T2 Mapping Values Research Articles

Cardiac magnetic resonance in recovering COVID-19 patients. Feature tracking and mapping analysis to detect persistent myocardial involvement.

Post-COVID-19 patients may incur myocardial involvement secondary to systemic inflammation. Our aim was to detect possible oedema/diffuse fibrosis using cardiac magnetic resonance imaging (CMR) mapping and to study myocardial deformation of the left ventricle (LV) using feature tracking (FT). Prospective analysis of consecutively recruited post-COVID-19 patients undergoing CMR. T1 and T2 mapping sequences were acquired and FT analysis was performed using 2D steady-state free precession cine sequences. Statistical significance was set to p<0.05. Included were 57 post-COVID-19 patients and 20 healthy controls, mean age 59±15years, men 80.7%. The most frequent risk factors were hypertension (33.3%) and dyslipidaemia (36.8%). The contact-to-CMR interval was 81±27days. LV ejection fraction (LVEF) was 61±10%. Late gadolinium enhancement (LGE) was evident in 26.3% of patients (19.3%, non-ischaemic). T2 mapping values (suggestive of oedema) were higher in the study patients than in the controls (50.9±4.3ms vs 48±1.9ms, p<0.01). No between-group differences were observed for native T1 nor for circumferential strain (CS) or radial strain (RS) values (18.6±3.3% vs 19.2±2.1% (p=0.52) and 32.3±8.1% vs 33.6±7.1% (p=0.9), respectively). A sub-group analysis for the contact-to-CMR interval (<8 weeks vs≥8weeks) showed that FT-CS (15.6±2.2% vs 18.9±2.6%, p<0.01) and FT-RS (24.9±5.8 vs 33.5±7.2%, p<0.01) values were lower for the shorter interval. Post-COVID-19 patients compared to heathy controls had raised T2 values (related to oedema), but similar native T1, FT-CS and FT-RS values. FT-CS and FT-RS values were lower in post-COVID-19 patients undergoing CMR after<8weeks compared to≥8weeks.

Prevalence of cardiac magnetic resonance myocarditis after SARS-CoV-2 infection

Funding AcknowledgementsType of funding sources: None.BackgroundMyocarditis and myocardial inflammation constitute an important complication after viral infection. The frequency of myocardial involvement in seasonal influenza virus varies from 0 to 10%.The prevalence of myocardial injury among patients with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still unclear.The purpose of this study is to estimate the prevalence of myocarditis among unselected patients that recovered recently from SARS-CoV-2 by cardiac magnetic resonance.MethodsWe evaluated 153 consequent cardiac magnetic resonance findings that were performed from 1st of June 2020 until 15th of February 2021. Out of them, 35 patients (23%) underwent cardiac magnetic resonance due to persistent symptoms from SARS-CoV -2 infection. A conventional CMR protocol to rule out myocarditis was performed. Lake Louise Criteria were used for diagnosis of myocarditis. All scans were performed by Phillips Medical Systems Ingenia 1.5T. T1 native values were estimated elevated when mapping values measured above 1000ms, T2 mapping values were estimated elevated when greater than 55 ms. Mid wall or subepicardial late gadolinium enhancement were detected.Results Seven out of 35 patients (20%) fulfilled the Lake Louise criteria for myocarditis. The most prevalent symptoms were effort intolerance and palpitations (51% and 43% respectively). Mean age was 42 ± 14 years, 68% were males. T1 mapping values were increased in 31% of the patients. All patients with increased native T1, had symptoms of COVID for not more than 3 months from the symptom onset. Three out of seven patients had acute myocarditis (42%). Only 25% of this group of patients needed hospitalization due to COVID infection. All 7 patients with cardiac magnetic resonance signs for myocarditis also had X-Ray and/or multi-slice computer tomography signs for atypical pneumonia. None of these patients had signs of fulminant myocarditis.ConclusionThe prevalence of myocardial involvement after SARS-CoV-2 infection is higher than influenza virus. Myocardial inflammation in any form presents in the first three months after the first symptoms. Myocarditis after SARS-CoV-2infection develops regardless of the severity of the symptoms.

Arthroscopic Matrix-Assisted Autologous Chondrocyte Transplantation Versus Microfracture: A 6-Year Follow-up of a Prospective Randomized Trial

