Fat in left ventricular myocardium assessed by steady-state free precession pulse sequences

Aquaro, Giovanni Donato; Nucifora, Gaetano; Pederzoli, Laura; Strata, Elisabetta; Marchi, Daniele De; Todiere, Giancarlo; Barison, Andrea; Pingitore, Alessandro; Lombardi, Massimo

doi:10.1007/s10554-011-9886-2

Cited by 23 publications

(20 citation statements)

References 19 publications

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“…15,16 CMR enables the differentiation of underlying myocardial injuries, including inflammation, 16 focal and diffuse fibrosis, 17 or fatty infiltration. 18,19 Similar morphological changes were described in DM2 in histological reports. 13 In this study, we aimed to use the CMR to investigate whether subclinical myocardial alterations in patients with DM2 were detectable in preserved LV function.…”

Section: See Editorial By Shah and Semigran See Clinical Perspectivesupporting

confidence: 78%

Cardiac Involvement in Myotonic Dystrophy Type 2 Patients With Preserved Ejection Fraction

Schmacht

Traber

Grieben

et al. 2016

Circ: Cardiovascular Imaging

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H magnetic resonance spectroscopy were performed. Extracellular volume fraction was calculated. Conduction abnormalities were diagnosed based on Groh criteria. LGE located subepicardial basal inferolateral was detectable in 22% of the patients. Extracellular volume was increased in this region and in the adjacent medial inferolateral segment (P=0.03 compared with healthy controls). In 21% of patients with DM2, fat deposits were detectable (all women). The control group showed no abnormalities. Myocardial triglycerides were not different in LGE-positive and LGE-negative subjects (P=0.47). Six patients had indicators for conduction disease (60% of LGE-positive patients and 12.5% of LGE-negative patients). Conclusions-In DM2, subclinical myocardial injury was already detectable in preserved left ventricular ejection fraction.

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Section: See Editorial By Shah and Semigran See Clinical Perspectivesupporting

confidence: 78%

Cardiac Involvement in Myotonic Dystrophy Type 2 Patients With Preserved Ejection Fraction

Schmacht

Traber

Grieben

et al. 2016

Circ: Cardiovascular Imaging

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“…However, the evidence in the literature for arrhythmogenic potential of calcium deposits within MI appears negative 48 . Finally, the presence of fat may also appear as hypointense lines (‘india-ink’ artifact) or hypointense lines enclosing hyperintense territories in bSSFP images 35 . Based on our definition that HIC+ regions need to have at least eight contiguous nearest neighbor pixels, we believe that we were able to minimize fatty infarcts from being counted as HIC+.…”

Section: Discussionmentioning

confidence: 99%

“…All other subjects that did not have hypointense regions or those that did not conform to the identification criterion (i.e. those resembling ‘india-ink’ artifacts 35 , bSSFP banding artifacts 36 and hyperintense regions enclosed by fine hypointense lines 35 ) were identified as HIC−. The 8-pixel approach adapted here is similar to that used in previous publications to visually guide the detection of a desired image contrast 37,38 .…”

Section: Methodsmentioning

confidence: 99%

Iron-Sensitive Cardiac Magnetic Resonance Imaging for Prediction of Ventricular Arrhythmia Risk in Patients With Chronic Myocardial Infarction

