T1 Mapping for the diagnosis of acute myocarditis using CMR: Comparison to T2-Weighted and late gadolinium enhanced imaging

Vanessa M. Ferreira, Stefan K. Piechnik, Erica Dall'Armellina, Theodoros D. Karamitsos, Jane M. Francis, Ntobeko Ntusi, Cameron Holloway, Robin P. Choudhury, A. Kardos, Matthew D. Robson, Matthias G. Friedrich, Stefan Neubauer

Research output: Contribution to journalArticle

190 Citations (Scopus)

Abstract

Objectives This study sought to test the diagnostic performance of native T1 mapping in acute myocarditis compared with cardiac magnetic resonance (CMR) techniques such as dark-blood T2-weighted (T2W)-CMR, bright-blood T2W-CMR, and late gadolinium enhancement (LGE) imaging. Background The diagnosis of acute myocarditis on CMR often requires multiple techniques, including T2W, early gadolinium enhancement, and LGE imaging. Novel techniques such as T1 mapping and bright-blood T2W-CMR are also sensitive to changes in free water content. We hypothesized that these techniques can serve as new and potentially superior diagnostic criteria for myocarditis. Methods We investigated 50 patients with suspected acute myocarditis (age 42 ± 16 years; 22% women) and 45 controls (age 42 ± 14 years; 22% women). CMR at 1.5-T (median 3 days from presentation) included: 1) dark-blood T2W-CMR (short-tau inversion recovery); 2) bright-blood T2W-CMR (acquisition for cardiac unified T2 edema); 3) native T1 mapping (shortened modified look-locker inversion recovery); and 4) LGE. Image analysis included: 1) global T2 signal intensity ratio of myocardium compared with skeletal muscle; 2) myocardial T1 relaxation times; and 3) areas of LGE. Results Compared with controls, patients had significantly higher global T2 signal intensity ratios by dark-blood T2W-CMR (1.73 ± 0.27 vs. 1.56 ± 0.15, p <0.01), bright-blood T2W-CMR (2.02 ± 0.33 vs. 1.84 ± 0.17, p <0.01), and mean myocardial T1 (1,010 ± 65 ms vs. 941 ± 18 ms, p <0.01). Receiver-operating characteristic analysis showed clear differences in diagnostic performance. The areas under the curve for each method were: T1 mapping (0.95), LGE (0.96), dark-blood T2 (0.78), and bright-blood T2 (0.76). A T1 cutoff of 990 ms had a sensitivity, specificity, and diagnostic accuracy of 90%, 91%, and 91%, respectively. Conclusions Native T1 mapping as a novel criterion for the detection of acute myocarditis showed excellent and superior diagnostic performance compared with T2W-CMR. It also has a higher sensitivity compared with T2W and LGE techniques, which may be especially useful in detecting subtle focal disease and when gadolinium contrast imaging is not feasible.

Original languageEnglish
Pages (from-to)1048-1058
Number of pages11
JournalJACC: Cardiovascular Imaging
Volume6
Issue number10
DOIs
Publication statusPublished - Oct 2013

Fingerprint

Myocarditis
Gadolinium
Magnetic Resonance Spectroscopy
Routine Diagnostic Tests
ROC Curve
Area Under Curve
Edema
Myocardium
Skeletal Muscle
Sensitivity and Specificity

Keywords

  • cardiac magnetic resonance
  • myocarditis
  • ShMOLLI
  • T -weighted CMR
  • T mapping

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Ferreira, V. M., Piechnik, S. K., Dall'Armellina, E., Karamitsos, T. D., Francis, J. M., Ntusi, N., ... Neubauer, S. (2013). T1 Mapping for the diagnosis of acute myocarditis using CMR: Comparison to T2-Weighted and late gadolinium enhanced imaging. JACC: Cardiovascular Imaging, 6(10), 1048-1058. https://doi.org/10.1016/j.jcmg.2013.03.008

T1 Mapping for the diagnosis of acute myocarditis using CMR : Comparison to T2-Weighted and late gadolinium enhanced imaging. / Ferreira, Vanessa M.; Piechnik, Stefan K.; Dall'Armellina, Erica; Karamitsos, Theodoros D.; Francis, Jane M.; Ntusi, Ntobeko; Holloway, Cameron; Choudhury, Robin P.; Kardos, A.; Robson, Matthew D.; Friedrich, Matthias G.; Neubauer, Stefan.

In: JACC: Cardiovascular Imaging, Vol. 6, No. 10, 10.2013, p. 1048-1058.

