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Published on: June 20, 2014
Endogenous T1ρ cardiovascular magnetic resonance in hypertrophic cardiomyopathy
Elizabeth W Thompson1,2, Srikant Kamesh Iyer3, Michael P Solomon1
1Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, USA.
Insights
T1ρ imaging shows moderate correlation with late gadolinium enhancement (LGE) in hypertrophic cardiomyopathy (HCM) patients. Both T1ρ and T1 relaxation times, along with extracellular volume (ECV), are elevated in HCM patients, suggesting T1ρ
Area of Science:
- Cardiovascular Magnetic Resonance Imaging
- Cardiac Pathology
- Biomedical Engineering
Background:
- Hypertrophic cardiomyopathy (HCM) involves left ventricular wall thickening, cardiomyocyte hypertrophy, and fibrosis.
- Current risk stratification methods include late gadolinium enhancement (LGE), native T1, and extracellular volume (ECV) imaging.
- T1ρ imaging, a technique less sensitive to magnetic field inhomogeneities, offers a potential alternative for assessing cardiac tissue characteristics.
Purpose of the Study:
- To evaluate the utility of T1ρ cardiovascular magnetic resonance (CMR) imaging in patients with HCM.
- To compare T1ρ imaging with established CMR techniques like native T1, extracellular volume (ECV), and late gadolinium enhancement (LGE).
- To assess differences in T1ρ, T1, and ECV between HCM patients and healthy controls.
Main Methods:
- Recruited 40 HCM patients and 10 matched healthy controls for cardiovascular magnetic resonance (CMR) imaging at 1.5T.
- Acquired short-axis T1 and T1ρ images, along with gadolinium-enhanced LGE images covering the entire heart.
- Quantified percent enhancement area using full-width half-maximum thresholding for LGE, T1, and T1ρ, and calculated ECV.
Main Results:
- T1ρ and T1 percent enhancement areas showed moderate correlation with LGE percent enhancement area (Spearman's rho = 0.48, p<0.001 and rho = 0.61, p<1e-5, respectively).
- HCM patients exhibited significantly longer T1 and T1ρ relaxation times compared to controls across all LGE categories (p<0.001).
- HCM patients demonstrated significantly higher ECV compared to controls (p<0.01), with lower ECV in LGE-negative slices.
Conclusions:
- T1ρ imaging demonstrates a moderate correlation with LGE in quantifying hyperenhancement areas in HCM.
- Elevated T1, T1ρ, and ECV in HCM patients compared to controls suggest potential for T1ρ in disease assessment.
- Further research is warranted to explore the prognostic value of T1ρ imaging in HCM patient management.
Background:
Hypertrophic cardiomyopathy (HCM) is characterized by increased left ventricular wall thickness, cardiomyocyte hypertrophy, and fibrosis. Adverse cardiac risk characterization has been performed using late gadolinium enhancement (LGE), native T1, and extracellular volume (ECV). Relaxation time constants are affected by background field inhomogeneity. T1ρ utilizes a spin-lock pulse to decrease the effect of unwanted relaxation. The objective of this study was to study T1ρ as compared to T1, ECV, and LGE in HCM patients.
Methods:
HCM patients were recruited as part of the Novel Markers of Prognosis in Hypertrophic Cardiomyopathy study, and healthy controls were matched for comparison. In addition to cardiac functional imaging, subjects underwent T1 and T1ρ cardiovascular magnetic resonance imaging at short-axis positions at 1.5T. Subjects received gadolinium and underwent LGE imaging 15-20 min after injection covering the entire heart. Corresponding basal and mid short axis LGE slices were selected for comparison with T1 and T1ρ. Full-width half-maximum thresholding was used to determine the percent enhancement area in each LGE-positive slice by LGE, T1, and T1ρ. Two clinicians independently reviewed LGE images for presence or absence of enhancement. If in agreement, the image was labeled positive (LGE + +) or negative (LGE --); otherwise, the image was labeled equivocal (LGE + -).
Results:
In 40 HCM patients and 10 controls, T1 percent enhancement area (Spearman's rho = 0.61, p < 1e-5) and T1ρ percent enhancement area (Spearman's rho = 0.48, p < 0.001e-3) correlated with LGE percent enhancement area. T1 and T1ρ percent enhancement areas were also correlated (Spearman's rho = 0.28, p = 0.047). For both T1 and T1ρ, HCM patients demonstrated significantly longer relaxation times compared to controls in each LGE category (p < 0.001 for all). HCM patients also showed significantly higher ECV compared to controls in each LGE category (p < 0.01 for all), and LGE -- slices had lower ECV than LGE + + (p = 0.01).
Conclusions:
Hyperenhancement areas as measured by T1ρ and LGE are moderately correlated. T1, T1ρ, and ECV were elevated in HCM patients compared to controls, irrespective of the presence of LGE. These findings warrant additional studies to investigate the prognostic utility of T1ρ imaging in the evaluation of HCM patients.
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