Native T1 mapping: inter-study, inter-observer and inter-center reproducibility in hemodialysis patients

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Abstract

Background

Native T1 mapping is a cardiovascular magnetic resonance (CMR) technique that associates with markers of fibrosis and strain in hemodialysis patients. The reproducibility of T1 mapping in hemodialysis patients, prone to changes in fluid status, is unknown. Accurate quantification of myocardial fibrosis in this population has prognostic potential.

Methods

Using 3 Tesla CMR, we report the results of 1) the inter-study, inter-observer and intra-observer reproducibility of native T1 mapping in 10 hemodialysis patients; 2) inter-study reproducibility of left ventricular (LV) structure and function in 10 hemodialysis patients; 3) the agreement of native T1 map and native T1 phantom analyses between two centres in 20 hemodialysis patients; 4) the effect of changes in markers of fluid status on native T1 values in 10 hemodialysis patients.

Results

Inter-study, inter-observer and intra-observer variability of native T1 mapping were excellent with co-efficients of variation (CoV) of 0.7, 0.3 and 0.4% respectively. Inter-study CoV for LV structure and function were: LV mass = 1%; ejection fraction = 1.1%; LV end-diastolic volume = 5.2%; LV end-systolic volume = 5.6%. Inter-centre variability of analysis techniques were excellent with CoV for basal and mid-native T1 slices between 0.8–1.2%. Phantom analyses showed comparable native T1 times between centres, despite different scanners and acquisition sequences (centre 1: 1192.7 ± 7.5 ms, centre 2: 1205.5 ± 5 ms). For the 10 patients who underwent inter-study testing, change in body weight (Δweight) between scans correlated with change in LV end-diastolic volume (ΔLVEDV) ( r = 0.682; P = 0.03) representing altered fluid status between scans. There were no correlations between change in native T1 between scans (ΔT1) and ΔLVEDV or Δweight ( P > 0.6). Linear regression confirmed ΔT1 was unaffected by ΔLVEDV or Δweight ( P > 0.59).

Conclusions

Myocardial native T1 is reproducible in HD patients and unaffected by changes in fluid status at the levels we observed. Native T1 mapping is a potential imaging biomarker for myocardial fibrosis in patients with end-stage renal disease.

Electronic supplementary material

The online version of this article (doi:10.1186/s12968-017-0337-7) contains supplementary material, which is available to authorized users.

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Most cited references 43

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

Daniel R Messroghli, Aleksandra Radjenovic, Sebastian Kozerke … (2004)

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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Noncontrast T1 mapping for the diagnosis of cardiac amyloidosis.

Theodoros D. Karamitsos, Stefan K Piechnik, Sanjay Banypersad … (2013)

This study sought to explore the potential role of noncontrast myocardial T1 mapping for detection of cardiac involvement in patients with primary amyloid light-chain (AL) amyloidosis. Cardiac involvement carries a poor prognosis in systemic AL amyloidosis. Late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) is useful for the detection of cardiac amyloid, but characteristic LGE patterns do not always occur or they appear late in the disease. Noncontrast characterization of amyloidotic myocardium with T1 mapping may improve disease detection. Furthermore, quantitative assessment of myocardial amyloid load would be of great value. Fifty-three AL amyloidosis patients (14 with no cardiac involvement, 11 with possible involvement, and 28 with definite cardiac involvement based on standard biomarker and echocardiographic criteria) underwent CMR (1.5-T) including noncontrast T1 mapping (shortened modified look-locker inversion recovery [ShMOLLI] sequence) and LGE imaging. These were compared with 36 healthy volunteers and 17 patients with aortic stenosis and a comparable degree of left ventricular hypertrophy as the cardiac amyloid patients. Myocardial T1 was significantly elevated in cardiac AL amyloidosis patients (1,140 ± 61 ms) compared to normal subjects (958 ± 20 ms, p < 0.001) and patients with aortic stenosis (979 ± 51 ms, p < 0.001). Myocardial T1 was increased in AL amyloid even when cardiac involvement was uncertain (1,048 ± 48 ms) or thought absent (1,009 ± 31 ms). A noncontrast myocardial T1 cutoff of 1,020 ms yielded 92% accuracy for identifying amyloid patients with possible or definite cardiac involvement. In the AL amyloidosis cohort, there were significant correlations between myocardial T1 time and indices of systolic and diastolic dysfunction. Noncontrast T1 mapping has high diagnostic accuracy for detecting cardiac AL amyloidosis, correlates well with markers of systolic and diastolic dysfunction, and is potentially more sensitive for detecting early disease than LGE imaging. Elevated myocardial T1 may represent a direct marker of cardiac amyloid load. Further studies are needed to assess the prognostic significance of T1 elevation. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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Shortened Modified Look-Locker Inversion recovery (ShMOLLI) for clinical myocardial T1-mapping at 1.5 and 3 T within a 9 heartbeat breathhold

