T1, T2 Mapping and Extracellular Volume Fraction (ECV): Application, Value and Further Perspectives in Myocardial Inflammation and Cardiomyopathies

 

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Abstract

Cardiac magnetic resonance imaging (CMRI) is a versatile diagnostic tool. One of its main advantages is the possibility of tissue characterization. T1-weighted images for scar and T2-weighted images for edema visualization are key methods for tissue characterization. Otherwise these sequences are strongly limited for the detection of diffuse myocardial pathologies. Recently, rapid technical innovations have generated new techniques. T1, T2 mapping and evaluation of the extracellular volume fraction (ECV) allow quantification of diffuse myocardial pathologies and showed great potential in the visualization of fibrosis, edema, amyloid, iron overload and lipid. In the future these techniques might enable the detection of early cardiac involvement, even act as a prognosticator. Moreover, therapy monitoring and follow-up might be possible due to versatile parameter quantification with these new techniques.

Key points:

• CMR allows for tissue characterization via T1- and T2-weighted sequences.

• In cases of diffuse, global myocardial pathologies, correct image interpretation with traditional CMR sequences might be difficult.

• T1, T2 mapping and ECV can quantify diffuse, global myocardial pathologies.

• Alterations of myocardial T1 and T2 relaxation times occur in various myocardial diseases (e. g. acute myocarditis).

• In the future mapping might act as a prognosticator or therapy monitoring tool.

Citation Format:

• Roller FC, Harth S, Schneider C et al. T1, T2 Mapping and Extracellular Volume Fraction (ECV): Application, Value and Further Perspectives in Myocardial Inflammation and Cardiomyopathies. Fortschr Röntgenstr 2015; 187: 760 – 770

Zusammenfassung

Die kardiale Magnetresonanztomografie (MRT) ist eine sehr vielseitig einsetzbare diagnostische Modalität. Einer ihrer Hauptvorteile liegt in der Möglichkeit Gewebecharakterisierung zu betreiben. Bisher wurden standardmäßig vor allem T1-gewichtete Sequenzen zur Bildgebung von fokalen myokardialen Narben bzw. Schädigungen und T2-gewichtete Bilder für die Ödembildgebung genutzt. Andererseits sind diese Techniken insbesondere bei der Visualisierung von globalen myokardialen Veränderungen technisch bedingt stark limitiert. Aktuell entwickelte Techniken wie das T1- und das T2-Mapping oder auch die Bestimmung des „Extrazellulären Volumens“ ermöglichen uns hingegen eine Quantifizierung von globalen myokardialen Veränderungen und Pathologien wie bereits für Fibrose und Ödem aber auch für Amyloidose, Fett- bzw. Eisenspeichererkrankungen gezeigt werden konnte. Aufgrund der vielversprechenden Ergebnisse, ihrer Robustheit sowie einer Quantifizierung von T1- und T2-Zeiten erlauben uns diese Techniken in Zukunft eine Detektion von frühen Krankheitsstadien oder eignen sich darüber hinaus vielleicht auch für eine Therapiemonitoring und eine Prognoseabschätzung im Rahmen von Verlaufskontrollen.

Kernaussagen:

• Die kardiale MRT ermöglicht eine Gewebecharakterisierung mittels T1- und T2-gewichteten Sequenzen.

• Bei globalen bzw. diffusen myokardialen Veränderungen sind diese Sequenzen jedoch limitiert und schränken die korrekte Bildinterpretation ein.

• Im Gegensatz dazu ermöglichen T1-, T2-Mapping und ECV eine Quantifizierung globaler myokardialer Veränderungen.

• Bei sehr vielen unterschiedlichen Erkrankungen konnten Veränderungen von T1 und T2 Relaxationszeiten gezeigt werden (z.B. Myokarditis)

• Zukünftig könnte Mapping auch in der Prognose und im Therapiemonitoring eine bedeutende Rolle zukommen

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