Virtual native enhancement (VNE), a contrast-free cardiac MRI technique powered by artificial intelligence, demonstrated high diagnostic performance in detecting and quantifying myocardial scarring in patients undergoing assessment for ischemic heart disease or prior myocardial infarction (MI), according to research published July 15 in JACC.

In the prospective, blinded, multicenter validation study conducted at two sites in the UK and China, 136 patients (mean age, 62 years; 22% women) underwent standard CMR imaging, including precontrast cine imaging, native T1 mapping and conventional late gadolinium enhancement (LGE) imaging utilizing gadolinium-based contrast agents (GBCAs). A blinded team then generated VNE images through the precontrast cine and T1 mapping images alone, after which an additional four blinded clinical readers conducted head-to-head comparisons of the two image sets.

Results showed that VNE achieved 88% overall accuracy for MI detection among all patients and 94% accuracy in scans classified as diagnostically confident (n=107). VNE correlated strongly with LGE on scar burden measurement and somewhat less strongly with scar transmurality, with agreement on infarcted myocardial territories at 90%.

The blinded clinical readers considered VNE to be sufficient without proceeding to LGE in 70% of cases, and within this subgroup, diagnostic accuracy was 93.7% vs. 93.9% for VNE vs. LGE, respectively.

“Translation of VNE at independent centers is a crucial step for ultimately offering an alternative to the current clinical standard CMR LGE that is injection free and significantly faster (10 minutes),” write authors Qiang Zhang, PhD, et al. “This may significantly reduce scan cost, increase clinical throughput, and expand the capabilities of CMR to include patients in whom GBCAs are contraindicated.”

In an accompanying editorial comment, Rohan Dharmakumar, PhD, and Khalid Youssef, PhD, ask if this is the “emergence of a new era?” They add that “eliminating reliance on GBCAs offers clear advantages in cost and workflow, but it may also inaugurate a new era of CMR that provides deeper insight into chronic MI pathophysiology and its relationship to post-MI outcomes.”