Background: Few randomized controlled trials with a midterm follow-up have compared matrix-assisted autologous chondrocyte transplantation (MACT) with microfracture (MFx) for knee cartilage lesions. Purpose: To compare the structural, clinical, and safety outcomes at midterm follow-up of MACT versus MFx for treating symptomatic knee cartilage lesions. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 48 patients aged between 18 and 50 years, with 1- to 4-cm2 International Cartilage Repair Society (ICRS) grade III to IV knee chondral lesions, were randomized in a 1:1 ratio to the MACT and MFx treatment groups. A sequential prospective evaluation was performed using magnetic resonance imaging (MRI) T2 mapping, the MOCART (magnetic resonance observation of cartilage repair tissue) score, second-look arthroscopic surgery, patient-reported outcome measures, the responder rate (based on achieving the minimal clinically important difference for the Knee injury and Osteoarthritis Outcome Score [KOOS] pain and KOOS Sport/Recreation), adverse events, and treatment failure (defined as a reoperation because of symptoms caused by the primary defect and the detachment or absence of >50% of the repaired tissue during revision surgery). Results: Overall, 35 patients (18 MACT and 17 MFx) with a mean chondral lesion size of 1.8 ± 0.8 cm2 (range, 1-4 cm2) were followed up to a mean of 6 years postoperatively (range, 4-9 years). MACT demonstrated significantly better structural outcomes than MFx at 1 to 6 years postoperatively. At final follow-up, the MRI T2 mapping values of the repaired tissue were 37.7 ± 8.5 ms for MACT versus 46.4 ± 8.5 ms for MFx (P = .003), while the MOCART scores were 59.4 ± 17.3 and 42.4 ± 16.3, respectively (P = .006). More than 50% defect filling was seen in 95% of patients at 2 years and 82% at 6 years in the MACT group and in 67% at 2 years and 53% at 6 years in the MFx group. The second-look ICRS scores at 1 year were 10.7 ± 1.3 for MACT and 9.0 ± 1.8 for MFx (P = .001). Both groups showed significant clinical improvements at 6 years postoperatively compared with their preoperative status. Significant differences favoring the MACT group were observed at 2 years on the KOOS Activities of Daily Living (P = .043), at 4 years on all KOOS subscales (except Symptoms; P < .05) and the Tegner scale (P = .008), and at 6 years on the Tegner scale (P = .010). The responder rates at 6 years were 53% and 77% for MFx and MACT, respectively. There were no reported treatment failures after MACT; the failure rate was 8.3% in the MFx group. Neither group had serious adverse events related to treatment. Conclusion: Patients who underwent MACT had better structural outcomes than those who underwent MFx at 1 to 6 years postoperatively. Both groups of patients showed significant clinical improvements at final follow-up compared with their preoperative status. MACT showed superiority at 4 years for the majority of the KOOS subscales and for the Tegner scale at 4 to 6 years. The MACT group also had a higher responder rate and lower failure rate at final follow-up. Registration: NCT01947374 (ClinicalTrials.gov identifier).

Role of Cardiac Magnetic Resonance Imaging in Assessment of Cardiovascular Abnormalities in Patients with Coronavirus Disease 2019

Background: Long-term effects of coronavirus disease-2019 (COVID-19) causing pulmonary fibrosis are a well-established fact. Whether similar changes persist in myocardium remains a cause of concern. Cardiac magnetic resonance imaging (MRI), although logistically limited during the acute phase of illness, is an excellent modality for evaluating persisting myocardial involvement in patients recovering from COVID-19. No previous study has described cardiac MRI in Indian patients with COVID-19. Materials and Methods: We summarize cardiac MRI findings in 43 patients (29 males) who underwent cardiac MRI at our center for various clinical indications after recovering from their COVID-19 episodes. All cardiac MRI examinations were performed on Siemens Verio 3 Tesla Scanner System with 70 cm bore. Necessary precautions and safety measures were taken as per the Society for Cardiovascular Magnetic Resonance recommendations and standard imaging protocols were followed. Results: Half of all patients (22, 51.2%) had presented after 6 weeks of their initial COVID-19, whereas most of the remaining patients (19, 44.2%) underwent MRI during 3–6 weeks after recovering from COVID-19. Exercise intolerance was the most common clinical presentation observed in 22 (51.2%) patients, followed by fatigue or generalized weakness (15 patients), fast heart rate (12 patients), and breathlessness (12 patients). The most common cardiac MRI finding was elevated T1 and T2 mapping values (14 patients, 32.6%). The other common findings were late gadolinium enhancement in 12 (27.9%) patients, pericardial effusion ± enhancement in 12 (27.9%) patients, and impaired left ventricular systolic function in 9 (20.9%) patients. Eleven (25.6%) patients had normal cardiac MRI. Conclusions: Our findings summarize common cardiac abnormalities detected by cardiac MRI in patients with recent COVID-19. Although these results cannot be postulated to estimate the overall burden of cardiac involvement in COVID-19, they provide valuable insight into clinical spectrum of these patients in Indian scenario.

Role of CMR feature-tracking derived left ventricular strain in predicting myocardial iron overload and assessing myocardial contractile dysfunction in patients with thalassemia major.

Myocardial iron overload (MIO) in thalassemia major (TM) may cause subclinical left ventricular (LV) dysfunction which manifests with abnormal strain parameters before a decrease in ejection fraction (EF). Early detection of MIO using cardiovascular magnetic resonance (CMR)-T2* is vital. Our aim was to assess if CMR feature-tracking (FT) strain correlates with T2*, and whether it can identify early contractile dysfunction in patients with MIO but normal EF. One hundred and four consecutive TM patients with LVEF > 55% on echocardiography were prospectively enrolled. Those fulfilling the inclusion criteria underwent CMR, with T2* being the gold standard for detecting MIO. Group 1 included patients without significant MIO (T2* > 20 ms) and group 2 with significant MIO (T2* < 20 ms). Eighty-six patients (mean age, 17.32 years, 59 males) underwent CMR. There were 68 (79.1%) patients in group 1 and 18 (20.9%) in group 2. Fourteen patients (16.3%) had mild-moderate MIO, and four (4.6%) had severe MIO. Patients in group 2 had significantly lower global radial strain (GRS). Global longitudinal strain (GLS) and global circumferential strain (GCS) did not correlate with T2*. T1 mapping values were significantly lower in patients with T2* < 10 ms than those with T2* of 10-20 ms; however, FT-strain values were not significantly different between these two groups. CMR-derived GRS, but not GLS and GCS, correlated with CMR T2*. GRS is significantly decreased in TM patients with MIO and normal EF when compared with those without. FT-strain may be a useful adjunct to CMR T2* and maybe an early marker of myocardial dysfunction in TM. • A global radial strain of < 29.3 derived from cardiac MRI could predict significant myocardial iron overload in patients with thalassemia, with a sensitivity of 76.5% and specificity of 66.7%. • Patients with any myocardial iron overload have significantly lower GRS, compared to those without, suggesting the ability of CMR strain to identify subtle myocardial contractile disturbances. • T1 and T2 mapping values are significantly lower in those with severe myocardial iron than those with mild-moderate iron, suggesting a potential role of T1 and T2 mapping in grading myocardial iron.

