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Liu D, Borlotti A, Viliani D, Jerosch-Herold M, Alkhalil M, De Maria GL, Fahrni G, Dawkins S, Wijesurendra R, Francis J, Ferreira V, Piechnik S, Robson MD, Banning A, Choudhury R, Neubauer S, Channon K, Kharbanda R, Dall'Armellina E. CMR Native T1 Mapping Allows Differentiation of Reversible Versus Irreversible Myocardial Damage in ST-Segment-Elevation Myocardial Infarction: An OxAMI Study (Oxford Acute Myocardial Infarction). Circ Cardiovasc Imaging 2017; 10:e005986. [PMID: 28798137 PMCID: PMC5555391 DOI: 10.1161/circimaging.116.005986] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 07/12/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND CMR T1 mapping is a quantitative imaging technique allowing the assessment of myocardial injury early after ST-segment-elevation myocardial infarction. We sought to investigate the ability of acute native T1 mapping to differentiate reversible and irreversible myocardial injury and its predictive value for left ventricular remodeling. METHODS AND RESULTS Sixty ST-segment-elevation myocardial infarction patients underwent acute and 6-month 3T CMR, including cine, T2-weighted (T2W) imaging, native shortened modified look-locker inversion recovery T1 mapping, rest first pass perfusion, and late gadolinium enhancement. T1 cutoff values for oedematous versus necrotic myocardium were identified as 1251 ms and 1400 ms, respectively, with prediction accuracy of 96.7% (95% confidence interval, 82.8% to 99.9%). Using the proposed threshold of 1400 ms, the volume of irreversibly damaged tissue was in good agreement with the 6-month late gadolinium enhancement volume (r=0.99) and correlated strongly with the log area under the curve troponin (r=0.80) and strongly with 6-month ejection fraction (r=-0.73). Acute T1 values were a strong predictor of 6-month wall thickening compared with late gadolinium enhancement. CONCLUSIONS Acute native shortened modified look-locker inversion recovery T1 mapping differentiates reversible and irreversible myocardial injury, and it is a strong predictor of left ventricular remodeling in ST-segment-elevation myocardial infarction. A single CMR acquisition of native T1 mapping could potentially represent a fast, safe, and accurate method for early stratification of acute patients in need of more aggressive treatment. Further confirmatory studies will be needed.
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Affiliation(s)
- Dan Liu
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Alessandra Borlotti
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Dafne Viliani
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Michael Jerosch-Herold
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Mohammad Alkhalil
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Giovanni Luigi De Maria
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Gregor Fahrni
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Sam Dawkins
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Rohan Wijesurendra
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Jane Francis
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Vanessa Ferreira
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Stefan Piechnik
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Matthew D Robson
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Adrian Banning
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Robin Choudhury
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Stefan Neubauer
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Keith Channon
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Rajesh Kharbanda
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.)
| | - Erica Dall'Armellina
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, United Kingdom (D.L., A.B., D.V., M.A., G.L.D.M., G.F., S.D., R.W., J.F., V.F., S.P., M.D.R., R.C., S.N., E.D.A.); Department of Cardiovascular Medicine, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, United Kingdom (A.B., K.C., R.K.); and Department of Radiology, Brigham and Women's Hospital, Boston, MA (M.J.-H.).
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Saremi F. Cardiac MR Imaging in Acute Coronary Syndrome: Application and Image Interpretation. Radiology 2017; 282:17-32. [PMID: 28005512 DOI: 10.1148/radiol.2016152849] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Acute coronary syndrome (ACS) is a frequent cause of hospitalization and coronary interventions. Cardiac magnetic resonance (MR) imaging is an increasingly used technique for initial work-up of chest pain and early post-reperfusion and follow-up evaluation of ACS to identify patients at high risk of further cardiac events. Cardiac MR imaging can evaluate with accuracy a variety of prognostic indicators of myocardial damage, including regional myocardial dysfunction, infarct distribution, infarct size, myocardium at risk, microvascular obstruction, and intramyocardial hemorrhage in both acute setting and later follow-up examinations. In addition, MR imaging is useful to rule out other causes of acute chest pain in patients admitted to the emergency department. In this article, a brief explanation of the pathophysiology, classification, and treatment options for patients with ACS will be introduced. Indications of cardiac MR imaging in ACS patients will be reviewed and specific cardiac MR protocol, image interpretation, and potential diagnostic pitfalls will be discussed. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Farhood Saremi
- From the Department of Radiology, University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles CA 90033
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53
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Puntmann VO, Peker E, Chandrashekhar Y, Nagel E. T1 Mapping in Characterizing Myocardial Disease: A Comprehensive Review. Circ Res 2017; 119:277-99. [PMID: 27390332 DOI: 10.1161/circresaha.116.307974] [Citation(s) in RCA: 220] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 05/20/2016] [Indexed: 01/06/2023]
Abstract
Cardiovascular magnetic resonance provides insights into myocardial structure and function noninvasively, with high diagnostic accuracy and without ionizing radiation. Myocardial tissue characterization in particular gives cardiovascular magnetic resonance a prime role among all the noninvasive cardiovascular investigations. Late gadolinium enhancement imaging is an established method for visualizing replacement scar, providing diagnostic and prognostic information in a variety of cardiac conditions. Late gadolinium enhancement, however, relies on the regional segregation of tissue characteristics to generate the imaging contrast. Thus, myocardial pathology that is diffuse in nature and affecting the myocardium in a rather uniform and global distribution is not well visualized with late gadolinium enhancement. Examples include diffuse myocardial inflammation, fibrosis, hypertrophy, and infiltration. T1 mapping is a novel technique allowing to diagnose these diffuse conditions by measurement of T1 values, which directly correspond to variation in intrinsic myocardial tissue properties. In addition to providing clinically meaningful indices, T1-mapping measurements also allow for an estimation of extracellular space by calculation of extracellular volume fraction. Multiple lines of evidence suggest a central role for T1 mapping in detection of diffuse myocardial disease in early disease stages and complements late gadolinium enhancement in visualization of the regional changes in common advanced myocardial disease. As a quantifiable measure, it may allow grading of disease activity, monitoring progress, and guiding treatment, potentially as a fast contrast-free clinical application. We present an overview of clinically relevant technical aspects of acquisition and processing, and the current state of art and evidence, supporting its clinical use.
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Affiliation(s)
- Valentina O Puntmann
- From the Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging (V.O.P., E.P., E.N.) and Department of Cardiology (V.O.P., E.N.), Goethe University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Radiology, Ankara University School of Medicine, Ankara, Turkey (E.P.); and University of Minnesota and VA Medical Centre, Minneapolis (Y.C.)
| | - Elif Peker
- From the Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging (V.O.P., E.P., E.N.) and Department of Cardiology (V.O.P., E.N.), Goethe University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Radiology, Ankara University School of Medicine, Ankara, Turkey (E.P.); and University of Minnesota and VA Medical Centre, Minneapolis (Y.C.)
| | - Y Chandrashekhar
- From the Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging (V.O.P., E.P., E.N.) and Department of Cardiology (V.O.P., E.N.), Goethe University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Radiology, Ankara University School of Medicine, Ankara, Turkey (E.P.); and University of Minnesota and VA Medical Centre, Minneapolis (Y.C.)
| | - Eike Nagel
- From the Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging (V.O.P., E.P., E.N.) and Department of Cardiology (V.O.P., E.N.), Goethe University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Radiology, Ankara University School of Medicine, Ankara, Turkey (E.P.); and University of Minnesota and VA Medical Centre, Minneapolis (Y.C.).
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Kim PK, Hong YJ, Im DJ, Suh YJ, Park CH, Kim JY, Chang S, Lee HJ, Hur J, Kim YJ, Choi BW. Myocardial T1 and T2 Mapping: Techniques and Clinical Applications. Korean J Radiol 2017; 18:113-131. [PMID: 28096723 PMCID: PMC5240500 DOI: 10.3348/kjr.2017.18.1.113] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 07/29/2016] [Indexed: 01/02/2023] Open
Abstract
Cardiac magnetic resonance (CMR) imaging is widely used in various medical fields related to cardiovascular diseases. Rapid technological innovations in magnetic resonance imaging in recent times have resulted in the development of new techniques for CMR imaging. T1 and T2 image mapping sequences enable the direct quantification of T1, T2, and extracellular volume fraction (ECV) values of the myocardium, leading to the progressive integration of these sequences into routine CMR settings. Currently, T1, T2, and ECV values are being recognized as not only robust biomarkers for diagnosis of cardiomyopathies, but also predictive factors for treatment monitoring and prognosis. In this study, we have reviewed various T1 and T2 mapping sequence techniques and their clinical applications.
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Affiliation(s)
- Pan Ki Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Yoo Jin Hong
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Dong Jin Im
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Young Joo Suh
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Chul Hwan Park
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Jin Young Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Suyon Chang
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Hye-Jeong Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Jin Hur
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Young Jin Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Byoung Wook Choi
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
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Taylor AJ, Salerno M, Dharmakumar R, Jerosch-Herold M. T1 Mapping: Basic Techniques and Clinical Applications. JACC Cardiovasc Imaging 2016; 9:67-81. [PMID: 26762877 DOI: 10.1016/j.jcmg.2015.11.005] [Citation(s) in RCA: 338] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/03/2015] [Accepted: 11/05/2015] [Indexed: 02/06/2023]
Abstract
In cardiac magnetic resonance (CMR) imaging, the T1 relaxation time for the 1H magnetization in myocardial tissue may represent a valuable biomarker for a variety of pathological conditions. This possibility has driven the growing interest in quantifying T1, rather than just relying on its effect on image contrast. The techniques have advanced to where pixel-level myocardial T1 mapping has become a routine component of CMR examinations. Combined with the use of contrast agents, T1 mapping has led an expansive investigation of interstitial remodeling in ischemic and nonischemic heart disease. The purpose of this review was to introduce the reader to the physical principles of T1 mapping, the imaging techniques developed for T1 mapping, the pathophysiological markers accessible by T1 mapping, and its clinical uses.
