Global T2 Values Research Articles

Exploring cardiovascular involvement in IgG4-related disease: a case series approach with cardiovascular magnetic resonance

BackgroundIgG4-related disease (IgG4-RD) is a relapsing–remitting, fibroinflammatory, multisystem disorder. Cardiovascular involvement from IgG4-RD has not been systematically characterised. In this study, we sought to evaluate consecutive patients with IgG4-RD using...

Myocardial parametric mapping in patients with suspected acute myocarditis: a prognosis study

Abstract Background T1 mapping and T2 mapping have become essential components of the 2018 Lake Louise criteria and obtained excellent results in diagnosing myocarditis. However, their prognostic value in acute myocarditis has not yet been well recognized or established. Purpose Our study aims to investigate the prognostic value of T1 mapping, T2 mapping, and extracellular volume fraction (ECV) in a large cohort of patients with suspected acute myocarditis. Materials Patients meeting the recommended clinical criteria for suspected acute myocarditis were consecutively enrolled. The primary endpoint is the composite of cardiac death, heart failure hospitalization, heart transplantation, sustained ventricular arrhythmia, and recurrent myocarditis, defined as major adverse cardiovascular events (MACE). All patients underwent CMR at 3.0 T scanner using a standardized, routine imaging protocol, and the three short-axis view slices (basal, mid-ventricular, and apical) were divided into 16 segments according to the American Heart Association 17-segment model (apex excluded). We also averaged the native T1 values, ECV, and T2 values of all 16 segments to get global T1 and ECV fraction values, respectively. Statistically significant parameters from univariate Cox analyses were put into multivariate Cox analysis. Results A total of 235 patients (150 men; 32±13 years) were enrolled in this study. During a mean follow-up of 43.0±3.6 months, MACE occurred in 37 patients (15.7%) and was univariably associated with heart failure presentation, left ventricular ejection fraction, left ventricular end-systolic volume index, left ventricular end-diastolic volume index, native T1 and ECV. Patients with MACE showed higher global native T1, ECV, and T2 values (1348±59 vs 1266±51, p=<0.001; 40.0±8.7 vs 32.8±5.9, p<0.001; 63.4±12.1 vs. 55.5±9.1, p=0.011), and were more likely to have tissue changes in the interventricular septum and anterior wall (Figure 1). In a series of nesting multivariable Cox regression models, the addition of native T1 (per 10-ms increase: HR, 1.128; 95% CI: 1.043, 1.220; p = 0.003; Harrell’s C-index = 0.833) or ECV (per 5% increase: HR, 1.382; 95% CI: 1.060, 1.802; p = 0.017; Harrell’s C-index = 0.847) improved prognostication compared with the model based on clinical variables, left ventricular ejection fraction, and septal late gadolinium enhancement (Harrell’s C-index = 0.762) (Figure 2). T2 in multivariate Cox regression analysis didn’t show predictive value, but his inclusion increased the C-index of the model to 0.814. Conclusions Myocardial parametric mapping not only holds substantial diagnostic value but also plays a critical role in the prognostic assessment and risk prediction of myocarditis. Their utilization in these contexts enhances the accuracy and effectiveness of clinical evaluations and decision-making processes.

Age and sex-related differences in T1 and T2 mapping. 1.5 magnetic resonance referent values

Introduction: Parametric mapping is a non-invasive method to quantify tissue changes in the myocardium by measuring T1, T2 and T2* relaxation times and extracellular volume, requiring a pre-established range of normal values. Purpose: To establish reference values for native T1 and T2 myocardial relaxation times in healthy subjects on 1.5 T magnetic resonance imaging and to assess changes in their values according to left ventricular segments, age, sex, heart rate, and myocardial thickness. Material and Methods: A prospective 1.5 T magnetic resonance imaging study was performed with the voluntary participation of 50 healthy individuals in different age groups. Image analysis was performed by a radiologist with 5 years of experience in the field of CMRT and further coordinated with a radiologist with more than 20 years of expe-rience in the field. Siemens ARGUS integrated software was used to calculate the volumes and function of both cameras. Global and segmental T1 and T2 values were measured in the shortaxis midlevel section by manually delineating the region of interest. Myocardial thickness of the mid septum was measured for each patient. Results: The distribution of volunteers was 25 men and 25 women. Significantly higher global T1 values were observed in women (1027.7 ± 25.4 ms) compared to men (992.9 ± 24.4 ms), at p < 0.001. The same correlation was observed in individual segments, with a significant difference between genders. Examination of the correlation between T1 and other parameters demonstrated a negative linear relationship only with myocardial thickness. Global T2 in women (48.6 ± 2.49 ms) was also significantly higher than in men (44.6 ± 2.06 ms), with an observed difference of 3.95, p < 0.001. Global T2 showed a very strong negative correlation with myocardial thickness (r = -0.769; p < 0.001). There was no sig-nificant correlation between T2 times and heart rate and age of patients. Conclusion: A statistically significant difference in native T1 and T2 values by sex was demonstrated. The use of sex-specific reference values to distinguish healthy from pathologically affected myocardium is recommended.