Ventricular Tachycardia Has Mainly Non-Ischaemic Substrates in Patients with Autoimmune Rheumatic Diseases and a Preserved Ejection Fraction.

Non-sustained ventricular tachycardia (NSVT) is a potentially lethal arrhythmia that is most commonly attributed to coronary artery disease. We hypothesised that among patients with NSVT and preserved ejection fraction, cardiovascular magnetic resonance (CMR) would identify a different proportion of ischaemic/non-ischaemic arrhythmogenic substrates in those with and without autoimmune rheumatic diseases (ARDs). In total, 80 consecutive patients (40 with ARDs, 40 with non-ARD-related cardiac pathology) with NSVT in the past 15 days and preserved left ventricular ejection fraction were examined using a 1.5-T system. Evaluated parameters included biventricular volumes/ejection fractions, T2 signal ratio, early/late gadolinium enhancement (EGE/LGE), T1 and T2 mapping and extracellular volume fraction (ECV). Mean age did not differ across groups, but patients with ARDs were more often women (32 (80%) vs. 15 (38%), p < 0.001). Biventricular systolic function, T2 signal ratio and EGE and LGE extent did not differ significantly between groups. Patients with ARDs had significantly higher median native T1 mapping (1078.5 (1049.0–1149.0) vs. 1041.5 (1014.0–1079.5), p = 0.003), higher ECV (31.0 (29.0–32.0) vs. 28.0 (26.5–30.0), p = 0.003) and higher T2 mapping (57.5 (54.0–61.0) vs. 52.0 (48.0–55.5), p = 0.001). In patients with ARDs, the distribution of cardiac fibrosis followed a predominantly non-ischaemic pattern, with ischaemic patterns being more common in those without ARDs (p < 0.001). After accounting for age and cardiovascular comorbidities, most findings remained unaffected, while only tissue characterisation indices remained significant after additionally correcting for sex. Patients with ARDs had a predominantly non-ischaemic myocardial scar pattern and showed evidence of diffuse inflammatory/ischaemic changes (elevated native T1-/T2-mapping and ECV values) independent of confounding factors.

T2-mapping increase is the prevalent imaging biomarker of myocardial involvement in active COVID-19: a Cardiovascular Magnetic Resonance study

BackgroundEarly detection of myocardial involvement can be relevant in coronavirus disease 2019 (COVID-19) patients to timely target symptomatic treatment and decrease the occurrence of the cardiac sequelae of the infection.The aim of the present study was to assess the clinical value of cardiovascular magnetic resonance (CMR) in characterizing myocardial damage in active COVID-19 patients, through the correlation between qualitative and quantitative imaging biomarkers with clinical and laboratory evidence of myocardial injury.MethodsIn this retrospective observational cohort study, we enrolled 27 patients with diagnosis of active COVID-19 and suspected cardiac involvement, referred to our institution for CMR between March 2020 and January 2021.Clinical and laboratory characteristics, including high sensitivity troponin T (hs-cTnT), and CMR imaging data were obtained. Relationships between CMR parameters, clinical and laboratory findings were explored.Comparisons were made with age-, sex- and risk factor–matched control group of 27 individuals, including healthy controls and patients without other signs or history of myocardial disease, who underwent CMR examination between January 2020 and January 2021.ResultsThe median (IQR) time interval between COVID-19 diagnosis and CMR examination was 20 (13.5–31.5) days. Hs-cTnT values were collected within 24 h prior to CMR and resulted abnormally increased in 18 patients (66.6%). A total of 20 cases (74%) presented tissue signal abnormalities, including increased myocardial native T1 (n = 11), myocardial T2 (n = 14) and extracellular volume fraction (ECV) (n = 10), late gadolinium enhancement (LGE) (n = 12) or pericardial enhancement (n = 2). A CMR diagnosis of myocarditis was established in 9 (33.3%), pericarditis in 2 (7.4%) and myocardial infarction with non-obstructive coronary arteries in 3 (11.11%) patients. T2 mapping values showed a moderate positive linear correlation with Hs-cTnT (r = 0.58; p = 0.002). A high degree positive linear correlation between ECV and Hs-cTnT was also found (r 0.77; p < 0.001).ConclusionsCMR allows in vivo recognition and characterization of myocardial damage in a cohort of selected COVID-19 individuals by means of a multiparametric scanning protocol including conventional imaging and T1–T2 mapping sequences. Abnormal T2 mapping was the most commonly abnormality observed in our cohort and positively correlated with hs-cTnT values, reflecting the predominant edematous changes characterizing the active phase of disease.

T2 mapping of the median nerve in patients with carpal tunnel syndrome and healthy volunteers.

We investigated the changes in MRI T2 mapping values in subjects with carpal tunnel syndrome (CTS) compared to healthy controls. We enrolled 71 patients with CTS and 26 healthy controls. Median nerve T2 values were measured at the distal carpal tunnel, hamate bone, proximal carpal tunnel, and forearm levels. These were compared between patients and controls and correlated with median nerve cross-sectional area (CSA) and nerve conduction measurements. The mean T2 values at the proximal carpal tunnel levels were higher in the CTS group (56.7 ms) than in the control group (51.2 ms, P = .02) and also were higher than at the distal carpal tunnel (51.0 ms, P < .001) and forearm levels (47.6 ms, P < .001). T2 values were not significantly associated with CSA or nerve conduction measurements. T2 mapping of the carpal tunnel provides qualitative information on median nerve pathology but does not reflect CTS severity.

