scholarly journals Cardiac stress T1-mapping response and extracellular volume stability of MOLLI-based T1-mapping methods

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Matthew K. Burrage ◽  
Mayooran Shanmuganathan ◽  
Qiang Zhang ◽  
Evan Hann ◽  
Iulia A. Popescu ◽  
...  
Keyword(s):  
T1 Mapping ◽  
Extracellular Volume ◽  
Individual Variability ◽  
Percentage Increase ◽  
Post Contrast ◽  
Volume Stability ◽  
Time Dependencies ◽  
Time Drift ◽  
Stress Cmr ◽  
Regadenoson Stress

AbstractStress and rest T1-mapping may assess for myocardial ischemia and extracellular volume (ECV). However, the stress T1 response is method-dependent, and underestimation may lead to misdiagnosis. Further, ECV quantification may be affected by time, as well as the number and dosage of gadolinium (Gd) contrast administered. We compared two commonly available T1-mapping approaches in their stress T1 response and ECV measurement stability. Healthy subjects (n = 10, 50% female, 35 ± 8 years) underwent regadenoson stress CMR (1.5 T) on two separate days. Prototype ShMOLLI 5(1)1(1)1 sequence was used to acquire consecutive mid-ventricular T1-maps at rest, stress and post-Gd contrast to track the T1 time evolution. For comparison, standard MOLLI sequences were used: MOLLI 5(3)3 Low (256 matrix) & High (192 matrix) Heart Rate (HR) to acquire rest and stress T1-maps, and MOLLI 4(1)3(1)2 Low & High HR for post-contrast T1-maps. Stress and rest myocardial blood flow (MBF) maps were acquired after IV Gd contrast (0.05 mmol/kg each). Stress T1 reactivity (delta T1) was defined as the relative percentage increase in native T1 between rest and stress. Myocardial T1 values for delta T1 (dT1) and ECV were calculated. Residuals from the identified time dependencies were used to assess intra-method variability. ShMOLLI achieved a greater stress T1 response compared to MOLLI Low and High HR (peak dT1 = 6.4 ± 1.7% vs. 4.8 ± 1.3% vs. 3.8 ± 1.0%, respectively; both p < 0.0001). ShMOLLI dT1 correlated strongly with stress MBF (r = 0.77, p < 0.001), compared to MOLLI Low HR (r = 0.65, p < 0.01) and MOLLI High HR (r = 0.43, p = 0.07). ShMOLLI ECV was more stable to gadolinium dose with less time drift (0.006–0.04% per minute) than MOLLI variants. Overall, ShMOLLI demonstrated less intra-individual variability than MOLLI variants for stress T1 and ECV quantification. Power calculations indicate up to a fourfold (stress T1) and 7.5-fold (ECV) advantage in sample-size reduction using ShMOLLI. Our results indicate that ShMOLLI correlates strongly with increased MBF during regadenoson stress and achieves a significantly higher stress T1 response, greater effect size, and greater ECV measurement stability compared with the MOLLI variants tested.

scholarly journals T1 and T2 Mapping in Cardiology: “Mapping the Obscure Object of Desire”

Cardiology ◽  
2017 ◽  
Vol 138 (4) ◽  
pp. 207-217 ◽  
Author(s):  
Sophie Mavrogeni ◽  
Dimitris Apostolou ◽  
Panayiotis Argyriou ◽  
Stella Velitsista ◽  
Lilika Papa ◽  
...  
Keyword(s):  
Heart Failure ◽  
T1 Mapping ◽  
Clinical Decision Making ◽  
Volume Fraction ◽  
T2 Mapping ◽  
Extracellular Volume ◽  
Diffuse Fibrosis ◽  
Post Contrast ◽  
Cardiac Amyloid ◽  
Native T1

