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Cai S, Haghbayan H, Chan KKW, Deva DP, Jimenez-Juan L, Connelly KA, Ng MY, Yan RT, Yan AT. Tissue mapping by cardiac magnetic resonance imaging for the prognostication of cardiac amyloidosis: A systematic review and meta-analysis. Int J Cardiol 2024; 403:131892. [PMID: 38382853 DOI: 10.1016/j.ijcard.2024.131892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/05/2024] [Accepted: 02/18/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Cardiac amyloidosis is increasingly recognized as a significant contributor to cardiovascular morbidity and mortality. With the emergence of novel therapies, there is a growing interest in prognostication of patients with cardiac amyloidosis using cardiac magnetic resonance imaging (CMR). In this systematic review and meta-analysis, we aimed to examine the prognostic significance of myocardial native T1 and T2, and extracellular volume (ECV). METHODS Observational cohort studies or single arms of clinical trials were eligible. MEDLINE, EMBASE and CENTRAL were systematically searched from their respective dates of inception to January 2023. No exclusions were made based on date of publication, study outcomes, or study language. The study populations composed of adult patients (≥18 years old) with amyloid cardiomyopathy. All studies included the use of CMR with and without intravenous gadolinium contrast administration to assess myocardial native T1 mapping, T2 mapping, and ECV in association with the pre-specified primary outcome of all-cause mortality. Data were extracted from eligible primary studies by two independent reviewers and pooled via the inverse variance method using random effects models for meta-analysis. RESULTS A total of 3852 citations were reviewed. A final nine studies including a total of 955 patients (mean age 65 ± 10 years old, 32% female, mean left ventricular ejection fraction (LVEF) 59 ± 12% and 24% had NYHA class III or IV symptoms) with cardiac amyloidosis [light chain amyloidosis (AL) 50%, transthyretin amyloidosis (ATTR) 49%, other 1%] were eligible for inclusion and suitable for data extraction. All included studies were single centered (seven with 1.5 T MRI scanners, two with 3.0 T MRI scanners) and non-randomized in design, with follow-up spanning from 8 to 64 months (median follow-up = 25 months); 320 patients died during follow-up, rendering a weighted mortality rate of 33% across studies. Compared with patients with AL amyloid, patients with ATTR amyloid had significantly higher mean left ventricular mass index (LVMi) (102 ± 34 g/m2 vs 127 ± 37 g/m2, p = 0.02). N-terminal pro-brain natriuretic peptide (NT-proBNP), troponin T levels, mean native T1 values, ECV and T2 values did not differ between patients with ATTR amyloid and AL amyloid (all p > 0.25). Overall, the hazard ratios for mortality were 1.33 (95% CI = [1.10, 1.60]; p = 0.003; I2 = 29%) for every 60 ms higher T1 time, 1.16 (95% CI = [1.09, 1.23], p < 0.0001; I2 = 76%) for every 3% higher ECV, and 5.23 (95% CI = [2.27, 12.02]; p < 0.0001; I2 = 0%) for myocardial-to-skeletal T2 ratio below the mean (vs above the mean). CONCLUSION Higher native T1 time and ECV, and lower myocardial to skeletal T2 ratio, on CMR are associated with worse mortality in patients with cardiac amyloidosis. Therefore, tissue mapping using CMR may offer a useful non-invasive technique to monitor disease progression and determine prognosis in patients with cardiac amyloidosis.
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Affiliation(s)
- Sean Cai
- Department of Medicine, University of Toronto, Toronto, Canada
| | | | - Kelvin K W Chan
- Department of Medicine, University of Toronto, Toronto, Canada; Department of Medical Oncology, Sunnybrook Hospital, Toronto, Canada
| | - Djeven P Deva
- Department of Medical Imaging, University of Toronto, Toronto, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada; Department of Medical Imaging, St. Michael's Hospital, Toronto, Canada
| | - Laura Jimenez-Juan
- Department of Medical Imaging, University of Toronto, Toronto, Canada; Department of Medical Imaging, St. Michael's Hospital, Toronto, Canada
| | - Kim A Connelly
- Department of Medicine, University of Toronto, Toronto, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada; Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, Toronto, Canada
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, The University of Hong Kong, HKU-Shenzhen Hospital, China
| | - Raymond T Yan
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Andrew T Yan
- Department of Medicine, University of Toronto, Toronto, Canada; Department of Medical Imaging, University of Toronto, Toronto, Canada; Department of Medical Imaging, St. Michael's Hospital, Toronto, Canada; Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, Toronto, Canada.
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Viezzer D, Hadler T, Gröschel J, Ammann C, Blaszczyk E, Kolbitsch C, Hufnagel S, Kranzusch-Groß R, Lange S, Schulz-Menger J. Post-hoc standardisation of parametric T1 maps in cardiovascular magnetic resonance imaging: a proof-of-concept. EBioMedicine 2024; 102:105055. [PMID: 38490103 PMCID: PMC10951905 DOI: 10.1016/j.ebiom.2024.105055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/28/2024] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND In cardiovascular magnetic resonance imaging parametric T1 mapping lacks universally valid reference values. This limits its extensive use in the clinical routine. The aim of this work was the introduction of our self-developed Magnetic Resonance Imaging Software for Standardization (MARISSA) as a post-hoc standardisation approach. METHODS Our standardisation approach minimises the bias of confounding parameters (CPs) on the base of regression models. 214 healthy subjects with 814 parametric T1 maps were used for training those models on the CPs: age, gender, scanner and sequence. The training dataset included both sex, eleven different scanners and eight different sequences. The regression model type and four other adjustable standardisation parameters were optimised among 240 tested settings to achieve the lowest coefficient of variation, as measure for the inter-subject variability, in the mean T1 value across the healthy test datasets (HTE, N = 40, 156 T1 maps). The HTE were then compared to 135 patients with left ventricular hypertrophy including hypertrophic cardiomyopathy (HCM, N = 112, 121 T1 maps) and amyloidosis (AMY, N = 24, 24 T1 maps) after applying the best performing standardisation pipeline (BPSP) to evaluate the diagnostic accuracy. FINDINGS The BPSP reduced the COV of the HTE from 12.47% to 5.81%. Sensitivity and specificity reached 95.83% / 91.67% between HTE and AMY, 71.90% / 72.44% between HTE and HCM, and 87.50% / 98.35% between HCM and AMY. INTERPRETATION Regarding the BPSP, MARISSA enabled the comparability of T1 maps independently of CPs while keeping the discrimination of healthy and patient groups as found in literature. FUNDING This study was supported by the BMBF / DZHK.
