scholarly journals 29Detection of myocardial iron overload with magnetic resonance by native T1 and T2* mapping using a segmental approach

2019 ◽  
Vol 20 (Supplement_2) ◽  
Author(s):  
A Pepe ◽  
N Martini ◽  
D De Marchi ◽  
A Barison ◽  
L Pistoia ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Iron Overload ◽  
T2 Mapping ◽  
Myocardial Iron ◽  
Native T1 ◽  
T1 And T2 ◽  
Segmental Approach

scholarly journals Detection of Myocardial Iron Overload with Magnetic Resonance By Native T1 and T2* Mapping Using a Segmental Approach

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2346-2346
Author(s):  
Alessia Pepe ◽  
Laura Pistoia ◽  
Nicola Martini ◽  
Daniele De Marchi ◽  
Andrea Barison ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Iron Overload ◽  
T1 Mapping ◽  
T2 Mapping ◽  
Basal Medium ◽  
Motion Artifacts ◽  
Myocardial Iron ◽  
Native T1 ◽  
T1 And T2 ◽  
Segmental Approach

Abstract Introduction. T2* measurement of myocardial iron overload (MIO) is presently the gold standard for monitoring and tailoring the chelation in thalassemia patients. Native T1 mapping has been proposed also for the MIO quantification because it is known that iron can reduce native T1 values. No data are available in literature comparing T1 and T2* mapping using a segmental approach including the whole left ventricle. The goal of our study was to assess the relationship between T1 and T2* values using a segmental approach. Methods. 29 patients with hemoglopinopathies (18 females, 45.39±13.49 years) enrolled in the Extension Myocardial Iron Overload in Thalassemia (eMIOT) Network were considered. Native T1 and T2* images were acquired, respectively, with the Modified Look-Locker Inversion recovery (MOLLI) and with the multi-echo gradient-echo techniques. Three parallel short-axis views (basal, medium and apical) of the left ventricle (LV) were acquired with ECG-gating. The myocardial T1 and T2* distribution was mapped into a 16-segment LV model, according to the AHA/ACC model. The lower limit of normal for each segment was established as mean±2 standard deviations on data acquired on 14 healthy volunteers. In 25 patients also post-contrastografic images were acquired. Results. T1 images showed more pronounced motion artifacts and lower contrast-to-noise-ratio, determining the exclusion of 18/464 segments. No segments were excluded by T2* mapping. So, globally, 446 segmental T1 and T2* values were considered. The mean of all segmental T2* and T1 values were, respectively, 37.83±11.30 ms and 982.72±118.24 ms. Normal T2* and T1 values were found in 374 segments (83.9%) while 29 (6.5%) segments had pathologic T2* and T1 values. For 33 segments (7.4%) (13 patients) a pathologic T1 value was detected in presence of a normal T2* value. For 10 segments (2.2%) a pathologic T2* value was detected in presence of a normal T1 value. Out of the 9 patients with pathologic T2* values in presence of normal T1, in 7 patients post-contrastografic images were acquired; in all segments with pathologic T2* value macroscopic fibrosis by late gadolinium enhancement technique and/or microscopic fibrosis by T1 mapping were found. The relation between segmental T1 and T2* values is shown in the figure. For patients with pathologic segmental T2* values there was a linear relationship between T1 and T2* values (R=0.735, P<0.0001) while the whole data was fitted with a quadratic curve. Conclusion. T2* and T1 mapping showed a good correlation in identifying iron by a segmental approach. However, we found a scatter between results. In 9 patients T1 mapping was not able to detect iron probably due to the presence of macroscopic and/or microscopic fibrosis that it is known to increase the native T1 . Conversely, in 13 patients T1 mapping seems to be more sensitive than T2* (sensitive to different iron chemistry or error measurements?). Further studies on larger population and correlation with clinical outcome are need. Figure. Figure. Disclosures Pepe: Chiesi Farmaceutici S.p.A., ApoPharma Inc., and Bayer: Other: No profit support.