Cokic

Kali

Yang

et al. 2015

Circ: Cardiovascular Imaging

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BACKGROUND Recent canines studies have shown that iron deposition within chronic myocardial infarction (CMI) influences the electrical behavior of the heart. To date, the link between the iron deposition and malignant ventricular arrhythmias (mVA) in humans with CMI is unknown. METHODS AND RESULTS CMI patients (n=94) who underwent late-gadolinium-enhanced CMR prior to ICD implantation for primary and secondary prevention were retrospectively analyzed. The predictive values of hypointense cores (HIC) in balanced steady-state free precession (bSSFP) images and conventional CMR and ECG mVA parameters for the prediction of primary combined outcome (appropriate ICD therapy, survived cardiac arrest or sudden cardiac death) were studied. The use of HIC within CMI on bSSFP as a marker of iron deposition was validated in a canine MI model (n=18). Nineteen patients met the study criteria with events occurring at a median of 249 (interquartile range (IQR) of 540) days after ICD placement. Of the 19 patients meeting the primary endpoint, 18 were classified as HIC+, while only 1 was HIC−. Among the cohort in whom the primary endpoint was not met, there were 28 HIC+ and 47 HIC− patients. ROC analysis demonstrated an additive predictive value of HIC for mVAs with an increased AUC to 0.87 when added to LVEF (LVEF alone 0.68). Both CMR and histological validation studies performed in canines demonstrated that HIC regions in bSSFP images within CMI likely result from iron depositions. CONCLUSIONS Hypointense cores within CMI on bSSFP CMR can be used as a marker of iron deposition and yields incremental information toward improved prediction of mVA.

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“…Artifacts due to partial volume effects between water and fat are well known [ 4 - 9 ] and the out-of-phase cancellation causes a distinctive appearance sometimes referred to as an India ink artifact. A number of studies have proposed exploiting the appearance of this artifact to detect the presence of fat [ 4 , 6 , 7 , 10 ]. This approach to detection of fat is limited by the fraction of fat in the voxel and the size of the region which determine the contrast and conspicuity between water and fat.…”

Section: Introductionmentioning

confidence: 99%

Characterization of myocardial T1-mapping bias caused by intramyocardial fat in inversion recovery and saturation recovery techniques

Kellman

Bandettini

Mancini

et al. 2015

Journal of Cardiovascular Magnetic Resonance

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BackgroundQuantitative measurement of T1 in the myocardium may be used to detect both focal and diffuse disease processes such as interstitial fibrosis or edema. A partial volume problem exists when a voxel in the myocardium also contains fat. Partial volume with fat occurs at tissue boundaries or within the myocardium in the case of lipomatous metaplasia of replacement fibrosis, which is commonly seen in chronic myocardial infarction. The presence of fat leads to a bias in T1 measurement. The mechanism for this artifact for widely used T1 mapping protocols using balanced steady state free precession readout and the dependence on off-resonance frequency are described in this paper.MethodsSimulations were performed to illustrate the behavior of mono-exponential fitting to bi-exponential mixtures of myocardium and fat with varying fat fractions. Both inversion recovery and saturation recovery imaging protocols using balanced steady state free precession are considered. In-vivo imaging with T1-mapping, water/fat separated imaging, and late enhancement imaging was performed on subjects with chronic myocardial infarction.ResultsIn n = 17 subjects with chronic myocardial infarction, lipomatous metaplasia is evident in 8 patients (47%). Fat fractions as low as 5% caused approximately 6% T1 elevation for the out-of-phase condition, and approximately 5% reduction of T1 for the in-phase condition. T1 bias in excess of 1000 ms was observed in lipomatous metaplasia with fat fraction of 38% in close agreement with simulation of the specific imaging protocols.ConclusionsMeasurement of the myocardial T1 by widely used balanced steady state free precession mapping methods is subject to bias when there is a mixture of water and fat in the myocardium. Intramyocardial fat is frequently present in myocardial scar tissue due lipomatous metaplasia, a process affecting myocardial infarction and some non-ischemic cardiomyopathies. In cases of lipomatous metaplasia, the T1 biases will be additive or subtractive depending on whether the center frequency corresponds to the myocardium and fat being in-phase or out-of-phase, respectively. It is important to understand this mechanism, which may otherwise lead to erroneous interpretation.

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Fat in left ventricular myocardium assessed by steady-state free precession pulse sequences

Cited by 23 publications

References 19 publications

Cardiac Involvement in Myotonic Dystrophy Type 2 Patients With Preserved Ejection Fraction

Cardiac Involvement in Myotonic Dystrophy Type 2 Patients With Preserved Ejection Fraction

Iron-Sensitive Cardiac Magnetic Resonance Imaging for Prediction of Ventricular Arrhythmia Risk in Patients With Chronic Myocardial Infarction

Characterization of myocardial T1-mapping bias caused by intramyocardial fat in inversion recovery and saturation recovery techniques

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