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Affiliation(s)
- Darian Viezzer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC Experimental and Clinical Research Center, Lindenberger Weg 80, 13125 Berlin, Germany; Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, A Joint Cooperation Between the Charité - Universitätsmedizin Berlin and the Max-Delbrück-Center for Molecular Medicine, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
| | - Thomas Hadler
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC Experimental and Clinical Research Center, Lindenberger Weg 80, 13125 Berlin, Germany; Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, A Joint Cooperation Between the Charité - Universitätsmedizin Berlin and the Max-Delbrück-Center for Molecular Medicine, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Jan Gröschel
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC Experimental and Clinical Research Center, Lindenberger Weg 80, 13125 Berlin, Germany; Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, A Joint Cooperation Between the Charité - Universitätsmedizin Berlin and the Max-Delbrück-Center for Molecular Medicine, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Clemens Ammann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC Experimental and Clinical Research Center, Lindenberger Weg 80, 13125 Berlin, Germany; Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, A Joint Cooperation Between the Charité - Universitätsmedizin Berlin and the Max-Delbrück-Center for Molecular Medicine, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Edyta Blaszczyk
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC Experimental and Clinical Research Center, Lindenberger Weg 80, 13125 Berlin, Germany; Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, A Joint Cooperation Between the Charité - Universitätsmedizin Berlin and the Max-Delbrück-Center for Molecular Medicine, Berlin, Germany
| | - Christoph Kolbitsch
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
| | - Simone Hufnagel
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
| | - Riccardo Kranzusch-Groß
- Universitätsklinikum Schleswig-Holstein, Klinik für Radiologie und Nuklearmedizin, Lübeck, Germany
| | - Steffen Lange
- Hochschule Darmstadt (University of Applied Sciences), Faculty for Computer Sciences, Darmstadt, Germany
| | - Jeanette Schulz-Menger
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC Experimental and Clinical Research Center, Lindenberger Weg 80, 13125 Berlin, Germany; Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, A Joint Cooperation Between the Charité - Universitätsmedizin Berlin and the Max-Delbrück-Center for Molecular Medicine, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany; Helios Hospital Berlin-Buch, Department of Cardiology and Nephrology, Berlin, Germany
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Ghekiere O, Herbots L, Peters B, Berg BV, Dresselaers T, Franssen W, Padovani B, Ducreux D, Ferrari E, Nchimi A, Demanez S, De Bosscher R, Willems R, Heidbuchel H, La Gerche A, Claessen G, Bogaert J, Eijnde BO. Exercise-induced myocardial T1 increase and right ventricular dysfunction in recreational cyclists: a CMR study. Eur J Appl Physiol 2023; 123:2107-2117. [PMID: 37480391 PMCID: PMC10492712 DOI: 10.1007/s00421-023-05259-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/13/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE Although cardiac troponin I (cTnI) increase following strenuous exercise has been observed, the development of exercise-induced myocardial edema remains unclear. Cardiac magnetic resonance (CMR) native T1/T2 mapping is sensitive to the pathological increase of myocardial water content. Therefore, we evaluated exercise-induced acute myocardial changes in recreational cyclists by incorporating biomarkers, echocardiography and CMR. METHODS Nineteen male recreational participants (age: 48 ± 5 years) cycled the 'L'étape du tour de France" (EDT) 2021' (175 km, 3600 altimeters). One week before the race, a maximal graded cycling test was conducted to determine individual heart rate (HR) training zones. One day before and 3-6 h post-exercise 3 T CMR and echocardiography were performed to assess myocardial native T1/T2 relaxation times and cardiac function, and blood samples were collected. All participants were asked to cycle 2 h around their anaerobic gas exchange threshold (HR zone 4). RESULTS Eighteen participants completed the EDT stage in 537 ± 58 min, including 154 ± 61 min of cycling time in HR zone 4. Post-race right ventricular (RV) dysfunction with reduced strain and increased volumes (p < 0.05) and borderline significant left ventricular global longitudinal strain reduction (p = 0.05) were observed. Post-exercise cTnI (0.75 ± 5.1 ng/l to 69.9 ± 41.6 ng/l; p < 0.001) and T1 relaxation times (1133 ± 48 ms to 1182 ± 46 ms, p < 0.001) increased significantly with no significant change in T2 (p = 0.474). cTnI release correlated with increase in T1 relaxation time (p = 0.002; r = 0.703), post-race RV dysfunction (p < 0.05; r = 0.562) and longer cycling in HR zone 4 (p < 0.05; r = 0.607). CONCLUSION Strenuous exercise causes early post-race cTnI increase, increased T1 relaxation time and RV dysfunction in recreational cyclists, which showed interdependent correlation. The long-term clinical significance of these changes needs further investigation. TRIAL REGISTRATION NUMBERS AND DATE NCT04940650 06/18/2021. NCT05138003 06/18/2021.
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Affiliation(s)
- Olivier Ghekiere
- Faculty of Medicine and Life Sciences/LCRC (-MHU), Hasselt University, Agoralaan, 3590, Diepenbeek, Belgium.
- Department of Radiology and Department of Jessa & Science, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium.
| | - Lieven Herbots
- Faculty of Medicine and Life Sciences/LCRC (-MHU), Hasselt University, Agoralaan, 3590, Diepenbeek, Belgium
- Heart Centre, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium
| | - Benjamin Peters
- Faculty of Medicine and Life Sciences/LCRC (-MHU), Hasselt University, Agoralaan, 3590, Diepenbeek, Belgium
- Department of Radiology and Department of Jessa & Science, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium
| | | | - Tom Dresselaers
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Wouter Franssen
- SMRC Sports Medical Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- Department of Nutrition and Movement Sciences; NUTRIM, School for Nutrition and Translation Research Maastricht, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | | | | | - Emile Ferrari
- Department of Cardiology, University Hospital Nice, Nice, France
| | - Alain Nchimi
- Department of Radiology, Centre Hospitalier Universitaire Luxembourg, Luxembourg, Luxembourg
| | - Sophie Demanez
- Department of Cardiology, Centre Cardiologique Orban, Liège, Belgium
| | - Ruben De Bosscher
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Rik Willems
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Hein Heidbuchel
- Department of Cardiovascular Sciences, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
| | - Andre La Gerche
- Department of Cardiology, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Guido Claessen
- Faculty of Medicine and Life Sciences/LCRC (-MHU), Hasselt University, Agoralaan, 3590, Diepenbeek, Belgium
- Heart Centre, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium
| | - Jan Bogaert
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Bert O Eijnde
- SMRC Sports Medical Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
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Jahnke C, Sinn M, Hot A, Cavus E, Erley J, Schneider J, Chevalier C, Bohnen S, Radunski U, Meyer M, Lund G, Adam G, Kirchhof P, Blankenberg S, Muellerleile K, Tahir E. Differentiation of acute non-ST elevation myocardial infarction and acute infarct-like myocarditis by visual pattern analysis: a head-to-head comparison of different cardiac MR techniques. Eur Radiol 2023; 33:6258-6266. [PMID: 37438640 PMCID: PMC10415415 DOI: 10.1007/s00330-023-09905-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 04/19/2023] [Accepted: 05/28/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVES Parametric cardiac magnetic resonance (CMR) techniques have improved the diagnosis of pathologies. However, the primary tool for differentiating non-ST elevation myocardial infarction (NSTEMI) from myocarditis is still a visual assessment of conventional signal-intensity-based images. This study aimed at analyzing the ability of parametric compared to conventional techniques to visually differentiate ischemic from non-ischemic myocardial injury patterns. METHODS Twenty NSTEMI patients, twenty infarct-like myocarditis patients, and twenty controls were examined using cine, T2-weighted CMR (T2w) and late gadolinium enhancement (LGE) imaging and T1/T2 mapping on a 1.5 T scanner. CMR images were presented in random order to two experienced fully blinded observers, who had to assign them to three categories by a visual analysis: NSTEMI, myocarditis, or healthy. RESULTS The conventional approach (cine, T2w and LGE combined) had the best diagnostic accuracy with 92% (95%CI: 81-97) for NSTEMI and 86% (95%CI: 71-94) for myocarditis. The diagnostic accuracies using T1 maps were 88% (95%CI: 74-95) and 80% (95%CI: 62-91), 84% (95%CI: 67-93) and 74% (95%CI: 54-87) for LGE, and 83% (95%CI: 66-92) and 73% (95%CI: 53-87) for T2w. The accuracies for cine (72% (95%CI: 52-86) and 60% (95%CI: 38-78)) and T2 maps (62% (95%CI: 40-79) and 47% (95%CI: 28-68)) were significantly lower compared to the conventional approach (p < 0.001 and p < 0.0001). CONCLUSIONS The conventional approach provided a reliable visual discrimination between NSTEMI, myocarditis, and controls. The diagnostic accuracy of a visual pattern analysis of T1 maps was not significantly inferior, whereas the diagnostic accuracy of T2 maps was not sufficient in this context. CLINICAL RELEVANCE STATEMENT The ability of parametric compared to conventional CMR techniques to visually differentiate ischemic from non-ischemic myocardial injury patterns can avoid potentially unnecessary invasive coronary angiography and help to shorten CMR protocols and to reduce the need of gadolinium contrast agents. KEY POINTS • A visual differentiation of ischemic from non-ischemic patterns of myocardial injury is reliably achieved by a combination of conventional CMR techniques (cine, T2-weighted and LGE imaging). • There is no significant difference in accuracies between visual pattern analysis on native T1 maps without providing quantitative values and a conventional combined approach for differentiating non-ST elevation myocardial infarction, infarct-like myocarditis, and controls. • T2 maps do not provide a sufficient diagnostic accuracy for visual pattern analysis for differentiating non-ST elevation myocardial infarction, infarct-like myocarditis, and controls.