Tissue characteristics of the athlete"s heart: differentiation of physiological and pathological hypertrophy using parametric T1 and T2 mapping

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Research, Development and Innovation Fund of Hungary Background Intensive physical exercise leads to structural and functional cardiac adaptation termed athlete’s heart. Cardiac magnetic resonance (CMR) has an important role in the differentiation of physiological adaptation and pathological conditions. Beside the precise measurement of the ventricular volumes, mass, and function, it provides tissue specific information. Recently, native T1 mapping technique has been applied as a non-contrast method to detect myocardial fibrosis. Previous studies suggested that native T1 mapping can identify myocardial pathology before other CMR imaging techniques. T2 mapping values are elevated in case of myocardial edema. Purpose The aim of our study was to investigate the differences in CMR characteristics especially the native T1 and T2 mapping values of highly trained healthy athletes, healthy controls and patients with hypertrophic cardiomyopathy (HCM). Methods A total of 43 healthy athletes (water polo, swimming, football, 22 ± 8 training hours/week), 27 non-athlete healthy control and 25 HCM patients were involved in the study. Our inclusion criteria were: age &amp;gt;18 years, in the athlete group &amp;gt;7 training hours per week . We evaluated the left ventricular (LV) end-systolic, end-diastolic (EDVi) and stroke volume (SVi) index, mass index (LVMi), ejection fraction (EF) and maximal end-diastolic wall thickness (EDWT). In a basal short axis slice the native T1 and T2 mapping values were evaluated. Results Athletes had significantly higher LV volumes compared to the control and HCM group (LVEDVi 114 ± 13 vs. 86 ± 11; 84 ± 15 ml/m2, LVSVi 64 ± 7 vs. 51 ± 7; 54 ± 10 ml/m2, respectively, p &amp;lt; 0.0001). HCM patients had the highest LVMi (72 ± 14 g/m2) and EDWT (18 ± 4 mm) compared to athletes and controls, athletes had higher LVMi (60 ± 11 vs. 42 ± 8 g/m2) and EDWT (10 ± 2 vs. 8 ± 1 mm) compared to the controls (p &amp;lt; 0.001). The native T1 mapping values differed significantly in the three groups, athletes had the lowest, HCM patients had the highest T1 values (athletes: 956 ± 19 ms, controls: 971 ± 20 ms, HCM patients: 993 ± 39 ms; p &amp;lt; 0.0001). There was no difference in the T2 mapping values between athletes and controls (44 ± 2 vs. 43 ± 2 ms), HCM patients had higher T2 values (45 ± 2 ms) compared to the other two groups (p &amp;lt; 0.01). Conclusion Intensive and regular training may lead to tissue specific changes of the myocardium. T1 and T2 mapping are potentially useful tools for differentiating between athlete"s heart and patients with hypertrophic cardiomyopathy. Abstract Figure. T1 mapping in HCM and athlete

Gender difference in extreme cardiac remodelling in endurance olympic athletes assessed by non-contrast CMR

Abstract Funding Acknowledgements Type of funding sources: None. Background Male and female athletes present difference spectrum of cardiac remodelling related to their sport activity. However data in elite female athletes are scarce and mainly limited to echocardiography evaluation. Purpose The aim of the study was to assess gender difference in extreme cardiac remodelling in Olympic athletes engaged in endurance sport assessed by non-contrast Cardiovascular Magnetic Resonance including Mapping. Methods Olympic athletes engaged in endurance sport (rowing, canoeing, mid/long distance swimming) were examined with history, physical examination, 12-lead and exercise electrocardiogram, and echocardiography as part of their evaluation prior the Olympic games (Tokyo 2020). Athletes with unremarkable evaluation were undergone to non-contrast CMR including Mapping. The following parameters were calculated: indexed left ventricle (LV) and right ventricle (RV) end-diastolic (EDVi) and end-systolic volumes (ESVi), stroke volume (SVi), ejection fraction (EF), left and right atria area (LAAi and RAAi), LV Mass (Massi) and maximum wall thickness (MWT), RV/LV EDV ratio, spericity index [SI=(long axis diameter/2)3 * 4,187], myocardial native T1 (nT1) and T2 Mapping. Results 51 caucasian elite athletes (without difference in term of age, years of training and hours of training/week) were enrolled and 59% were male. Male showed greater LV EDVi (123 ± 28 ml vs 103 ± 10, p = 0.003), ESVi (55 ± 14 ml vs 44 ± 7, p = 0.001), SVi (68 ± 15 ml vs 59 ± 7, p = 0.023), Massi (76 ± 19 vs 57 ± 10, p &amp;lt; 0.001), MWT (10 ± 1 mm vs 8 ± 1, p &amp;lt; 0.001) and RV EDVi (129 ± 48 ml vs 104 ± 13, p = 0.026), ESVi (57 ± 10 ml vs 45 ± 9, p &amp;lt; 0.001), SVi (68 ± 15 ml vs 59 ± 7, p = 0.018) compared to female, as expected. LVEF (p = 0.05) and RVEF (p = 0.17) did not show significant difference. Despite greater volumes, SI (43 ± 12% vs 44 ± 8, p = 0.8) and RV/LV EDV ratio (0.99 ± 0.05 vs 1 ± 0.05, p = 0.405) did not differ between male and female athletes, as well as LAAi (13 ± 3 cm2 vs 13 ± 1.5, p = 0.86) and RAAi (13 ± 1.9 vs 13 ± 18, p = 0.56). Native T1 mapping was lower in male compared with female (934 ± 21 ms vs 956 ± 33, p = 0.028) while T2 Map values were slightly higher (53 ± 3.9 ms vs 50 ± 3.8, p = 0.027) . Conclusions Male endurance Olympic athletes presented higher volumes and LV mass compared to their female counterparts, while atria dimension, systolic function and sphericity index did not differ. Ventricles showed balanced dilatation in both gender. Lower T1 value observed in male suggested cellular hypertrophy. Figure 1 showed CMR images in a male (top row) and a female (bottom row) Olympic athletes: 4 chamber end-diastolic and end-systolic frame and end-diastolic basal short axis (SAX) showed balanced dilatation. Graphs showed higher EDVi and Massi in male compared o female, no difference in sphericity index and lower native T1 mapping. Abstract Figure 1