Cardiac MRI T2 mapping with heart phase acquisition and improved motion-sensitized driven equilibrium blood suppression

Abstract Background Cardiovascular magnetic resonance (CMR) imaging relies on T2 mapping to assess myocardial tissue properties. However, T2 maps are subject to motion artifacts and signal interference, prompting exploration of techniques such as gradient-spin-echo (GraSE) sequences, heart phase acquisition, and dark blood (DB) imaging to improve image quality and reliability. Purpose This prospective study evaluates the T2 relaxation time (T2) variability and the image quality of T2 maps obtained in end-systole and end-diastole with and without fat saturation (FS), using GraSE sequence in CMR imaging. Furthermore, improved motion-sensitized driven-equilibrium (iMSDE) was compared with double inversion recovery (DIR) as an alternative DB technique. Materials and Methods Five variants of the DB GraSE sequence were developed and performed on a 1.5 Tesla MRI scanner. Forty-four healthy volunteers prospectively underwent the following sequences: GraSE in end-diastole (GraSE-ED), GraSE-ED with FS (GraSE-ED-FS), GraSE in end-systole (GraSE-ES), GraSE-ES with FS (GraSE-ES-FS), and commercial GraSE-ED (GraSE-CO). Four GraSE variants utilized iMSDE technique, while GraSE-CO used DIR for blood suppression. T2, image quality, and visual artifacts were measured. Results Ten volunteers were excluded due to image artifacts or missing datasets. Among the remaining 34 participants, the mean global T2 was measured. No significant differences were seen among all variants (P > .05 for all comparisons). Intra- and inter-reader agreement of global T2 values for all GraSE sequence were very good (r > 0.8 for both). Image quality was rated moderate or good for all variants of GraSE sequences. A lower incidence of artifacts was observed in end-systolic compared to end-diastolic imaging. Conclusion All variants of GraSE sequence are highly reproducible and myocardial T2 values did not significantly differ with heart phase. iMSDE is feasible as an alternative DB technique for T2 mapping enabling acquisition in systole, which shows a lower incidence of artifacts compared to diastole.

MR imaging after patellar MACI and MPFL reconstruction: a comparison of isolated versus combined procedures.

To qualitatively and quantitatively evaluate the 2.5-year MRI outcome after Matrix-associated autologous chondrocyte implantation (MACI) at the patella, reconstruction of the medial patellofemoral ligament (MPFL), and combined procedures. In 66 consecutive patients (age 22.8 ± 6.4years) with MACI at the patella (n = 16), MPFL reconstruction (MPFL; n = 31), or combined procedures (n = 19) 3T MRI was performed 2.5 years after surgery. For morphological MRI evaluation WORMS and MOCART scores were obtained. In addition quantitative cartilage T2 and T1rho relaxation times were acquired. Several clinical scores were obtained. Statistical analyses included descriptive statistics, Mann-Whitney-U-tests and Pearson correlations. WORMS scores at follow-up (FU) were significantly worse after combined procedures (8.7 ± 4.9) than after isolated MACI (4.3 ± 3.6, P = 0.005) and after isolated MPFL reconstruction (5.3 ± 5.7, P = 0.004). Bone marrow edema at the patella in the combined group was the only (non-significantly) worsening WORMS parameter from pre- to postoperatively. MOCART scores were significantly worse in the combined group than in the isolated MACI group (57 ± 3 vs 88 ± 9, P < 0.001). Perfect defect filling was achieved in 26% and 69% of cases in the combined and MACI group, respectively (P = 0.031). Global and patellar T2 values were higher in the combined group (Global T2: 34.0 ± 2.8ms) and MACI group (35.5 ± 3.1ms) as compared to the MPFL group (31.1 ± 3.2ms, P < 0.05). T2 values correlated significantly with clinical scores (P < 0.005). Clinical Cincinnati scores were significantly worse in the combined group (P < 0.05). After combined surgery with patellar MACI and MPFL reconstruction inferior MRI outcomes were observed than after isolated procedures. Therefore, patients with need for combined surgery may be at particular risk for osteoarthritis.