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Affiliation(s)
- Charlotte Jahnke
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Martin Sinn
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Amra Hot
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ersin Cavus
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Jennifer Erley
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Schneider
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Celeste Chevalier
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | | | - Ulf Radunski
- Department of Cardiology, Regio Clinics, Pinneberg, Germany
| | - Mathias Meyer
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gunnar Lund
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Kai Muellerleile
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Gröschel J, Trauzeddel RF, Müller M, von Knobelsdorff-Brenkenhoff F, Viezzer D, Hadler T, Blaszczyk E, Daud E, Schulz-Menger J. Multi-site comparison of parametric T1 and T2 mapping: healthy travelling volunteers in the Berlin research network for cardiovascular magnetic resonance (BER-CMR). J Cardiovasc Magn Reson 2023; 25:47. [PMID: 37574535 PMCID: PMC10424349 DOI: 10.1186/s12968-023-00954-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Parametric mapping sequences in cardiovascular magnetic resonance (CMR) allow for non-invasive myocardial tissue characterization. However quantitative myocardial mapping is still limited by the need for local reference values. Confounders, such as field strength, vendors and sequences, make intersite comparisons challenging. This exploratory study aims to assess whether multi-site studies that control confounding factors provide first insights whether parametric mapping values are within pre-defined tolerance ranges across scanners and sites. METHODS A cohort of 20 healthy travelling volunteers was prospectively scanned at three sites with a 3 T scanner from the same vendor using the same scanning protocol and acquisition scheme. A Modified Look-Locker inversion recovery sequence (MOLLI) for T1 and a fast low-angle shot sequence (FLASH) for T2 were used. At one site a scan-rescan was performed to assess the intra-scanner reproducibility. All acquired T1- and T2-mappings were analyzed in a core laboratory using the same post-processing approach and software. RESULTS After exclusion of one volunteer due to an accidentally diagnosed cardiac disease, T1- and T2-maps of 19 volunteers showed no significant differences between the 3 T sites (mean ± SD [95% confidence interval] for global T1 in ms: site I: 1207 ± 32 [1192-1222]; site II: 1207 ± 40 [1184-1225]; site III: 1219 ± 26 [1207-1232]; p = 0.067; for global T2 in ms: site I: 40 ± 2 [39-41]; site II: 40 ± 1 [39-41]; site III 39 ± 2 [39-41]; p = 0.543). CONCLUSION Parametric mapping results displayed initial hints at a sufficient similarity between sites when confounders, such as field strength, vendor diversity, acquisition schemes and post-processing analysis are harmonized. This finding needs to be confirmed in a powered clinical trial. Trial registration ISRCTN14627679 (retrospectively registered).
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Affiliation(s)
- Jan Gröschel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, ECRC Experimental and Clinical Research Center, Lindenberger Weg 80, 13125, Berlin, Germany
- Working Group On Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Ralf-Felix Trauzeddel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, ECRC Experimental and Clinical Research Center, Lindenberger Weg 80, 13125, Berlin, Germany
- Working Group On Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Anaesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin Und Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Maximilian Müller
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, ECRC Experimental and Clinical Research Center, Lindenberger Weg 80, 13125, Berlin, Germany
- Working Group On Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany
| | - Florian von Knobelsdorff-Brenkenhoff
- Working Group On Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany
- KIZ, Kardiologie im Zentrum, Eisenmannstr. 4, 80331, Munich, Deutschland
| | - Darian Viezzer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, ECRC Experimental and Clinical Research Center, Lindenberger Weg 80, 13125, Berlin, Germany
- Working Group On Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Thomas Hadler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, ECRC Experimental and Clinical Research Center, Lindenberger Weg 80, 13125, Berlin, Germany
- Working Group On Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Edyta Blaszczyk
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, ECRC Experimental and Clinical Research Center, Lindenberger Weg 80, 13125, Berlin, Germany
- Working Group On Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Elias Daud
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, ECRC Experimental and Clinical Research Center, Lindenberger Weg 80, 13125, Berlin, Germany
- Working Group On Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- The Cardiology Department, Galilee Medical Center, Azrieli Faculty of Medicine Bar-Ilan University, Nahariya, Safed, Israel
| | - Jeanette Schulz-Menger
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, ECRC Experimental and Clinical Research Center, Lindenberger Weg 80, 13125, Berlin, Germany.
- Working Group On Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
- Department of Cardiology and Nephrology, HELIOS Hospital Berlin-Buch, Berlin, Germany.
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Topriceanu CC, Fornasiero M, Seo H, Webber M, Keenan KE, Stupic KF, Bruehl R, Ittermann B, Price K, McGrath L, Pang W, Hughes AD, Nezafat R, Kellman P, Pierce I, Moon JC, Captur G. Developing a medical device-grade T 2 phantom optimized for myocardial T 2 mapping by cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2023; 25:19. [PMID: 36935515 PMCID: PMC10026458 DOI: 10.1186/s12968-023-00926-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 01/26/2023] [Indexed: 03/21/2023] Open
Abstract
INTRODUCTION A long T2 relaxation time can reflect oedema, and myocardial inflammation when combined with increased plasma troponin levels. Cardiovascular magnetic resonance (CMR) T2 mapping therefore has potential to provide a key diagnostic and prognostic biomarkers. However, T2 varies by scanner, software, and sequence, highlighting the need for standardization and for a quality assurance system for T2 mapping in CMR. AIM To fabricate and assess a phantom dedicated to the quality assurance of T2 mapping in CMR. METHOD A T2 mapping phantom was manufactured to contain 9 T1 and T2 (T1|T2) tubes to mimic clinically relevant native and post-contrast T2 in myocardium across the health to inflammation spectrum (i.e., 43-74 ms) and across both field strengths (1.5 and 3 T). We evaluated the phantom's structural integrity, B0 and B1 uniformity using field maps, and temperature dependence. Baseline reference T1|T2 were measured using inversion recovery gradient echo and single-echo spin echo (SE) sequences respectively, both with long repetition times (10 s). Long-term reproducibility of T1|T2 was determined by repeated T1|T2 mapping of the phantom at baseline and at 12 months. RESULTS The phantom embodies 9 internal agarose-containing T1|T2 tubes doped with nickel di-chloride (NiCl2) as the paramagnetic relaxation modifier to cover the clinically relevant spectrum of myocardial T2. The tubes are surrounded by an agarose-gel matrix which is doped with NiCl2 and packed with high-density polyethylene (HDPE) beads. All tubes at both field strengths, showed measurement errors up to ≤ 7.2 ms [< 14.7%] for estimated T2 by balanced steady-state free precession T2 mapping compared to reference SE T2 with the exception of the post-contrast tube of ultra-low T1 where the deviance was up to 16 ms [40.0%]. At 12 months, the phantom remained free of air bubbles, susceptibility, and off-resonance artifacts. The inclusion of HDPE beads effectively flattened the B0 and B1 magnetic fields in the imaged slice. Independent temperature dependency experiments over the 13-38 °C range confirmed the greater stability of shorter vs longer T1|T2 tubes. Excellent long-term (12-month) reproducibility of measured T1|T2 was demonstrated across both field strengths (all coefficients of variation < 1.38%). CONCLUSION The T2 mapping phantom demonstrates excellent structural integrity, B0 and B1 uniformity, and reproducibility of its internal tube T1|T2 out to 1 year. This device may now be mass-produced to support the quality assurance of T2 mapping in CMR.
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Affiliation(s)
- Constantin-Cristian Topriceanu
- Barts Heart Center, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | | | - Han Seo
- Department of Cardiology, Center for Inherited Heart Muscle Conditions, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Matthew Webber
- Barts Heart Center, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Department of Cardiology, Center for Inherited Heart Muscle Conditions, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Kathryn E Keenan
- National Institute of Standards and Technology (NIST), 325 Broadway, Boulder, CO, 80305, USA
| | - Karl F Stupic
- National Institute of Standards and Technology (NIST), 325 Broadway, Boulder, CO, 80305, USA
| | - Rüdiger Bruehl
- Physikalisch-Technische Bundesanstalt (PTB), Abbestraße 2-12, 10587, Berlin, Germany
| | - Bernd Ittermann
- Physikalisch-Technische Bundesanstalt (PTB), Abbestraße 2-12, 10587, Berlin, Germany
| | - Kirsty Price
- UCL Bloomsbury Center for Clinical Phenotyping, London, WC1E 6HX, UK
| | - Louise McGrath
- UCL Bloomsbury Center for Clinical Phenotyping, London, WC1E 6HX, UK
| | - Wenjie Pang
- Resonance Health (RH), 141 Burswood Road, Burswood, WA, 6100, Australia
| | - Alun D Hughes
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Reza Nezafat
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Peter Kellman
- National Heart, Lung and Blood Institute, National Institutes of Health (NIH), Rockville Pike, Bethesda, MD, 20892, USA
| | - Iain Pierce
- Barts Heart Center, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - James C Moon
- Barts Heart Center, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Gabriella Captur
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK.