Short- to Midterm Clinical and Radiological Outcomes After Matrix-Associated Autologous Chondrocyte Implantation for Chondral Defects in Knees.

Background:Matrix-associated autologous chondrocyte implantation (MACI) has been proven to provide favorable short-term results for chondral defects in knees. However, it remains unclear whether the clinical benefits of MACI persist in the longer term.Purpose:The purpose of this prospective study was to evaluate the clinical and radiological outcomes, at short- and midterm follow-up, for patients undergoing MACI for focal chondral defects of the knee.Study Design:Case series; Level of evidence, 4.Methods:A total of 30 consecutive patients (31 knees) were treated using MACI between October 2010 and March 2018. There were 24 male patients and 6 female patients with an average age of 26 years (range, 12-48 years). The areas of the cartilage defect were consistently >2 cm2. All patients underwent MACI for a focal chondral defect of the femoral condyles or trochlea in the knee. These patients had been evaluated for up to 5 years, with an average follow-up of 44 months (range, 6-60 months) postoperatively.The International Knee Documentation Committee (IKDC) score, Lysholm score, and magnetic resonance imaging (MRI) with T2 mapping were used to assess the outcomes.Results:No patients were lost to follow-up. Mean IKDC scores improved from 58.6 (range, 40.2-80.5) to 79.1 (range, 39.1-94.3) at 12 months and up to 88.4 (range, 83.9-100) at 5 years; mean Lysholm scores improved from 67.3 (range, 46-95) to 90.6 (range, 71-100) at 12 months and up to 95.9 (range, 85-100) at 5 years. The MRI with T2 mapping value of the transplanted area was evaluated for 21 knees, which revealed no differences compared with the normal area at 12 months postoperatively.Conclusion:From the first year onward, the clinical outcome scores and MRI with T2 mapping values showed continuous and marked improvement, suggesting that MACI is a valid option for localized cartilage defects in the knee.

MRI quantification techniques in fatty liver: the diagnostic performance of hepatic T1, T2, and stiffness measurements in relation to the proton density fat fraction.

Nonalcoholic fatty liver disease (NAFLD) can progress to liver cirrhosis and is predicted to become the most frequent indication for liver transplantation in the near future. Noninvasive assessment of NAFLD is important for diagnosis and patient management. This study aims to prospectively determine the liver stiffness and T1 and T2 values in patients with NAFLD and to compare the diagnostic performance of magnetic resonance elastography (MRE) and mapping techniques in relation to the proton density fat fraction (PDFF). Eighty-three patients with NAFLD and 26 participants with normal livers were imaged with a 1.5 T scanner. PDFF measurements obtained from the multiecho Dixon technique were used to quantify the liver fat. MRE, native T1 mapping (modified Look-Locker inversion recovery [MOLLI] schemes 5(3)3, 3(3)3(3)5, and 3(2)3(2)5 and the B1-corrected variable flip angle [VFA] method), and T2 mapping values were correlated with PDFF. The diagnostic performance of MRE and the mapping techniques were analyzed and compared. T1 values measured with the MOLLI schemes and the B1-corrected VFA (P < 0.001), and the stiffness values from MRE (P = 0.047) were significantly higher in the NAFLD group. No significant difference was found between the groups in terms of T2 values (P = 0.127). In differentiation of the NAFLD and control groups, the B1-corrected VFA technique had slightly higher accuracy and area under the curve (AUC) than the MOLLI schemes. In the NAFLD group, there was a good correlation between the PDFF, MOLLI 3(3)3(3)5 and 3(2)3(2)5, and VFA T1 measurements (r=0.732; r=0.735; r=0.716, P < 0.001, respectively). Liver T1 mapping techniques have the potential to distinguish steatotic from nonsteatotic livers, and T1 values seem to have a strong correlation with the liver fat content.