Stefan K Piechnik, Vanessa M. Ferreira, Erica Dall’Armellina … (2010)

Background T1 mapping allows direct in-vivo quantitation of microscopic changes in the myocardium, providing new diagnostic insights into cardiac disease. Existing methods require long breath holds that are demanding for many cardiac patients. In this work we propose and validate a novel, clinically applicable, pulse sequence for myocardial T1-mapping that is compatible with typical limits for end-expiration breath-holding in patients. Materials and methods The Shortened MOdified Look-Locker Inversion recovery (ShMOLLI) method uses sequential inversion recovery measurements within a single short breath-hold. Full recovery of the longitudinal magnetisation between sequential inversion pulses is not achieved, but conditional interpretation of samples for reconstruction of T1-maps is used to yield accurate measurements, and this algorithm is implemented directly on the scanner. We performed computer simulations for 100 ms

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Author and article information

Contributors

Matthew P. M. Graham-Brown: +44 (0)116252 2522 , mpmgb1@le.ac.uk

Journal

Journal ID (nlm-ta): J Cardiovasc Magn Reson

Journal ID (iso-abbrev): J Cardiovasc Magn Reson

Title: Journal of Cardiovascular Magnetic Resonance

Publisher: BioMed Central (London )

ISSN (Print): 1097-6647

ISSN (Electronic): 1532-429X

Publication date (Electronic): 27 February 2017

Publication date PMC-release: 27 February 2017

Publication date Collection: 2017

Volume: 19

Electronic Location Identifier: 21

Affiliations

[1 ]ISNI 0000 0001 0435 9078, GRID grid.269014.8, John Walls Renal Unit, , University Hospitals Leicester NHS Trust, ; Leicester, UK

[2 ]ISNI 0000 0004 1936 8411, GRID grid.9918.9, Department of Infection Immunity and Inflammation, School of Medicine and Biological Sciences, , University of Leicester, ; Leicester, LE1 9HN UK

[3 ]ISNI 0000 0004 1936 8542, GRID grid.6571.5, National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, , Loughborough University, ; Loughborough, UK

[4 ]ISNI 0000 0001 2193 314X, GRID grid.8756.c, BHF Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, , University of Glasgow, ; 126 University Place, Glasgow, UK

[5 ]ISNI 0000 0001 2177 007X, GRID grid.415490.d, The Glasgow Renal & Transplant Unit, , Queen Elizabeth University Hospital, ; 1345 Govan Road, Glasgow, UK

[6 ]ISNI 0000 0004 1936 8411, GRID grid.9918.9, Department of Cardiovascular Sciences, , University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital Leicester, ; Leicester, UK

[7 ]ISNI 0000 0001 0523 9342, GRID grid.413301.4, , Clinical Physics, NHS Greater Glasgow and Clyde, ; Glasgow, UK

[8 ]ISNI 0000 0004 0590 2070, GRID grid.413157.5, West of Scotland Heart and Lung Centre, , Golden Jubilee National Hospital, ; Clydebank, UK

[9 ]ISNI 0000000121901201, GRID grid.83440.3b, UCL Institute of Cardiovascular Science, , University College London, ; London, UK

Article

Publisher ID: 337

DOI: 10.1186/s12968-017-0337-7

PMC ID: 5327541

PubMed ID: 28238284

SO-VID: 88df7fb9-5e6d-4971-b68e-e6d0429f14ef

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 27 January 2017

Date accepted : 2 February 2017

Funding

Funded by: National Institue for Health Research

Award ID: CS-2013-13-014

Award Recipient : Matthew P. M. Graham-Brown

Funded by: FundRef http://dx.doi.org/10.13039/501100000291, Kidney Research UK;

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ScienceOpen disciplines: Cardiovascular Medicine

Keywords: hemodialysis,myocardial fibrosis,native t1,reproducibility,cardiovascular magnetic resonance

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ScienceOpen disciplines: Cardiovascular Medicine

Keywords: hemodialysis, myocardial fibrosis, native t1, reproducibility, cardiovascular magnetic resonance

Native T1 mapping: inter-study, inter-observer and inter-center reproducibility in hemodialysis patients

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UCL: UN SDG 03 Good Health and Well-Being

Most cited references 43

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

Noncontrast T1 mapping for the diagnosis of cardiac amyloidosis.

Shortened Modified Look-Locker Inversion recovery (ShMOLLI) for clinical myocardial T1-mapping at 1.5 and 3 T within a 9 heartbeat breathhold

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