T1 Mapping Shows Increased Extracellular Matrix Size in the Myocardium Due to Amyloid Depositions

Robbers, Lourens; