Measurement of myocardial native T1 in cardiovascular diseases and norm in 1291 subjects

Abstract

BackgroundNative T1-mapping provides quantitative myocardial tissue characterization for cardiovascular diseases (CVD), without the need for gadolinium. However, its translation into clinical practice is hindered by differences between techniques and the lack of established reference values. We provide typical myocardial T1-ranges for 18 commonly encountered CVDs using a single T1-mapping technique – Shortened Look-Locker Inversion Recovery (ShMOLLI), also used in the large UK Biobank and Hypertrophic Cardiomyopathy Registry study.MethodsWe analyzed 1291 subjects who underwent CMR (1.5-Tesla, MAGNETOM-Avanto, Siemens Healthcare, Erlangen, Germany) between 2009 and 2016, who had a single CVD diagnosis, with mid-ventricular T1-map assessment. A region of interest (ROI) was placed on native T1-maps in the “most-affected myocardium”, characterized by the presence of late gadolinium enhancement (LGE), or regional wall motion abnormalities (RWMA) on cines. Another ROI was placed in the “reference myocardium” as far as possible from LGE/RWMA, and in the septum if no focal abnormality was present. To further define normality, we included native T1 of healthy subjects from an existing dataset after sub-endocardial pixel-erosions.ResultsNative T1 of patients with normal CMR (938 ± 21 ms) was similar compared to healthy subjects (941 ± 23 ms). Across all patient groups (57 ± 19 yrs., 65% males), focally affected myocardium had significantly different T1 value compared to reference myocardium (all p < 0.001). In the affected myocardium, cardiac amyloidosis (1119 ± 61 ms) had the highest native T1 compared to normal and all other CVDs, while iron-overload (795 ± 58 ms) and Anderson-Fabry disease (863 ± 23 ms) had the lowest native reference T1 (all p < 0.001). Future studies designed to detect the large T1 differences between affected and reference myocardium are estimated to require small sample-sizes (n < 50). However, studies designed to detect the small T1 differences between reference myocardium in CVDs and healthy controls can require several thousand of subjects.ConclusionsWe provide typical T1-ranges for common clinical cardiac conditions in the largest cohort to-date, using ShMOLLI T1-mapping at 1.5 T. Sample-size calculations from this study may be useful for the design of future studies and trials that use T1-mapping as an endpoint.Electronic supplementary materialThe online version of this article (doi:10.1186/s12968-017-0386-y) contains supplementary material, which is available to authorized users.

Native myocardial T1 time can predict development of subsequent anthracycline‐induced cardiomyopathy

“…Native T1 time is increased in case of myocardial oedema or inflammation and decreased by iron overload such as in haemochromatosis or in case of lipid deposition as in Fabry disease …”

“…30 Native T1 time is increased in case of myocardial oedema or inflammation and decreased by iron overload such as in haemochromatosis or in case of lipid deposition as in Fabry disease. 31 While it is unlikely that a temporary myocardial iron overload is triggered by anthracyclines, they may lead to an increase of intracellular lipid contents affecting native myocardial T1 times.…”

Normal values of native T1 and T2 relaxation times on 3T cardiac MR in a healthy pediatric population aged 9–18 years

“…1,9 Use of mapping techniques requires accurate knowledge of normal ranges. 3,4,[12][13][14][15][16][17] Therefore, the aim of our study was to present limited normal values of native T 1 and T 2 mapping relaxation times in healthy pediatric subjects of different age and sex. [10][11][12] In recent years, there have been reports presenting established normal values for T 1 and T 2 , but none of them included pediatric populations.…”

“…2,3 Cardiac native T 1 mapping has proven sensitivity to a variety of pathologies, including acute myocardial infarction, cardiomyopathies, diffuse fibrosis or protein, lipid and iron deposition. 2,4 Moreover, native T 1 mapping can display the typical nonischemic patterns of fibrosis in various diseases such as acute myocarditis or hypertrophic cardiomyopathy, similar to late gadolinium enhancement (LGE) imaging. 5,6 T 2 relaxation time mapping is another quantitative technique used to distinguish between normal and abnormal tissues 1,7 ; for example, for the detection of myocardial edema in patients with acute myocardial infarction, myocarditis, sarcoidosis, cardiomyopathy, or cardiac allograft rejection.…”

“…[10][11][12] In recent years, there have been reports presenting established normal values for T 1 and T 2 , but none of them included pediatric populations. 3,4,[12][13][14][15][16][17] Therefore, the aim of our study was to present limited normal values of native T 1 and T 2 mapping relaxation times in healthy pediatric subjects of different age and sex.…”