Non-contrast T1 mapping characterizes the myocardium beyond that achieved by late gadolinium enhancement in both hypertrophic and dilated cardiomyopathy
verfasst von:
Sairia Dass, Joseph Suttie, Stefan K Piechnik, Vanessa Ferreira, Cameron Holloway, Matthew D Robson, Hugh Watkins, Theodoros Karamitsos, Stefan Neubauer
T1 relaxation is prolonged in hypertrophic (HCM) and dilated cardiomyopathy (DCM) and reflects myocardial changes prior to presence of LGE or development of hypertrophy in HCM and wall thinning in DCM.
Background
Both HCM and DCM exhibit variable clinical outcomes. Unfortunately, our ability to risk stratify and characterize disease mechanisms in these patients remains poor, and improved biomarkers are needed. Myocardial fibrosis, both focal and diffuse, is a feature of both HCM and DCM and focal myocardial fibrosis, as assessed by LGE, has been recently identified as a predictor of cardiac death in HCM and DCM.
Anzeige
We recently developed a novel method for non-contrast CMR T1 mapping, a recognized marker of increased water content such as in fibrotic tissue. We hypothesized that T1 mapping offers an alternative to late gadolinium enhancement (LGE) techniques, providing additional non- invasive diagnostic information in HCM and DCM.
Methods
Sixty one subjects underwent CMR imaging, 3T Siemens Trio,(29 HCM, 18 DCM and 14 normals). Matching short axis slices were acquired for cine, T1 mapping (short modified look locker inversion recovery - ShMOLLI - sequence) and late gadolinium enhancement (LGE) imaging (0.1 mmol/kg). Myocardium was manually contoured on each slice and divided into 6 segments to calculate: mean T1, mean LGE enhancement (segment intensity divided by signal in remote myocardium), end diastolic wall thickness from cine images.
Results
Mean T1 relaxation time was significantly elevated in HCM and DCM (HCM 1208±47ms, DCM 1224±69ms, normal 1172±45ms, p<0.05, figure 1a). Interestingly, myocardial T1 values were elevated in HCM gene carriers without LVH (n=8) to similar levels as those with LVH (n=21), figure. 1b. None-the-less T1 was elevated irrespective of wall thickness. However, there was a positive correlation between T1 values and wall thickness in HCM. In DCM, there was a negative correlation, figure 2.
Figure 1
Myocardial T1 relaxation times in a) normal controls, HCM and DCM; b) normal controls, HCM pre hypertrophy and HCM with hypertrophy. P values represent 3 way Bonferroni corrected ANOVA, * represents P<0.0001 vs normal, † P<0.01 vs normal. Error bars are standard error of mean.
Figure 2
In HCM and DCM, T1 relaxation time ploted in tertiles of end diastolic wall thickness, error bars are standard error of the mean.
×
×
There was a weak, but significant, correlation between mean T1 and LGE (r= 0.32, p< 0.001). T1 values were significantly higher in segments with LGE than in those without (HCM with LGE 1229±42ms vs no LGE 1193±44ms, p<0.05; DCM with LGE 1252±87ms vs no LGE 1213±55ms p<0.05). However, even in segments unaffected by LGE, T1 values were significantly higher than normal (p<0.001).
Anzeige
Conclusions
In HCM and DCM, non-contrast T1 mapping detects underlying disease processes which to some extent reflect the presence of LGE but yields further insights into adverse ventricular remodeling beyond the traditional measures of wall thickness and LGE. Myocardial T1 values are elevated in HCM patients without LVH and in DCM patients pre wall thinning suggesting that absolute T1 mapping may also have applications in the detection of early myocardial disease. Hence, T1 mapping may become an important new tool for diagnosis, therapy monitoring and prognostic assessment in HCM and DCM.
Funding
This research was funded by the British heart foundation.
This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Non-contrast T1 mapping characterizes the myocardium beyond that achieved by late gadolinium enhancement in both hypertrophic and dilated cardiomyopathy
verfasst von
Sairia Dass Joseph Suttie Stefan K Piechnik Vanessa Ferreira Cameron Holloway Matthew D Robson Hugh Watkins Theodoros Karamitsos Stefan Neubauer
Extreme Arbeitsverdichtung und kaum Supervision: Dr. Andrea Martini, Sprecherin des Bündnisses Junge Ärztinnen und Ärzte (BJÄ) über den Frust des ärztlichen Nachwuchses und die Vorteile des Rucksack-Modells.
Darauf haben viele Praxen gewartet: Das Zi hat eine Liste von Praxisverwaltungssystemen veröffentlicht, die von Nutzern positiv bewertet werden. Eine gute Grundlage für wechselwillige Ärztinnen und Psychotherapeuten.
Akuter Schwindel stellt oft eine diagnostische Herausforderung dar. Wie nützlich dabei eine MRT ist, hat eine Studie aus Finnland untersucht. Immerhin einer von sechs Patienten wurde mit akutem ischämischem Schlaganfall diagnostiziert.
Routinemäßige Mammografien helfen, Brustkrebs frühzeitig zu erkennen. Anhand der Röntgenuntersuchung lassen sich aber auch kardiovaskuläre Risikopatientinnen identifizieren. Als zuverlässiger Anhaltspunkt gilt die Verkalkung der Brustarterien.
Update Radiologie
Bestellen Sie unseren Fach-Newsletterund bleiben Sie gut informiert.
