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Małek ŁA, Śpiewak M. Isolated myocardial edema in cardiac magnetic resonance - in search of a management strategy. Trends Cardiovasc Med 2023; 33:395-402. [PMID: 35405307 DOI: 10.1016/j.tcm.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/23/2022] [Accepted: 04/01/2022] [Indexed: 01/04/2023]
Abstract
Isolated myocardial edema not accompanied by late gadolinium enhancement (LGE) may be occasionally found on cardiac magnetic resonance (CMR). This type of picture may be encountered in patients with suspected myocarditis, post some acute cardiac events, with cardiac allograft rejection or even in athletes after an extreme exercise. Currently, there is no clear management strategy for this type of incidental finding. In this narrative review we discuss the methods and pitfalls of edema detection with means of CMR, review published data on isolated myocardial edema for each of the most probable clinical scenarios and propose a structured clinical decision-making algorithm to help clinicians navigate through this type of CMR result. Finally, we highlight the most important gaps in evidence related to isolated myocardial edema without fibrosis, where further research is particularly needed.
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Affiliation(s)
- Łukasz A Małek
- Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, National Institute of Cardiology, Warsaw, Poland.
| | - Mateusz Śpiewak
- Magnetic Resonance Unit, Department of Radiology, National Institute of Cardiology, Warsaw, Poland
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O'Brien AT, Gil KE, Varghese J, Simonetti OP, Zareba KM. T2 mapping in myocardial disease: a comprehensive review. J Cardiovasc Magn Reson 2022; 24:33. [PMID: 35659266 PMCID: PMC9167641 DOI: 10.1186/s12968-022-00866-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 04/27/2022] [Indexed: 12/20/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) is considered the gold standard imaging modality for myocardial tissue characterization. Elevated transverse relaxation time (T2) is specific for increased myocardial water content, increased free water, and is used as an index of myocardial edema. The strengths of quantitative T2 mapping lie in the accurate characterization of myocardial edema, and the early detection of reversible myocardial disease without the use of contrast agents or ionizing radiation. Quantitative T2 mapping overcomes the limitations of T2-weighted imaging for reliable assessment of diffuse myocardial edema and can be used to diagnose, stage, and monitor myocardial injury. Strong evidence supports the clinical use of T2 mapping in acute myocardial infarction, myocarditis, heart transplant rejection, and dilated cardiomyopathy. Accumulating data support the utility of T2 mapping for the assessment of other cardiomyopathies, rheumatologic conditions with cardiac involvement, and monitoring for cancer therapy-related cardiac injury. Importantly, elevated T2 relaxation time may be the first sign of myocardial injury in many diseases and oftentimes precedes symptoms, changes in ejection fraction, and irreversible myocardial remodeling. This comprehensive review discusses the technical considerations and clinical roles of myocardial T2 mapping with an emphasis on expanding the impact of this unique, noninvasive tissue parameter.
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Affiliation(s)
- Aaron T O'Brien
- Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio, USA
| | - Katarzyna E Gil
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Juliet Varghese
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Orlando P Simonetti
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
- Department of Radiology, The Ohio State University, Columbus, Ohio, USA
| | - Karolina M Zareba
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA.
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Clarke GD, Li J, Kuo AH, Moody AJ, Nathanielsz PW. Cardiac magnetic resonance imaging: insights into developmental programming and its consequences for aging. J Dev Orig Health Dis 2021; 12:203-219. [PMID: 33349289 PMCID: PMC7987688 DOI: 10.1017/s2040174420001233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Cardiovascular diseases (CVD) are important consequences of adverse perinatal conditions such as fetal hypoxia and maternal malnutrition. Cardiac magnetic resonance imaging (CMR) can produce a wealth of physiological information related to the development of the heart. This review outlines the current state of CMR technologies and describes the physiological biomarkers that can be measured. These phenotypes include impaired ventricular and atrial function, maladaptive ventricular remodeling, and the proliferation of myocardial steatosis and fibrosis. The discussion outlines the applications of CMR to understanding the developmental pathways leading to impaired cardiac function. The use of CMR, both in animal models of developmental programming and in human studies, is described. Specific examples are given in a baboon model of intrauterine growth restriction (IUGR). CMR offers great potential as a tool for understanding the sequence of dysfunctional adaptations of developmental origin that can affect the human cardiovascular system.
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Affiliation(s)
- G D Clarke
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - J Li
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - A H Kuo
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - A J Moody
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - P W Nathanielsz
- Department of Animal Science, University of Wyoming, Laramie, WY, USA
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Pediatric Myocardial T1 and T2 Value Associations with Age and Heart Rate at 1.5 T. Pediatr Cardiol 2021; 42:269-277. [PMID: 33006645 DOI: 10.1007/s00246-020-02479-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/26/2020] [Indexed: 10/23/2022]
Abstract
The objective of the study was to determine normal global left ventricular reference values for T1 and T2 in children. This is a retrospective study that included healthy subjects, age 5-19 years, who underwent CMR for the indication of pectus excavatum from 2018 to 2019. Linear regression models were used to determine associations of native T1 and T2 values to heart rate, age, and other CMR parameters. 102 patients with a mean age of 14.0 ± 2.4 years were included (range 5.4-18.8). 87 (85%) were males and 15 (15%) were females. The mean global T1 was 1018 ± 25 ms and the mean T2 was 53 ± 3 ms. T1 was negatively correlated with age (r = - 0.39, p < 0.001) and positively correlated with heart rate (r = 0.32, p < 0.001) by univariate analysis. Multivariable analysis showed that age and heart rate were independently associated with T1. T2 demonstrated a weak negative correlation with age (r = - 0.20, p = 0.047) and no correlation with heart rate. There was no difference in T1 (p = 0.23) or T2 (p = 0.52) between genders. This study reports normal pediatric T1 and T2 values at a 1.5 Tesla scanner. T1 was dependent on age and heart rate, while T2 was less dependent on age with no correlation with heart rate.
