The dynamics of extracellular gadolinium-based contrast agent excretion into pleural and pericardial effusions quantified by T1 mapping cardiovascular magnetic resonance

Thalén, Simon; Maanja, Maren; Sigfridsson, Andreas; Maret, Eva; Sörensson, Peder

doi:10.1186/s12968-019-0580-1

Cited by 4 publications

(8 citation statements)

References 36 publications

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“…Measurement of blood T1 values has shown that almost 80% of measured blood T1 variability can be explained by differences in hematocrit, iron and HDL-cholesterol levels in healthy subjects (18). Recently, Thalen et al evaluated the diagnostic utility of T1 mapping to determine quantitative contrast dynamics in pericardial and pleural effusions (35). In this study no fluid biochemical data was available, but the estimation of native T1 mapping was performed using the same sequence (MOLLI) at the same field strength (1.5T).…”

Section: Discussionmentioning

confidence: 99%

Non-invasive characterization of pleural and pericardial effusions using T1 mapping by magnetic resonance imaging

Rosmini

Seraphim

Knott

et al. 2021

European Heart Journal - Cardiovascular Imaging

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Aims Differentiating exudative from transudative effusions is clinically important and is currently performed via biochemical analysis of invasively obtained samples using Light’s criteria. Diagnostic performance is however limited. Biochemical composition can be measured with T1 mapping using cardiovascular magnetic resonance (CMR) and hence may offer diagnostic utility for assessment of effusions. Methods and results A phantom consisting of serially diluted human albumin solutions (25–200 g/L) was constructed and scanned at 1.5 T to derive the relationship between fluid T1 values and fluid albumin concentration. Native T1 values of pleural and pericardial effusions from 86 patients undergoing clinical CMR studies retrospectively analysed at four tertiary centres. Effusions were classified using Light’s criteria where biochemical data was available (n = 55) or clinically in decompensated heart failure patients with presumed transudative effusions (n = 31). Fluid T1 and protein values were inversely correlated both in the phantom (r = −0.992) and clinical samples (r = −0.663, P < 0.0001). T1 values were lower in exudative compared to transudative pleural (3252 ± 207 ms vs. 3596 ± 213 ms, P < 0.0001) and pericardial (2749 ± 373 ms vs. 3337 ± 245 ms, P < 0.0001) effusions. The diagnostic accuracy of T1 mapping for detecting transudates was very good for pleural and excellent for pericardial effusions, respectively [area under the curve 0.88, (95% CI 0.764–0.996), P = 0.001, 79% sensitivity, 89% specificity, and 0.93, (95% CI 0.855–1.000), P < 0.0001, 95% sensitivity; 81% specificity]. Conclusion Native T1 values of effusions measured using CMR correlate well with protein concentrations and may be helpful for discriminating between transudates and exudates. This may help focus the requirement for invasive diagnostic sampling, avoiding unnecessary intervention in patients with unequivocal transudative effusions.

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Section: Discussionmentioning

confidence: 99%

Non-invasive characterization of pleural and pericardial effusions using T1 mapping by magnetic resonance imaging

Rosmini

Seraphim

Knott

et al. 2021

European Heart Journal - Cardiovascular Imaging

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“…One study showed 100% positive predictive value in diagnosing exudative pleural effusions using T1-weighted imaging and GBCA excretion [15]. More recently, T1 mapping of pericardial and pleural effusion fluid has also shown that GBCA routinely administered during CMR exams is always excreted into the effusion fluid, albeit with considerable variability in the amount excreted [16].…”

Section: Introductionmentioning

confidence: 99%

“…The current study aimed to measure T1 in pericardial fluid before, early, and late after intravenous GBCA administration in healthy volunteers to determine the feasibility of these measurements and establish normal values. We also sought to compare the normal values to that of a clinical cohort examined in a previously published study [16].…”

Section: Introductionmentioning

confidence: 99%

Normal values for native T1 at 1.5T in the pericardial fluid of healthy volunteers

Thalén

Ramos

Engblom

et al. 2022

Preprint

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T1 mapping cardiovascular magnetic resonance (CMR) imaging has been used to characterize pericardial effusions, and shown that routinely administered gadolinium-based contrast agents (GBCA) are excreted into effusion fluid.AimsTo measure pericardial fluid T1 before and after contrast administration in healthy volunteers to establish normal values and compare them to patients with pericardial effusion. Volunteers (n=30) were compared to retrospectively included patients with at least 5 mm of pericardial effusion (n=69). T1 maps were acquired at 1.5T CMR. A volume of pericardial fluid was imaged in a short-axis slice and in a slice perpendicular to the short-axis orientation. A reliable measurement had a region of interest size >10mm2, coefficient of variation <10%, and a relative difference <5% between the two slice orientations. In 26/30 (87%) of volunteers, there was a sufficient amount of pericardial fluid to enable reliable measurement. Native T1 did not differ between slice orientations (3262±163 vs 3267±173 ms, p=0.75). In patients, native T1 was normal in 41%, above normal in 3%, below normal in 56%, and GBCA concentration, estimated using the specific relaxivity of the GBCA used, was normal in 65% and above normal in 35%. More than half of effusions in patients had a native T1 below normal, consistent with higher protein content, and a third had an above normal GBCA excretion despite dilution effects, suggesting an inflammatory and exudative etiology. The use of T1 mapping and contrast dynamics to characterize pericardial fluid merits prospective evaluation.