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Affiliation(s)
- Andrew J Taylor
- Department of Cardiovascular Medicine, Alfred Hospital and BakerIDI Heart and Diabetes Research Institute, Melbourne, Australia
| | - Michael Salerno
- Departments of Medicine, Radiology, and Biomedical Engineering, University of Virginia, Charlottesville, Virginia
| | - Rohan Dharmakumar
- Biomedical Imaging Research Institute and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
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Vassiliou VS, Heng EL, Gatehouse PD, Donovan J, Raphael CE, Giri S, Babu-Narayan SV, Gatzoulis MA, Pennell DJ, Prasad SK, Firmin DN. Magnetic resonance imaging phantoms for quality-control of myocardial T1 and ECV mapping: specific formulation, long-term stability and variation with heart rate and temperature. J Cardiovasc Magn Reson 2016; 18:62. [PMID: 27659737 PMCID: PMC5034463 DOI: 10.1186/s12968-016-0275-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/23/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) phantoms are routinely used for quality assurance in MRI centres; however their long term stability for verification of myocardial T1/ extracellular volume fraction (ECV) mapping has never been investigated. METHODS Nickel-chloride agarose gel phantoms were formulated in a reproducible laboratory procedure to mimic blood and myocardial T1 and T2 values, native and late after Gadolinium administration as used in T1/ECV mapping. The phantoms were imaged weekly with an 11 heart beat MOLLI sequence for T1 and long TR spin-echo sequences for T2, in a carefully controlled reproducible manner for 12 months. RESULTS There were only small relative changes seen in all the native and post gadolinium T1 values (up to 9.0 % maximal relative change in T1 values) or phantom ECV (up to 8.3 % maximal relative change of ECV, up to 2.2 % maximal absolute change in ECV) during this period. All native and post gadolinium T2 values remained stable over time with <2 % change. Temperature sensitivity testing showed MOLLI T1 values in the long T1 phantoms increasing by 23.9 ms per degree increase and short T1 phantoms increasing by 0.3 ms per degree increase. There was a small absolute increase in ECV of 0.069 % (~0.22 % relative increase in ECV) per degree increase. Variation in heart rate testing showed a 0.13 % absolute increase in ECV (~0.45 % relative increase in ECV) per 10 heart rate increase. CONCLUSIONS These are the first phantoms reported in the literature modeling T1 and T2 values for blood and myocardium specifically for the T1mapping/ECV mapping application, with stability tested rigorously over a 12 month period. This work has significant implications for the utility of such phantoms in improving the accuracy of serial scans for myocardial tissue characterisation by T1 mapping methods and in multicentre work.
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Affiliation(s)
- Vassilios S. Vassiliou
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- Imperial College, National Heart and Lung Institute, London, UK
| | - Ee Ling Heng
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- Imperial College, National Heart and Lung Institute, London, UK
| | - Peter D. Gatehouse
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- Imperial College, National Heart and Lung Institute, London, UK
| | - Jacqueline Donovan
- Department of Biochemistry, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
| | - Claire E. Raphael
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- Imperial College, National Heart and Lung Institute, London, UK
| | | | - Sonya V. Babu-Narayan
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- Imperial College, National Heart and Lung Institute, London, UK
| | - Michael A. Gatzoulis
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- Imperial College, National Heart and Lung Institute, London, UK
| | - Dudley J. Pennell
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- Imperial College, National Heart and Lung Institute, London, UK
| | - Sanjay K. Prasad
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- Imperial College, National Heart and Lung Institute, London, UK
| | - David N. Firmin
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- Imperial College, National Heart and Lung Institute, London, UK
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Mapeo miocárdico con resonancia magnética cardiaca: valor diagnóstico de las nuevas secuencias. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2016.04.