scholarly journals Myocardial iron overload by cardiovascular magnetic resonance native segmental T1 mapping: a sensitive approach that correlates with cardiac complications

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Antonella Meloni ◽  
Nicola Martini ◽  
Vincenzo Positano ◽  
Antonio De Luca ◽  
Laura Pistoia ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Iron Overload ◽  
Left Ventricular ◽  
Cardiac Complications ◽  
Lv Function ◽  
Myocardial Iron ◽  
Thalassaemia Major ◽  
Native T1 ◽  
T1 And T2

Abstract Background We compared cardiovascular magnetic resonance segmental native T1 against T2* values for the detection of myocardial iron overload (MIO) in thalassaemia major and we evaluated the clinical correlates of native T1 measurements. Methods We considered 146 patients (87 females, 38.7 ± 11.1 years) consecutively enrolled in the Extension-Myocardial Iron Overload in Thalassaemia Network. T1 and T2* values were obtained in the 16 left ventricular (LV) segments. LV function parameters were quantified by cine images. Post-contrast late gadolinium enhancement (LGE) and T1 images were acquired. Results 64.1% of segments had normal T2* and T1 values while 10.1% had pathologic T2* and T1 values. In 526 (23.0%) segments, there was a pathologic T1 and a normal T2* value while 65 (2.8%) segments had a pathologic T2* value but a normal T1 and an extracellular volume (ECV) ≥ 25% was detected in 16 of 19 segments where ECV was quantified. Global native T1 was independent from gender or LV function but decreased with increasing age. Patients with replacement myocardial fibrosis had significantly lower native global T1. Patients with cardiac complications had significantly lower native global T1. Conclusions The combined use of both segmental native T1 and T2* values could improve the sensitivity for detecting MIO. Native T1 is associated with cardiac complications in thalassaemia major.

scholarly journals 66 Heart and lung tissue characterization of COVID-19 pneumonia by T1 and T2 mapping magnetic resonance imaging

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Giovanni Camastra ◽  
Luca Arcari ◽  
Federica Ciolina ◽  
Massimiliano Danti ◽  
Luca Cacciotti ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Tissue Characterization ◽  
T2 Mapping ◽  
Left Ventricular ◽  
Resonance Imaging ◽  
Native T1 ◽  
T1 And T2 ◽  
Lung Mri

Abstract Aims Coronavirus disease 2019 (COVID-19) is a respiratory tract infection which can lead to systemic involvement including myocardial injury, severe respiratory failure and death. Magnetic resonance imaging (MRI) could potentially offer advantages in providing tissue characterization of lung parenchyma and heart muscle in COVID-19. The aim of the present study was to describe data on heart and lung MRI in a cohort of patients hospitalized due to COVID-19 pneumonia. Methods and results n = 11 patients hospitalized with COVID-19 pneumonia underwent a comprehensive MRI examinations including lung and heart tissue mapping, findings were compared to those of an age- and sex-matched cohort of n = 11 individuals. Lung native T1 and T2 mapping assessments were performed by drawing a circular region of interest (ROI) with diameter of 2 cm in the parenchyma visualized from the cardiac four chamber long axis-oriented slice; vessels and areas of pleural effusion were carefully excluded. Myocardial native T1 and T2 mapping were assessed by drawing a ROI within the midventricular left ventricular (LV) septum. No patients had previous history of cardiovascular disease (including known coronary artery disease, heart failure, cardiomyopathy, atrial fibrillation). As compared to controls, patients with COVID-19 had similar cardiac function, higher mid-septum myocardial native T1 (1028 ms vs. 985, P = 0.05) and significantly higher lung native T1 and T2 within affected areas (1375 ms vs. 1201 ms, P = 0.016 and 70 ms vs. 30 ms, P &lt; 0.001 respectively), whereas non-significant differences were observed between remote lung areas of patients and controls (1238 ms vs. 1152 ms, P = 0.088 and 29 ms vs. 33 ms, P = 0.797 respectively). No significant associations were observed between cardiac and lung mapping findings. Conclusions In our cohort of patients with COVID-19, T1 and T2 mapping lung MRI identified pneumonia related abnormalities as compared to healthy controls, likely representing oedema and ongoing inflammation at the lung site. Myocardial native T1 was elevated suggesting the presence of cardiac involvement. A comprehensive MRI examination can be potentially used to assess multiorgan involvement in COVID-19.