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Pagano JJ, Yim D, Lam CZ, Yoo SJ, Seed M, Grosse-Wortmann L. Normative Data for Myocardial Native T1 and Extracellular Volume Fraction in Children. Radiol Cardiothorac Imaging 2020; 2:e190234. [PMID: 33778602 DOI: 10.1148/ryct.2020190234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 04/20/2020] [Accepted: 04/28/2020] [Indexed: 12/21/2022]
Abstract
Purpose To establish normative data for myocardial T1, including extracellular volume (ECV) fraction, in healthy children. Materials and Methods In this retrospective, single-center study, T1 mapping data were collected from 48 healthy pediatric patients (14 years ± 3 [standard deviation]; range, 9-18 years; 27 of 48 [56%] male) referred for cardiac screening 1.5-T MRI between 2014 and 2017. T1 relaxometry was performed using a 5(number of heartbeats [nHB])3 modified Look-Locker inversion recovery (MOLLI) sequence, where nHB was three to five heartbeats depending on the heart rate, and was repeated 15 minutes following the administration of 0.2 mmol per kilogram of body weight of gadobenate dimeglumine, with 19 patients receiving contrast material. T1 values were calculated using a curve-fitting algorithm on average region-of-interest signal and corrected for imperfect inversion pulse efficiency. Comparisons within patients were performed with paired Student t test, between groups with unpaired Student t test or Mann-Whitney U test, and linear regression was performed to examine for associations with other variables. Results Average native T1 was 1008 msec ± 31, with a nonsignificant increase in females (1017 msec ± 27 vs 1001 msec ± 33, P = .066). Average ECV was 20.8% ± 2.4, with a nonsignificant increase in values in females (21.7% ± 1.9 vs 20.0% ± 2.6, P = .123). T1 and ECV values were increased in the septum versus the free wall. Conclusion Normative data are presented for myocardial native T1 and ECV using the MOLLI T1 mapping sequence at 1.5 T.Supplemental material is available for this article.© RSNA, 2020.
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Affiliation(s)
- Joseph J Pagano
- Department of Pediatrics, Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (J.J.P.); Department of Paediatrics, Division of Cardiology (D.Y., S.J.Y., M.S., L.G.W.) and Department of Diagnostic Imaging (C.Z.L., S.J.Y., M.S., L.G.W.), The Hospital for Sick Children, University of Toronto, Toronto, Canada; and Department of Cardiology, Princess Margaret Hospital for Children, Perth, Australia (D.Y.)
| | - Deane Yim
- Department of Pediatrics, Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (J.J.P.); Department of Paediatrics, Division of Cardiology (D.Y., S.J.Y., M.S., L.G.W.) and Department of Diagnostic Imaging (C.Z.L., S.J.Y., M.S., L.G.W.), The Hospital for Sick Children, University of Toronto, Toronto, Canada; and Department of Cardiology, Princess Margaret Hospital for Children, Perth, Australia (D.Y.)
| | - Christopher Z Lam
- Department of Pediatrics, Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (J.J.P.); Department of Paediatrics, Division of Cardiology (D.Y., S.J.Y., M.S., L.G.W.) and Department of Diagnostic Imaging (C.Z.L., S.J.Y., M.S., L.G.W.), The Hospital for Sick Children, University of Toronto, Toronto, Canada; and Department of Cardiology, Princess Margaret Hospital for Children, Perth, Australia (D.Y.)
| | - Shi-Joon Yoo
- Department of Pediatrics, Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (J.J.P.); Department of Paediatrics, Division of Cardiology (D.Y., S.J.Y., M.S., L.G.W.) and Department of Diagnostic Imaging (C.Z.L., S.J.Y., M.S., L.G.W.), The Hospital for Sick Children, University of Toronto, Toronto, Canada; and Department of Cardiology, Princess Margaret Hospital for Children, Perth, Australia (D.Y.)
| | - Mike Seed
- Department of Pediatrics, Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (J.J.P.); Department of Paediatrics, Division of Cardiology (D.Y., S.J.Y., M.S., L.G.W.) and Department of Diagnostic Imaging (C.Z.L., S.J.Y., M.S., L.G.W.), The Hospital for Sick Children, University of Toronto, Toronto, Canada; and Department of Cardiology, Princess Margaret Hospital for Children, Perth, Australia (D.Y.)
| | - Lars Grosse-Wortmann
- Department of Pediatrics, Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (J.J.P.); Department of Paediatrics, Division of Cardiology (D.Y., S.J.Y., M.S., L.G.W.) and Department of Diagnostic Imaging (C.Z.L., S.J.Y., M.S., L.G.W.), The Hospital for Sick Children, University of Toronto, Toronto, Canada; and Department of Cardiology, Princess Margaret Hospital for Children, Perth, Australia (D.Y.)
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