Native T1 mapping and extracellular volume fraction for differentiation of myocardial diseases from normal CMR
Rawiwan Thongsongsang1, Thammarak Songsangjinda1, Prajak Tanapibunpon2
1Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
Insights
Native T1 and extracellular volume fraction (ECV) are elevated in myocardial disease and coronary artery disease (CAD), but values overlap. Amyloidosis showed the greatest clinical utility for these cardiac MRI biomarkers.
Area of Science:
- Cardiovascular Imaging
- Biomarkers
- Cardiac MRI
Background:
- Myocardial diseases like amyloidosis, dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), and myocarditis, along with coronary artery disease (CAD), present diagnostic challenges.
- Native T1 and extracellular volume fraction (ECV) are emerging cardiac MRI biomarkers for assessing myocardial tissue characteristics.
Purpose of the Study:
- To determine native T1 and ECV values in various myocardial diseases and CAD.
- To compare these biomarkers against a control group and assess their diagnostic yield.
Main Methods:
- Retrospective analysis of 1188 patients undergoing 3.0 Tesla cardiac MRI with T1 mapping.
- Regions of interest were drawn in the left ventricular (LV) myocardium (septum and mid-LV slice).
- Native T1 and ECV were calculated and compared between disease groups and controls.
Main Results:
- Native T1 values were significantly higher in patients with myocardial disease (amyloidosis, DCM, HCM, myocarditis) and CAD compared to controls.
- ECV values were also significantly elevated in these patient groups.
- Overlapping values between disease groups and controls were observed for both native T1 and ECV.
Conclusions:
- While native T1 and ECV are elevated in cardiomyopathy and CAD, their overlapping values limit definitive differentiation.
- Amyloidosis demonstrated the highest clinical utility among the studied conditions for these cardiac MRI parameters.
Background:
This study aimed to determine native T1 and extracellular volume fraction (ECV) in distinct types of myocardial disease, including amyloidosis, dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), myocarditis and coronary artery disease (CAD), compared to controls.
Methods:
We retrospectively enrolled patients with distinct types of myocardial disease, CAD patients, and control group (no known heart disease and negative CMR study) who underwent 3.0 Tesla CMR with routine T1 mapping. The region of interest (ROI) was drawn in the myocardium of the mid left ventricular (LV) short axis slice and at the interventricular septum of mid LV slice. ECV was calculated by actual hematocrit (Hct) and synthetic Hct. T1 mapping and ECV was compared between myocardial disease and controls, and between CAD and controls. Diagnostic yield and cut-off values were assessed.
Results:
A total of 1188 patients were enrolled. The average T1 values in the control group were 1304 ± 42 ms at septum, and 1294 ± 37 ms at mid LV slice. The average T1 values in patients with myocardial disease and CAD were significantly higher than in controls (1441 ± 72, 1349 ± 59, 1345 ± 59, 1355 ± 56, and 1328 ± 54 ms for septum of amyloidosis, DCM, HCM, myocarditis, and CAD). Native T1 of the mid LV level and ECV at septum and mid LV with actual and synthetic Hct of patients with myocardial disease or CAD were significantly higher than in controls.
Conclusions:
Although native T1 and ECV of patients with cardiomyopathy and CAD were significantly higher than controls, the values overlapped. The greatest clinical utilization was found for the amyloidosis group.
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