- Department of Cardiology, Center for Inherited Heart Muscle Conditions, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK.
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK.
- Institute of Cardiovascular Science, Consultant Cardiologist in Inherited Heart Muscle Conditions, University College London, Gower Street, London, WC1E 6BT, UK.
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Abstract
Myocardial inflammation occurs following activation of the cardiac immune system, producing characteristic changes in the myocardial tissue. Cardiovascular magnetic resonance is the non-invasive imaging gold standard for myocardial tissue characterization, and is able to detect image signal changes that may occur resulting from inflammation, including edema, hyperemia, capillary leak, necrosis, and fibrosis. Conventional cardiovascular magnetic resonance for the detection of myocardial inflammation and its sequela include T2-weighted imaging, parametric T1- and T2-mapping, and gadolinium-based contrast-enhanced imaging. Emerging techniques seek to image several parameters simultaneously for myocardial tissue characterization, and to depict subtle immune-mediated changes, such as immune cell activity in the myocardium and cardiac cell metabolism. This review article outlines the underlying principles of current and emerging cardiovascular magnetic resonance methods for imaging myocardial inflammation.
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Affiliation(s)
- Katharine E Thomas
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (K.E.T., V.M.F.)
| | - Anastasia Fotaki
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, United Kingdom (A.F., R.M.B.)
| | - René M Botnar
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, United Kingdom (A.F., R.M.B.)
- Escuela de Ingeniería, Pontificia Universidad Católica de Chile, Santiago, Chile (R.M.B.)
- Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.M.B.)
| | - Vanessa M Ferreira
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (K.E.T., V.M.F.)
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8
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Using Multiparametric Cardiac Magnetic Resonance to Phenotype and Differentiate Biopsy-Proven Chronic from Healed Myocarditis and Dilated Cardiomyopathy. J Clin Med 2022; 11:jcm11175047. [PMID: 36078976 PMCID: PMC9457265 DOI: 10.3390/jcm11175047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 12/17/2022] Open
Abstract
(1) Objectives: To discriminate biopsy-proven myocarditis (chronic vs. healed myocarditis) and to differentiate from dilated cardiomyopathy (DCM) using cardiac magnetic resonance (CMR). (2) Methods: A total of 259 consecutive patients (age 51 ± 15 years; 28% female) who underwent both endomyocardial biopsy (EMB) and CMR in the years 2008−2021 were evaluated. According to right-ventricular EMB results, patients were divided into either chronic (n = 130, 50%) or healed lymphocytic myocarditis (n = 60, 23%) or DCM (n = 69, 27%). The CMR protocol included functional, strain, and late gadolinium enhancement (LGE) imaging, T2w imaging, and T2 mapping. (3) Results: Left-ventricular ejection fraction (LV-EF) was higher, and the indexed end-diastolic volume (EDV) was lower in myocarditis patients (chronic: 42%, median 96 mL/m²; healed: 49%, 86 mL/m²) compared to the DCM patients (31%, 120 mL/m²), p < 0.0001. Strain analysis demonstrated lower contractility in DCM patients vs. myocarditis patients, p < 0.0001. Myocarditis patients demonstrated a higher LGE prevalence (68% chronic; 59% healed) than the DCM patients (45%), p = 0.01. Chronic myocarditis patients showed a higher myocardial edema prevalence and ratio (59%, median 1.3) than healed myocarditis (23%, 1.3) and DCM patients (13%, 1.0), p < 0.0001. T2 mapping revealed elevated values more frequently in chronic (90%) than in healed (21%) myocarditis and DCM (23%), p < 0.0001. T2 mapping yielded an AUC of 0.89 (sensitivity 90%, specificity 76%) in the discrimination of chronic from healed myocarditis and an AUC of 0.92 (sensitivity 86%, specificity 91%) in the discrimination of chronic myocarditis from DCM, both p < 0.0001. (4) Conclusions: Multiparametric CMR imaging, including functional parameters, LGE and T2 mapping, may allow differentiation of chronic from healed myocarditis and DCM and therefore help to optimize patient management in this clinical setting.
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9
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Topriceanu CC, Pierce I, Moon JC, Captur G. T 2 and T 2⁎ mapping and weighted imaging in cardiac MRI. Magn Reson Imaging 2022; 93:15-32. [PMID: 35914654 DOI: 10.1016/j.mri.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/20/2022] [Accepted: 07/20/2022] [Indexed: 11/29/2022]
Abstract
Cardiac imaging is progressing from simple imaging of heart structure and function to techniques visualizing and measuring underlying tissue biological changes that can potentially define disease and therapeutic options. These techniques exploit underlying tissue magnetic relaxation times: T1, T2 and T2*. Initial weighting methods showed myocardial heterogeneity, detecting regional disease. Current methods are now fully quantitative generating intuitive color maps that do not only expose regionality, but also diffuse changes - meaning that between-scan comparisons can be made to define disease (compared to normal) and to monitor interval change (compared to old scans). T1 is now familiar and used clinically in multiple scenarios, yet some technical challenges remain. T2 is elevated with increased tissue water - oedema. Should there also be blood troponin elevation, this oedema likely reflects inflammation, a key biological process. T2* falls in the presence of magnetic/paramagnetic materials - practically, this means it measures tissue iron, either after myocardial hemorrhage or in myocardial iron overload. This review discusses how T2 and T2⁎ imaging work (underlying physics, innovations, dependencies, performance), current and emerging use cases, quality assurance processes for global delivery and future research directions.
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Affiliation(s)
- Constantin-Cristian Topriceanu
- Cardiac MRI Unit, Barts Heart Centre, West Smithfield, London, UK; UCL Institute of Cardiovascular Science, University College London, London, UK; UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Iain Pierce
- Cardiac MRI Unit, Barts Heart Centre, West Smithfield, London, UK; UCL Institute of Cardiovascular Science, University College London, London, UK
| | - James C Moon
- Cardiac MRI Unit, Barts Heart Centre, West Smithfield, London, UK; UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Gabriella Captur
- Cardiac MRI Unit, Barts Heart Centre, West Smithfield, London, UK; UCL Institute of Cardiovascular Science, University College London, London, UK; UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK; The Royal Free Hospital, Centre for Inherited Heart Muscle Conditions, Cardiology Department, Pond Street, Hampstead, London, UK.
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10
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Ge Y, Jia Y, Li X, Dou W, Chen Z, Yan G. T2 relaxation time for the early prediction of treatment response to chemoradiation in locally advanced rectal cancer. Insights Imaging 2022; 13:113. [PMID: 35796881 PMCID: PMC9263013 DOI: 10.1186/s13244-022-01254-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/19/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives Poor responders to chemoradiotherapy (CRT) for locally advanced rectal cancer (LARC) can still have a good prognosis if the treatment strategy is changed in time. However, no reliable predictor of early-treatment response has been identified. The purpose of this study was to investigate the role of T2 relaxation time in magnetic resonance imaging (MRI) for the early prediction of a pathological response to CRT in LARC. Methods A total of 123 MRIs were performed on 41 LARC patients immediately before, during, and after CRT. The corresponding tumor volume, T2 relaxation time, and apparent diffusion coefficient (ADC) values at different scan time points were obtained. The Mann–Whitney U test was used to compare the T2 relaxation time between pathological good responders (GR) and non-good responders (non-GR). The area under the curve (AUC) value was used to quantify the diagnostic ability of each parameter in predicting tumor response to CRT. Results Twenty-one (51%) and 20 (49%) were GRs and non-GRs, respectively. T2 relaxation time showed an excellent intraclass correlation coefficient (ICC) of > 0.85 at three-time points. It was significantly lower in the GR group than in the non-GR group during and after CRT. The early T2 decrease had a high AUC of 0.91 in differentiating non-GRs and GRs, similar to 0.90 of the T2 value after CRT. Conclusions T2 relaxation time may help predict treatment response to CRT for LARC earlier, rather than having to wait until the end of CRT, thereby alleviating the physical burden for patients with no good response. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-022-01254-z.
