CMR–Derived Extracellular Volume Fraction as a Marker for Myocardial Fibrosis

Lurz, Julia; Luecke, Christian; Lang, David J.; Besler, Christian; Rommel, Karl‐Philipp; Klingel, Karin; Kandolf, Reinhard; Adams, Volker; Schöne, Katharina; Hindricks, Gerhard; Schuler, Gerhard; Linke, Axel; Thiele, Holger; Gutberlet, Matthias; Lurz, Philipp

doi:10.1016/j.jcmg.2017.01.025

Cited by 72 publications

(50 citation statements)

References 35 publications

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“…One previous study had demonstrated that in cases with coexisting inflammation and diffuse fibrosis, the ECV would reflect the sum of both pathologies [31]. ECV has shown excellent discriminative value in differentiating myocarditis patients from healthy subjects [21,32], and declined significantly with the recovery of myocarditis [21].…”

Section: Abbreviationsmentioning

confidence: 99%

Multiparametric cardiovascular magnetic resonance characteristics and dynamic changes in myocardial and skeletal muscles in idiopathic inflammatory cardiomyopathy

Sun

Wan

et al. 2020

Journal of Cardiovascular Magnetic Resonance

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Background: Idiopathic inflammatory myopathy (IIM) manifest as systematic muscle involvement. Multiparametric cardiovascular magnetic resonance (CMR) could be a useful technique to detect systemic involvement and disease progression in IIM patients. This study aimed to describe the tissue characteristics and dynamic changes in myocardial and skeletal muscles after treatment in IIM patients. Methods: Forty-four consecutively recruited IIM patients (49.0 ± 12.0 years; 22 males) underwent 3 T CMR at first diagnosis, and 28 patients underwent follow-up scan after receiving standard treatment for more than 1 year. Thirty age-and sex-matched healthy subjects served as controls. The CMR protocol included: cines, T2-weighted (T2w), late gadolinium enhancement (LGE), T1 and T2 mapping, and extracellular volume (ECV) evaluated for the myocardium, and T1 and T2 mapping and ECV evaluated for skeletal muscles. Correlations between laboratory biomarkers and myocardial and skeletal tissue characteristics were analyzed. Comparisons between baseline and follow-up scans were performed using paired t-tests. Results: At baseline, IIM patients showed significantly decreased hematocrit, higher left ventricular (LV) mass index, right ventricular (RV) volume index, myocardial and skeletal native T1, T2 mapping, and ECV than healthy controls. Significant correlations were found among myocardial native T1, T2 mapping, and ECV values and N-terminal pro btype natriuretic peptide (NT-proBNP) levels, and significant correlations between skeletal T2 mapping and inflammatory biomarkers in IIM patients. During the follow-up, 28 patients underwent repeated CMR scan (median interval, 14.5 months, interquartile range: 13.2-15.5 months). Significant relief from clinical symptoms and decreased inflammatory biomarkers levels were observed. Significant reduction in myocardial native T1, T2, ECV, and skeletal native T1, T2, and ECV were observed (Continued on next page)

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Section: Abbreviationsmentioning

confidence: 99%

Multiparametric cardiovascular magnetic resonance characteristics and dynamic changes in myocardial and skeletal muscles in idiopathic inflammatory cardiomyopathy

Sun

Wan

et al. 2020

Journal of Cardiovascular Magnetic Resonance

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“…The fact that only ECV values were significantly different is probably based on that fact that the native T 1 signal including, besides the myocardium itself, blood flow, water, and fibrosis, whereas ECV is representing the extracellular space more exclusively, and therefore is more sensitive for fibrosis. 32 In a study by Ellims et al, ECV and not native T 1 was well correlated with ventricular stiffness in a transplant cohort. 33 In addition, we could show, within this small cohort, that there is a weak correlation between overall [ 11 C]mHED retention (regardless of the 7% cutoff defining a segment as reinnervated) and native T 1 times, as well as the percentage of ECV by MRI.…”

Section: Discussionmentioning

confidence: 92%

“…In our study, using mapping techniques and a 16‐segment myocardial model, segments with evidence of reinnervation by PET, mainly located on the anterior wall, showed nonsignificantly higher T 1 relaxation times and significantly higher ECV when compared with segments without evidence of reinnervation. The fact that only ECV values were significantly different is probably based on that fact that the native T 1 signal including, besides the myocardium itself, blood flow, water, and fibrosis, whereas ECV is representing the extracellular space more exclusively, and therefore is more sensitive for fibrosis . In a study by Ellims et al, ECV and not native T 1 was well correlated with ventricular stiffness in a transplant cohort …”

Section: Discussionmentioning

confidence: 96%

Assessment of sympathetic reinnervation after cardiac transplantation using hybrid cardiac PET/MRI: A pilot study

