MOLLI and AIR T1 mapping pulse sequences yield different myocardial T1 and ECV measurements

Both post-contrast myocardial T1 and extracellular volume (ECV) have been reported to be associated with diffuse interstitial fibrosis. Recently, the cardiovascular magnetic resonance (CMR) field is recognizing that post-contrast myocardial T1 is sensitive to several confounders and migrating towards ECV as a measure of collagen volume fraction. Several recent studies using widely available Modified Look-Locker Inversion-recovery (MOLLI) have reported ECV cutoff values to distinguish between normal and diseased myocardium. It is unclear if these cutoff values are translatable to different T1 mapping pulse sequences such as arrhythmia-insensitive-rapid (AIR) cardiac T1 mapping, which was recently developed to rapidly image patients with cardiac rhythm disorders. We sought to evaluate, in well-controlled canine and pig experiments, the relative accuracy and precision, as well as intra- and inter-observer variability in data analysis, of ECV measured with AIR as compared with MOLLI. In 16 dogs, as expected, the mean T1 was significantly different (p < 0.001) between MOLLI (891 ± 373 ms) and AIR (1071 ± 503 ms), but, surprisingly, the mean ECV between MOLLI (21.8 ± 2.1%) and AIR (19.6 ± 2.4%) was also significantly different (p < 0.001). Both intra- and inter-observer agreements in T1 calculations were higher for MOLLI than AIR, but intra- and inter-observer agreements in ECV calculations were similar between MOLLI and AIR. In six pigs, the coefficient of repeatability (CR), as defined by the Bland-Altman analysis, in T1 calculation was considerably lower for MOLLI (32.5 ms) than AIR (82.3 ms), and the CR in ECV calculation was also lower for MOLLI (1.8%) than AIR (4.5%). In conclusion, this study shows that MOLLI and AIR yield significantly different T1 and ECV values in large animals and that MOLLI yields higher precision than AIR. Findings from this study suggest that CMR researchers must consider the specific pulse sequence when translating published ECV cutoff values into their own studies.