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Affiliation(s)
- Yuxi Ge
- Department of Radiology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Yanlong Jia
- Department of Radiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Xiaohong Li
- Department of Radiology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Weiqiang Dou
- GE Healthcare, MR Research China, Beijing, China
| | - Zhong Chen
- School of Electronic Science and Engineering, Xiamen University, Xiamen, Fujian, China
| | - Gen Yan
- Department of Radiology, The Second Affiliated Hospital of Xiamen University, Xiamen, 361021, Fujian, China.
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11
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Baohong W, Jing Z, Zanxia Z, kun F, Liang L, eryuan G, Yong Z, Fei H, Jingliang C, Jinxia Z. T2 mapping and readout segmentation of long variable echo-train diffusion-weighted imaging for the differentiation of parotid gland tumors. Eur J Radiol 2022; 151:110265. [DOI: 10.1016/j.ejrad.2022.110265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/27/2022] [Accepted: 03/16/2022] [Indexed: 11/03/2022]
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12
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Klingebiel M, Schimmöller L, Weiland E, Franiel T, Jannusch K, Kirchner J, Hilbert T, Strecker R, Arsov C, Wittsack HJ, Albers P, Antoch G, Ullrich T. Value of T 2 Mapping MRI for Prostate Cancer Detection and Classification. J Magn Reson Imaging 2022; 56:413-422. [PMID: 35038203 DOI: 10.1002/jmri.28061] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Currently, multi-parametric prostate MRI (mpMRI) consists of a qualitative T2 , diffusion weighted, and dynamic contrast enhanced imaging. Quantification of T2 imaging might further standardize PCa detection and support artificial intelligence solutions. PURPOSE To evaluate the value of T2 mapping to detect prostate cancer (PCa) and to differentiate PCa aggressiveness. STUDY TYPE Retrospective single center cohort study. POPULATION Forty-four consecutive patients (mean age 67 years; median PSA 7.9 ng/mL) with mpMRI and verified PCa by subsequent targeted plus systematic MR/ultrasound (US)-fusion biopsy from February 2019 to December 2019. FIELD STRENGTH/SEQUENCE Standardized mpMRI at 3 T with an additionally acquired T2 mapping sequence. ASSESSMENT Primary endpoint was the analysis of quantitative T2 values and contrast differences/ratios (CD/CR) between PCa and benign tissue. Secondary objectives were the correlation between T2 values, ISUP grade, apparent diffusion coefficient (ADC) value, and PI-RADS, and the evaluation of thresholds for differentiating PCa and clinically significant PCa (csPCa). STATISTICAL TESTS Mann-Whitney test, Spearman's rank (rs ) correlation, receiver operating curves, Youden's index (J), and AUC were performed. Statistical significance was defined as P < 0.05. RESULTS Median quantitative T2 values were significantly lower for PCa in PZ (85 msec) and PCa in TZ (75 msec) compared to benign PZ (141 msec) or TZ (97 msec) (P < 0.001). CD/CR between PCa and benign PZ (51.2/1.77), respectively TZ (19.8/1.29), differed significantly (P < 0.001). The best T2 -mapping threshold for PCa/csPCa detection was for TZ 81/86 msec (J = 0.929/1.0), and for PZ 110 msec (J = 0.834/0.905). Quantitative T2 values of PCa did not correlate significantly with the ISUP grade (rs = 0.186; P = 0.226), ADC value (rs = 0.138; P = 0.372), or PI-RADS (rs = 0.132; P = 0.392). DATA CONCLUSION Quantitative T2 values could differentiate PCa in TZ and PZ and might support standardization of mpMRI of the prostate. Different thresholds seem to apply for PZ and TZ lesions. However, in the present study quantitative T2 values were not able to indicate PCa aggressiveness. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Maximilian Klingebiel
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Dusseldorf, Germany
| | - Lars Schimmöller
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Dusseldorf, Germany
| | - Elisabeth Weiland
- MR Applications Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Tobias Franiel
- Department of Diagnostic and Interventional Radiology, University Hospital Jena, Jena, Germany
| | - Kai Jannusch
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Dusseldorf, Germany
| | - Julian Kirchner
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Dusseldorf, Germany
| | - Tom Hilbert
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland.,Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,LTS5, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Ralph Strecker
- SHS EMEA ST&BD SP PS&O, Siemens Healthcare GmbH, Eschborn, Germany
| | - Christian Arsov
- Department of Urology, University Dusseldorf, Medical Faculty, Dusseldorf, Germany
| | - Hans-Jörg Wittsack
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Dusseldorf, Germany
| | - Peter Albers
- Department of Urology, University Dusseldorf, Medical Faculty, Dusseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Dusseldorf, Germany
| | - Tim Ullrich
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Dusseldorf, Germany
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Meloni A, Nicola M, Positano V, D'Angelo G, Barison A, Todiere G, Grigoratos C, Keilberg P, Pistoia L, Gargani L, Ripoli A, Pepe A. Myocardial T2 values at 1.5 T by a segmental approach with healthy aging and gender. Eur Radiol 2022; 32:2962-2975. [PMID: 35028749 DOI: 10.1007/s00330-021-08396-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/15/2021] [Accepted: 10/09/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Our aims were to obtain myocardial regional and global T2 values as a reference for normality for the first time using a GE scanner and to assess their association with physiological variables. METHODS One hundred healthy volunteers aged 20-70 years (50% females) underwent cardiovascular magnetic resonance. Basal, mid-ventricular, and apical short-axis slices of the left ventricle were acquired by a multi-echo fast-spin-echo (MEFSE) sequence. Image analysis was performed with a commercially available software package. The T2 value was assessed in all 16 myocardial segments and the global value was the mean. RESULTS The global T2 value averaged across all subjects was 52.2 ± 2.5 ms (range: 47.0-59.9 ms). Inter-study, intra-observer, and inter-observer reproducibility was good (coefficient of variation < 5%). 3.6% of the segments was excluded because of artifacts and/or partial-volume effects. Segmental T2 values differed significantly (p < 0.0001), with the lowest value in the basal anterolateral segment (50.0 ± 3.5 ms) and the highest in the apical lateral segment (54.9 ± 5.1 ms). Mean T2 was significantly lower in the basal slice compared to both mid-ventricular and apical slices and in the mid-ventricular slice than in the apical slice. Aging was associated with increased segmental and global T2 values. Females showed higher T2 values than males. T2 values were not correlated to heart rate. A significant inverse correlation was detected between global T2 values and mean wall thickness. CONCLUSIONS The optimized MEFSE sequence allows for robust and reproducible quantification of segmental T2 values. Gender- and age-specific segmental reference values must be defined for distinguishing healthy and diseased myocardium. KEY POINTS • In healthy subjects, T2 values differ among myocardial segments and are influenced by age and gender. • Normal T2 values in the myocardium, usable as a benchmark by other GE sites, were established.
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Affiliation(s)
- Antonella Meloni
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy.,Bioengineering Unit, Fondazione G. Monasterio CNR-Regione Toscana, Area della Ricerca S. Cataldo, Via Moruzzi, 1 -, 56124, Pisa, Italy
| | - Martini Nicola
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy.,Bioengineering Unit, Fondazione G. Monasterio CNR-Regione Toscana, Area della Ricerca S. Cataldo, Via Moruzzi, 1 -, 56124, Pisa, Italy
| | - Vincenzo Positano
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy.,Bioengineering Unit, Fondazione G. Monasterio CNR-Regione Toscana, Area della Ricerca S. Cataldo, Via Moruzzi, 1 -, 56124, Pisa, Italy
| | - Gennaro D'Angelo
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Andrea Barison
- Division of Cardiology and Cardiovascular Medicine, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Giancarlo Todiere
- Division of Cardiology and Cardiovascular Medicine, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Chrysanthos Grigoratos
- Division of Cardiology and Cardiovascular Medicine, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Petra Keilberg
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Laura Pistoia
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Luna Gargani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Andrea Ripoli
- Bioengineering Unit, Fondazione G. Monasterio CNR-Regione Toscana, Area della Ricerca S. Cataldo, Via Moruzzi, 1 -, 56124, Pisa, Italy
| | - Alessia Pepe
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy. .,Institute of Radiology, University of Padua, Padua, Italy.