Inter-scanner comparability of Z-scores for native myocardial T1 and T2 mapping

BackgroundCardiovascular Magnetic Resonance (CMR) native T1 and T2 mapping serve as robust, contrast-agent-free diagnostic tools, but hardware- and software-specific sources of variability limit the generalizability of data across CMR platforms, consequently limiting the interpretability of patient-specific parametric data. Z-scores are used to describe the relationship of observed values to the mean results as obtained in a sufficiently large normal sample. They have been successfully used to describe the severity of quantifiable abnormalities in medicine, specifically in children and adolescents. The objective of this study was to observe whether z-scores can improve the comparability of T1 and T2 mapping values across CMR scanners, field strengths, and sequences from different vendors in the same participant rather than different participants (as seen in previous studies). MethodsFifty-one healthy volunteers (26 men/25 women, mean age = 43 ± 13.51) underwent three CMR exams on three different scanners, using a Modified Look-Locker Inversion Recovery (MOLLI) 5-(3)− 3 sequence to quantify myocardial T1. For T2 mapping, a True Fast Imaging with steady-state free precession (TRUFI) sequence was used on a 3 T Skyra™ (Siemens), and a T2 Fast Spin Echo (FSE) sequence was used on 1.5 T Artist™ (GE) and 3.0 T Premier™ (GE) scanners. The averages of basal and mid-ventricular short axis slices were used to derive means and standard deviations of global mapping values. We used intra-class comparisons (ICC), repeated measures ANOVA, and paired Student’s t-tests for statistical analyses. ResultsThere was a significant improvement in intra-subject comparability of T1 (ICC of 0.11 (95% CI= −0.018, −0.332) vs 0.78 (95% CI= 0.650, 0.866)) and T2 (ICC of 0.35 (95% CI= −0.053, 0.652) vs 0.83 (95% CI= 0.726, 0.898)) when using z-scores across all three scanners. While the absolute global T1 and T2 values showed a statistically significant difference between scanners (p < 0.001), no such differences were identified using z-scores (T1z: p = 0.771; T2z: p = 0.985). Furthermore, when images were not corrected for motion, T1 z-scores showed significant inter-scanner variability (p < 0.001), resolved by motion correction. ConclusionEmploying z-scores for reporting myocardial T1 and T2 removes the variation of quantitative mapping results across different MRI systems and field strengths, improving the clinical utility of myocardial tissue characterization in patients with suspected myocardial disease.

Liver T1 and T2 mapping in a large cohort of healthy subjects: normal ranges and correlation with age and sex.

We established normal ranges for native T1 and T2 values in the human liver using a 1.5T whole-body imager (General Electric) and we evaluated their variation across hepatic segments and their association with age and sex. One-hundred healthy volunteers aged 20-70years (50% females) underwent MRI. Modified Look-Locker inversion recovery and multi-echo fast-spin-echo sequences were used to measure hepatic native global and segmental T1 and T2 values, respectively. T1 and T2 values exhibited good intra- and inter-observer reproducibility (coefficient of variation < 5%). T1 value over segment 4 was significantly lower than the T1 values over segments 2 and 3 (p < 0.0001). No significant regional T2 variability was detected. Segmental and global T1 values were not associated with age or sex. Global T2 values were independent from age but were significantly lower in males than in females. The lower and upper limits of normal for global T1 values were, respectively, 442ms and 705ms. The normal range for global T2 values was 35ms-54ms in males and 39ms-54ms in females. Liver T1 and T2 mapping is feasible and reproducible and the provided normal ranges may help to establish diagnosis and progression of various liver diseases.

Ultrastructural myocardial changes in patients with severe aortic stenosis referred for surgical aortic valve replacement

Abstract Structural myocardial adaptation to pressure overload such as severe aortic stenosis (AS) goes further beyond cardiomyocyte hypertrophy. Progressive fibrosis takes part in left ventricular (LV) remodeling and drives the transition to heart failure. However, the mechanisms underlying this are not fully clarified. Aim To assess ultrastructural myocardial changes occurring in patients with severe AS referred for surgical aortic valve replacement (SAVR). Methods Prospective study of 158 patients (70.9±7.8y, 50%women), with severe symptomatic AS (mean gradient: 60.9±17.4mmHg; valve area: 0.72±0.17cm2; all with high gradient) referred for SAVR with no history of ischemic cardiomyopathy. All patients had complete pre-operative transthoracic echo (LV ejection fraction: 58.9±9.2%; GLS:-14.9±3.7%) and cardiac magnetic resonance with tissue characterization: LV mass index: 80.1±5.9g/m2. Myocardial samples were obtained in 99 patients (62.3%) from intraoperative septal biopsy. Tissue was stained with Verhoeff and Masson´s trichrome for elastic fibers and myocardial fibrosis (MF) assessment, respectively. MF was quantified at an automatic algorithm (QuPath). Inflammation was searched through CD45, CD3, CD20 and CD68 immunostaining. Extracellular matrix (ECM) characterization was performed in 34 samples (alpha-actin, type I collagen, fibronectin and tenascin C immunostaining). Results Mid-wall late gadolinium enhancement was present in 103 patients (65,1%) with a median fraction of 1.9%[IQR 0,1-6,0%] of LV mass. Global LV native T1 and T2 values and extracellular volume fraction were within normal ranges (1057.8±75.4ms, 39.9±4.3ms, 24.7±6.2%, respectively). At histopathology (sample size: 2,446mm [IQR 1,790-3,350mm]) there was cardiomyocyte hypertrophy (median diameter 35mm[IQR 30.2-42.0mm])(Fig, A), variable elastic deposition (elastic endocardium ratio 0.40[IQR 0.2-0.5])(Fig, B), predominant perivascular fibrosis (93.9%) (Fig, C), with a median MF of 13.3% [IQR 7.1-21.0%];57.6% of the patients with dysplastic vessels (Fig, C). Cardiomyocyte enlargement, cytoplasmatic vacuolization and myofiber detachment occurred in 40 cases (40.4%) (Fig, D). This was confirmed as stunning at Periodic acid-Schiff-diastase stain. Inflammation was considered absent in all cases as inflammatory cells were scantily present (median number of CD45+ cells/field: 3[IQR 1.35-6.0]; predominant CD3+). Type I collagen matched MF distribution, following vessel web, such as fibronectin (Fig, E-H). Alpha-actin was detected at the subendocardium in 2/3 of the cases; tenascin C was diffusely positive in 9 cases (27%)(Fig, I). Conclusion These patients with classical severe symptomatic AS were referred for SAVR with diverse ultrastructural myocardial changes. Myocardial stunning occurs in a significant proportion of patients despite the absence of ischemic cardiomyopathy. Inflammation is not involved at this stage of the disease. Distinct grades of ECM remodeling are probably occurring.Figure