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Chow K, Yang Y, Shaw P, Kramer CM, Salerno M. Robust free-breathing SASHA T1 mapping with high-contrast image registration. J Cardiovasc Magn Reson 2016; 18:47. [PMID: 27535744 PMCID: PMC4989502 DOI: 10.1186/s12968-016-0267-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 07/09/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Many widely used myocardial T1 mapping sequences use breath-hold acquisitions that limit the precision of calculated T1 maps. The SAturation-recovery single-SHot Acquisition (SASHA) sequence has high accuracy with robustness against systematic confounders, but has poorer precision compared to the commonly used MOdified Look-Locker Inversion recovery (MOLLI) sequence. We propose a novel method for generating high-contrast SASHA images to enable a robust image registration approach to free-breathing T1 mapping with high accuracy and precision. METHODS High-contrast (HC) images were acquired in addition to primary variable flip angle (VFA) SASHA images by collecting an additional 15 k-space lines and sharing k-space data with the primary image. The number of free-breathing images and their saturation recovery times were optimized through numerical simulations. Accuracy and precision of T1 maps using the proposed SASHA-HC sequence was compared in 10 volunteers at 1.5 T to MOLLI, a breath-hold SASHA-VFA sequence, and free-breathing SASHA-VFA data processed using conventional navigator gating and standard image registration. Free-breathing T1 maps from 15 patients and 10 volunteers were graded by blinded observers for sharpness and artifacts. RESULTS Difference images calculated by subtracting HC and primary SASHA images had greater tissue-blood contrast than the primary images alone, with a 3× improvement for 700 ms TS saturation recovery images and a 6× increase in tissue-blood contrast for non-saturated images. Myocardial T1s calculated in volunteers with free-breathing SASHA-HC were similar to standard breath-hold SASHA-VFA (1156.1 ± 28.1 ms vs 1149.4 ± 26.5 ms, p >0.05). The standard deviation of myocardial T1 values using a 108 s free-breathing SASHA-HC (36.2 ± 3.1 ms) was 50 % lower (p <0.01) than breath-hold SASHA-VFA (72.7 ± 8.0 ms) and 34 % lower (p <0.01) than breath-hold MOLLI (54.7 ± 5.9 ms). T1 map quality scores in volunteers were higher with SASHA-HC (4.7 ± 0.3 out of 5) than navigator gating (3.6 ± 0.4, p <0.01) or normal registration (3.7 ± 0.4, p <0.01). SASHA-HC T1 maps had comparable precision to breath-hold MOLLI using a retrospectively down-sampled 30 s free-breathing acquisition and 30 % higher precision with a 60 s acquisition. CONCLUSIONS High-contrast SASHA images enable a robust image registration approach to free-breathing T1 mapping. Free-breathing SASHA-HC provides accurate T1 maps with higher precision than MOLLI in acquisitions longer than 30 s.
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Affiliation(s)
- Kelvin Chow
- Department of Medicine, University of Virginia Health System, PO Box 800158, 1215 Lee St, Charlottesville, 22908 VA USA
| | - Yang Yang
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, VA USA
| | - Peter Shaw
- Department of Medicine, University of Virginia Health System, PO Box 800158, 1215 Lee St, Charlottesville, 22908 VA USA
| | - Christopher M. Kramer
- Department of Medicine, University of Virginia Health System, PO Box 800158, 1215 Lee St, Charlottesville, 22908 VA USA
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA USA
| | - Michael Salerno
- Department of Medicine, University of Virginia Health System, PO Box 800158, 1215 Lee St, Charlottesville, 22908 VA USA
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, VA USA
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA USA
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Rutherford E, Talle MA, Mangion K, Bell E, Rauhalammi SM, Roditi G, McComb C, Radjenovic A, Welsh P, Woodward R, Struthers AD, Jardine AG, Patel RK, Berry C, Mark PB. Defining myocardial tissue abnormalities in end-stage renal failure with cardiac magnetic resonance imaging using native T1 mapping. Kidney Int 2016; 90:845-52. [PMID: 27503805 PMCID: PMC5035134 DOI: 10.1016/j.kint.2016.06.014] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/25/2016] [Accepted: 06/02/2016] [Indexed: 01/24/2023]
Abstract
Noninvasive quantification of myocardial fibrosis in end-stage renal disease is challenging. Gadolinium contrast agents previously used for cardiac magnetic resonance imaging (MRI) are contraindicated because of an association with nephrogenic systemic fibrosis. In other populations, increased myocardial native T1 times on cardiac MRI have been shown to be a surrogate marker of myocardial fibrosis. We applied this method to 33 incident hemodialysis patients and 28 age- and sex-matched healthy volunteers who underwent MRI at 3.0T. Native T1 relaxation times and feature tracking–derived global longitudinal strain as potential markers of fibrosis were compared and associated with cardiac biomarkers. Left ventricular mass indices were higher in the hemodialysis than the control group. Global, Septal and midseptal T1 times were all significantly higher in the hemodialysis group (global T1 hemodialysis 1171 ± 27 ms vs. 1154 ± 32 ms; septal T1 hemodialysis 1184 ± 29 ms vs. 1163 ± 30 ms; and midseptal T1 hemodialysis 1184 ± 34 ms vs. 1161 ± 29 ms). In the hemodialysis group, T1 times correlated with left ventricular mass indices. Septal T1 times correlated with troponin and electrocardiogram-corrected QT interval. The peak global longitudinal strain was significantly reduced in the hemodialysis group (hemodialysis -17.7±5.3% vs. -21.8±6.2%). For hemodialysis patients, the peak global longitudinal strain significantly correlated with left ventricular mass indices (R = 0.426), and a trend was seen for correlation with galectin-3, a biomarker of cardiac fibrosis. Thus, cardiac tissue properties of hemodialysis patients consistent with myocardial fibrosis can be determined noninvasively and associated with multiple structural and functional abnormalities.