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14
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Henningsson M. Cartesian dictionary-based native T 1 and T 2 mapping of the myocardium. Magn Reson Med 2022; 87:2347-2362. [PMID: 34985143 DOI: 10.1002/mrm.29143] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/08/2021] [Accepted: 12/14/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE To implement and evaluate a new dictionary-based technique for native myocardial T1 and T2 mapping using Cartesian sampling. METHODS The proposed technique (Multimapping) consisted of single-shot Cartesian image acquisitions in 10 consecutive cardiac cycles, with inversion pulses in cycle 1 and 5, and T2 preparation (TE: 30 ms, 50 ms, and 70 ms) in cycles 8-10. Multimapping was simulated for different T1 and T2 , where entries corresponding to the k-space centers were matched to acquired data. Experiments were performed in a phantom, 16 healthy subjects, and 3 patients with cardiovascular disease. RESULTS Multimapping phantom measurements showed good agreement with reference values for both T1 and T2 , with no discernable heart-rate dependency for T1 and T2 within the range of myocardium. In vivo mean T1 in healthy subjects was significantly higher using Multimapping (T1 = 1114 ± 14 ms) compared to the reference (T1 = 991 ± 26 ms) (p < 0.01). Mean Multimapping T2 (47.1 ± 1.3 ms) and T2 spatial variability (5.8 ± 1.0 ms) was significantly lower compared to the reference (T2 = 54.7 ± 2.2 ms, p < 0.001; spatial variability = 8.4 ± 2.0 ms, p < 0.01). Increased T1 and T2 was detected in all patients using Multimapping. CONCLUSIONS Multimapping allows for simultaneous native myocardial T1 and T2 mapping with a conventional Cartesian trajectory, demonstrating promising in vivo image quality and parameter quantification results.
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Affiliation(s)
- Markus Henningsson
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences (HMV), Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
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15
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Akdag O, Mandija S, van Lier AL, Borman PT, Schakel T, Alberts E, van der Heide O, Hassink RJ, Verhoeff JJ, Mohamed Hoesein FA, Raaymakers BW, Fast MF. Feasibility of cardiac-synchronized quantitative T1 and T2 mapping on a hybrid 1.5 Tesla magnetic resonance imaging and linear accelerator system. Phys Imaging Radiat Oncol 2022; 21:153-159. [PMID: 35287380 PMCID: PMC8917300 DOI: 10.1016/j.phro.2022.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/18/2022] [Accepted: 02/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background and Purpose Materials and methods Results Conclusions
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Affiliation(s)
- Osman Akdag
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
- Corresponding author.
| | - Stefano Mandija
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
- Computational Imaging Group for MR Diagnostics and Therapy, Center for Image Sciences, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Astrid L.H.M.W. van Lier
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Pim T.S. Borman
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Tim Schakel
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Eveline Alberts
- Philips Healthcare, Veenpluis 6 5684 PC Best, The Netherlands
| | - Oscar van der Heide
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
- Computational Imaging Group for MR Diagnostics and Therapy, Center for Image Sciences, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Rutger J. Hassink
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Joost J.C. Verhoeff
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Firdaus A.A. Mohamed Hoesein
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Bas W. Raaymakers
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Martin F. Fast
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
- Corresponding author.
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16
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Cicolari D, Lizio D, Pedrotti P, Moioli MT, Lascialfari A, Mariani M, Torresin A. A method for T 1 and T 2 relaxation times validation and harmonization as a support to MRI mapping. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2022; 334:107110. [PMID: 34844075 DOI: 10.1016/j.jmr.2021.107110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/09/2021] [Accepted: 11/17/2021] [Indexed: 06/13/2023]
Abstract
We present a proof-of-concept study focusing on a method for the intra- and inter-center validation and harmonization of data obtained from MRI T1 and T2 maps. The method is based on a set of MnCl2 samples that provide in-scan ground-truth reference values regardless of the details of the MRI protocol. The relaxation times of MnCl2 aqueous solutions were first measured by means of an NMR laboratory relaxometer, as a function of concentration and temperature. The obtained T1 and T2 values, once renormalized at the scanner temperature, were used as reference values for the MRI mapping measurements of the MnCl2 relaxation times. By using different clinical MRI scanners and sequences, we found a good agreement for standard and turbo sequences (limits of agreement: 5% for IR, SE, IR-TSE; 10% for TSE), while an under-estimation and an over-estimation were found respectively for MOLLI and T2-prep TrueFISP, as already reported in the literature. The linearity of the relaxation rates with the concentration predicted by the Solomon-Bloembergen-Morgan theory was observed for every dataset at all temperatures, except for T2-prep TrueFISP maps results. Some preliminary results of an in vivo experiment are also presented.
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Affiliation(s)
- Davide Cicolari
- University of Pavia, Department of Physics, and INFN-Pavia Unit, Via Bassi 6, 27100 Pavia, Italy.
| | - Domenico Lizio
- ASST Grande Ospedale Metropolitano Niguarda, Department of Medical Physics, P.zza Ospedale Maggiore 3, 20162 Milan, Italy.
| | - Patrizia Pedrotti
- ASST Grande Ospedale Metropolitano Niguarda, Department of Cardiology, P.zza Ospedale Maggiore 3, 20162 Milan, Italy.
| | - Monica Teresa Moioli
- ASST Grande Ospedale Metropolitano Niguarda, Department of Medical Physics, P.zza Ospedale Maggiore 3, 20162 Milan, Italy.
| | - Alessandro Lascialfari
- University of Pavia, Department of Physics, and INFN-Pavia Unit, Via Bassi 6, 27100 Pavia, Italy.
| | - Manuel Mariani
- University of Pavia, Department of Physics, and INFN-Pavia Unit, Via Bassi 6, 27100 Pavia, Italy.
| | - Alberto Torresin
- ASST Grande Ospedale Metropolitano Niguarda, Department of Medical Physics, P.zza Ospedale Maggiore 3, 20162 Milan, Italy; University of Milan, Department of Physics, Via Celoria 16, 20133 Milan, Italy.
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17
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Kharabish A, Hosny M, Hassan M, Mahrous MR, Elbayoumy M, Ahmed AE, Deyaa N, El Mozy W, Behairy N. Assessment of segmental agreement of T2 mapping versus triple inversion recovery in detection of acute myocardial edema. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00476-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
There are some limitations using the different sequences of clinical cardiac magnetic resonance (cardiac MR) in detection of edema in patients presenting with acute myocardial injury. The purpose of this study is to evaluate the myocardial segmental agreement between the different edema sequences: T2 mapping and turbo inversion recovery magnitude (TIRM) in detection of acute myocardial edema.
Results
Thirty-seven patients presented with acute infarction were sent to cardiac MR to assess myocardial edema. All cardiac MR studies were scanned using cine, TIRM, and late gadolinium enhancement (LGE) in short axis views (SAX). Position of the T2 mapping slices were copied from the TIRM. The left ventricle (LV) was divided into apical, mid, and basal segments per visualization of the papillary muscles. Edema mass was assessed separately in each segment as well as the total edema mass in both the TIRM and T2 mapping. Twenty-four patients of whom 12.5% had multi-territorial coronary lesions and edema were assessed. Myocardial edema was not assessed in thirteen patients (35%) due to significant intra myocardial hemorrhage (T2 mapping < 60 ms). No statistical significance was found between the TIRM and the T2 mapping neither in the total amount of edema (p = 0.79), nor in the LV basal, mid, and apical segments’ edema (p = 0.69, 0.5, and 0.8 respectively). The upper and lower limits of agreements were tested between the TIRM and the T2 mapping of total edema mass, basal segments, mid, and apical ventricular segments were = 18 and − 7.7 g, 11.3 and − 5.1 g, 12.3 and − 5.2 g, and 15.5 and − 7.8 g respectively.
