IR Fast Gradient Echo: Late Gadolinium Enhancement

Anteroapical Infarct X40276S3

Imaging Sequence Type:

  • 2D Gradient echo with IR prep pulse
  • Acquisition typically occurs over several heartbeats and within a breathhold
  • Alternative 2D sequences are available that use SSFP with IR prep pulse: acquisition can occur over a single heart beat
  • 3D sequences are also available: acquisition occurs over several heartbeats, usually within a breathhold

Acquisition Modes:

  • 2D: Single slice, single phase
  • 3D: Multislice, single phase

Image Contrast:

  • Bright Blood
  • T1 weighting

Imaging Options:

  • 2D vs. 3D
  • Segmented acquisition over several heart vs. single shot with one image per heart beat
  • Phase-sensitive reconstruction vs. magnitude reconstruction
  • Inversion time (TI) must be set by the technologist. The goal is to null the normal myocardium
  • Images are usually acquired at mid diastole.

Clinical Utility: The sequence is designed to detect late gadolinium enhancement which serves as a marker for a variety of abnormalities such as:

  • myocardial infarction
  • myocarditis
  • amyloid

This sequence is also useful for visualizing cardiac thrombus.

At the top of this page are 4-chamber, 2 chamber, and 3-chamber views of a patient who had an LAD occlusion. The LGE images show a large, transmural, anterior, anteroseptal, and apical infarct. The dead myocardium is white, while the viable myocardium is black (“bright spots are bad”).