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Objectives: To prospectively compare image quality and infarct sizing methods between magnetization-transfer "flow-independent dark-blood delayed enhancement" (MT-FIDDLE) and standard "bright-blood"-late gadolinium enhancement (LGE) cardiac-magnetic-resonance (CMR) sequence., Methods: "Bright-blood"-LGE and MT-FIDDLE sequence were acquired in 110 patients at 4 days (n = 33), 4 months (n = 39) and 12 months (n = 38) after acute ST-elevation myocardial infarction (STEMI). Subjective image quality, including confidence in infarct segmentation and blood-pool bordering, were each rated on a 4-point Likert scale. Objective image quality was assessed by the detectability index (DI). Infarct volumes derived via full-width at half-maximum (FWHM) and different number of standard deviations ("n-SD") methods on MT-FIDDLE images were compared with FWHM and reference 5-SD results from "bright-blood-LGE images., Results: Overall subjective median image quality was excellent for both LGE sequences. Qualitative analysis revealed a significantly higher confidence in infarct segmentation and in blood-pool bordering for MT-FIDDLE as compared to "bright-blood"-LGE (all p < 0.001). Infarct volumes assessed by the FWHM technique on MT-FIDDLE and "bright-blood"-LGE showed excellent agreement overall (Concordance correlation coefficient, CCC = 0.96). The 3-SD technique for MT-FIDDLE showed the best agreement with the 5-SD method for "bright-blood"-LGE overall (CCC = 0.94), as well as in the subgroup with excellent confidence in infarct segmentation on "bright-blood"-LGE (CCC = 0.96). DI of scar versus LV blood-pool was higher for MT-FIDDLE (8.9 ± 5.5) compared to "bright-blood"-LGE sequence (2.0 ± 1.5; p < 0.001)., Conclusion: MT-FIDDLE significantly optimizes the discrimination between myocardial infarction and adjacent blood-pool in STEMI patients. As compared to the established 5-SD technique on "bright-blood"-LGE, the 3-SD method on MT-FIDDLE results in consistent infarct volumes., Key Points: Question Does magnetization-transfer "flow-independent dark-blood delayed enhancement" (MT-FIDDLE) offer any benefits over standard "bright-blood"-late gadolinium enhancement (LGE) cardiac-magnetic-resonance (CMR) for identifying STEMI infarct borders? Findings MT-FIDDLE image quality was higher than LGE CMR and measured infarct volume comparability to the standard 5-SD-threshold-technique. Clinical relevance MT-FIDDLE facilitates the assessment of myocardial infarctions at the subendocardial border, improving the discrimination between myocardial infarction and adjacent blood-pool in STEMI patients., Competing Interests: Compliance with ethical standards. Guarantor: The scientific guarantor of this publication is Agnes Mayr, MD. Conflict of interest: One of the authors (Wolfgang G. Rehwald) is an employee of Siemens Medical Solutions. The remaining authors declare no relationships with any companies whose products or services may be related to the subject matter of the article. Statistics and biometry: One of the authors (Christian Kremser, PhD) has significant statistical expertise. Informed consent: Written informed consent was obtained from all subjects (patients) in this study. Ethical approval: Institutional Review Board approval was obtained. Study subjects or cohorts overlap: Some study subjects or cohorts have been not previously reported. Methodology: Prospective study, (© 2024. The Author(s).)

Objectives: To investigate the prognostic value of pulmonary transit time (pTT) determined by cardiac magnetic resonance (CMR) after acute ST-segment-elevation myocardial infarction (STEMI)., Methods: Comprehensive CMR examinations were performed in 207 patients 3 days and 4 months after reperfused STEMI. Functional parameters and infarct characteristics were assessed. PTT was defined as the interval between peaks of gadolinium contrast time-intensity curves in the right and left ventricles in first-pass perfusion imaging. Cox regression models were calculated to assess the association between pTT and the occurrence of major adverse cardiac events (MACE), defined as a composite of death, re-infarction, and congestive heart failure., Results: PTT was 8.6 s at baseline and 7.8 s at the 4-month CMR. In Cox regression, baseline pTT (hazard ratio [HR]: 1.58; 95% CI: 1.12 to 2.22; p = 0.009) remained significantly associated with MACE occurrence after adjustment for left ventricular ejection fraction (LVEF) and cardiac index. The association of pTT and MACE remained significant also after adjusting for infarct size and microvascular obstruction size. In Kaplan-Meier analysis, pTT ≥ 9.6 s was associated with MACE (p < 0.001). Addition of pTT to LVEF resulted in a categorical net reclassification improvement of 0.73 (95% CI: 0.27 to 1.20; p = 0.002) and integrated discrimination improvement of 0.07 (95% CI: 0.02 to 0.13; p = 0.007)., Conclusions: After reperfused STEMI, CMR-derived pTT was associated with hard clinical events with prognostic information independent of and incremental to infarct size and LV systolic function., Key Points: • Pulmonary transit time is the duration it takes the heart to pump blood from the right chambers across lung vessels to the left chambers. • This prospective single-centre study showed inferior outcome in patients with prolonged pulmonary transit time after myocardial infarction. • Pulmonary transit time assessed by magnetic resonance imaging added incremental information to established prognostic markers., (© 2022. The Author(s).)