Conclusion
This study supports the proof of the principle that there is no statistical significant difference per myocardial segments between the T2 mapping and routine edema’s sequences. Larger studies are recommended to assess the impact in clinical outcome.
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18
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Urmeneta Ulloa J, Martínez de Vega V, Salvador Montañés O, Álvarez Vázquez A, Sánchez-Enrique C, Hernández Jiménez S, Sancho García FD, López Ruiz L, Recio Rodríguez M, Pizarro G, Carnevali Ruiz D, Ángel Cabrera J. Cardiac magnetic resonance in recovering COVID-19 patients. Feature tracking and mapping analysis to detect persistent myocardial involvement. IJC HEART & VASCULATURE 2021; 36:100854. [PMID: 34368419 PMCID: PMC8328575 DOI: 10.1016/j.ijcha.2021.100854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Post-COVID-19 patients may incur myocardial involvement secondary to systemic inflammation. Our aim was to detect possible oedema/diffuse fibrosis using cardiac magnetic resonance imaging (CMR) mapping and to study myocardial deformation of the left ventricle (LV) using feature tracking (FT). METHODS Prospective analysis of consecutively recruited post-COVID-19 patients undergoing CMR. T1 and T2 mapping sequences were acquired and FT analysis was performed using 2D steady-state free precession cine sequences. Statistical significance was set to p < 0.05. RESULTS Included were 57 post-COVID-19 patients and 20 healthy controls, mean age 59 ± 15 years, men 80.7%. The most frequent risk factors were hypertension (33.3%) and dyslipidaemia (36.8%). The contact-to-CMR interval was 81 ± 27 days. LV ejection fraction (LVEF) was 61 ± 10%. Late gadolinium enhancement (LGE) was evident in 26.3% of patients (19.3%, non-ischaemic). T2 mapping values (suggestive of oedema) were higher in the study patients than in the controls (50.9 ± 4.3 ms vs 48 ± 1.9 ms, p < 0.01). No between-group differences were observed for native T1 nor for circumferential strain (CS) or radial strain (RS) values (18.6 ± 3.3% vs 19.2 ± 2.1% (p = 0.52) and 32.3 ± 8.1% vs 33.6 ± 7.1% (p = 0.9), respectively). A sub-group analysis for the contact-to-CMR interval (<8 weeks vs ≥ 8 weeks) showed that FT-CS (15.6 ± 2.2% vs 18.9 ± 2.6%, p < 0.01) and FT-RS (24.9 ± 5.8 vs 33.5 ± 7.2%, p < 0.01) values were lower for the shorter interval. CONCLUSIONS Post-COVID-19 patients compared to heathy controls had raised T2 values (related to oedema), but similar native T1, FT-CS and FT-RS values. FT-CS and FT-RS values were lower in post-COVID-19 patients undergoing CMR after < 8 weeks compared to ≥ 8 weeks.
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Key Words
- CMR, Cardiac-magnetic-resonance-imaging
- COVID-19
- COVID-19, coronavirus disease-2019
- CRP, C-reactive-protein
- CS, circumferential-strain
- Cardiac magnetic resonance imaging
- ECG, electrocardiogram
- ECV, extracellular-volume
- EGE, early-gadolinium-enhancement
- FT, feature-tracking
- Feature tracking
- ICU, intensive-care-unit
- IQR, interquartile-range
- IR, inversion-recovery
- LAX, long-axis-view
- LGE, late-gadolinium-enhancement
- LS, longitudinal-strain
- LV, left-ventricle
- LVEDV, LV end-diastolic-volume
- LVEF, LV-Ejection-fraction
- LVESV, LV-end-systolic-volume
- MERS-CoV, Middle-East-respiratory-syndrome-coronavirus
- Mapping
- PCR, polymerase-chain-reaction
- ROI, region-of-interest
- RS, radial-strain
- RV, right-ventricle
- RVEDV, end-diastolic-volume
- RVEF, RV-ejection-fraction
- RVESV, RV-end-systolic-volume
- SARS-CoV-2, severe-acute-respiratory-syndrome-coronavirus-2
- SAX, short-axis-view
- SCLS, systemic-capillary-leak-syndrome
- SD, standard-deviation
- SIRS, systemic-inflammatory-response-syndrome
- SSFP, steady-state-free-precession
- STIR, short-tau-inversion-recovery
- TR, repetition-time
- TTE, transthoracic-echocardiography
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Affiliation(s)
- Javier Urmeneta Ulloa
- Cardiology Department, Hospital Universitario Quirónsalud, Madrid, Spain
- Radiology Department, Hospital Universitario Quirónsalud, Madrid, Spain
| | | | | | | | | | | | | | - Luis López Ruiz
- Radiology Department, Hospital Universitario Quirónsalud, Madrid, Spain
| | | | - Gonzalo Pizarro
- Cardiology Department, Ruber Juan Bravo Hospital Complex, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | - José Ángel Cabrera
- Cardiology Department, Hospital Universitario Quirónsalud, Madrid, Spain
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19
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Wong J. The Mapping of Rejection. JACC Cardiovasc Imaging 2021; 14:2350-2352. [PMID: 34538626 DOI: 10.1016/j.jcmg.2021.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Joyce Wong
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield Clinical Group, Guys' and St Thomas' National Health Service Foundation Trust, Harefield, United Kingdom.
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20
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Singh M, Mehta N, Hayat F, Soria CE, Hashim H, Satler LF, Barac A. Recurrent Chest Pain after COVID-19: Diagnostic Utility of Cardiac Magnetic Resonance Imaging. CJC Open 2021; 4:100-104. [PMID: 34458709 PMCID: PMC8380068 DOI: 10.1016/j.cjco.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/11/2021] [Indexed: 11/30/2022] Open
Abstract
We report a case of myocarditis in an adult patient with recent coronavirus disease 2019 (COVID-19) infection presenting as recurrent ST-segment elevation, mimicking coronary vasospasm. This case highlights the wide range of presentations of COVID-19–related myocarditis. The novel teaching point is that COVID-19 myocarditis can present with acute manifestations such as chest pain and transient ST-segment elevation even several weeks after complete recovery from the initial infection. Cardiac magnetic resonance imaging should be considered in patients with chest pain syndromes and angiographically normal coronary arteries, as the presence of late gadolinium enhancement and a high T2 signal can be diagnostic. Follow-up cardiac magnetic resonance imaging may be used to assess resolution.