Quantitative T2 mapping of the glenohumeral joint cartilage in asymptomatic shoulders and shoulders with increasing severity of rotator cuff pathology

PurposeTo examine the relationship between glenohumeral cartilage T2 mapping values and rotator cuff pathology. MethodFifty-nine subjects (age 48.2 ± 13.5 years, 15 asymptomatic volunteers and 10 tendinosis, 13 partial-thickness tear, 8 full-thickness tear, and 13 massive tear patients) underwent glenohumeral cartilage T2 mapping. The humeral head cartilage was segmented in the sagittal and coronal planes. The glenoid cartilage was segmented in the coronal plane. Group means for each region were calculated and compared between the groups. ResultsMassive tear group T2 values were significantly higher than the asymptomatic group values for the humeral head cartilage included in the sagittal (45 ± 7 versus 32 ± 4 ms, p < .001) and coronal (44 ± 6 versus 38 ± 1 ms, p = 0.01) plane images. Mean T2 was also significantly higher for massive than full-thickness tears (45 ± 7 versus 38 ± 5 ms, p = 0.02), massive than partial-thickness tears (45 ± 7 versus 34 ± 4 ms, p < 0.001), and massive tears than tendinosis (45 ± 7 versus 35 ± 4 ms, p = 0.001) in the sagittal-images humeral head region and significantly higher for massive tears than asymptomatic shoulders (44 ± 6 versus 38 ± 1 ms, p = 0.01) in the coronal-images humeral head region. ConclusionHumeral head cartilage T2 values were significantly positively correlated with rotator cuff pathology severity. Massive rotator cuff tear patients demonstrated significantly higher superior humeral head cartilage T2 mapping values relative to subjects with no/lesser degrees of rotator cuff pathology.

Quantitative Analysis of Magnetic Resonance Image Sagittal T2 Mapping in Lumbar Spine Classification

Objective: To evaluate the significance of T2 value changes of nucleus pulposus and annulus fibrosus in intervertebral disc degeneration, and to discuss feasibility and effectivity of intervertebral disc classification through MRI sagittal T2 mapping (specifically based on sagittal multi-echo SE sequence T2 mapping). Methods : 35 healthy volunteers (including 20 males and 15 females, aged 20 to 48, average age is 36.8) were randomly selected and their intervertebral discs of L3/L4, L4/L5 and L5/S1, with a sum-up of 90 discs, were scanned by sagittal MRI using routine FSE sequence as well as multi-echo SE sequence. T2 mapping was handled by image post-processing and each intervertebral disc was classified. T2 values of nucleus pulposus and annulus fibrosus were measured and statistical analysis were performed to study the relationship between T2 values and ages, disc grades or disc locations. Results: In classification through MRI sagittal T2 mapping, the disc grade increased along with the decrease of disc location or the increase of age. T2 value of nucleus pulposus decreased along with the increase of age (P &lt; 0.05). There was a significant difference in T2 mean values of nucleus pulposus of different grades (P &lt; 0.05). Conclusion: MRI sagittal T2 mapping provides us with a classification of intervertebral disc based on T2 values. Through evaluation of T2 mapping and measurement of T2 values of nucleus pulposus and annulus fibrosus, early stage degeneration of intervertebral disc can be monitored and the its relationship with relevant factors can be studied.

Abstract 16030: Myocardial Abnormalities in Competitive Athletes on T1 and T2 Parametric Mapping by Cardiovascular Magnetic Resonance Imaging

Introduction: Athletic cardiac adaptation is associated with structural changes that can overlap with disease states, unnecessarily limiting sports participation. Cardiovascular magnetic resonance (CMR) is useful in athlete’s heart and provides myocardial tissue characterization by T1 and T2 mapping. Hypothesis: CMR in competitive athletes will show abnormal T1 and T2 mapping due to intense exercise induced myocardial edema that can overlap with myocarditis. Methods: CMR data including left ventricular ejection fraction (LVEF) and T1/T2 maps were collected using standardized protocols on a 1.5 T scanner and compared between competitive athletes (N = 18, 83% male, median age 20 years), clinical myocarditis (N = 42, 71% male, median age 23 years) and controls (N = 35, 86% male, median age 22 years) between 2016-2020. T2 values of &lt;59 ms and native T1 &lt;1080 ms were defined as normal per institutional data. Extracellular volume fraction (ECV) and late gadolinium enhancement (LGE) were compared between athlete and myocarditis groups. Results: Figure 1 (panel A) shows participating sport and indications for CMR in athletes. There were 11 athletes (61%) with elevated T2 values (&gt;59 ms), of which 9 (82%) were without clinical myocarditis. Average T2, native T1, ECV, and LVEF are shown in panels B-E. T2 values were highest in myocarditis, followed by athletes and controls (p = 0.001). ECV was higher in myocarditis compared to athletes (p = 0.002). LGE was present in 8/18 athletes and 41/42 myocarditis patients. 6 athletes had follow-up CMR after a period of deconditioning, with 3 (50%) demonstrating an improvement in T2 values and LGE. Conclusions: To conclude, we demonstrate abnormalities on T2 mapping in athletes consistent with myocardial edema or inflammation. Changes in T2 may be related to intense training. Additional studies are required to prospectively evaluate athletes for normative T1 and T2 mapping values, relationship to training, and their correlation with LGE.

Value of baseline clinical and CMR characteristics for the prediction of cancer therapeutics-related cardiac dysfunction: results from the Cardiotoxicity Prevention Research Initiative (CAPRI)