The Role of Improved Motion-Sensitized Driven Equilibrium Blood Suppression and Fat Saturation on T2 Relaxation Time, Using GraSE Sequence in Cardiac Magnetic Resonance Imaging.

T2 mapping is a valuable technique in cardiac MR imaging that offers insights into the microstructural characteristics of myocardial tissue. However, it was shown that myocardial T2 relaxation times (T2) measured vary significantly depending on sequence, sequence parameters, and field strength. To assess T2 variability and image quality in cardiac T2 maps using four variants of the gradient-spin echo (GraSE) sequence, having different methods of blood signal suppression (double inversion recovery (DIR) and improved motion-sensitized driven equilibrium (iMSDE) and with and without the addition of fat saturation (FS). Prospective. 48 healthy volunteers (46.7 +/- 21.5 years, 24 male) with no cardiac history. GraSE sequence with DIR (GraSEDIR), with iMSDE (GraSEiMSDE) and FS (GraSEDIR-FS) and with both iMSDE and FS (GraSEiMSDE-FS) at 1.5T. Global T2 from three short axis myocardial slices. and image quality assessments using a 5-point Lickert scale (1, (non-diagnostic) to 5, (excellent)) were conducted to evaluate the impact of DB and FS techniques on myocardial T2 measurements and image quality. Paired t-tests or non-parametric equivalents for comparisons between sequences. The Bland-Altmann plots and Pearson rank correlation analyses, as appropriate. A P value <0.05 was considered statistically significant. The mean global T2 values for GraSEDIR, GraSEDIR-FS, GraSEiMSDE, and GraSEiMSDE-FS, were 52.84 ± 5.72 msec, 54.98 ± 3.59 msec, 53.9 ± 4.05 msec, and 55.14 ± 4.28 msec, respectively, with no significant differences (P = 0.092). High image quality scores (>4 out of 5) were obtained for all sequence variants with no significant differences between them (P = 0.11). All GraSE sequence variants exhibited approximately the same results and variations in the DB technique and addition of FS did not have significant impact on myocardial T2 values. 2 TECHNICAL EFFICACY: Stage 1.

Quantitative Assessment of Myocardial Edema by MR T2 Mapping in Children With Kawasaki Disease.

Few studies assessed myocardial inflammation using Cardiovascular Magnetic Resonance Imaging in Kawasaki disease (KD) patients. To quantify myocardial edema in KD patients using T2 mapping and explore the independent predictors of T2 values. Prospective. Ninety KD patients including 40 in acute phase (26 males, 65.0%) and 50 in chronic phase (34 males, 68.0%). Thirty-one healthy volunteers (21 males, 70.0%). 3.0 T T2-weighted Turbo Spin Echo-Short Time of Inversion Recovery sequence, True fast imaging with steady precession flash sequence and fast low-angle shot 3D spoiled gradient echo sequence. T2 values were compared among KD groups and controls. Student's t test and Fisher's exact test; One-way analysis of variance; Pearson correlation analysis; Receiver operating curve analysis; Multivariable linear regression. Global T2 value of KD patients in acute phase was the highest, followed by those of chronic-phase patients and controls (38.83 ± 2.41 msec vs. 37.55 ± 2.28 msec vs. 36.05 ± 1.64 msec). Regional T2 values showed a same trend. There were no significant differences in global and regional T2 values between KD patients with and without coronary artery (CA) dilation, no matter in acute or chronic phase (all KD patients: P = 0.51, 0.51, 0.53, 0.72; acute KD: P = 0.61, 0.37, 0.33, 0.83; chronic KD: P = 0.65, 0.79, 0.62, 0.79). No significant difference was observed in global T2 values between KD patients with Z score > 5.0 and 2.0 < Z score ≤ 5.0 (P = 0.65). Multivariate analysis demonstrated that stage of disease (β = -0.123) and heart rate (β = 0.280) were independently associated with global T2 values. The degree of myocardial edema was more severe in acute-phase than in chronic-phase KD patients. Myocardial edema persists in patients regardless of the existence or degree of CA dilation. 2 TECHNICAL EFFICACY: Stage 2.

