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Verification of Pathologic ECV Estimated with Clinical T1 Mapping Methods Using an Isotope-based Reference.

David Nordlund¹, Sascha Kopic¹, Robert Jablonowski¹

¹Department of Clinical Sciences, Clinical Physiology, Skåne University Hospital and Lund University, 221 85 Lund, Sweden.

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|August 7, 2025

Summary

Clinically used cardiac MRI T1 mapping sequences accurately measure extracellular volume fraction (ECV) in pigs, though some sequences overestimate ECV in infarct and remote regions compared to a SPECT reference standard.

Keywords:

Animal Studies Cardiac Edema Imaging Sequences Ischemia/Infarction MR Imaging

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Area of Science:

Cardiovascular Imaging
Radiology
Medical Physics

Background:

Cardiac MRI T1 mapping sequences are clinically used to measure extracellular volume fraction (ECV).
Accurate ECV measurement is crucial for diagnosing and managing various cardiac pathologies.
Independent validation of these sequences against a reference standard is necessary.

Purpose of the Study:

To verify the accuracy of clinically used cardiac MRI T1 mapping sequences for measuring ECV.
To assess ECV measurement accuracy across a spectrum of pathologic values using an independent reference standard.
To compare ECV measurements from different T1 mapping sequences (MOLLI and SASHA) against ex vivo SPECT.

Main Methods:

Acute myocardial ischemia was induced in six pigs, followed by 7 days of reperfusion.
In vivo ECV was measured using three modified Look-Locker inversion recovery (MOLLI) and one saturation recovery single-shot acquisition (SASHA) sequences.
Ex vivo SPECT imaging with technetium 99m diethylenetriamine pentaacetic acid served as the reference standard for ECV calculation.

Main Results:

All T1 mapping sequences demonstrated high correlation with the reference standard (r² range, 0.71-0.99).
MOLLI 5(3)3 and MOLLI 5s(3s)3s sequences overestimated ECV in the infarct region compared to SPECT.
All sequences, including SASHA, showed ECV overestimation in the remote myocardium compared to the reference standard.

Conclusions:

Clinically used cardiac MRI T1 mapping sequences show high correlation with a radioisotope-based reference standard for ECV measurement.
Certain MOLLI sequences may overestimate ECV in infarct and remote myocardial regions.
This study validates the use of T1 mapping sequences for ECV quantification, highlighting potential biases in specific sequences.