Abstract Background Whether baseline cardiovascular health status significantly influences the risk of Cancer Therapeutics-Related Cardiac Dysfunction (CTRCD) in patients receiving de-novo chemotherapy exposure is an important clinical question for both surveillance and management decisions. The reference standard technique for the serial monitoring of left ventricular (LV) volumes and ejection fraction (EF) is cardiovascular magnetic resonance (CMR). Using this technique, we sought to prospectively evaluate baseline clinical risk factors and CMR-based pre-exposure characteristics for their influence on the incident occurrence of CTRCD. Methods We prospectively enrolled 371 cancer patients referred for baseline (pre-chemotherapy) followed by surveillance CMR imaging as part of the Cardiotoxicity Prevention Research Initiative (CAPRI). We also recruited 62 healthy volunteers to evaluate for referral population differences in CMR-based markers. Study subjects and healthy volunteers underwent identical CMR imaging protocols inclusive of cine imaging, T1 and T2 mapping. CTRCD was defined according to surveillance CMR imaging with criteria established as a drop in LVEF by &amp;gt;5% (meaningful detectable difference for CMR technique) to a value ≤56% (lower limit of normal) at any time point during chemotherapy surveillance. A total of 1474 CMR studies were performed over a median surveillance period of 12.5 months (range 2.3 to 68.9 months). Results The majority of patients were female (77%), being referred for breast cancer (64%) or lymphoma (36%), with a mean age of 54.0±14 years. The baseline prevalence of hypertension, diabetes, hyperlipidemia, and current smoking were 32%, 11%, 46%, and 13%, respectively. Compared to healthy volunteers, cancer patients at baseline showed smaller indexed LV and RV volumes, higher indexed LV mass, and higher native T1 values (mean difference +33 msec; p&amp;lt;0.001). LV and right ventricular (RV) EF and T2 mapping values were not significantly different. CTRCD criteria were met in 22% of patients. Figure 1 shows a forest plot of univariable and multivariable predictors of CTRCD occurrence. Following multivariable adjustment, only combined anthracycline/trastuzumab regimen (OR 4.4, 95% CI 2.0–9.5) and baseline indexed LVEDV (OR 2.3, 95% CI 1.2–4.5) were found to be significant predictors of this outcome. Conclusion Using the reference standard of serial CMR imaging we identified that of all baseline (pre-chemotherapy) clinical and CMR-based markers of cardiovascular health, only indexed LV end-doastolic volume (EDV) was independently associated with future occurrence of CTRCD following adjustment for chemotherapy regimen. We did not observe significant associations with conventional cardiac risk factors in our study population. The observed risk for indexed LVEDV was clinically meaningful (2.3-fold risk per 10 ml/m2) and warrants further investigation as a relevant baseline marker of risk in this referral population. Figure 1. Forest plot of predictors of CTRCD Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Alberta Innovates/Genome Alberta: CAPRI

Structural and functional cardiac changes after transplantation: experiences of the first year of the prospective Heart-TIming CMR substudy

Abstract Background In case of heart transplantation (HTX) the heart is affected by several factors e.g. ischaemia/reperfusion, denervation, immunosuppression. During the adaptation, the heart may show marked temporal changes in terms of myocardial mechanics, function and tissue characteristics. To better understand cardiac temporal characteristics after orthotopic bicaval HTX we started the prospective Heart-TIming (Transplantation Imaging) trial in January 2018. Purpose In our CMR substudy we aimed to evaluate the physiological structural and functional left and right ventricular characteristics and their temporal changes after HTX using cardiac magnetic resonance. Methods As part of the study HTX patients underwent CMR at one, three, six and twelve months after HTX (n=49; 53±11y, 39 male). Cine images, T2-weighted, native T1 and T2 mapping, late gadolinium enhancement (LGE) and adenosine stress perfusion (at 1 and 12 month) images were acquired. In order to describe physiological characteristics of the transplanted heart we excluded pts with significant coronary artery disease, ischaemic scar, ≥Grade II allograft rejection from this present study (n=9). We evaluated the left (LV) and right ventricular (RV) ejection fractions (EF), volumes, masses (M) and the global LV strain values: longitudinal (GLS), circumferential (GCS) strain and the standard deviation (SD) of the peak longitudinal strain (LS) and the mechanical dispersion. In a basal short axis slice the native T1 and T2 mapping values were evaluated. We compared baseline CMR parameters to age and gender matched healthy controls (n=20; 48±10y, 16 male), and analyzed the temporal changes after HTX. Results Comparing the HTX patients' CMR parameters at one month with normal controls, HTX patients had lower end-diastolic volumes (LVEDVi: 74±15 vs 89±13 ml/m2; RVEDVi: 72±16 vs 89±15 ml/m2 p&amp;lt;0.05), stroke volumes (LVSVi: 45±7 vs 55±8 ml/m2, RVSVi: 43±8 vs 54±8 ml/m2, p&amp;lt;0.0001), higher LVMi (63±2 vs 55±3 g/m2, p&amp;lt;0.05), increased SD of peak LS (14±2 vs 10±2, p&amp;lt;0.0001) and more pronounced mechanical dispersion (18±5 vs 12±4, p&amp;lt;0.0001). The native T1 mapping values were significantly higher in HTX pts (1007±40 vs 975±24 ms, p&amp;lt;0,01). Examining temporal changes in HTX pts we found a decrease in LVMi (66±14 vs 59±10 g/m2, p&amp;lt;0.01) already at three months. At 12 months LVMi decreased further, less negative GLS (−25±4 vs −20±4, p&amp;lt;0.01) and GCS (−38±7 vs −34±4, p&amp;lt;0.05), and lower SD of the peak LS (14±2 vs 11±2, p&amp;lt;0.01) were measured. Conclusions Understanding the temporal changes of cardiac mechanics, function and tissue characteristics, furthermore the establishment of physiological values may help in the early, noninvasive identification of pathological changes in HTX pts. Tissue specific information in HTX pts Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Project no. NVKP_16-1-2016-0017 has been implemented with the support provided from the National Research, Development and Innovation Fund of Hungary, financed under the NVKP_16 funding scheme. Supported by the ÚNKP-18-3-IV New National Excellence Program of Human Capacities.

T2 Mapping Values in Postmeniscectomy Knee Articular Cartilage after Running: Early Signs of Osteoarthritis?

