Characterization of radiofrequency ablation lesions with gadolinium-enhanced cardiovascular magnetic resonance imaging

Timm Dickfeld, Ritsushi Kato, Menekhem Zviman, Shenghan Lai, Glenn Meininger, Albert C. Lardo, Ariel Roguin, David Blumke, Ronald D Berger, Hugh Calkins, Henry R Halperin

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: This study was designed to evaluate the characteristics of gadolinium-enhanced imaging of radiofrequency ablations. BACKGROUND: Gadolinium-enhanced magnetic resonance imaging (MRI) has been used successfully to evaluate tissue necrosis after myocardial infarction. In electrophysiology, radiofrequency energy is used to create a targeted myocardial necrosis for the treatment of various arrhythmias. METHODS: Using a power-controlled, cooled-tip 7-F catheter system, radiofrequency lesions (10 to 40 W for 30 s) were created on the epicardium of the right ventricle in eight mongrel dogs. After injection of 0.225 mmol/kg gadolinium, T1-weighted fast gradient echo images were obtained during a follow-up of 10 h using an intrathoracic high-resolution coil. Radiofrequency ablations were analyzed on the MR images and compared with gross anatomy and histopathology. RESULTS: Four distinct phases of signal enhancement were observed. After gadolinium injection, radiofrequency lesions were delineated clearly as contrast-free areas of low signal intensity (contrast-to-noise ratio [CNR] = -21.1 ± 19.8). Signal enhancement in the lesion periphery started 4.0 ± 1.8 min after injection and progressively extended toward the lesion center at a rate of 0.02 mm/min. Full delayed enhancement was observed after 98 ± 21 min (CNR = +17.8 ± 9.0). During the follow-up period, CNR started to decrease, but the lesions were detectable for as long as 10 h of follow-up. During the first three phases of enhancement, MRI correlated well with the pathological findings (r = 0.88, r = 0.88, and r = 0.86 [p <0.001], respectively). CONCLUSIONS: Radiofrequency ablation can be evaluated accurately by using gadolinium-enhanced MRI, which may allow the noninvasive assessment of procedural success. The dissimilar wash-in and wash-out kinetics compared with myocardial infarction suggest a different pathophysiological process with complete loss of microvasculature.

Original languageEnglish (US)
Pages (from-to)370-378
Number of pages9
JournalJournal of the American College of Cardiology
Volume47
Issue number2
DOIs
StatePublished - Jan 17 2006
Externally publishedYes

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Gadolinium
Magnetic Resonance Imaging
Noise
Injections
Necrosis
Myocardial Infarction
Electrophysiology
Pericardium
Microvessels
Heart Ventricles
Cardiac Arrhythmias
Anatomy
Catheters
Dogs

ASJC Scopus subject areas

  • Nursing(all)

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Characterization of radiofrequency ablation lesions with gadolinium-enhanced cardiovascular magnetic resonance imaging. / Dickfeld, Timm; Kato, Ritsushi; Zviman, Menekhem; Lai, Shenghan; Meininger, Glenn; Lardo, Albert C.; Roguin, Ariel; Blumke, David; Berger, Ronald D; Calkins, Hugh; Halperin, Henry R.

In: Journal of the American College of Cardiology, Vol. 47, No. 2, 17.01.2006, p. 370-378.

Research output: Contribution to journalArticle

Dickfeld, Timm ; Kato, Ritsushi ; Zviman, Menekhem ; Lai, Shenghan ; Meininger, Glenn ; Lardo, Albert C. ; Roguin, Ariel ; Blumke, David ; Berger, Ronald D ; Calkins, Hugh ; Halperin, Henry R. / Characterization of radiofrequency ablation lesions with gadolinium-enhanced cardiovascular magnetic resonance imaging. In: Journal of the American College of Cardiology. 2006 ; Vol. 47, No. 2. pp. 370-378.
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abstract = "OBJECTIVES: This study was designed to evaluate the characteristics of gadolinium-enhanced imaging of radiofrequency ablations. BACKGROUND: Gadolinium-enhanced magnetic resonance imaging (MRI) has been used successfully to evaluate tissue necrosis after myocardial infarction. In electrophysiology, radiofrequency energy is used to create a targeted myocardial necrosis for the treatment of various arrhythmias. METHODS: Using a power-controlled, cooled-tip 7-F catheter system, radiofrequency lesions (10 to 40 W for 30 s) were created on the epicardium of the right ventricle in eight mongrel dogs. After injection of 0.225 mmol/kg gadolinium, T1-weighted fast gradient echo images were obtained during a follow-up of 10 h using an intrathoracic high-resolution coil. Radiofrequency ablations were analyzed on the MR images and compared with gross anatomy and histopathology. RESULTS: Four distinct phases of signal enhancement were observed. After gadolinium injection, radiofrequency lesions were delineated clearly as contrast-free areas of low signal intensity (contrast-to-noise ratio [CNR] = -21.1 ± 19.8). Signal enhancement in the lesion periphery started 4.0 ± 1.8 min after injection and progressively extended toward the lesion center at a rate of 0.02 mm/min. Full delayed enhancement was observed after 98 ± 21 min (CNR = +17.8 ± 9.0). During the follow-up period, CNR started to decrease, but the lesions were detectable for as long as 10 h of follow-up. During the first three phases of enhancement, MRI correlated well with the pathological findings (r = 0.88, r = 0.88, and r = 0.86 [p <0.001], respectively). CONCLUSIONS: Radiofrequency ablation can be evaluated accurately by using gadolinium-enhanced MRI, which may allow the noninvasive assessment of procedural success. The dissimilar wash-in and wash-out kinetics compared with myocardial infarction suggest a different pathophysiological process with complete loss of microvasculature.",
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AU - Dickfeld, Timm