Early effect of contemporary radiotherapy protocol on myocardium in patients with breast cancer assessed with cardiac magnetic resonance

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): University Medical Centre Ljubljana Research Grant. Introduction Early cardiotoxicity of modern radiotherapy (RT) is not known. Purpose To study the early cardiotoxic effect of contemporary RT on myocardium with cardiac magnetic resonance (CMR) in patients with breast cancer (BC). Methods Patients with in-situ ductal carcinoma of the breast, scheduled for RT were included. All patients had undergone surgical tumorectomy. Exclusion criteria were prior systemic chemotherapy, prior RT or known cardiac disease. Patients were treated with 3-dimensional conformal RT or intensity-modulated RT, left-sided BC patients were also scheduled for deep inspiration breath hold protocol, if feasible. Patients underwent CMR imaging prior to RT and within 2 weeks after RT. Left and right ventricular volumes and ejection fraction, global native and postcontrast T1 values and T2 values, prior to and after completion of RT were analyzed. All patients provided written informed consent. Results A total of 40 female patients (mean age 55 ± 7 years) were included, 22 with left-sided BC. The mean radiation dose was 42 Gy. CMR results are presented in Table 1. Left-sided BC patients had statistically significant increase in global T2 values. There were no significant differences in other studied parameters. No patient developed pericardial effusion and no patient had presence of late gadolinium enhancement at both exams. Conclusion Modern RT of left-sided BC is associated with increased T2 values, most likely representing myocardial edema, early after completion of RT.

Myocardial tissue characterization by segmental T2 mapping in thalassaemia major: detecting inflammation beyond iron.

We measured myocardial T2 values by a segmental approach in thalassaemia major (TM) patients, comparing such values against T2* values for the detection of myocardial iron overload (MIO), evaluating their potential in detecting subclinical inflammation, and correlating with clinical status. One-hundred and sixty-six patients (102 females, 38.29 ± 11.49years) enrolled in the Extension-Myocardial Iron Overload in Thalassemia Network underwent magnetic resonance imaging for the assessment of hepatic, pancreatic, and cardiac iron overload (T2* technique), of biventricular function (cine images), and of replacement myocardial fibrosis [late gadolinium enhancement (LGE)]. T2 and T2* values were quantified in all 16 myocardial segments, and the global value was the mean of all segments. Global heart T2 values were significantly higher in TM than in a cohort of 80 healthy subjects. T2 and T2* values were significantly correlated. Out of the 25 patients with a decreased global heart T2* value, 11 (44.0%) had reduced T2 values. No patient with a normal T2* value had a decreased T2 value.Eleven (6.6%) patients had a decreased global heart T2 value, 74 (44.6%) a normal global heart T2 value, and 81 (48.8%) an increased global heart T2 value. Biventricular function was comparable amongst the three groups, whilst LGE was significantly more frequent in patients with reduced vs. increased global heart T2 value. Compared with the other two groups, patients with reduced T2 values had significantly higher hepatic and pancreatic iron deposition. In TM, T2 mapping does not offer any advantage in terms of sensitivity for MIO assessment but detects subclinical myocardial inflammation.

Reference ranges of myocardial T1 and T2 mapping in healthy Chinese adults: a multicenter 3T cardiovascular magnetic resonance study

BackgroundAlthough reference ranges of T1 and T2 mapping are well established for cardiovascular magnetic resonance (CMR) at 1.5T, data for 3T are still lacking. The objective of this study is to establish reference ranges of myocardial T1 and T2 based on a large multicenter cohort of healthy Chinese adults at 3T CMR. MethodsA total of 1015 healthy Chinese adults (515 men, age range: 19–87 years) from 11 medical centers who underwent CMR using 3T Siemens scanners were prospectively enrolled. T1 mapping was performed with a motion-corrected modified Look–Locker inversion recovery sequence using a 5(3)3 scheme. T2 mapping images were acquired using T2-prepared fast low-angle shot sequence. T1 and T2 relaxation times were quantified for each slice and each myocardial segment. The T1 mapping and extracellular volume standardization (T1MES) phantom was used for quality assurance at each center prior to subject scanning. ResultsThe phantom analysis showed strong consistency of spin echo, T1 mapping, and T2 mapping among centers. In the entire cohort, global T1 and T2 reference values were 1193 ± 34 ms and 36 ± 2.5 ms. Global T1 and T2 values were higher in females than in males (T1: 1211 ± 29 ms vs. 1176 ± 30 ms, p < 0.001; T2: 37 ± 2.3 ms vs. 35 ± 2.5 ms, p < 0.001). There were statistical differences in global T2 across age groups (p < 0.001), but not in global T1. Linear regression showed no correlation between age and global T1 or T2 values. In males, positive correlation was found between heart rate and global T1 (r = 0.479, p < 0.001). ConclusionsUsing phantom-validated imaging sequences, we provide reference ranges for myocardial T1 and T2 values on 3T scanners in healthy Chinese adults, which can be applied across participating sites.Trial registration URL: http://www.chictr.org.cn/index.aspx. Unique identifier: ChiCTR1900025518. Registration name: 3T magnetic resonance myocardial quantitative imaging standardization and reference value study: a multi-center clinical study.