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Affiliation(s)
- Elaine Rutherford
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK; University of Dundee, Division of Cardiovascular & Diabetes Medicine, Dundee, Scotland, UK.
| | - Mohammed A Talle
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK
| | - Kenneth Mangion
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK
| | - Elizabeth Bell
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK
| | - Samuli M Rauhalammi
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK
| | - Giles Roditi
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK
| | - Christie McComb
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK
| | - Aleksandra Radjenovic
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK
| | - Paul Welsh
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK
| | - Rosemary Woodward
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK
| | - Allan D Struthers
- University of Dundee, Division of Cardiovascular & Diabetes Medicine, Dundee, Scotland, UK
| | - Alan G Jardine
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK
| | - Rajan K Patel
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK
| | - Colin Berry
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK
| | - Patrick B Mark
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK
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Sanz J, LaRocca G, Mirelis JG. Myocardial Mapping With Cardiac Magnetic Resonance: The Diagnostic Value of Novel Sequences. ACTA ACUST UNITED AC 2016; 69:849-61. [PMID: 27450946 DOI: 10.1016/j.rec.2016.04.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 04/18/2016] [Indexed: 01/05/2023]
Abstract
Cardiac magnetic resonance has evolved into a crucial modality for the evaluation of cardiomyopathy due to its ability to characterize myocardial structure and function. In the last few years, interest has increased in the potential of "mapping" techniques that provide direct and objective quantification of myocardial properties such as T1, T2, and T2* times. These approaches enable the detection of abnormalities that affect the myocardium in a diffuse fashion and/or may be too subtle for visual recognition. This article reviews the current state of myocardial T1 and T2-mapping in both health and disease.
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Affiliation(s)
- Javier Sanz
- The Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, United States; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
| | - Gina LaRocca
- The Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, United States
| | - Jesús G Mirelis
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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Abstract
T1 or longitudinal relaxation time is one of the very fundamental magnetic resonance imaging (MRI) time constants and a tissue characterizing parameter. Only during the last decade did it become possible to quantify T1 values of the myocardium through T1 mapping. Evolving from only region of interest analysis and long acquisition times to the pixel-based parametric mapping and short breath-hold sequences, T1 mapping is reaching maturity among cardiac magnetic resonance (CMR) techniques. Both inversion recovery methods such as MOdified Look-Locker Inversion (MOL-LI) and Shortened MOLLI (ShMOLLI) and saturation recovery methods such as Saturation recovery Single-Shot Acquisition (SASHA) are available for T1 quantification with variable degrees of accuracy, precision, and reproducibility. Native (non-contrast) T1 values increase with edema, amyloid deposition, and fibrosis, while they decrease in fat or iron deposition in the myocardium. These features enabled significant expansion of the clinical applications of native T1 mapping where it provides high sensitivity and specificity and even acts as a disease biomarker or a predictor of prognosis. It is of particular usefulness in diffuse myocardial diseases where conventional CMR techniques might be deceiving. A brighter future for the technique is expected if certain challenges are to be faced, examples of which are the need for standardization of normal values, acquisition techniques, and improving analysis tools.
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Affiliation(s)
- Ahmed Hamdy
- Department of Radiology, Mie University Hospital
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62
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Lewandowski AJ, Lamata P, Francis JM, Piechnik SK, Ferreira VM, Boardman H, Neubauer S, Singhal A, Leeson P, Lucas A. Breast Milk Consumption in Preterm Neonates and Cardiac Shape in Adulthood. Pediatrics 2016; 138:peds.2016-0050. [PMID: 27302980 PMCID: PMC6198929 DOI: 10.1542/peds.2016-0050] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Preterm birth relates to long-term alterations in cardiac morphology and function. Understanding whether preterm postnatal life is a tractable period of cardiovascular development that can be positively altered by nutrition is relevant to long-term outcomes. We hypothesized that being fed human breast milk during early postnatal life is beneficial to long-term cardiac structure and function in preterm-born individuals compared with infant formulas. METHODS A total of 926 preterm-born infants originally took part in a randomized controlled trial of postnatal milk-feeding regimens between 1982 and 1985 across 5 different UK centers. Preterm-born individuals were randomly assigned to either breast milk donated by unrelated lactating women or nutrient-enriched formulas. We followed 102 individuals from this cohort: 30 of whom had been randomized to being fed exclusively human milk and 16 to being fed exclusively formula. As a comparison group, we recruited an additional 102 individuals born term to uncomplicated pregnancies. Cardiac morphology and function were assessed by MRI. RESULTS Preterm-born individuals fed exclusively human milk as infants had increased left and right ventricular end-diastolic volume index (+9.73%, P = .04 and +18.2%, P < .001) and stroke volume index (+9.79%, P = .05 and +22.1%, P = .01) compared with preterm-born individuals who were exclusively formula fed as infants. CONCLUSIONS This study provides the first evidence of a beneficial association between breast milk and cardiac morphology and function in adult life in those born preterm and supports promotion of human milk for the care of preterm infants to reduce long-term cardiovascular risk.