AU - Kato, Ritsushi

AU - Zviman, Menekhem

AU - Lai, Shenghan

AU - Meininger, Glenn

AU - Lardo, Albert C.

AU - Roguin, Ariel

AU - Blumke, David

AU - Berger, Ronald D

AU - Calkins, Hugh

AU - Halperin, Henry R

PY - 2006/1/17

Y1 - 2006/1/17

N2 - OBJECTIVES: This study was designed to evaluate the characteristics of gadolinium-enhanced imaging of radiofrequency ablations. BACKGROUND: Gadolinium-enhanced magnetic resonance imaging (MRI) has been used successfully to evaluate tissue necrosis after myocardial infarction. In electrophysiology, radiofrequency energy is used to create a targeted myocardial necrosis for the treatment of various arrhythmias. METHODS: Using a power-controlled, cooled-tip 7-F catheter system, radiofrequency lesions (10 to 40 W for 30 s) were created on the epicardium of the right ventricle in eight mongrel dogs. After injection of 0.225 mmol/kg gadolinium, T1-weighted fast gradient echo images were obtained during a follow-up of 10 h using an intrathoracic high-resolution coil. Radiofrequency ablations were analyzed on the MR images and compared with gross anatomy and histopathology. RESULTS: Four distinct phases of signal enhancement were observed. After gadolinium injection, radiofrequency lesions were delineated clearly as contrast-free areas of low signal intensity (contrast-to-noise ratio [CNR] = -21.1 ± 19.8). Signal enhancement in the lesion periphery started 4.0 ± 1.8 min after injection and progressively extended toward the lesion center at a rate of 0.02 mm/min. Full delayed enhancement was observed after 98 ± 21 min (CNR = +17.8 ± 9.0). During the follow-up period, CNR started to decrease, but the lesions were detectable for as long as 10 h of follow-up. During the first three phases of enhancement, MRI correlated well with the pathological findings (r = 0.88, r = 0.88, and r = 0.86 [p <0.001], respectively). CONCLUSIONS: Radiofrequency ablation can be evaluated accurately by using gadolinium-enhanced MRI, which may allow the noninvasive assessment of procedural success. The dissimilar wash-in and wash-out kinetics compared with myocardial infarction suggest a different pathophysiological process with complete loss of microvasculature.

AB - OBJECTIVES: This study was designed to evaluate the characteristics of gadolinium-enhanced imaging of radiofrequency ablations. BACKGROUND: Gadolinium-enhanced magnetic resonance imaging (MRI) has been used successfully to evaluate tissue necrosis after myocardial infarction. In electrophysiology, radiofrequency energy is used to create a targeted myocardial necrosis for the treatment of various arrhythmias. METHODS: Using a power-controlled, cooled-tip 7-F catheter system, radiofrequency lesions (10 to 40 W for 30 s) were created on the epicardium of the right ventricle in eight mongrel dogs. After injection of 0.225 mmol/kg gadolinium, T1-weighted fast gradient echo images were obtained during a follow-up of 10 h using an intrathoracic high-resolution coil. Radiofrequency ablations were analyzed on the MR images and compared with gross anatomy and histopathology. RESULTS: Four distinct phases of signal enhancement were observed. After gadolinium injection, radiofrequency lesions were delineated clearly as contrast-free areas of low signal intensity (contrast-to-noise ratio [CNR] = -21.1 ± 19.8). Signal enhancement in the lesion periphery started 4.0 ± 1.8 min after injection and progressively extended toward the lesion center at a rate of 0.02 mm/min. Full delayed enhancement was observed after 98 ± 21 min (CNR = +17.8 ± 9.0). During the follow-up period, CNR started to decrease, but the lesions were detectable for as long as 10 h of follow-up. During the first three phases of enhancement, MRI correlated well with the pathological findings (r = 0.88, r = 0.88, and r = 0.86 [p <0.001], respectively). CONCLUSIONS: Radiofrequency ablation can be evaluated accurately by using gadolinium-enhanced MRI, which may allow the noninvasive assessment of procedural success. The dissimilar wash-in and wash-out kinetics compared with myocardial infarction suggest a different pathophysiological process with complete loss of microvasculature.

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