The increasing use of cardiovascular magnetic resonance (CMR) is based on its capability to perform biventricular function assessment and tissue characterization without radiation and with high reproducibility. The use of late gadolinium enhancement (LGE) gave the potential of non-invasive biopsy for fibrosis quantification. However, LGE is unable to detect diffuse myocardial disease. Native T1 mapping and extracellular volume fraction (ECV) provide knowledge about pathologies affecting both the myocardium and interstitium that is otherwise difficult to identify. Changes of myocardial native T1 reflect cardiac diseases (acute coronary syndromes, infarction, myocarditis, and diffuse fibrosis, all with high T1) and systemic diseases such as cardiac amyloid (high T1), Anderson-Fabry disease (low T1), and siderosis (low T1). The ECV, an index generated by native and post-contrast T1 mapping, measures the cellular and extracellular interstitial matrix (ECM) compartments. This myocyte-ECM dichotomy has important implications for identifying specific therapeutic targets of great value for heart failure treatment. On the other hand, T2 mapping is superior compared with myocardial T1 and ECM for assessing the activity of myocarditis in recent-onset heart failure. Although these indices can significantly affect the clinical decision making, multicentre studies and a community-wide approach (including MRI vendors, funding, software, contrast agent manufacturers, and clinicians) are still missing.

scholarly journals T1-mapping and extracellular volume in patients with hypertrophic cardiomyopathy without focal myocardial injury in late gadolinium enhancement sequence

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
P Gac ◽  
B Kedzierski ◽  
K Truszkiewicz ◽  
R Poreba
Keyword(s):  
Late Gadolinium Enhancement ◽  
Hypertrophic Cardiomyopathy ◽  
Myocardial Injury ◽  
T1 Mapping ◽  
Extracellular Volume ◽  
Left Ventricular ◽  
Gadolinium Enhancement ◽  
Post Contrast ◽  
Mapping Sequence ◽  
The Mean

Abstract Funding Acknowledgements Type of funding sources: None. Background The LGE (late gadolinium enhancement) sequence is a recognized classic tool for imaging focal myocardial injury. The T1-mapping sequence to assess native T1 myocardial time, post-contrast T1 time, and myocardial extracellular volume (ECV) is a widely studied tool for imaging focal and diffused myocardial injury. Purpose The aim of the study was to evaluate the native T1 time, the post-contrast T1 time and the myocardial extracellular volume in the T1-mapping sequence in patients with hypertrophic cardiomyopathy without focal LGE myocardial injury. Methods The study group consisted of 28 consecutive patients who met the criteria for diagnosis of hypertrophic cardiomyopathy without focal LGE myocardial injury (HCM group; mean age 52.17 ± 6.35 years). 28 patients without cardiomyopathy (CON group; mean age 51.76 ± 6.49 years) with similar anthropometric parameters were selected by the case-to-case method as a control group. All patients underwent 1.5 T cardiac magnetic resonance, including cinematographic sequences (CINE), LGE sequence and T1-mapping sequences before (native) and 20-minutes after intravenous administration of a paramagnetic agent (post-contrast). In the T1-mapping sequences, the mean T1 time of the whole myocardium (T1 whole myocardium) was assessed, as well as the T1 time in the basal layers (T1 basal), middle layers (T1 middle) and apical layers (T1 apical) of the myocardium. Moreover, the mean T1 time was assessed in the 16-segment myocardial AHA model (T1 segment 1-16). The extracellular volume of the myocardium was estimated in an analogous way. Results In CINE sequences, in the HCM group compared to the CON group, the end-diastolic thickness of the anterior part of interventricular septum, the end-diastolic thickness of the left ventricular posterior wall and the left ventricular mass index were significantly higher. The studied groups did not differ in left ventricular ejection fraction. In both groups, no foci of myocardial injury in the LGE sequence were found. There were no statistically significant differences in T1 times between the study groups. In the HCM group as compared to the CON group, the ECV whole myocardium, ECV basal, ECV apical and ECV segments 1-3, 8, 13-16 were statistically significantly higher. Conclusion Patients with hypertrophic cardiomyopathy without myocardium focal injury in the LGE sequence are characterized by higher myocardial ECV values, assessed in the T1-mapping sequence.