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Affiliation(s)
- Adam J. Lewandowski
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom,Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Pablo Lamata
- Department of Biomedical Engineering, King’s College London, London, United Kingdom
| | - Jane M. Francis
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stefan K. Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Vanessa M. Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Henry Boardman
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom,Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Atul Singhal
- MRC Childhood Nutrition Research Centre, Institute of Child Health, University College London, London, United Kingdom
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom,Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Alan Lucas
- MRC Childhood Nutrition Research Centre, Institute of Child Health, University College London, London, United Kingdom
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Nezafat R. Native T1 Mapping for Myocardial Infarction: Time to Throw Out the Gadolinium? JACC Cardiovasc Imaging 2016; 8:1031-1033. [PMID: 26381765 DOI: 10.1016/j.jcmg.2015.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 06/26/2015] [Accepted: 07/15/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Reza Nezafat
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
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Wu LM, Chen BH, Yao QY, Ou YR, Wu R, Jiang M, Hu J, An DA, Xu JR. Quantitative diffusion-weighted magnetic resonance imaging in the assessment of myocardial fibrosis in hypertrophic cardiomyopathy compared with T1 mapping. Int J Cardiovasc Imaging 2016; 32:1289-97. [PMID: 27198892 DOI: 10.1007/s10554-016-0909-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 05/05/2016] [Indexed: 11/29/2022]
Abstract
To identify myocardial fibrosis in hypertrophic cardiomyopathy (HCM) subjects using quantitative cardiac diffusion-weighted imaging (DWI) and to compare its performance with native T1 mapping and extracellular volume (ECV). Thirty-eight HCM subjects (mean age, 53 ± 9 years) and 14 normal controls (mean age, 51 ± 8 years) underwent cardiac magnetic resonance imaging (CMRI) on a 3.0T magnetic resonance (MR) machine with DWI, T1 mapping and late gadolinium enhancement (LGE) imaging as the reference standard. The mean apparent diffusion coefficient (ADC), native T1 value and ECV were determined for each subject. Overall, the HCM subjects exhibited an increased native T1 value (1241.04 ± 78.50 ms), ECV (0.31 ± 0.03) and ADC (2.36 ± 0.34 s/mm(2)) compared with the normal controls (1114.60 ± 37.99 ms, 0.24 ± 0.04, and 1.62 ± 0.38 s/mm(2), respectively) (p < 0.05). DWI differentiated healthy and fibrotic myocardia with an area under the curve (AUC) of 0.93, while the AUCs of the native T1 values (0.93), (p > 0.05) and ECV (0.94), (p > 0.05) exhibited an equal differentiation ability. Both HCM LGE+ and HCM LGE- subjects had an increased native T1 value, ECV and ADC compared to the normal controls (p < 0.05). HCM LGE+ subjects exhibited an increased ECV (0.31 ± 0.04) and ADC (2.43 ± 0.36 s/mm(2)) compared to HCM LGE- subjects (p < 0.05). HCM LGE+ and HCM LGE- subjects had similar native T1 values (1250 ± 76.36 ms vs. 1213.98 ± 92.30 ms, respectively) (p > 0.05). ADC values were linearly associated with increased ECV (R(2) = 0.36) and native T1 values (R(2) = 0.40) among all subjects. DWI is a feasible alternative to native T1 mapping and ECV for the identification of myocardial fibrosis in patients with HCM. DWI and ECV can quantitatively characterize the extent of fibrosis in HCM LGE+ and HCM LGE- patients.
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Affiliation(s)
- Lian-Ming Wu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bing-Hua Chen
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qiu-Ying Yao
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yang-Rongzheng Ou
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Rui Wu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Meng Jiang
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, MI, USA
| | - Dong-Aolei An
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jian-Rong Xu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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von Knobelsdorff-Brenkenhoff F, Prothmann M, Dieringer MA, Wassmuth R, Rudolph A, Utz W, Traber J, Greiser A, Niendorf T, Schulz-Menger J. Current T₁ and T₂ mapping techniques applied with simple thresholds cannot discriminate acute from chronic myocadial infarction on an individual patient basis: a pilot study. BMC Med Imaging 2016; 16:35. [PMID: 27129879 PMCID: PMC4850633 DOI: 10.1186/s12880-016-0135-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 04/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studying T1- and T2-mapping for discrimination of acute from chronic myocardial infarction (AMI, CMI). METHODS Eight patients with AMI underwent CMR at 3 T acutely and after >3 months. Imaging techniques included: T2-weighted imaging, late enhancement (LGE), T2-mapping, native and post-contrast T1-mapping. Myocardial T2- and T1-relaxation times were determined for every voxel. Abnormal voxels as defined by having T2- and T1-values beyond a predefined threshold (T2 > 50 ms, native T1 > 1250 ms and post-contrast T1 < 350 ms) were highlighted and compared with LGE as the reference. RESULTS Abnormal T2-relaxation times were present in the voxels with AMI (=> delete acute infarction; unfortunately this is not possible in your web interface) acute infarction only in half of the subjects. Abnormal T2-values were also present in subjects with CMI, thereby matching the chronically infarcted territory in some. Abnormal native T1 times were present in voxels with AMI in 5/8 subjects, but also remote from the infarcted territory in four. In CMI, abnormal native T1 values corresponded with infarcted voxels, but were also abnormal remote from the infarcted territory. Voxels with abnormal post-contrast T1-relaxation times agreed well with LGE in AMI and CMI. CONCLUSIONS In this pilot-study, T2- and T1-mapping with simple thresholds did not facilitate the discrimination of AMI and CMI.