Regional extracellular volume within late gadolinium enhancement-positive myocardium to differentiate cardiac sarcoidosis from myocarditis of other etiology: a cardiovascular magnetic resonance study

BackgroundCardiovascular magnetic resonance (CMR) plays a pivotal role in diagnosing myocardial inflammation. In addition to late gadolinium enhancement (LGE), native T1 and T2 mapping as well as extracellular volume (ECV) are essential tools for tissue characterization. However, the differentiation of cardiac sarcoidosis (CS) from myocarditis of other etiology can be challenging. Positron-emission tomography-computed tomography (PET-CT) regularly shows the highest Fluordesoxyglucose (FDG) uptake in LGE positive regions. It was therefore the aim of this study to investigate, whether native T1, T2, and ECV measurements within LGE regions can improve the differentiation of CS and myocarditis compared with using global native T1, T2, and ECV values alone. MethodsPET/CT confirmed CS patients and myocarditis patients (both acute and chronic) from a prospective registry were compared with respect to regional native T1, T2, and ECV. Acute and chronic myocarditis were defined based on the 2013 European Society of Cardiology position paper on myocarditis. All parametric measures and ECV were acquired in standard fashion on three short-axis slices according to the ConSept study for global values and within PET-CT positive regions of LGE. ResultsBetween 2017 and 2020, 33 patients with CS and 73 chronic and 35 acute myocarditis patients were identified. The mean ECV (± SD) in LGE regions of CS patients was higher than in myocarditis patients (CS vs. acute and chronic, respectively: 0.65 ± 0.12 vs. 0.45 ± 0.13 and 0.47 ± 0.1; p < 0.001). Acute and chronic myocarditis patients had higher global native T1 values (1157 ± 54 ms vs. 1196 ± 63 ms vs. 1215 ± 74 ms; p = 0.001). There was no difference in global T2 and ECV values between CS and acute or chronic myocarditis patients. ConclusionThis is the first study to show that the calculation of regional ECV within LGE-positive regions may help to differentiate CS from myocarditis. Further studies are warranted to corroborate these findings.

Additional value of T1 and T2 mapping techniques for early detection of myocardial involvement in scleroderma

BackgroundWe evaluated the prevalence of myocardial involvement by native T1 and T2 mapping, the diagnostic performance of mapping in addition to conventional Lake Louise Criteria (LLC), as well as correlations between mapping findings and clinical or conventional cardiovascular magnetic resonance (CMR) parameters in systemic sclerosis (SSc) patients. MethodsFifty-five SSc patients (52.31 ± 13.24 years, 81.8% female) and 55 age- and sex-matched healthy subjects underwent clinical, bio-humoral assessment, and CMR. The imaging protocol included: T2-weighted, early post-contrast cine sequences, native T1 and T2 mapping by a segmental approach, and late gadolinium enhancement (LGE) technique. ResultsGlobal myocardial T1 and T2 values were significantly higher in SSc patients than in healthy subjects. An increase in native T1 and/or T2 was present in the 62.1% of patients with normal conventional CMR techniques (negative LGE and T2-weighted images). Respectively, 13.5% and 59.6% of patients fulfilled original and updated LLC (overall agreement = 53.9%).Compared with patients with normal native T1, patients with increased T1 (40.0%) featured significantly higher left ventricular end-diastolic volume index and cardiac index, biventricular stroke volume indexes, and global heart T2 values, and more frequently had a history of digital ulcers. Biochemical and functional CMR parameters were comparable between patients with normal and increased T2 (61.8%). ConclusionT1 and T2 mapping are sensitive parameters that should be included in the routine clinical assessment of SSc patients for detecting early/subclinical myocardial involvement.

Normal Values of Magnetic Resonance T1ρ Relaxation Times in the Adult Heart at 1.5T MRI.

