"Black blood" T2-weighted inversion-recovery MR imaging of the heart.

Simonetti, Orlando P.; Finn, J. Paul; White, Richard D.; Laub, Gerhard; Henry, Daniel

doi:10.1148/radiology.199.1.8633172

Cited by 520 publications

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“…This may be a source of error at the endocardial infarct boundary. The surrounding blood pool reduces the conspicuity of the infarct at the septal wall and may be eliminated in the future by suppression of flowing blood by incorporating a preparation RF pulse to suppress flowing magnetization [12]. …”

Section: Resultsmentioning

confidence: 99%

“…T2-weighted images showsignal enhancement in acute MI [12,22,23], correlating with an increase water content and edema [24,25]. T2-weighted CMR is ambiguously sensitive to chronic MI, with no observed increase in signal intensity or T2 relaxation at the site of infarct [6] or changes in T2 that were dependent on the location of infarction [26].…”

Section: Discussionmentioning

confidence: 99%

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In vivo chronic myocardial infarction characterization by spin locked cardiovascular magnetic resonance

Witschey

Zsido

Koomalsingh

et al. 2012

Journal of Cardiovascular Magnetic Resonance

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BackgroundLate gadolinium enhanced (LGE) cardiovascular magnetic resonance (CMR) is frequently used to evaluate myocardial viability, estimate total infarct size and transmurality, but is not always straightforward is and contraindicated in patients with renal failure because of the risk of nephrogenic systemic fibrosis. T2- and T1-weighted CMR alone is however relatively insensitive to chronic myocardial infarction (MI) in the absence of a contrast agent. The objective of this manuscript is to explore T1ρ-weighted rotating frame CMR techniques for infarct characterization without contrast agents. We hypothesize that T1ρ CMR accurately measures infarct size in chronic MI on account of a large change in T1ρ relaxation time between scar and myocardium.Methods7Yorkshire swine underwent CMR at 8 weeks post-surgical induction of apical or posterolateral myocardial infarction. Late gadolinium enhanced and T1ρ CMR were performed at high resolution to visualize MI. T1ρ-weighted imaging was performed with a B1 = 500 Hz spin lock pulse on a 3 T clinical MR scanner. Following sacrifice, the heart was excised and infarct size was calculated by optical planimetry. Infarct size was calculated for all three methods (LGE, T1ρ and planimetry) and statistical analysis was performed. T1ρ relaxation time maps were computed from multiple T1ρ-weighted images at varying spin lock duration.ResultsMean infarct contrast-to-noise ratio (CNR) in LGE and T1ρ CMR was 2.8 ± 0.1 and 2.7 ± 0.1. The variation in signal intensity of tissues was found to be, in order of decreasing signal intensity, LV blood, fat and edema, infarct and healthy myocardium. Infarct size measured by T1ρ CMR (21.1% ± 1.4%) was not significantly different from LGE CMR (22.2% ± 1.5%) or planimetry (21.1% ± 2.7%; p < 0.05).T1ρ relaxation times were T1ρinfarct = 91.7 ms in the infarct and T1ρremote = 47.2 ms in the remote myocardium.ConclusionsT1ρ-weighted imaging using long spin locking pulses enables high discrimination between infarct and myocardium. T1ρ CMR may be useful to visualizing MI without the need for exogenous contrast agents for a wide range of clinical cardiac applications such as to distinguish edema and scar tissue and tissue characterization of myocarditis and ventricular fibrosis.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

In vivo chronic myocardial infarction characterization by spin locked cardiovascular magnetic resonance

Witschey

Zsido

Koomalsingh

et al. 2012

Journal of Cardiovascular Magnetic Resonance

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“…CMR scans assessed LV function, T1-mapping, edema and LGE, with matching short-axis images. T1-mapping was performed using the novel sequence ShMOLLI (Shortened Modified Look-Locker Inversion Recovery) [16]; dark-blood and bright-blood T2w-CMR were performed with the STIR [8], and the ACUT2E [10] sequences, respectively. All were acquired before administration of contrast agents.…”

Section: Methodsmentioning

confidence: 99%

“…Conventional T2w images are acquired using the short-tau inversion recovery (STIR) sequence at 1.5 T [8]. Limitations of this technique include signal drop-out, bright signals adjacent to the subendocardium due to slow-flow blood, image quality impairment in tachyarrhythmias, and long breath-holds [5,9].…”

Section: Introductionmentioning

confidence: 99%

Non-contrast T1-mapping detects acute myocardial edema with high diagnostic accuracy: a comparison to T2-weighted cardiovascular magnetic resonance