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Affiliation(s)
- Florian von Knobelsdorff-Brenkenhoff
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Lindenberger Weg 80, Berlin, 13125, Germany. .,Berlin Ultrahigh Field Facility, Max-Delbrueck Center for Molecular Medicine, Robert-Rössle-Str. 10, Berlin, 13125, Germany.
| | - Marcel Prothmann
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Lindenberger Weg 80, Berlin, 13125, Germany.,Berlin Ultrahigh Field Facility, Max-Delbrueck Center for Molecular Medicine, Robert-Rössle-Str. 10, Berlin, 13125, Germany
| | - Matthias A Dieringer
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Lindenberger Weg 80, Berlin, 13125, Germany.,Berlin Ultrahigh Field Facility, Max-Delbrueck Center for Molecular Medicine, Robert-Rössle-Str. 10, Berlin, 13125, Germany
| | - Ralf Wassmuth
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Lindenberger Weg 80, Berlin, 13125, Germany
| | - André Rudolph
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Lindenberger Weg 80, Berlin, 13125, Germany
| | - Wolfgang Utz
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Lindenberger Weg 80, Berlin, 13125, Germany
| | - Julius Traber
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Lindenberger Weg 80, Berlin, 13125, Germany
| | - Andreas Greiser
- Siemens Healthcare, Allee am Roethelheimpark 2, Erlangen, 91052, Germany
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility, Max-Delbrueck Center for Molecular Medicine, Robert-Rössle-Str. 10, Berlin, 13125, Germany.,Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Lindenberger Weg 80, Berlin, 13125, Germany
| | - Jeanette Schulz-Menger
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Lindenberger Weg 80, Berlin, 13125, Germany.,Berlin Ultrahigh Field Facility, Max-Delbrueck Center for Molecular Medicine, Robert-Rössle-Str. 10, Berlin, 13125, Germany
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Baxa J, Ferda J, Hromádka M. T1 mapping of the ischemic myocardium: Review of potential clinical use. Eur J Radiol 2016; 85:1922-1928. [PMID: 27105590 DOI: 10.1016/j.ejrad.2016.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 03/26/2016] [Accepted: 04/13/2016] [Indexed: 12/25/2022]
Abstract
Cardiac magnetic resonance imaging (CMR) is an indispensable part of the diagnostic algorithm in cardiology. CMR has become a gold standard in various disorders; moreover, it is well established also as a surrogate end-point in experimental and clinical studies. Particularly, the ability to directly display myocardial injury is a unique feature in comparison with other methods. The mapping of magnetic relaxation properties (T1, T2 and T2* relaxation times) are still relatively new techniques, but promising to improve the robustness of CMR and add new appropriate indications. The high potential of T1 mapping in the diagnostic of myocardial ischemic involvement has been highlighted in several experimental and clinical studies, but the use in clinical routine was limited due to the shortcomings in scanning and image evaluation. However, the quantitative technique of T1 mapping is now commercially available and its simple use, good reproducibility and limited subjectivity allow its incorporation into routine CMR protocols. This review article is aimed to summarise existing results and clinical experience with T1 mapping in patients with ischemic cardiac disease.
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Affiliation(s)
- Jan Baxa
- Department of Imaging Methods, Faculty of Medicine in Pilsen, Charles University in Prague and University Hospital Pilsen, Czech Republic.
| | - Jiří Ferda
- Department of Imaging Methods, Faculty of Medicine in Pilsen, Charles University in Prague and University Hospital Pilsen, Czech Republic
| | - Milan Hromádka
- Department of Cardiology, University Hospital Pilsen, Czech Republic
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68
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Everett RJ, Stirrat CG, Semple SIR, Newby DE, Dweck MR, Mirsadraee S. Assessment of myocardial fibrosis with T1 mapping MRI. Clin Radiol 2016; 71:768-78. [PMID: 27005015 DOI: 10.1016/j.crad.2016.02.013] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/15/2016] [Accepted: 02/09/2016] [Indexed: 11/18/2022]
Abstract
Myocardial fibrosis can arise from a range of pathological processes and its presence correlates with adverse clinical outcomes. Cardiac magnetic resonance (CMR) can provide a non-invasive assessment of cardiac structure, function, and tissue characteristics, which includes late gadolinium enhancement (LGE) techniques to identify focal irreversible replacement fibrosis with a high degree of accuracy and reproducibility. Importantly the presence of LGE is consistently associated with adverse outcomes in a range of common cardiac conditions; however, LGE techniques are qualitative and unable to detect diffuse myocardial fibrosis, which is an earlier form of fibrosis preceding replacement fibrosis that may be reversible. Novel T1 mapping techniques allow quantitative CMR assessment of diffuse myocardial fibrosis with the two most common measures being native T1 and extracellular volume (ECV) fraction. Native T1 differentiates normal from infarcted myocardium, is abnormal in hypertrophic cardiomyopathy, and may be particularly useful in the diagnosis of Anderson-Fabry disease and amyloidosis. ECV is a surrogate measure of the extracellular space and is equivalent to the myocardial volume of distribution of the gadolinium-based contrast medium. It is reproducible and correlates well with fibrosis on histology. ECV is abnormal in patients with cardiac failure and aortic stenosis, and is associated with functional impairment in these groups. T1 mapping techniques promise to allow earlier detection of disease, monitor disease progression, and inform prognosis; however, limitations remain. In particular, reference ranges are lacking for T1 mapping values as these are influenced by specific CMR techniques and magnetic field strength. In addition, there is significant overlap between T1 mapping values in healthy controls and most disease states, particularly using native T1, limiting the clinical application of these techniques at present.