Loading on the joints during running may have a deleterious effect on post-partial meniscectomy knee cartilage, leading to osteoarthritis. Utilizing T2-mapping measurements before and after running may enable the observation of changes in the articular cartilage of the postmeniscectomy knees compared with healthy knees. After medial partial meniscectomy, 12 volunteers underwent magnetic resonance imaging (MRI) of the both knees, before and immediately after 30 minutes of running. Quantitative assessment of articular cartilage was performed using a T2-mapping technique. In the medial compartment of the operated knees, significantly lower T2 values were found in anterior tibial plateau (pre- vs. postrun: 33.85 vs. 30.45 ms; p = 0.003) and central tibial plateau (33.33 vs. 30.63 ms; p = 0.007). Similar differences were found in lateral regions of central femur (post- vs. prerun: 35.86 vs. 40.35 ms; p = 0.015), posterior femur (34.89 vs. 37.73 ms; p = 0.001), and anterior tibia (24.66 vs. 28.70 ms, p = 0.0004). In lateral compartment, postrun values were significantly lower in operated compared with healthy knees, in central femur (34.89 vs. 37.59 ms; p = 0.043), posterior femoral (36.88 vs. 39.36 ms; p = 0.017), anterior tibia (24.66 vs. 30.20 ms; p = 0.009), and posterior tibia (28.84 vs. 33.17 ms; p = 0.006). No statistical difference was found while comparing postrun to prerun healthy knees. Lower T2 values were found in operated knees after 30 minutes of running. These changes were seen in medial and lateral compartments. We suspect that running may subject the articular cartilage to excessive loads in the post-partial meniscectomy knee, loads that in healthy knee do not cause any changes.

T1 and T2 mapping to detect chronic inflammation in cardiac magnetic resonance imaging in heart failure with reduced ejection fraction.

AimsThe purpose of this retrospective single‐centre study was to evaluate the non‐invasive detection of endomyocardial biopsy (EMB)‐established chronic myocardial inflammation in patients with heart failure with reduced ejection fraction (HFrEF) using T1 and T2 mapping.Methods and resultsThe study population consisted of 52 retrospectively identified HFrEF patients who underwent EMB and cardiac magnetic resonance imaging at 3 Tesla. EMB was defined according to the position statement of the European Society of Cardiology and served as reference to identify inflammation in all patients. A control group of healthy volunteers with prior cardiac magnetic resonance imaging studies (n = 58) was also identified. Global and segmental T1 and T2 values as well as septal measurements and tissue heterogeneity parameters were calculated.Out of the 52 patients with HFrEF, 33 patients had myocardial inflammation detected by EMB, while 19 patients were EMB negative for inflammation. Mean left ventricular ejection fraction was 31% in both groups (P = 0.97). Global T1 and T2 values in HFrEF patients were significantly higher compared with healthy controls (T1 1275 ± 69 ms vs. 1,175 ± 44 ms, P < 0.001; T2 40.0 ± 3.4 ms vs. 37.9 ± 1.6 ms, P < 0.001). The distribution of T1 and T2 values between patients with and without EMB‐proven chronic myocardial inflammation was not statistically different when regarding global (T1 1292 ± 71 ms vs. 1266 ± 67 ms, P = 0.26; T2 40.0 ± 2.6 ms vs. 40.0 ± 3.9 ms, P = 1.0), septal (T1 1299 ± 63 ms vs. 1289 ± 76 ms, P = 0.76; T2 40.1 ± 3.5 ms vs 40.0 ± 6.4 ms, P = 0.49) or maximum segmental values (T1 1414 ± 111 ms vs. 1363 ± 88 ms, P = 0.15; T2 47.3 ± 5.2 ms vs. 48.8 ± 11.8 ms, P = 0.53). Mean absolute deviation of segmental T1 and T2 values and log‐transformed pixel‐wise standard deviation as parameters of tissue heterogeneity did not reveal statistical significant differences between inflammation‐positive and inflammation‐negative HFrEF patients (all P > 0.4).ConclusionsConventionally performed quantitative T1 and T2 mapping values significantly correlated with prevalence of HFrEF but did not discriminate HFrEF patients with or without chronic myocardial inflammation in our cohort. This suggests that EMB is the preferred method to detect chronic myocardial inflammation in HFrEF.

Evaluation of autologous adipose-derived mesenchymal stem cell therapy in focal chondral defects of the knee: a pilot case series.

Aim: To evaluate the safety, pain, functional and structural improvements after autologous adipose-derived mesenchymal stem cell (ADMSC) therapy in combination with arthroscopic abrasion arthroplasty in focal chondral defects of the knee. Methods: Eight patients with a focal full thickness chondral defect of the knee underwent arthroscopic abrasion arthroplasty followed by postoperative intra-articular injections of autologous ADMSCs (50×106 ADMSCs at baseline and 6 months). Clinical outcome was assessed using numeric pain rating scale, Knee Injury and Osteoarthritis Outcome Score and the Western Ontario and McMaster Universities Osteoarthritis Index. Structural outcome was determined bymagnetic resonance imaging. Outcome was assessed over 24 months. Results: No serious adverse events occurred. Participants observed clinically significant improvement in pain and function. Magnetic resonance imaging analysis showed cartilage regeneration with T2 mapping values comparable to hyaline cartilage. Conclusion: Arthroscopic abrasion arthroplasty in combination with intra-articular ADMSC therapy results in reproducible pain, functional and structural improvements with regeneration of hyaline-like cartilage. Trial registration number: ACTRN12617000638336.