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CLINICAL RESEARCH

Characterization of Radiofrequency Ablation Lesions With Gadolinium-Enhanced Cardiovascular Magnetic Resonance Imaging

Division of Cardiology, Department of RadiologyJohns Hopkins School of Medicine, and the Division of Cardiology, University of Maryland, Baltimore, Maryland

Manuscript received November 16, 2004; revised manuscript received June 14, 2005, accepted July 26, 2005.

^_* Reprint requests and correspondence: Dr. Timm Dickfeld, University of Maryland, School of Medicine, Division of Cardiology, 22 South Greene Street, Room N3W77, Baltimore, Maryland 21201 (Email: tdickfel{at}medicine.umaryland.edu).

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.

Abbreviations and Acronyms   ANOVA = analysis of variance   CNR = contrast-to-noise ratio   GEE = generalized estimating equation   MRI = magnetic resonance imaging   RFA = radiofrequency ablation   SI = signal intensity   SNR = signal-to-noise ratio

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