T1ρ mapping is a new quantitative MRI technique in recent years. In order to use T1ρ mapping as a noncontrast method to assess myocardial fibrosis, it is necessary to establish a range of normal values. To establish a potential normal range of cardiac T1ρ values in healthy adults and to explore the influence of slice location and gender on T1ρ values. Prospective. A total of 57 healthy volunteers without cardiovascular risk factors (age 26.7 ± 11.8 years; 29 males). 1.5 T; modified Look-Locker inversion recovery (MOLLI) (T1 mapping), multiecho gradient-spin-echo (GraSE) (T2 mapping) and T1ρ -prepared steady-state free precession (T1ρ mapping) sequences. Basal, mid, and apical short-axis left ventricular T1 , T2 , and T1ρ maps were acquired. T1ρ maps at spin-locking frequencies of 5 and 400 Hz were subtracted to create myocardial fibrosis index (mFI) maps. Slice-average and global average T1 , T2 , T1ρ , and mFI values were determined. Shapiro-Wilk test, Independent t-test, ANOVA test, Pearson correlation coefficient (r). P value < 0.05. The global average values of T1 , T2 , T1ρ, and mFI were 1053 ± 34 msec, 51.9 ± 2.3msec, 47.9 ± 2.8msec, and 4.4 ± 1.6msec. T1ρ values showed a significant gradual increase from the basal slice to the apical slice of the heart (basal 46.5 ± 2.7msec, mid 48.0 ± 2.9msec, apical 49.2 ± 3.3msec). The T1ρ and mFI values of females (49.7 ± 2.4msec and 5.1 ± 1.2msec, respectively) were significantly higher than those of males (46.2 ± 1.9msec and 3.7 ± 1.7msec, respectively). In addition, there was a moderate positive correlation between global T1ρ values and global T1 values (r=0.44, P < 0.05) and a moderate positive correlation between global T1ρ values and global T2 values (r=0.42, P < 0.05). In this study, the global T1ρ values of healthy adults' hearts were 47.9 ± 2.8msec. This study found that gender and slice location of myocardium can affect the T1ρ values. 4 TECHNICAL EFFICACY: Stage 1.

Cardiac magnetic resonance imaging parameters show association between myocardial abnormalities and severity of chronic kidney disease.

Chronic kidney disease patients have increased risk of cardiovascular abnormalities. This study investigated the relationship between cardiovascular abnormalities and the severity of chronic kidney disease using cardiac magnetic resonance imaging. We enrolled 84 participants with various stages of chronic kidney disease (group I: stages 1-3, n = 23; group II: stages 4-5, n = 20; group III: hemodialysis patients, n = 41) and 32 healthy subjects. The demographics and biochemical parameters of the study subjects were evaluated. All subjects underwent non-contrast cardiac magnetic resonance scans. Myocardial strain, native T1, and T2 values were calculated from the scanning results. Analysis of covariance was used to compare the imaging parameters between group I-III and the controls. The left ventricular ejection fraction (49 vs. 56%, p = 0.021), global radial strain (29 vs. 37, p = 0.019) and global circumferential strain (-17.4 vs. -20.6, p < 0.001) were significantly worse in group III patients compared with the controls. Furthermore, the global longitudinal strain had a significant decline in group II and III patients compared with the controls (-13.7 and -12.9 vs. -16.2, p < 0.05). Compared with the controls, the native T1 values were significantly higher in group II and III patients (1,041 ± 7 and 1,053 ± 6 vs. 1,009 ± 6, p < 0.05), and T2 values were obviously higher in group I-III patients (49.9 ± 0.6 and 53.2 ± 0.7 and 50.1 ± 0.5 vs. 46.6 ± 0.5, p < 0.001). The advanced chronic kidney disease stage showed significant positive correlation with global radial strain (r = 0.436, p < 0.001), global circumferential strain (r = 0.386, p < 0.001), native T1 (r = 0.5, p < 0.001) and T2 (r = 0.467, p < 0.001) values. In comparison with the group II patients, hemodialysis patients showed significantly lower T2 values (53.2 ± 0.7 vs. 50.1 ± 0.5, p = 0.002), but no significant difference in T1 values (1,041 ± 7 vs. 1,053 ± 6). Our study showed that myocardial strain, native T1, and T2 values progressively got worse with advancing chronic kidney disease stage. The increased T1 values and decreased T2 values of hemodialysis patients might be due to increasing myocardial fibrosis but with reduction in oedema following effective fluid management. ChiCTR2100053561 (http://www.chictr.org.cn/edit.aspx?pid=139737&htm=4).

Increased myocardial extracellular volume is associated with myocardial iron overload and heart failure in thalassemia major.

Myocardial extracellular volume (ECV) by cardiovascular magnetic resonance (CMR) is a surrogate marker of diffuse fibrosis. We evaluated the association between ECV and demographics, CMR findings, and cardiac involvement in patients with thalassemia major (TM). A total of 108 β-TM patients (62 females, 40.16 ± 8.83 years), consecutively enrolled in the Extension-Myocardial Iron Overload in Thalassemia Network, and 16 healthy subjects (6 females, 37.12 ± 16.13 years) underwent CMR. The protocol included assessment of T2*, native T1, and T2 values in all 16 myocardial segments for myocardial iron overload (MIO) quantification, cine images for left ventricular (LV) function quantification, post-contrast T1 mapping for ECV calculation, and late gadolinium enhancement (LGE) technique for replacement myocardial fibrosis detection. Global ECV values were significantly higher in females than in males. Global ECV values were significantly higher in patients with significant MIO (global heart T2* < 20 ms) than in patients without significant MIO, and both groups exhibited higher global ECV values than healthy subjects. No association was detected between native T1 and ECV values, while patients with reduced global heart T2 values showed significantly higher global ECV values than patients with normal and increased global heart T2. Global ECV values were not correlated with LV function/size and were comparable between patients with and without LGE. Compared to patients without heart failure, patients with a history of heart failure (N = 10) showed significantly higher global heart ECV values. In TM, increased myocardial ECV, potentially reflecting diffuse interstitial fibrosis, is associated with MIO and heart failure. • CMR-derived myocardial extracellular volume is increased in thalassemia major patients, irrespective of the presence of late gadolinium enhancement. • In thalassemia major, myocardial iron overload contributes to the increase in myocardial ECV, which potentially reflects diffuse interstitial fibrosis and is significantly associated with a history of heart failure.