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Affiliation(s)
- Manavotam Singh
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC
| | - Neil Mehta
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC.,Georgetown University, Washington, DC
| | - Fatima Hayat
- Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Cesar E Soria
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC.,Georgetown University, Washington, DC
| | - Hayder Hashim
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC.,Georgetown University, Washington, DC
| | - Lowell F Satler
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC.,Georgetown University, Washington, DC
| | - Ana Barac
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC.,Georgetown University, Washington, DC
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21
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Böttcher B, Lorbeer R, Stöcklein S, Beller E, Lang CI, Weber MA, Meinel FG. Global and Regional Test-Retest Reproducibility of Native T1 and T2 Mapping in Cardiac Magnetic Resonance Imaging. J Magn Reson Imaging 2021; 54:1763-1772. [PMID: 34075646 DOI: 10.1002/jmri.27755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Mapping of T1 and T2 relaxation times in cardiac MRI is an invaluable tool for the diagnosis and risk stratification of a wide spectrum of cardiac diseases. PURPOSE To investigate the global and regional reproducibility of native T1 and T2 mapping and to analyze the influence of demographic factors, physiological parameters, slice position, and myocardial regions on reproducibility. STUDY TYPE Prospective single-center cohort-study. POPULATION Fifty healthy volunteers (29 female, 21 male) with a mean age of 39.4 ± 13.7 years. FIELD STRENGTH/SEQUENCE Each volunteer was investigated twice at 1.5 T using a modified look-locker inversion-recovery (MOLLI) sequence (T1 mapping) and a T2-prepared steady-state free precession (SSFP) sequence (T2 mapping). ASSESSMENT Global T1 and T2 values were quantified for the entire left ventricle in three short-axis slices. Regional T1 and T2 values were measured for each myocardial segment and for myocardial segments grouped by slice position and anatomical region. STATISTICAL TESTS Test-retest reproducibility was assessed using intraclass correlation coefficient (ICC) and Bland-Altman statistics. A P value < 0.05 was considered statistically significant. RESULTS Reproducibility was good for global T1 values (ICC 0.88) and excellent for global T2 values (ICC 0.91). Reproducibility of T1 values was excellent (ICC 0.91) for midventricular slice and good for apical (ICC 0.86) and basal slice (ICC 0.81). Reproducibility of T1 mapping values was highest in the septum (ICC 0.90) compared to the anterior (0.81), lateral (0.86), and inferior (0.86) wall. For T2 mapping, reproducibility was good for all slice positions (ICC 0.86 for midventricular, 0.83 for basal, and 0.80 for apical slice). Reproducibility of T2 mapping was significantly lower for the inferior wall (ICC 0.58) than for septum (0.89), anterior (0.85), and lateral (0.87) wall. DATA CONCLUSION Native T1 and T2 mapping has good to excellent reproducibility with significant regional differences. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Benjamin Böttcher
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Rostock, Germany
| | - Roberto Lorbeer
- Department of Radiology, Ludwig-Maximilian University, Munich, Germany
| | - Sophia Stöcklein
- Department of Radiology, Ludwig-Maximilian University, Munich, Germany
| | - Ebba Beller
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Rostock, Germany
| | - Cajetan I Lang
- Department of Internal Medicine, Division of Cardiology, University Medical Center Rostock, Rostock, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Rostock, Germany
| | - Felix G Meinel
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Rostock, Germany
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22
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Hu C, Huber S, Nguyen V, Baldassarre L, Mojibian H, Peters D. Fat-saturated dark-blood cardiac T2 mapping in a single breath-hold. Magn Reson Imaging 2021; 81:24-32. [PMID: 34044065 DOI: 10.1016/j.mri.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 05/06/2021] [Accepted: 05/23/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE Conventional cardiac T2 mapping suffers from the partial-voluming effect in the endocardium and epicardium due to the co-presence of intra-cavity blood and epicardial fat. The aim of the study is to develop a novel single-breath-hold Fat-Saturated Dark-Blood (FSDB) cardiac T2-mapping technique to mitigate the partial-voluming and improve T2 accuracy. METHODS The proposed FSDB T2-mapping technique combines T2-prepared bSSFP, a novel use of double inversion-recovery with heart-rate-adaptive TI, and spectrally-selective fat saturation to mitigate partial-voluming from both the blood and fat. FSDB T2 mapping was compared to conventional T2 mapping via simulations, phantom imaging, healthy-subject imaging (n = 8), and patient imaging (n = 7). In the healthy subjects, a high-resolution coplanar anatomical imaging was performed to provide a gold standard for segmentation of endocardium and epicardium. T2 maps were registered to the gold standard image to evaluate any inter-layer T2 difference, which is a surrogate for partial-voluming. RESULTS Simulations and phantom imaging showed that FSDB T2 mapping was accurate in a range of heartrates, off-resonance, and T2 values, and blood/fat reasonably nulled in a range of heartrates. In healthy subjects, FSDB T2 mapping showed similar T2 values over different myocardial layers in all 3 short-axis slices (e.g. basal epicardial/mid-wall/endocardial T2 = 42 ± 2 ms/41 ± 1 ms/42 ± 1 ms), whereas conventional T2 mapping showed considerably increased T2 in the endocardium and epicardium (e.g. basal epicardial/mid-wall/endocardial T2 = 48 ± 3 ms/43 ± 1 ms/49 ± 3 ms). The homogeneous T2 in the FSDB T2 mapping increased the apparent LV-wall thickness by 25-41% compared with the conventional method. CONCLUSIONS The proposed technique improves accuracy of myocardial T2 mapping against partial-voluming associated with both fat and blood, facilitating a multi-layer T2 evaluation of the myocardium. This technique may improve utility of cardiac T2 mapping in diseases affecting the endocardium and epicardium, and in patients with a small heart.
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Affiliation(s)
- Chenxi Hu
- The Institute of Medical Imaging Technology, School of Biomedical Engineering, Shanghai Jiao Tong University (SJTU), Shanghai, PR China.
| | - Steffen Huber
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, CT, United States of America
| | - Vinh Nguyen
- Cardiovascular Section, Department of Internal Medicine, Yale School of Medicine, Yale University, , New Haven, CT, United States of America
| | - Lauren Baldassarre
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, CT, United States of America; Cardiovascular Section, Department of Internal Medicine, Yale School of Medicine, Yale University, , New Haven, CT, United States of America
| | - Hamid Mojibian
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, CT, United States of America
| | - Dana Peters
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, CT, United States of America
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23
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Brito D, Meester S, Yanamala N, Patel HB, Balcik BJ, Casaclang-Verzosa G, Seetharam K, Riveros D, Beto RJ, Balla S, Monseau AJ, Sengupta PP. High Prevalence of Pericardial Involvement in College Student Athletes Recovering From COVID-19. JACC Cardiovasc Imaging 2021; 14:541-555. [PMID: 33223496 PMCID: PMC7641597 DOI: 10.1016/j.jcmg.2020.10.023] [Citation(s) in RCA: 134] [Impact Index Per Article: 44.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES This study sought to explore the spectrum of cardiac abnormalities in student athletes who returned to university campus in July 2020 with uncomplicated coronavirus disease 2019 (COVID-19). BACKGROUND There is limited information on cardiovascular involvement in young individuals with mild or asymptomatic COVID-19. METHODS Screening echocardiograms were performed in 54 consecutive student athletes (mean age 19 years; 85% male) who had positive results of reverse transcription polymerase chain reaction nasal swab testing of the upper respiratory tract or immunoglobulin G antibodies against severe acute respiratory syndrome coronavirus type 2. Sequential cardiac magnetic resonance imaging was performed in 48 (89%) subjects. RESULTS A total of 16 (30%) athletes were asymptomatic, whereas 36 (66%) and 2 (4%) athletes reported mild and moderate COVID-19 related symptoms, respectively. For the 48 athletes completing both imaging studies, abnormal findings were identified in 27 (56.3%) individuals. This included 19 (39.5%) athletes with pericardial late enhancements with associated pericardial effusion. Of the individuals with pericardial enhancements, 6 (12.5%) had reduced global longitudinal strain and/or an increased native T1. One patient showed myocardial enhancement, and reduced left ventricular ejection fraction or reduced global longitudinal strain with or without increased native T1 values was also identified in an additional 7 (14.6%) individuals. Native T2 findings were normal in all subjects, and no specific imaging features of myocardial inflammation were identified. Hierarchical clustering of left ventricular regional strain identified 3 unique myopericardial phenotypes that showed significant association with the cardiac magnetic resonance findings (p = 0.03). CONCLUSIONS More than 1 in 3 previously healthy college athletes recovering from COVID-19 infection showed imaging features of a resolving pericardial inflammation. Although subtle changes in myocardial structure and function were identified, no athlete showed specific imaging features to suggest an ongoing myocarditis. Further studies are needed to understand the clinical implications and long-term evolution of these abnormalities in uncomplicated COVID-19.
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Affiliation(s)
- Daniel Brito
- Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA
| | - Scott Meester
- Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Naveena Yanamala
- Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA
| | - Heenaben B Patel
- Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA
| | - Brenden J Balcik
- Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Grace Casaclang-Verzosa
- Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA
| | - Karthik Seetharam
- Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA
| | - Diego Riveros
- Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Robert James Beto
- Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA
| | - Sudarshan Balla
- Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA
| | - Aaron J Monseau
- Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Partho P Sengupta
- Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA.
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24
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Ma Y. Editorial for "Assessment of Repeatability, Reproducibility, and Performances of T2-Mapping-Based Radiomics Features: A Comparative Study". J Magn Reson Imaging 2021; 54:549-550. [PMID: 33634896 DOI: 10.1002/jmri.27582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/11/2021] [Indexed: 11/07/2022] Open
Affiliation(s)
- Yanqing Ma
- Department of Radiology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College 310000, Hangzhou, China
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