Abstract 14244: Gender-Specific Association Between Serum Markers of Systemic Inflammation and Interstitial Cardiac Fibrosis: The Multi-Ethnic Study of Atherosclerosis (MESA)

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Victor Nauffal ◽  
Bharath Ambale Venkatesh ◽  
Colin Wu ◽  
Hossein Bahrami ◽  
Russell Tracy ◽  
...  
Keyword(s):  
Systemic Inflammation ◽  
T1 Mapping ◽  
Cardiac Fibrosis ◽  
Ventricular Remodeling ◽  
Volume Fraction ◽  
Interstitial Fibrosis ◽  
Extracellular Volume ◽  
Inverse Association ◽  
Post Contrast ◽  
Markers Of Inflammation

Introduction: Inflammation contributes to pathogenic ventricular remodeling. Recently, T1 mapping has been used to non-invasively measure interstitial myocardial fibrosis. We examined the association between baseline markers of systemic inflammation and interstitial fibrosis measured using T1 mapping at 10 years follow-up in MESA. Methods and Results: 1,156 participants underwent cardiac magnetic resonance imaging with T1 mapping. All analyses were stratified by gender. Three hierarchical multivariable linear regression models were constructed to assess the risk-adjusted association of baseline C-reactive protein (CRP), interleukin 6 (IL-6) and fibrinogen with 25 minutes post-contrast myocardial T1 time (T1Myo25). Shorter T1Myo25 reflect increasing levels of interstitial fibrosis. We found a non-linear relationship between IL-6 and T1Myo25 in males (Figure 1A). A significant negative association between T1Myo25 and increasing levels of IL-6 was found in males that reversed at IL-6 levels ≥2.7pg/ml. Moreover in males, increasing levels of fibrinogen were significantly negatively associated with T1Myo25, while a similar but non-significant trend was found for CRP (Figure 1B). In women, there was a similar inverse association between T1Myo25 and increasing levels of all three markers of systemic inflammation prior to adjusting for body mass index that became statistically non-significant following adjustment (Figure 1B). Similar associations with markers of inflammation were found using extracellular volume fraction and T1Myo12 as measures of interstitial fibrosis. Conclusions: Markers of systemic inflammation in males, particularly IL-6 and fibrinogen, are independently associated with increased interstitial fibrosis. In females, this association may be mediated by the obesity-induced inflammatory-state. These findings highlight the early role of inflammation in the pathogenesis of heart failure.

Abstract 14921: Right Ventricular Extracellular Volume Fraction by Magnetic Resonance T1 Mapping in Pulmonary Hypertension and Heart Failure

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Kenneth C Bilchick ◽  
Bhairav B Mehta ◽  
Virginia Workman ◽  
Daniel Auger ◽  
Xiao Chen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Magnetic Resonance ◽  
T1 Mapping ◽  
Extracellular Volume ◽  
World Health ◽  
Outcome Variable ◽  
Post Contrast ◽  
Thin Walled ◽  
Rv Function

Introduction: Current cardiac magnetic resonance (CMR) T1 mapping techniques such as Modified Look-Locker inversion recovery (MOLLI) imaging have limited resolution, but the Accelerated and Navigator-Gated Look-Locker Imaging for Cardiac T1 Estimation (ANGIE) is a novel CMR sequence with spatial resolution suitable for T1 mapping of the thin-walled RV. Hypothesis: In pulmonary hypertension (PH) and heart failure (HF), RV extracellular volume (ECV) fraction (as a surrogate measure for RV fibrosis) is a unique parameter describing RV structure that tends to increase with increasing RV size and declining RV function. Methods: Patients with either World Health Organization group 1 or group 4 pulmonary hypertension (PH) or heart failure with reduced ejection fraction (HFrEF) were recruited to undergo contrast-enhanced CMR. RV and LV ECV fractions were determined using pre-contrast and post-contrast T1 mapping using ANGIE (RV and LV) and MOLLI (LV). Results: 22 patients (41% female, median age 61 years old, IQR 51-70 years old) were enrolled, including n=12 with PH and n=10 with HFrEF. ANGIE ECV imaging was of high quality (Figure). A multivariable linear model with RVEF and RVEDVI as independent variables and RVECV as the outcome variable showed independent associations for RVEF and RVEDVI with RVECV (R 2 =0.553) (Table), consistent with a complex relationship involving RV function, dilation, and fibrosis. Conclusions: Pre- and post-contrast ANGIE imaging provides high-resolution ECV determination for the thin-walled RV. RV fibrosis increases with increasing RV size and decreasing overall RV function. Further studies of RVECV in PH and HFrEF are indicated.