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Affiliation(s)
- R J Everett
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, UK.
| | - C G Stirrat
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, UK
| | - S I R Semple
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, UK; Clinical Research Imaging Centre, University of Edinburgh, UK
| | - D E Newby
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, UK; Clinical Research Imaging Centre, University of Edinburgh, UK
| | - M R Dweck
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, UK
| | - S Mirsadraee
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, UK; Clinical Research Imaging Centre, University of Edinburgh, UK
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Mirsadraee S, Tse M, Kershaw L, Semple S, Schembri N, Chin C, Murchison JT, Hirani N, van Beek EJR. T1 characteristics of interstitial pulmonary fibrosis on 3T MRI-a predictor of early interstitial change? Quant Imaging Med Surg 2016; 6:42-9. [PMID: 26981454 DOI: 10.3978/j.issn.2223-4292.2016.02.02] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Computed tomography (CT) is routinely used for diagnosis and characterisation of idiopathic pulmonary fibrosis (IPF). The technique however has limited sensitivity in detection and monitoring of early fibrotic changes. The aim of this study was to evaluate T1 characteristics in the radiologically diseased lung parenchyma in IPF patient compared to apparently normal parenchyma in both interstitial lung disease (ILD) patients and healthy volunteers and to investigate the feasibility of the technique in prediction of early fibrotic lung changes that may not be visible on CT. METHODS Ten patients with IPF underwent high resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) on the same day of attendance. 3T MRI was repeated in seven patients with IPF to test the reproducibility of results. The control group included healthy volunteers (n=10). A modified look-locker inversion-recovery (MOLLI) sequence (124×192 acquisition matrix; 8 mm slice) was performed during a 15-20 s breathhold in a single slice. The position of MR slice was pre-selected where there was CT evidence of normal and fibrotic lung. MOLLI imaging was performed prior to the contrast administration, and at 15, 25, 30 and 35 min post Gadolinium. The imaging data were then processed with a curve-fitting technique to estimate T1 values. T1 values of the apparent fibrotic and normal lung in IPF patients and normal lung were compared. RESULTS Fibrotic lung had a higher pre-contrast T1 than either morphologically normal lung in ILD patients or control lung (P=0.02) in healthy volunteers (1309±123, 1069±71, and 1011±172 ms, respectively). Morphologically normal lung T1 and control lung T1 were not significantly different pre-contrast, however, at 10 min after administration of Gadolinium, control lung had a significantly shorter T1 than either fibrotic or morphologically normal lung (494±34, 670±63, and 619±41 ms, respectively; P=0.001). T1 for fibrotic lung continued to decrease until 20 min after contrast agent administration (P≤0.0001), whereas morphologically normal lung T1 did not significantly change after 10 min (P>0.3). This indicates delayed uptake of contrast agent in the fibrotic lung compared with morphologically normal lung. CONCLUSIONS T1 mapping of patients with IPF at 3T is feasible and demonstrates a significant difference between fibrotic lung tissue and morphologically normal lung tissue both before Gadolinium administration and at 10 min delayed post-contrast images. The technique is able to evaluate early fibrosis in patients with apparently morphologically normal lung.
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Affiliation(s)
- Saeed Mirsadraee
- 1 Clinical Research Imaging Centre, 2 MRC Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Matthew Tse
- 1 Clinical Research Imaging Centre, 2 MRC Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Lucy Kershaw
- 1 Clinical Research Imaging Centre, 2 MRC Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Scott Semple
- 1 Clinical Research Imaging Centre, 2 MRC Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Nicola Schembri
- 1 Clinical Research Imaging Centre, 2 MRC Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Calvin Chin
- 1 Clinical Research Imaging Centre, 2 MRC Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - John T Murchison
- 1 Clinical Research Imaging Centre, 2 MRC Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Nik Hirani
- 1 Clinical Research Imaging Centre, 2 MRC Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Edwin J R van Beek
- 1 Clinical Research Imaging Centre, 2 MRC Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
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