Abstract 15703: Cardiac Magnetic Resonance Imaging Can Non-invasively Detect Rejection in Pediatric Heart Transplant Recipients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jonathan H Soslow ◽  
Justin Godown ◽  
David Bearl ◽  
Kimberly Crum ◽  
Kristen George-Durrett ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Heart Transplant ◽  
T2 Mapping ◽  
Extracellular Volume ◽  
Transplant Recipients ◽  
Native T1 ◽  
Heart Transplant Recipients ◽  
T1 And T2 ◽  
Pediatric Heart Transplant

Introduction: Pediatric heart transplant recipients (PHTx) undergo frequent surveillance endomyocardial biopsies (EMB). Non-invasive screening for acute rejection (AR) could decrease morbidity, improve quality of life, and decrease healthcare costs. Hypothesis: We hypothesized that cardiac magnetic resonance (CMR) extracellular volume (ECV), native T1, and T2 mapping can detect AR in PHTx. Methods: PHTx (n=29) were prospectively enrolled at two sites at time of surveillance EMB or EMB for AR. AR was defined as a clinical change or positive EMB requiring intensification of immunosuppression. Subjects with cardiac allograft vasculopathy (n=3) were excluded; ECV was not measured in 2 subjects without rejection (no IV, poor breathholds). CMR without sedation included standard volumetrics, modified Look-Locker inversion recovery before and after contrast, and T2 mapping. A Wilcoxon rank sum was used to assess for a difference between groups. Results: Median age was 17 y/o (range 9-19). There were 9 subjects with and 17 subjects without AR. Base ECV, mid ECV, 4-ch ECV, and average ECV were increased in AR vs non-rejection (Table 1, Fig 1). Native T1 and T2 times were also increased in patients with AR (Table 1). A cut-off of 29% for mid ECV and 1070ms for mid native T1 identifies all patients with rejection with 6 false positive results in non-rejection (Fig 1) and could potentially decrease the need for EMB by 65%. Conclusions: ECV, native T1, and T2 mapping can non-invasively distinguish between PHTx with and without AR and have potential to decrease the required number of surveillance EMBs.

Abstract 16030: Myocardial Abnormalities in Competitive Athletes on T1 and T2 Parametric Mapping by Cardiovascular Magnetic Resonance Imaging

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Marc Lee ◽  
Richard Lafountain ◽  
Juliet Varghese ◽  
Christopher Hummel ◽  
James Borchers ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
T2 Mapping ◽  
Sports Participation ◽  
Myocardial Edema ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Native T1 ◽  
Competitive Athletes ◽  
T1 And T2

Introduction: Athletic cardiac adaptation is associated with structural changes that can overlap with disease states, unnecessarily limiting sports participation. Cardiovascular magnetic resonance (CMR) is useful in athlete’s heart and provides myocardial tissue characterization by T1 and T2 mapping. Hypothesis: CMR in competitive athletes will show abnormal T1 and T2 mapping due to intense exercise induced myocardial edema that can overlap with myocarditis. Methods: CMR data including left ventricular ejection fraction (LVEF) and T1/T2 maps were collected using standardized protocols on a 1.5 T scanner and compared between competitive athletes (N = 18, 83% male, median age 20 years), clinical myocarditis (N = 42, 71% male, median age 23 years) and controls (N = 35, 86% male, median age 22 years) between 2016-2020. T2 values of <59 ms and native T1 <1080 ms were defined as normal per institutional data. Extracellular volume fraction (ECV) and late gadolinium enhancement (LGE) were compared between athlete and myocarditis groups. Results: Figure 1 (panel A) shows participating sport and indications for CMR in athletes. There were 11 athletes (61%) with elevated T2 values (>59 ms), of which 9 (82%) were without clinical myocarditis. Average T2, native T1, ECV, and LVEF are shown in panels B-E. T2 values were highest in myocarditis, followed by athletes and controls (p = 0.001). ECV was higher in myocarditis compared to athletes (p = 0.002). LGE was present in 8/18 athletes and 41/42 myocarditis patients. 6 athletes had follow-up CMR after a period of deconditioning, with 3 (50%) demonstrating an improvement in T2 values and LGE. Conclusions: To conclude, we demonstrate abnormalities on T2 mapping in athletes consistent with myocardial edema or inflammation. Changes in T2 may be related to intense training. Additional studies are required to prospectively evaluate athletes for normative T1 and T2 mapping values, relationship to training, and their correlation with LGE.