scholarly journals CMR-based T1-mapping offers superior diagnostic value compared to longitudinal strain-based assessment of relative apical sparing in cardiac amyloidosis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Dennis Korthals ◽  
Grigorios Chatzantonis ◽  
Michael Bietenbeck ◽  
Claudia Meier ◽  
Philipp Stalling ◽  
...  
Keyword(s):  
Cardiac Amyloidosis ◽  
Longitudinal Strain ◽  
T1 Mapping ◽  
Volume Fraction ◽  
Extracellular Volume ◽  
Left Ventricular ◽  
Cine Imaging ◽  
Characteristic Analysis ◽  
Post Contrast ◽  
Native T1

AbstractCardiac amyloidosis (CA) is an infiltrative disease. In the present study, we compared the diagnostic accuracy of cardiovascular magnetic resonance (CMR)-based T1-mapping and subsequent extracellular volume fraction (ECV) measurement and longitudinal strain analysis in the same patients with (a) biopsy-proven cardiac amyloidosis (CA) and (b) hypertrophic cardiomyopathy (HCM). N = 30 patients with CA, N = 20 patients with HCM and N = 15 healthy control patients without relevant cardiac disease underwent dedicated CMR studies. The CMR protocol included standard sequences for cine-imaging, native and post-contrast T1-mapping and late-gadolinium-enhancement. ECV measurements were based on pre- and post-contrast T1-mapping images. Feature-tracking analysis was used to calculate 3D left ventricular longitudinal strain (LV-LS) in basal, mid and apical short-axis cine-images and to assess the presence of relative apical sparing. Receiver-operating-characteristic analysis revealed an area-under-the-curve regarding the differentiation of CA from HCM of 0.984 for native T1-mapping (p < 0.001), of 0.985 for ECV (p < 0.001) and only 0.740 for the “apical-to-(basal + midventricular)”-ratio of LV-LS (p = 0.012). A multivariable logistical regression analysis showed that ECV was the only statistically significant predictor of CA when compared to the parameter LV-LS or to the parameter “apical-to-(basal + midventricular)” LV-RLS-ratio. Native T1-mapping and ECV measurement are both superior to longitudinal strain measurement (with assessment of relative apical sparing) regarding the appropriate diagnosis of CA.

Myocardial extracellular volume fraction quantification based on T1 mapping at 3 T: quality optimization by contour-based registration and segmental analysis

2021 ◽  
pp. 028418512110671
Author(s):  
Ling Lin ◽  
Xu-Hui Zhou ◽  
Mei Zheng ◽  
Qiu-Xia Xie ◽  
Qian Tao ◽  
...  
Keyword(s):  
Image Quality ◽  
T1 Mapping ◽  
Volume Fraction ◽  
Extracellular Volume ◽  
Extracellular Volume Fraction ◽  
Left Ventricular ◽  
Repeated Measurements ◽  
Related Factors ◽  
Post Contrast