Beitzke

Wielandner

Wollenweber

et al. 2019

Magnetic Resonance Imaging

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Background Sympathetic reinnervation after heart transplantation (HTX) is a known phenomenon, which has an impact on patient heart rate variability and exercise capacity. The impact of reinnervation on myocardial structure has not been evaluated yet. Propose To evaluate the feasibility of simultaneous imaging of cardiac reinnervation and cardiac structure using a hybrid PET/MRI system. Study type Prospective / pilot study. Subjects Ten patients, 4–21 years after cardiac transplantation. Field Strength/Sequence 3 T hybrid PET/MRI system. Cine SSFP, T1 mapping (modified Look–Locker inversion recovery sequence) pre/postcontrast as well as dynamic [11C]meta‐hydroxyephedrine ([11C]mHED) PET. Assessment All MRI and PET parameters were evaluated by experienced readers using dedicated postprocessing software packages for cardiac MRI and PET. For all parameters a 16‐segment model for the left ventricle was applied. Statistical Tests Mann–Whitney U‐test; Spearman correlations. Results Thirty‐six of 160 myocardial segments showed evidence of reinnervation by PET. On a segment‐based analysis, mean native T1 relaxation times were nonsignificantly altered in segments with evidence of reinnervation (1305 ± 151 msec vs. 1270 ± 112 msec; P = 0.1), whereas mean extracellular volume (ECV) was significantly higher in segments with evidence of reinnervation (35.8 ± 11% vs. 30.9 ± 7%; P = 0.019). There were no significant differences in wall motion (WM) and wall thickening (WT) between segments with or without reinnervation (mean WM: 7.6 ± 4 mm vs. group B: 9.3 ± 7 mm [P = 0.13]; WT: 79 ± 63% vs. 94 ± 74% [P = 0.27]) under resting conditions. Data Conclusion The assessment of cardiac reinnervation using a hybrid PET/MRI system is feasible. Segments with evidence of reinnervation by PET showed nonsignificantly higher T1 relaxation times and a significantly higher ECV, suggesting a higher percentage of diffuse fibrosis in these segments, without impairment of rest WM and WT. Level of Evidence: 3 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;50:1326–1335.

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“…Our prospective single-center study represents a substudy from the Magnetic Resonance Imaging in Myocarditis (MyoRacer) trial (ClincialTrials.gov registration no. NCT02177630), including 44 of 129 originally reported consecutive participants (7,17). This prior article evaluated patients with acute and chronic myocarditis by using LLC and T1 and T2 mapping, whereas the present article reports the application of TA on T1 and T2 mapping not reported previously.…”

Section: Methodsmentioning

confidence: 97%

Cardiac MRI Texture Analysis of T1 and T2 Maps in Patients with Infarctlike Acute Myocarditis

Baeßler¹,

Luecke²,

Lurz³

et al. 2018

Radiology

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115

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Purpose To assess the diagnostic potential of texture analysis applied to T1 and T2 maps obtained with cardiac MRI for the diagnosis of acute infarctlike myocarditis. Materials and Methods This prospective study from August 2012 to May 2015 included 39 participants (overall mean age ± standard deviation, 34.7 years ± 12.2 [range, 18-63 years]; mean age of women, 46.1 years ± 10.8 [range, 24-63 years]; mean age of men, 29.8 years ± 9.2 [range, 18-56 years]) from the Magnetic Resonance Imaging in Myocarditis (MyoRacer) trial with clinical suspicion of acute myocarditis and infarctlike presentation. Participants underwent biventricular endomyocardial biopsy, cardiac catheterization, and cardiac MRI at 1.5 T, in which native T1 and T2 mapping as well as Lake Louise criteria (LLC) were assessed. Texture analysis was applied on T1 and T2 maps by using a freely available software package. Stepwise dimension reduction and texture feature selection was performed for selecting features enabling the diagnosis of myocarditis by using endomyocardial biopsy as the reference standard. Results Endomyocardial biopsy confirmed the diagnosis of acute myocarditis in 26 patients, whereas 13 participants had no signs of acute inflammation. Mean T1 and T2 values and LLC showed a low diagnostic performance, with area under the curve in receiver operating curve analyses as follows: 0.65 (95% confidence interval [CI]: 0.45, 0.85) for T1, 0.67 (95% CI: 0.49, 0.85) for T2, and 0.62 (95% CI: 0.42, 0.79) for LLC. Combining the texture features T2 run-length nonuniformity and gray-level nonuniformity resulted in higher diagnostic performance with an area under the curve of 0.88 (95% CI: 0.73, 1.00) (P < .001) and a sensitivity and specificity of 89% [95% CI: 81%, 93%] and 92% [95% CI: 77%, 93%], respectively. Conclusion Texture analysis of T2 maps shows high sensitivity and specificity for the diagnosis of acute infarctlike myocarditis. © RSNA, 2018 Online supplemental material is available for this article.

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CMR–Derived Extracellular Volume Fraction as a Marker for Myocardial Fibrosis

Cited by 72 publications

References 35 publications

Multiparametric cardiovascular magnetic resonance characteristics and dynamic changes in myocardial and skeletal muscles in idiopathic inflammatory cardiomyopathy

Multiparametric cardiovascular magnetic resonance characteristics and dynamic changes in myocardial and skeletal muscles in idiopathic inflammatory cardiomyopathy

Assessment of sympathetic reinnervation after cardiac transplantation using hybrid cardiac PET/MRI: A pilot study

Cardiac MRI Texture Analysis of T1 and T2 Maps in Patients with Infarctlike Acute Myocarditis

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