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Quantification of both the area-at-risk and acute myocardial infarct size in ST-segment elevation myocardial
Heerajnarain Bulluck1, Matthew Hammond-Haley2, Marianna Fontana3
1The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, UK. h.bulluck@gmail.com.
Insights
Native T1-mapping accurately assesses the area-at-risk and infarct size in ST-segment myocardial infarction (STEMI) patients. This method streamlines cardiovascular magnetic resonance (CMR) scans by potentially replacing T2-mapping and late gadolinium enhancement (LGE) imaging.
Area of Science:
- Cardiovascular Magnetic Resonance (CMR) Imaging
- Cardiac MRI Quantification
- Myocardial Infarction (MI) Assessment
Background:
- Comprehensive CMR in ST-segment myocardial infarction (STEMI) is time-consuming.
- Investigating T1-mapping for area-at-risk (AAR) and infarct size (MI) quantification is crucial.
- Reducing scan duration without compromising data quality is a key objective.
Purpose of the Study:
- To evaluate native T1-mapping for AAR delineation in STEMI patients.
- To assess post-contrast T1-mapping and synthetic late gadolinium enhancement (LGE) for MI size quantification.
- To determine if T1-mapping can replace conventional T2-mapping and LGE, shortening scan times.
Main Methods:
- Twenty-eight STEMI patients underwent 1.5 T CMR 3 days post-primary percutaneous coronary intervention.
- Native T1-mapping and T2-mapping were used to quantify AAR.
- MI size was quantified using conventional LGE, post-contrast T1-mapping, and synthetic LGE (MagIR and PSIR) derived from T1 maps.
Main Results:
- Native T1-mapping showed comparable AAR delineation to T2-mapping (41.6% vs. 41.7% LV, R²=0.97, ICC=0.986).
- Excellent correlation and agreement were found between conventional LGE and T1-derived MI quantification methods.
- Omitting T2-mapping and conventional LGE could shorten the CMR scan duration by 15-20 minutes.
Conclusions:
- Native T1-mapping accurately quantifies AAR in STEMI patients.
- Post-contrast T1-mapping accurately quantifies acute MI size.
- This T1-mapping approach shortens comprehensive CMR scan duration and obviates the need for T2 maps and LGE imaging.
Background:
A comprehensive cardiovascular magnetic resonance (CMR) in reperfused ST-segment myocardial infarction (STEMI) patients can be challenging to perform and can be time-consuming. We aimed to investigate whether native T1-mapping can accurately delineate the edema-based area-at-risk (AAR) and post-contrast T1-mapping and synthetic late gadolinium (LGE) images can quantify MI size at 1.5 T. Conventional LGE imaging and T2-mapping could then be omitted, thereby shortening the scan duration.
Methods:
Twenty-eight STEMI patients underwent a CMR scan at 1.5 T, 3 ± 1 days following primary percutaneous coronary intervention. The AAR was quantified using both native T1 and T2-mapping. MI size was quantified using conventional LGE, post-contrast T1-mapping and synthetic magnitude-reconstructed inversion recovery (MagIR) LGE and synthetic phase-sensitive inversion recovery (PSIR) LGE, derived from the post-contrast T1 maps.
Results:
Native T1-mapping performed as well as T2-mapping in delineating the AAR (41.6 ± 11.9% of the left ventricle [% LV] versus 41.7 ± 12.2% LV, P = 0.72; R2 0.97; ICC 0.986 (0.969-0.993); bias -0.1 ± 4.2% LV). There were excellent correlation and inter-method agreement with no bias, between MI size by conventional LGE, synthetic MagIR LGE (bias 0.2 ± 2.2%LV, P = 0.35), synthetic PSIR LGE (bias 0.4 ± 2.2% LV, P = 0.060) and post-contrast T1-mapping (bias 0.3 ± 1.8% LV, P = 0.10). The mean scan duration was 58 ± 4 min. Not performing T2 mapping (6 ± 1 min) and conventional LGE (10 ± 1 min) would shorten the CMR study by 15-20 min.
Conclusions:
T1-mapping can accurately quantify both the edema-based AAR (using native T1 maps) and acute MI size (using post-contrast T1 maps) in STEMI patients without major cardiovascular risk factors. This approach would shorten the duration of a comprehensive CMR study without significantly compromising on data acquisition and would obviate the need to perform T2 maps and LGE imaging.
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