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Native T1 mapping in differentiation of normal myocardium from diffuse disease in hypertrophic and dilated
Valentina O Puntmann1, Tobias Voigt, Zhong Chen
1Department of Cardiovascular Imaging, King's College London, London, United Kingdom.
Insights
Native T1 mapping effectively distinguishes healthy from diseased myocardium in hypertrophic and dilated cardiomyopathy. This cardiac MRI technique offers high accuracy for diagnosing diffuse myocardial conditions.
Area of Science:
- Cardiovascular Imaging
- Magnetic Resonance Imaging
- Myocardial Fibrosis Assessment
Background:
- T1 mapping is a promising quantitative method for assessing diffuse myocardial fibrosis.
- Previous studies have not systematically evaluated T1 mapping's clinical utility in differentiating healthy from diseased myocardium.
Purpose of the Study:
- To assess the diagnostic value of native and post-contrast T1 relaxation times for differentiating healthy myocardium from diffuse disease.
- To evaluate T1 mapping in hypertrophic cardiomyopathy (HCM) and nonischemic dilated cardiomyopathy (DCM) models.
Main Methods:
- Cardiac MRI with T1 mapping was performed on 52 patients (25 HCM, 27 DCM) and 30 controls.
- Single short-axis slice T1 mapping was acquired pre- and post-gadobutrol administration.
- Native T1 values and extracellular volume fractions (ECV) were calculated.
Main Results:
- Native T1 values were significantly longer in cardiomyopathy patients compared to controls (p < 0.01).
- Post-contrast T1 values and ECV were significantly higher in patients with cardiomyopathy (p < 0.01).
- Native T1 mapping achieved 100% sensitivity and 96% specificity for differentiating healthy from diseased myocardium (AUC 0.99).
Conclusions:
- Native and post-contrast T1 values serve as accurate indexes for discriminating normal from diffusely diseased myocardium.
- T1 mapping demonstrates high diagnostic performance in clinical settings for cardiomyopathies.
Objectives:
The aim of this study was to examine the value of native and post-contrast T1 relaxation in the differentiation between healthy and diffusely diseased myocardium in 2 model conditions, hypertrophic cardiomyopathy and nonischemic dilated cardiomyopathy.
Background:
T1 mapping has been proposed as potentially valuable in the quantitative assessment of diffuse myocardial fibrosis, but no studies to date have systematically evaluated its role in the differentiation of healthy myocardium from diffuse disease in a clinical setting.
Methods:
Consecutive subjects undergoing routine clinical cardiac magnetic resonance at King's College London were invited to participate in this study. Groups were based on cardiac magnetic resonance findings and consisted of subjects with known hypertrophic cardiomyopathy (n = 25) and nonischemic dilated cardiomyopathy (n = 27). Thirty normotensive subjects with low pre-test likelihood of cardiomyopathy, not taking any regular medications and with normal cardiac magnetic resonance findings including normal left ventricular mass indexes, served as controls. Single equatorial short-axis slice T1 mapping was performed using a 3-T scanner before and at 10, 20, and 30 minutes after the administration of 0.2 mmol/kg of gadobutrol. T1 values were quantified within the septal myocardium (T1 native), and extracellular volume fractions (ECV) were calculated.
Results:
T1 native was significantly longer in patients with cardiomyopathy compared with control subjects (p < 0.01). Conversely, post-contrast T1 values were significantly shorter in patients with cardiomyopathy at all time points (p < 0.01). ECV was significantly higher in patients with cardiomyopathy compared with controls at all time points (p < 0.01). Multivariate binary logistic regression revealed that T1 native could differentiate between healthy and diseased myocardium with sensitivity of 100%, specificity of 96%, and diagnostic accuracy of 98% (area under the curve 0.99; 95% confidence interval: 0.96 to 1.00; p < 0.001), whereas post-contrast T1 values and ECV showed lower discriminatory performance.
Conclusions:
This study demonstrates that native and post-contrast T1 values provide indexes with high diagnostic accuracy for the discrimination of normal and diffusely diseased myocardium.
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