Background Myocardial extracellular volume fraction (ECV) assessment can be affected by various technical and subject-related factors. Purpose To evaluate the role of contour-based registration in quantification of ECV and investigate normal segment-based myocardial ECV values at 3T. Material and Methods Pre- and post-contrast T1 mapping images of the left ventricular basal, mid-cavity, and apical slices were obtained in 26 healthy volunteers. ECV maps were generated using motion correction with and without contour-based registration. The image quality of all ECV maps was evaluated by a 4-point scale. Slices were dichotomized according to the occurrence of misregistration in the source data. Contour-registered ECVs and standard ECVs were compared within each subgroup using analysis of variance for repeated measurements and generalized linear mixed models. Results In all three slices, higher quality of ECV maps were found using contour-registered method than using standard method. Standard ECVs were statistically different from contour-registered ECVs in global (26.8% ± 2.8% vs. 25.8% ± 2.4%; P = 0.001), mid-cavity (25.4% ± 3.1% vs. 24.3% ± 2.5%; P = 0.016), and apical slices (28.7% ± 4.1% vs. 27.2% ± 3.4%; P = 0.010). In the misregistration subgroups, contour-registered ECVs were lower with smaller SDs (basal: 25.2% ± 1.8% vs. 26.7% ± 2.6%; P = 0.038; mid-cavity: 24.4% ± 2.3% vs. 26.8% ± 3.1%; P = 0.012; apical: 27.5% ± 3.6% vs. 29.7% ± 4.5%; P = 0.016). Apical (27.2% ± 3.4%) and basal-septal ECVs (25.6% ± 2.6%) were statistically higher than mid-cavity ECV (24.3% ± 2.5%; both P < 0.001). Conclusion Contour-based registration can optimize image quality and improve the precision of ECV quantification in cases demonstrating ventricular misregistration among source images.

scholarly journals The association of reduced left ventricular strains with increased extracellular volume and their collective impact on clinical outcomes

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Chunna Jin ◽  
Jonathan Weber ◽  
Harsimar Singh ◽  
Kathleen Gliganic ◽  
J. Jane Cao
Keyword(s):  
Heart Failure ◽  
Longitudinal Strain ◽  
T1 Mapping ◽  
Extracellular Volume ◽  
Left Ventricular ◽  
Collective Impact ◽  
Post Contrast ◽  
Tissue Properties ◽  
Kaplan Meier ◽  
The Relationship

Abstract Background Myocardial fibrosis and left ventricular (LV) longitudinal strain are independently associated with adverse clinical outcomes. However, the relationship between tissue properties and strain indices as well as their collective impact on outcomes are yet to be fully elucidated. We aim to investigate the relationship between LV global longitudinal strain (GLS), global circumferential strain (GCS) and global radial strain (GRS) with extracellular volume (ECV) and their collective impact. Methods Consecutive patients referred for clinical cardiovascular magnetic resonance (CMR) due to cardiomyopathy were prospectively enrolled. All patients underwent CMR with T1 mapping. ECV was calculated incorporating native and post-contrast T1 as well as hematocrit. LV GLS, GCS, and GRS were assessed by feature tracking. Hazard ratios and Kaplan–Meier curves were produced to assess the association between strains and T1 mapping indices with a composite outcome of all-cause mortality and hospitalized heart failure. Results The study consisted of 259 patients with mixed referring diagnoses of non-ischemic/ischemic cardiomyopathy and 21 normal controls. Decreased GLS, GCS and GRS were associated with increased ECV, increased native T1, and reduced post-contrast T1 in a dose dependent manner when T1 or ECV was in the abnormal range. After a mean follow-up of 31 ± 23 months, 41 events occurred including 37 heart failure admissions and 4 deaths. Kaplan–Meier plots demonstrated that reduced strains were associated with reduced event-free survival predominantly in patients with increased ECV (≥ 28.3%). The worst outcome was among those with both reduced strains and increased ECV. In the multivariable models, increased ECV, reduced post-contrast T1 and reduced strains in all 3 directions remained predictors of outcome risk, respectively. Conclusion Our findings highlight the intrinsic link between altered CMR tissue properties and impaired myocardial mechanical performance and additionally demonstrate improved risk stratification by characterizing tissue property among patients with reduced strain.

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