Page 19 - Rob Holtackers

Introduction | 9

additional magnetization preparation. The simplicity and ease of use of this novel
method should thereby accelerate its adaptation into clinical routine settings.

The entire development process from ‘bench-to-bedside’ was divided using the
following sub aims:

1. To create an overview of published dark-blood LGE methods that aim for
improved subendocardial scar conspicuity.

2. To develop a novel LGE method that increases scar-to-blood contrast while
being readily available and easy to implement in every clinical routine setting.

3. To histologically validate this novel LGE method in an animal model.

4. To evaluate ischemic scar detection of this novel LGE method in a large,
unselected cohort of patients.

5. To translate this novel LGE approach to 3D imaging methods with high
isotropic resolution, while maintaining superior scar-to-blood contrast.

6. To study the effect of this novel LGE method on the detection and assessment
of papillary muscle scar in patients with mitral valve prolapse.

7. To investigate the impact of this novel LGE method on the myocardial
ischemic burden (MIB) required for making patient management decisions.

This thesis follows the development progress around these sub aims. Chapter 2
provides a review of previous efforts that were made to increase scar-to-blood contrast
in LGE MRI. The used contrast mechanisms are described, (pre)clinical results are
discussed, and perspectives on future research are provided. Following this overview,
the development and feasibility of a novel dark-blood LGE method without additional
magnetization preparation are described in Chapter 3. Computer simulations were
performed, and contrast-to-noise ratios were obtained from a small number of patients
as a proof of principle. This novel method was then validated against histopathology
in a porcine animal model, of which the results are presented in Chapter 4. MI was
induced using catheter balloon inflation and assessed by both novel dark-blood LGE
and conventional bright-blood LGE MRI, using histopathology as reference standard.
Chapter 5 describes the clinical value of the novel LGE method as assessed in a large,
unselected cohort of patients using MR systems running at both 1.5 T and 3 T from
multiple vendors. Ischemic scar detection, among others, was assessed using novel
dark-blood LGE and compared to conventional bright-blood LGE. Chapter 6 focuses
on the translation of the dark-blood contrast mechanism to high resolution 3D imaging
methods. A novel dynamic TI mechanism is presented to ensure optimal blood pool
nulling and thereby obtain reliable dark-blood contrast throughout the entire 3D