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      Non-contrast-enhanced T1 Mapping of Dilated Cardiomyopathy: Comparison between Native T1 Values and Late Gadolinium Enhancement

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          Abstract

          Purpose:

          We sought to use non-contrast-enhanced T 1 mapping to determine the native T 1 values required to identify myocardial fibrosis in patients with dilated cardiomyopathy (DCM).

          Methods:

          A total of 25 patients with DCM and 15 healthy controls were enrolled. All subjects underwent T 1 mapping using modified look–locker inversion recovery, and the patients underwent late gadolinium-enhancement (LGE) imaging. Basal and mid-ventricular levels were divided into eight segments and the T 1 value was measured in each segment. The T 1 values of septal segments with LGE were compared with those of the septal segments without LGE, the minimum T 1 value of each patient, and the T 1 values of the normal septal myocardium.

          Results:

          Late gadolinium-enhancement was present in 12 septal segments (24.0%) from 10 patients (40.0%). T 1 values were significantly higher in septal segments with LGE than in those without (1373.7 vs. 1288.0 ms; P = 0.035) or in normal septal myocardium (1209.1 ms; P < 0.01). A receiver operating characteristic analysis revealed the appropriate cutoff value of 1349.4 ms for identifying LGE with a sensitivity of 75% and specificity of 92.1%. When the minimum T 1 value + 1.2 standard deviation (SD) was used as the threshold, the sensitivity was 75% and specificity was 89.5%.

          Conclusion:

          Non-contrast-enhanced T 1 mapping can be used for assessment of myocardial fibrosis associated with DCM by using the appropriate threshold.

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          Most cited references 28

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          2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.

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            Modified Look-Locker inversion recovery (MOLLI) for high-resolution T1 mapping of the heart.

            A novel pulse sequence scheme is presented that allows the measurement and mapping of myocardial T1 in vivo on a 1.5 Tesla MR system within a single breath-hold. Two major modifications of conventional Look-Locker (LL) imaging are introduced: 1) selective data acquisition, and 2) merging of data from multiple LL experiments into one data set. Each modified LL inversion recovery (MOLLI) study consisted of three successive LL inversion recovery (IR) experiments with different inversion times. We acquired images in late diastole using a single-shot steady-state free-precession (SSFP) technique, combined with sensitivity encoding to achieve a data acquisition window of < 200 ms duration. We calculated T1 using signal intensities from regions of interest and pixel by pixel. T1 accuracy at different heart rates derived from simulated ECG signals was tested in phantoms. T1 estimates showed small systematic error for T1 values from 191 to 1196 ms. In vivo T1 mapping was performed in two healthy volunteers and in one patient with acute myocardial infarction before and after administration of Gd-DTPA. T1 values for myocardium and noncardiac structures were in good agreement with values available from the literature. The region of infarction was clearly visualized. MOLLI provides high-resolution T1 maps of human myocardium in native and post-contrast situations within a single breath-hold. Copyright 2004 Wiley-Liss, Inc.
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              Myocardial T1 mapping and extracellular volume quantification: a Society for Cardiovascular Magnetic Resonance (SCMR) and CMR Working Group of the European Society of Cardiology consensus statement

              Rapid innovations in cardiovascular magnetic resonance (CMR) now permit the routine acquisition of quantitative measures of myocardial and blood T1 which are key tissue characteristics. These capabilities introduce a new frontier in cardiology, enabling the practitioner/investigator to quantify biologically important myocardial properties that otherwise can be difficult to ascertain clinically. CMR may be able to track biologically important changes in the myocardium by: a) native T1 that reflects myocardial disease involving the myocyte and interstitium without use of gadolinium based contrast agents (GBCA), or b) the extracellular volume fraction (ECV)–a direct GBCA-based measurement of the size of the extracellular space, reflecting interstitial disease. The latter technique attempts to dichotomize the myocardium into its cellular and interstitial components with estimates expressed as volume fractions. This document provides recommendations for clinical and research T1 and ECV measurement, based on published evidence when available and expert consensus when not. We address site preparation, scan type, scan planning and acquisition, quality control, visualisation and analysis, technical development. We also address controversies in the field. While ECV and native T1 mapping appear destined to affect clinical decision making, they lack multi-centre application and face significant challenges, which demand a community-wide approach among stakeholders. At present, ECV and native T1 mapping appear sufficiently robust for many diseases; yet more research is required before a large-scale application for clinical decision-making can be recommended.
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                Author and article information

                Affiliations
                [1 ]Department of Radiology, Nippon Medical School, Tokyo, Japan
                [2 ]Department of Radiology, Nihon University Hospital, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8309, Japan
                [3 ]Department of Cardiology, Nippon Medical School, Tokyo, Japan
                Author notes
                [* ]Corresponding author, Phone: +81-3-3293-1711, E-mail: yas-amano@ 123456nifty.com
                Journal
                Magn Reson Med Sci
                Magn Reson Med Sci
                mrms
                Magnetic Resonance in Medical Sciences
                Japanese Society for Magnetic Resonance in Medicine
                1347-3182
                1880-2206
                2019
                07 March 2018
                : 18
                : 1
                : 12-18
                mrms-18-12
                10.2463/mrms.mp.2017-0136
                6326770
                29515087
                © 2018 Japanese Society for Magnetic Resonance in Medicine

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/

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