Objectives: To prospectively compare unenhanced quiescent-interval single-shot MR angiography (QISS-MRA) with contrast-enhanced computed tomography angiography (CTA) for contrast-free guidance in transcatheter aortic valve intervention (TAVI)., Methods: Twenty-six patients (mean age 83 ± 5 years, 15 female [58%]) referred for TAVI evaluation underwent QISS-MRA for aortoiliofemoral access guidance and non-contrast three-dimensional (3D) "whole heart" MRI for prosthesis sizing on a 1.5-T system. Contrast-enhanced CTA was performed as imaging gold standard for TAVI planning. Image quality was assessed by a 4-point Likert scale; continuous MRA and CTA measurements were compared with regression and Bland-Altman analyses., Results: QISS-MRA and CTA-based measurements of aortoiliofemoral vessel diameters correlated moderately to very strong (r = 0.572 to 0.851, all p ≤ 0.002) with good to excellent inter-observer reliability (intra-class correlation coefficient (ICC) = 0.862 to 0.999, all p < 0.0001) regarding QISS assessment. Mean diameters of the infrarenal aorta and iliofemoral vessels differed significantly (bias 0.37 to 0.98 mm, p = 0.041 to < 0.0001) between the two modalities. However, inter-method decision for transfemoral access route was comparable (κ = 0.866, p < 0.0001). Aortic root parameters assessed by 3D whole heart MRI strongly correlated (r = 0.679 to 0.887, all p ≤ 0.0001) to CTA measurements., Conclusion: QISS-MRA provides contrast-free access route evaluation in TAVI patients with moderate to strong correlations compared with CTA and substantial inter-observer agreement. Despite some significant differences in minimal vessel diameters, inter-method agreement for transfemoral accessibility is strong. Combination with 3D whole heart MRI facilitates unenhanced TAVI guidance., Key Points: • QISS-MRA and CTA inter-method agreement for transfemoral approach is strong. • QISS-MRA is a very good alternative to CTA and MRA especially in patients with Kidney Disease Outcomes Quality Initiativestages 4 and 5. • Combination of QISS-MRA and 3D "whole heart" MRI facilitates fully unenhanced TAVI guidance.

Objectives: The purpose of this study was to assess the comparative prognostic value of mitral annular plane systolic excursion (MAPSE) versus left ventricular ejection fraction (LVEF), measured by cardiac magnetic resonance (CMR) imaging in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI)., Methods: CMR was performed in 255 STEMI patients within 2 days (interquartile range (IQR) 2-4 days) after infarction. CMR included MAPSE measurement on CINE 4-chamber view. Patients were followed for major adverse cardiovascular events (MACE)-death, non-fatal myocardial re-infarction, stroke, and new congestive heart failure., Results: Patients with MACE (n = 35, 14%, median follow-up 3 years [IQR 1-4 years]) showed significantly lower MAPSE (8 mm [7-8.8] vs. 9.6 mm [8.1-11.5], p < 0.001). The association between decreased MAPSE (< 9 mm, optimal cut-off value by c-statistics) remained significant after adjustment for independent clinical and CMR predictors of MACE. The AUC of MAPSE for the prediction of MACE was 0.74 (CI 95% 0.65-0.82), significantly higher than that of LVEF (0.61 [CI 95% 0.50-0.71]; p < 0.001)., Conclusions: Reduced long-axis function assessed with MAPSE measurement using CINE CMR independently predicts long-term prognosis following STEMI. Moreover, MAPSE provided significantly higher prognostic implication in comparison with conventional LVEF measurement., Key Points: • MAPSE determined by CMR independently predicts long-term prognosis following STEMI. • MACE-free survival is significantly higher in patients with MAPSE ≥ 9 mm than < 9 mm. • MAPSE provides significantly higher prognostic implication than conventional LVEF.

Purpose: To compare agreement between conventional B-mode ultrasound (US) and compression sonoelastography (SEL) of the common extensor tendons of the elbow with histological evaluation., Materials and Methods: Twenty-six common extensor tendons were evaluated in 17 cadavers (11 females, median age 85 years and 6 males, median age 80 years). B-mode US was graded into: Grade 1, homogeneous fibrillar pattern; grade 2, hypoechoic areas and/or calcifications <30%; and grade 3 > 30%. SEL was graded into: Grade 1 indicated blue (hardest) to green (hard); grade 2 yellow (soft); and grade 3 red (softest). B-mode US, SEL, and a combined grading score incorporating both were compared to histological findings in 76 biopsies., Results: Histological alterations were detected in 55/76 biopsies. Both modalities showed similar results (sensitivity, specificity, and accuracy 84%, 81%, and 83% for B-mode US versus 85%, 86%, and 86% for SEL, respectively, P > 0.3). However, a combination of both resulted in significant improvement in sensitivity (96%, P < 0.02) without significant change in specificity (81%, P < 0.3), yielding an improved overall accuracy (92%)., Conclusion: Combined imaging of the extensor tendons with both modalities is superior to either modality alone for predicting the presence of pathologic findings on histology., Key Points: • Combination of B-mode US and SEL proved efficiency in diagnosing lateral epicondylitis. • Combination of B-mode US and SEL in lateral epicondylitis correlates to histology. • Combination of both modalities provides improved sensitivity without loss of specificity.