Myocardial T2 values at 1.5 T by a segmental approach with healthy aging and gender

Our aims were to obtain myocardial regional and global T2 values as a reference for normality for the first time using a GE scanner and to assess their association with physiological variables. One hundred healthy volunteers aged 20-70 years (50% females) underwent cardiovascular magnetic resonance. Basal, mid-ventricular, and apical short-axis slices of the left ventricle were acquired by a multi-echo fast-spin-echo (MEFSE) sequence. Image analysis was performed with a commercially available software package. The T2 value was assessed in all 16 myocardial segments and the global value was the mean. The global T2 value averaged across all subjects was 52.2 ± 2.5 ms (range: 47.0-59.9 ms). Inter-study, intra-observer, and inter-observer reproducibility was good (coefficient of variation < 5%). 3.6% of the segments was excluded because of artifacts and/or partial-volume effects. Segmental T2 values differed significantly (p < 0.0001), with the lowest value in the basal anterolateral segment (50.0 ± 3.5 ms) and the highest in the apical lateral segment (54.9 ± 5.1 ms). Mean T2 was significantly lower in the basal slice compared to both mid-ventricular and apical slices and in the mid-ventricular slice than in the apical slice. Aging was associated with increased segmental and global T2 values. Females showed higher T2 values than males. T2 values were not correlated to heart rate. A significant inverse correlation was detected between global T2 values and mean wall thickness. The optimized MEFSE sequence allows for robust and reproducible quantification of segmental T2 values. Gender- and age-specific segmental reference values must be defined for distinguishing healthy and diseased myocardium. • In healthy subjects, T2 values differ among myocardial segments and are influenced by age and gender. • Normal T2 values in the myocardium, usable as a benchmark by other GE sites, were established.

Myocardial T2 values by a segmental approach with healthy ageing and gender

Abstract Funding Acknowledgements Type of funding sources: None. Introduction. No data are available in literature about normal ranges for T2 in human myocardium using GE scanners. Aims. Our aims were to obtain myocardial regional and global T2 values as a reference for normality for the first time using a GE scanner and to assess their association with physiological variables. Methods. A stratified approach was adopted for healthy volunteers recruitment, ensuring the presence of 10 participants for both genders in each age decile: 20–30, 30–40, 40-50, 50-60, 60-70 years. Basal, medium, and apical short-axis slices of the left ventricle were acquired by a multi-echo fast-spin-echo (MEFSE) sequence. Image analysis was performed with a commercially available software package. T2 value was assessed in all 16 myocardial segments and global value was the mean. Results. The global T2 value averaged across all subjects was 52.2 ± 2.5 ms (range: 47.0-59.9 ms). Inter-study, intra-observer, and inter-observer reproducibility was good (coefficient of variation &amp;lt; 5%). The 3.6% of segments was excluded because of artifacts and/or partial-volume effects. Segmental T2 values differed significantly (P &amp;lt; 0.0001), with the lowest value in the basal anterolateral segment (50.0 ± 3.5 ms) and the highest in the apical lateral segment (54.9 ± 5.1 ms). Mean T2 was significantly lower in the basal slice compared to both medium (51.0 ± 2.4 vs 51.8 ± 2.6 ms; P &amp;lt; 0.0001) and apical slices (51.0 ± 2.4 vs 54.2 ± 3.7 ms; P &amp;lt; 0.0001), and in the medium slice than in the apical slice (51.8 ± 2.6 vs 54.2 ± 3.7 ms; P &amp;lt; 0.0001). Aging was associated with increased segmental and global T2 values. Females showed higher T2 values than males. T2 values were not correlated to heart rate. Mean T2 values, standard deviation, and lower and upper limits of normal for all 16 myocardial segments are shown in Figure 1 for males and in Figure 2 for females, considering separately each age group. Conclusion. The optimized MEFSE sequence allows for robust, reliable, and reproducible quantification of segmental T2 values. T2 values differ among myocardial slices and are influenced by age and gender, making mandatory to define gender- and age-specific segmental reference values for distinguishing between healthy and diseased myocardium. The normal ranges defined in this study on a large cohort of healthy subjects could be used as reference by other sites using the same sequence, allowing them to recruit a smaller population and accelerating the spread of myocardial T2 mapping in the clinical arena.