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“…5 At present, the conventional methods for differentiation of CP and RCM are as follows: echocardiography (respiratory-related ventricular septal shift in CP); 6,7 chest computed tomography (CT, thickening of the pericardium [>4 mm]); 8 and cardiac magnetic resonance (CMR) imaging examination including T2 relaxation time sequences, short-tau inversion-recovery sequences, and late gadolinium enhancement. 9 The conventional imaging methods may lead to misdiagnosis and cannot completely distinguish CP and RCM. 10 Hence, more distinct diagnostic criteria are necessary.…”

Section: Introductionmentioning

confidence: 99%

“…However, the therapeutic options for RCM are very limited and the prognosis is usually poor; understandably, surgery for RCM that is misdiagnosed as CP can have catastrophic consequences 5 . At present, the conventional methods for differentiation of CP and RCM are as follows: echocardiography (respiratory‐related ventricular septal shift in CP); 6,7 chest computed tomography (CT, thickening of the pericardium [>4 mm]); 8 and cardiac magnetic resonance (CMR) imaging examination including T2 relaxation time sequences, short‐tau inversion‐recovery sequences, and late gadolinium enhancement 9 . The conventional imaging methods may lead to misdiagnosis and cannot completely distinguish CP and RCM 10 .…”

Section: Introductionmentioning

confidence: 99%

Left ventricular strain‐curve morphology to distinguish between constrictive pericarditis and restrictive cardiomyopathy

et al. 2021

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Aims To distinguish between constrictive pericarditis (CP) and restrictive cardiomyopathy (RCM) using cardiac magnetic resonance feature tracking (CMR‐FT) left ventricle (LV) diastolic time–strain curve patterns and myocardial strain. Methods and Results A total of 32 CP patients, 27 RCM patients, and 25 control subjects were examined by CMR‐FT and analysed for global strain, segmental strain, and LV time–strain curve patterns in the longitudinal, circumferential, and radial directions. Speckle tracking echocardiography (STE) strain imaging was performed in some cases. The peak global longitudinal strain (GLS) and global circumferential strain (GCS) of the RCM group were lower than those of the CP group. GLS [median (interquartile range) CP vs. RCM: −11.15 (−12.85, −9.35) vs. −6.5 (−8.75, −4.85), P < 0.001] and GCS (CP vs. RCM: −16.89 ± 5.11 vs. −13.37 ± 5.79, P < 0.001). In circumferential and radial directions, the strain ratios of the LV lateral/septal wall (LW/SW) of the CP group were significantly lower than those of the RCM group at the basal and mid segments. The CS ratio of LW/SW at the basal segment [CP vs. RCM: 0.95 (0.85, 1.25) vs. 1.43 (1.18, 1.89), P < 0.001] and mid segment [CP vs. RCM: 1.05 (0.92, 1.15) vs. 1.18 (1.06, 1.49), P = 0.026]. The RS ratio of LW/SW at the basal segment [CP vs. RCM: 0.97 (0.76, 1.37) vs. 1.55 (1.08, 2.31), P = 0.006] and mid segment [CP vs. RCM: 0.95 (0.70, 1.28) vs. 1.79 (1.32, 2.92), P < 0.001]. In the longitudinal and circumferential directions, the characteristic ‘plateau’ pattern of time–strain curves could be seen in the CP but not in the RCM during the diastole. The GCS ratio of 0–50%/50–75% diastolic period of the CP was higher than that of the RCM [CP vs. RCM: 17.01 (8.67, 23.75) vs. 5.38 (1.93, 11.24), P = 0.001], while the GCS ratio of 50–75%/75–100% diastolic period was lower than that of the RCM [CP vs. RCM: 0.36 (0.15, 1.67) vs. 1.12 (0.70, 5.58), P < 0.001]. The peak GLS (sensitivity, 85%; specificity, 78%) and the GCS ratio of 0–50%/50–75% diastolic period (sensitivity, 88%; specificity, 73%) had higher differential diagnosis value. Conclusions The CMR‐FT could distinctly differentiate CP from RCM based on LV myocardial strain and LV time–strain curve patterns. The characteristic ‘plateau’ pattern of the time–strain curve is specific for CP and not RCM and this curve can also be duplicated by STE.

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The dynamics of extracellular gadolinium-based contrast agent excretion into pleural and pericardial effusions quantified by T1 mapping cardiovascular magnetic resonance

Cited by 4 publications

References 36 publications

Non-invasive characterization of pleural and pericardial effusions using T1 mapping by magnetic resonance imaging

Non-invasive characterization of pleural and pericardial effusions using T1 mapping by magnetic resonance imaging

Normal values for native T1 at 1.5T in the pericardial fluid of healthy volunteers

Left ventricular strain‐curve morphology to distinguish between constrictive pericarditis and restrictive cardiomyopathy

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