
Figure 6.
Native T1w MRI acquired (A) acutely and (B) 1 week after ablation procedure in 4 animals. No obvious enhancement was observed in the T1w scans acquired a week after the ablation.
See this image and copyright information in PMC

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