Research output: Contribution to journalArticle

Ferreira, VM, Piechnik, SK, Dall'Armellina, E, Karamitsos, TD, Francis, JM, Ntusi, N, Holloway, C, Choudhury, RP, Kardos, A, Robson, MD, Friedrich, MG & Neubauer, S 2013, 'T1 Mapping for the diagnosis of acute myocarditis using CMR: Comparison to T2-Weighted and late gadolinium enhanced imaging', JACC: Cardiovascular Imaging, vol. 6, no. 10, pp. 1048-1058. https://doi.org/10.1016/j.jcmg.2013.03.008
Ferreira, Vanessa M. ; Piechnik, Stefan K. ; Dall'Armellina, Erica ; Karamitsos, Theodoros D. ; Francis, Jane M. ; Ntusi, Ntobeko ; Holloway, Cameron ; Choudhury, Robin P. ; Kardos, A. ; Robson, Matthew D. ; Friedrich, Matthias G. ; Neubauer, Stefan. / T1 Mapping for the diagnosis of acute myocarditis using CMR : Comparison to T2-Weighted and late gadolinium enhanced imaging. In: JACC: Cardiovascular Imaging. 2013 ; Vol. 6, No. 10. pp. 1048-1058.
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title = "T1 Mapping for the diagnosis of acute myocarditis using CMR: Comparison to T2-Weighted and late gadolinium enhanced imaging",
abstract = "Objectives This study sought to test the diagnostic performance of native T1 mapping in acute myocarditis compared with cardiac magnetic resonance (CMR) techniques such as dark-blood T2-weighted (T2W)-CMR, bright-blood T2W-CMR, and late gadolinium enhancement (LGE) imaging. Background The diagnosis of acute myocarditis on CMR often requires multiple techniques, including T2W, early gadolinium enhancement, and LGE imaging. Novel techniques such as T1 mapping and bright-blood T2W-CMR are also sensitive to changes in free water content. We hypothesized that these techniques can serve as new and potentially superior diagnostic criteria for myocarditis. Methods We investigated 50 patients with suspected acute myocarditis (age 42 ± 16 years; 22{\%} women) and 45 controls (age 42 ± 14 years; 22{\%} women). CMR at 1.5-T (median 3 days from presentation) included: 1) dark-blood T2W-CMR (short-tau inversion recovery); 2) bright-blood T2W-CMR (acquisition for cardiac unified T2 edema); 3) native T1 mapping (shortened modified look-locker inversion recovery); and 4) LGE. Image analysis included: 1) global T2 signal intensity ratio of myocardium compared with skeletal muscle; 2) myocardial T1 relaxation times; and 3) areas of LGE. Results Compared with controls, patients had significantly higher global T2 signal intensity ratios by dark-blood T2W-CMR (1.73 ± 0.27 vs. 1.56 ± 0.15, p <0.01), bright-blood T2W-CMR (2.02 ± 0.33 vs. 1.84 ± 0.17, p <0.01), and mean myocardial T1 (1,010 ± 65 ms vs. 941 ± 18 ms, p <0.01). Receiver-operating characteristic analysis showed clear differences in diagnostic performance. The areas under the curve for each method were: T1 mapping (0.95), LGE (0.96), dark-blood T2 (0.78), and bright-blood T2 (0.76). A T1 cutoff of 990 ms had a sensitivity, specificity, and diagnostic accuracy of 90{\%}, 91{\%}, and 91{\%}, respectively. Conclusions Native T1 mapping as a novel criterion for the detection of acute myocarditis showed excellent and superior diagnostic performance compared with T2W-CMR. It also has a higher sensitivity compared with T2W and LGE techniques, which may be especially useful in detecting subtle focal disease and when gadolinium contrast imaging is not feasible.",
keywords = "cardiac magnetic resonance, myocarditis, ShMOLLI, T -weighted CMR, T mapping",
author = "Ferreira, {Vanessa M.} and Piechnik, {Stefan K.} and Erica Dall'Armellina and Karamitsos, {Theodoros D.} and Francis, {Jane M.} and Ntobeko Ntusi and Cameron Holloway and Choudhury, {Robin P.} and A. Kardos and Robson, {Matthew D.} and Friedrich, {Matthias G.} and Stefan Neubauer",
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T1 - T1 Mapping for the diagnosis of acute myocarditis using CMR

T2 - Comparison to T2-Weighted and late gadolinium enhanced imaging

AU - Ferreira, Vanessa M.

AU - Piechnik, Stefan K.

AU - Dall'Armellina, Erica

AU - Karamitsos, Theodoros D.

AU - Francis, Jane M.

AU - Ntusi, Ntobeko

AU - Holloway, Cameron

AU - Choudhury, Robin P.

AU - Kardos, A.

AU - Robson, Matthew D.

AU - Friedrich, Matthias G.