scholarly journals Ultrahigh-field cardiovascular magnetic resonance T1 and T2 mapping for the assessment of anthracycline-induced cardiotoxicity in rat models: validation against histopathologic changes

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Heae Surng Park ◽  
Yoo Jin Hong ◽  
Kyunghwa Han ◽  
Pan Ki Kim ◽  
Eunkyung An ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
T2 Mapping ◽  
Histopathological Changes ◽  
Treatment Control ◽  
Ultrahigh Field ◽  
Rat Models ◽  
Native T1 ◽  
Vacuolar Change ◽  
T1 And T2

Abstract Background Chemotherapy-induced cardiotoxicity is a well-recognized adverse effect of chemotherapy. Quantitative T1-mapping cardiovascular magnetic resonance (CMR) is useful for detecting subclinical myocardial changes in anthracycline-induced cardiotoxicity. The aim of the present study was to histopathologically validate the T1 and T2 mapping parameters for the evaluation of diffuse myocardial changes in rat models of cardiotoxicity. Methods Rat models of cardiotoxicity were generated by injecting rats with doxorubicin (1 mg/kg, twice a week). CMR was performed with a 9.4 T ultrahigh-field scanner using cine, pre-T1, post-T1 and T2 mapping sequences to evaluate the left ventricular ejection fraction (LVEF), native T1, T2, and extracellular volume fraction (ECV). Histopathological examinations were performed and the association of histopathological changes with CMR parameters was assessed. Results Five control rats and 36 doxorubicin-treated rats were included and classified into treatment periods. In the doxorubicin-treated rats, the LVEF significantly decreased after 12 weeks of treatment (control vs. 12-week treated: 73 ± 4% vs. 59 ± 9%, P = 0.01).  Increased native T1 and ECV were observed after 6 weeks of treatment (control vs. 6-week treated: 1148 ± 58 ms, 14.3 ± 1% vs. 1320 ± 56 ms, 20.3 ± 3%; P = 0.005, < 0.05, respectively). T2 values also increased by six weeks of treatment (control vs. 6-week treated: 16.3 ± 2 ms vs. 10.3 ± 1 ms, P < 0.05). The main histopathological features were myocardial injury, interstitial fibrosis, inflammation, and edema. The mean vacuolar change (%), fibrosis (%), and inflammation score were significantly higher in 6-week treated rats than in the controls (P = 0.03, 0.03, 0.02, respectively). In the univariable analysis, vacuolar change showed the highest correlation with native T1 value (R = 0.60, P < 0.001), and fibrosis showed the highest correlation with ECV value (R = 0.78, P < 0.001). In the multiple linear regression analysis model, vacuolar change was a significant factor for change in native T1 (P = 0.01), and vacuolar change and fibrosis were significant factors for change in ECV (P = 0.006, P < 0.001, respectively) by adding other histopathological parameters (i.e., inflammation and edema scores) Conclusions Quantitative T1 and T2 mapping CMR is a useful non-invasive tool reflecting subclinical histopathological changes in anthracycline-induced cardiotoxicity.

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