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Most laboratories employ an ECG-gated 2D inversion recovery prepared; interleaved k-space segmented gradient recalled echo (IRISGRE) sequence acquired in a single breath-hold for assessment of myocardial viability through delayed enhancement. We have observed a septal mid-wall hyperenhancement in many clinical images acquired using IRISGRE with low-high (from ky = 0 outwards +/Kymax) phase encoding order (PEO). We have identified this enhancement as an imaging artifact by changing the phase encoding direction (PED). As shown in a representative short axis slice (Figure 1a, b) the change of PED from anterior-posterior to foot-head direction moves the mid-wall hyperenhancement from the septal and lateral to the anterior and inferior myocardial walls (arrows). The continuous evolution of the postinversion recovering signals cause modulation of the kspace data. Modulation of k-space for the IRISGRE sequence depends on: 1) approach to steady state; 2) readout duration for each shot; and 3) PEO; apart from other factors like, varying time of inversion (TI) for patients with variable heart rate. As PEO controls the distribution of the evolving signal along the PED of the k-space, it directly influences the point spread function (PSF) [1]. The analysis shows that PSF has significantly less oscillatory lobes (edge ringing) for the linear PEO (from +/kymax toward -/+ Kymax) compared to the low-high PEO. In addition, on low-high PEO the acquisition starts at TI and continues for the complete shot duration, thus allowing twice the signal recovery time compared to linear PEO, leading to the edge enhancement. Purpose The purpose of this study is to assess the clinical significance of the edge enhancement and ringing as an effect of PEO used for IRISGRE in delayed enhancement (DE) myocardial images.

112 Clinical significance of phase encoding order in delayed enhancement cardiac imaging