AU - Neubauer, Stefan

PY - 2013/10

Y1 - 2013/10

N2 - Objectives This study sought to test the diagnostic performance of native T1 mapping in acute myocarditis compared with cardiac magnetic resonance (CMR) techniques such as dark-blood T2-weighted (T2W)-CMR, bright-blood T2W-CMR, and late gadolinium enhancement (LGE) imaging. Background The diagnosis of acute myocarditis on CMR often requires multiple techniques, including T2W, early gadolinium enhancement, and LGE imaging. Novel techniques such as T1 mapping and bright-blood T2W-CMR are also sensitive to changes in free water content. We hypothesized that these techniques can serve as new and potentially superior diagnostic criteria for myocarditis. Methods We investigated 50 patients with suspected acute myocarditis (age 42 ± 16 years; 22% women) and 45 controls (age 42 ± 14 years; 22% women). CMR at 1.5-T (median 3 days from presentation) included: 1) dark-blood T2W-CMR (short-tau inversion recovery); 2) bright-blood T2W-CMR (acquisition for cardiac unified T2 edema); 3) native T1 mapping (shortened modified look-locker inversion recovery); and 4) LGE. Image analysis included: 1) global T2 signal intensity ratio of myocardium compared with skeletal muscle; 2) myocardial T1 relaxation times; and 3) areas of LGE. Results Compared with controls, patients had significantly higher global T2 signal intensity ratios by dark-blood T2W-CMR (1.73 ± 0.27 vs. 1.56 ± 0.15, p <0.01), bright-blood T2W-CMR (2.02 ± 0.33 vs. 1.84 ± 0.17, p <0.01), and mean myocardial T1 (1,010 ± 65 ms vs. 941 ± 18 ms, p <0.01). Receiver-operating characteristic analysis showed clear differences in diagnostic performance. The areas under the curve for each method were: T1 mapping (0.95), LGE (0.96), dark-blood T2 (0.78), and bright-blood T2 (0.76). A T1 cutoff of 990 ms had a sensitivity, specificity, and diagnostic accuracy of 90%, 91%, and 91%, respectively. Conclusions Native T1 mapping as a novel criterion for the detection of acute myocarditis showed excellent and superior diagnostic performance compared with T2W-CMR. It also has a higher sensitivity compared with T2W and LGE techniques, which may be especially useful in detecting subtle focal disease and when gadolinium contrast imaging is not feasible.

AB - Objectives This study sought to test the diagnostic performance of native T1 mapping in acute myocarditis compared with cardiac magnetic resonance (CMR) techniques such as dark-blood T2-weighted (T2W)-CMR, bright-blood T2W-CMR, and late gadolinium enhancement (LGE) imaging. Background The diagnosis of acute myocarditis on CMR often requires multiple techniques, including T2W, early gadolinium enhancement, and LGE imaging. Novel techniques such as T1 mapping and bright-blood T2W-CMR are also sensitive to changes in free water content. We hypothesized that these techniques can serve as new and potentially superior diagnostic criteria for myocarditis. Methods We investigated 50 patients with suspected acute myocarditis (age 42 ± 16 years; 22% women) and 45 controls (age 42 ± 14 years; 22% women). CMR at 1.5-T (median 3 days from presentation) included: 1) dark-blood T2W-CMR (short-tau inversion recovery); 2) bright-blood T2W-CMR (acquisition for cardiac unified T2 edema); 3) native T1 mapping (shortened modified look-locker inversion recovery); and 4) LGE. Image analysis included: 1) global T2 signal intensity ratio of myocardium compared with skeletal muscle; 2) myocardial T1 relaxation times; and 3) areas of LGE. Results Compared with controls, patients had significantly higher global T2 signal intensity ratios by dark-blood T2W-CMR (1.73 ± 0.27 vs. 1.56 ± 0.15, p <0.01), bright-blood T2W-CMR (2.02 ± 0.33 vs. 1.84 ± 0.17, p <0.01), and mean myocardial T1 (1,010 ± 65 ms vs. 941 ± 18 ms, p <0.01). Receiver-operating characteristic analysis showed clear differences in diagnostic performance. The areas under the curve for each method were: T1 mapping (0.95), LGE (0.96), dark-blood T2 (0.78), and bright-blood T2 (0.76). A T1 cutoff of 990 ms had a sensitivity, specificity, and diagnostic accuracy of 90%, 91%, and 91%, respectively. Conclusions Native T1 mapping as a novel criterion for the detection of acute myocarditis showed excellent and superior diagnostic performance compared with T2W-CMR. It also has a higher sensitivity compared with T2W and LGE techniques, which may be especially useful in detecting subtle focal disease and when gadolinium contrast imaging is not feasible.

KW - cardiac magnetic resonance

KW - myocarditis

KW - ShMOLLI

KW - T -weighted CMR

KW - T mapping

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