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In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
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Adenosine Stress and Rest T1 Mapping Can Differentiate Between Ischemic, Infarcted, Remote, and Normal Myocardium

Alexander Liu1, Rohan S Wijesurendra1, Jane M Francis1

  • 1Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom.

JACC. Cardiovascular Imaging
|December 20, 2015
PubMed

Insights

T1 mapping with cardiac magnetic resonance (CMR) can detect myocardial ischemia without gadolinium contrast. This novel technique differentiates normal, infarcted, and ischemic heart tissue using stress/rest T1 profiles.

Area of Science:

  • Cardiovascular Imaging
  • Medical Physics

Background:

  • Accurate ischemia detection is crucial in chronic coronary artery disease (CAD) for effective treatment and improved outcomes.
  • Myocardial blood volume (MBV) is a key marker of ischemia, potentially more comprehensive than myocardial blood flow.
  • T1 mapping using cardiac magnetic resonance (CMR) is sensitive to changes in myocardial water content, reflecting MBV.

Purpose of the Study:

  • To evaluate T1 mapping at rest and during adenosine stress for detecting ischemia without gadolinium contrast.
  • To assess if T1 mapping can identify changes in myocardial blood volume in normal and diseased myocardium in CAD patients.
  • To compare T1 mapping with conventional CMR methods for ischemia and infarction assessment.

Main Methods:

  • Conventional CMR (cine, LGE, first-pass perfusion) and novel pre-contrast stress/rest T1 mapping were performed on 20 controls and 10 CAD patients.
  • T1 mapping utilized the heart rate-independent Shortened Modified Look-Locker Inversion recovery technique.
  • T1 values were analyzed in normal, infarcted, ischemic, and remote myocardium.

Main Results:

  • Normal myocardium showed normal resting T1 and significant positive T1 reactivity during adenosine stress.
  • Infarcted myocardium exhibited the highest resting T1 without significant reactivity.
  • Ischemic myocardium had elevated resting T1 but no significant reactivity, while remote myocardium showed blunted T1 reactivity.

Conclusions:

  • Stress/rest T1 mapping effectively differentiates between normal, infarcted, ischemic, and remote myocardium based on distinct T1 profiles.
  • This novel T1 mapping approach shows promise for gadolinium-free ischemia detection in CAD.
  • T1 mapping offers a new avenue for assessing myocardial viability and ischemia in cardiovascular magnetic resonance.
Abstract

Keywords:
ShMOLLIT1 mappingadenosine stresscardiac magnetic resonanceischemia

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