Ferreira

Piechnik

Dall’Armellina

et al. 2012

Journal of Cardiovascular Magnetic Resonance

385

306

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BackgroundT2w-CMR is used widely to assess myocardial edema. Quantitative T1-mapping is also sensitive to changes in free water content. We hypothesized that T1-mapping would have a higher diagnostic performance in detecting acute edema than dark-blood and bright-blood T2w-CMR.MethodsWe investigated 21 controls (55 ± 13 years) and 21 patients (61 ± 10 years) with Takotsubo cardiomyopathy or acute regional myocardial edema without infarction. CMR performed within 7 days included cine, T1-mapping using ShMOLLI, dark-blood T2-STIR, bright-blood ACUT2E and LGE imaging. We analyzed wall motion, myocardial T1 values and T2 signal intensity (SI) ratio relative to both skeletal muscle and remote myocardium.ResultsAll patients had acute cardiac symptoms, increased Troponin I (0.15-36.80 ug/L) and acute wall motion abnormalities but no LGE. T1 was increased in patient segments with abnormal and normal wall motion compared to controls (1113 ± 94 ms, 1029 ± 59 ms and 944 ± 17 ms, respectively; p < 0.001). T2 SI ratio using STIR and ACUT2E was also increased in patient segments with abnormal and normal wall motion compared to controls (all p < 0.02). Receiver operator characteristics analysis showed that T1-mapping had a significantly larger area-under-the-curve (AUC = 0.94) compared to T2-weighted methods, whether the reference ROI was skeletal muscle or remote myocardium (AUC = 0.58-0.89; p < 0.03). A T1 value of greater than 990 ms most optimally differentiated segments affected by edema from normal segments at 1.5 T, with a sensitivity and specificity of 92 %.ConclusionsNon-contrast T1-mapping using ShMOLLI is a novel method for objectively detecting myocardial edema with a high diagnostic performance. T1-mapping may serve as a complementary technique to T2-weighted imaging for assessing myocardial edema in ischemic and non-ischemic heart disease, such as quantifying area-at-risk and diagnosing myocarditis.

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“…Following basic localization, retrospectively electrocardiogram (ECG) gated cine steady-state free precession (SSFP) images were acquired in short axis views covering the basal, mid, and apical portions of the left ventricle using a six-element body matrix coil and six elements of a 24-element spine matrix coil. A STIR turbo spin echo (TSE) sequence was applied as previously described (22), followed by DIR-AASPIR TSE. All T2-weighted images were acquired in basal and mid-ventricular short axis slices.…”

Section: Image Acquisitionmentioning

confidence: 99%

A New approach towards improved visualization of myocardial edema using T2‐weighted imaging: A cardiovascular magnetic resonance (CMR) study

Cocker

Shea

Strohm

et al. 2011

Magnetic Resonance Imaging

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Purpose: To compare T2-weighted cardiovascular magnetic resonance (CMR) imaging with AASPIR (asymmetric adiabatic spectral inversion recovery) and STIR (short T1 inversion recovery) for myocardial signal intensity, image quality, and fat suppression.Materials and Methods: Forty consecutive patients (47 6 16 years old) referred by cardiologists for CMR-based myocardial tissue characterization were scanned with both STIR and AASPIR T2-weighted imaging approaches. Signal intensity of left ventricular myocardium was normalized to a region of interest generating a signal-to-noise ratio (SNR). In six patients with regional edema on STIR the contrast-to-noise ratio (CNR) was assessed. Two independent observers used a scoring system to evaluate image quality and artifact suppression. Six healthy volunteers (three males, 32 6 7 years) were recruited to compare fat suppression between AASPIR and STIR.Results: SNR of AASPIR was greater than STIR for basal (128 6 44 vs. 83 6 40, P < 0.001), mid-(144 6 65 vs. 96 6 39, P < 0.01), and apical (145 6 59 vs. 105 6 35, P < 0.05) myocardium. Improved image quality and greater suppression of artifacts was demonstrated with AASPIR. In patients with regional edema, CNR increased by 49% with AASPIR, while SNR of pericardial fat did not differ (44 6 39 vs. 33 6 30, P > 0.05). Conclusion:Our findings support the implementation of an AASPIR-based approach for T2-weighted imaging due to improved pericardial fat suppression, image quality, and artifact suppression with greater CNR and SNR.

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"Black blood" T2-weighted inversion-recovery MR imaging of the heart.

Abstract: Fast STIR imaging of the heart with effective suppression of flow and motion artifacts was implemented. The approach has much potential for high-contrast imaging in a variety of diseases affecting the heart and mediastinum.

Cited by 520 publications

References 0 publications

In vivo chronic myocardial infarction characterization by spin locked cardiovascular magnetic resonance

In vivo chronic myocardial infarction characterization by spin locked cardiovascular magnetic resonance

Non-contrast T1-mapping detects acute myocardial edema with high diagnostic accuracy: a comparison to T2-weighted cardiovascular magnetic resonance

A New approach towards improved visualization of myocardial edema using T2‐weighted imaging: A cardiovascular magnetic resonance (CMR) study

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