Author + information
- Erica Dall'Armellina, MD, DPhil∗ (, )
- Vanessa M. Ferreira, MD, DPhil,
- Rajesh K. Kharbanda, MD,
- Bernard Prendergast, MD,
- Stefan K. Piechnik, PhD,
- Matthew D. Robson, PhD,
- Melanie Jones, DCR,
- Jane M. Francis, DCR(R), DNM,
- Robin P. Choudhury, DM and
- Stefan Neubauer, MD
- Oxford Centre for Clinical Magnetic Resonance Research, Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
- ↵∗Address for correspondence:
Dr. Erica Dall’Armellina, Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom.
accurate assessment of myocardial injury in coronary artery disease is important to address the efficacy of treatment. Novel cardiac magnetic resonance (CMR) pre-contrast T1 mapping techniques allow voxel-wise quantitative assessment of tissue composition. Although the clinical value of this technique in chronic myocardial scar is yet to be fully defined, T1 mapping allows assessment of acute myocardial edema (1) and the severity of acute ischemic injury (2,3). T1 mapping may provide a better understanding of the pathophysiology in acute ischemic injury, with potential to offer additional diagnostic and prognostic value compared with standard techniques. As shown in the following cases, T1 maps and T1 values are available immediately on the scanner console with no need for post-processing (Figs. 1 to 5)⇓⇓⇓. By allowing visualization of the tissue composition (including intracardiac masses and pericardium), T1 mapping may, in the near future, offer a comprehensive assessment of ischemic injury and related findings without the need for multiparametric acquisitions or exogenous contrast agents.
This series of cases illustrates the potential clinical utility of T1 mapping and its additional value in the clinical imaging workflow of patients with acute and chronic myocardial infarction. We have shown how this novel CMR mapping technique helps to define: 1) time-dependent changes in myocardial T1 values; and 2) associated intracavitary or pericardial pathology. Compared with standard CMR techniques (such as T2-weighted, early gadolinium-enhanced, and late gadolinium-enhanced imaging), the additional clinical value of T1 mapping lies in the ability to depict, on a voxel-wise basis, tissue changes that may otherwise not be evident, without need for signal intensity thresholding, post-processing, or contrast agents. Further research in this area will have to establish the full potential of this technique for tissue characterization (i.e., the differentiation between microvascular obstruction and hemorrhage, pericardial exudate and transudate), its prognostic value and clinical utility.
In conclusion, CMR pre-contrast mapping techniques may provide us with a unique opportunity to improve the diagnostic utility of CMR (i.e., its ability to comprehensively assess acute and chronic changes in patients with myocardial infarction without the need for multiparametric imaging).
Drs. Prendergast and Kharbanda are consultant cardiologists at the Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom. Drs. Piechnik and Robson have U.S. patent pending 61/387,591, Systems and Methods for Shortened Look Locker Inversion Recovery (Sh-MOLLI) Cardiac Gated Mapping of T1; and U.S. patent pending 61/689,067, Color Map Design Method for Immediate Assessment of the Deviation From Established Normal Population Statistics and Its Application to Cardiovascular T1 Mapping Images. Dr. Neubauer is a consultant for Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation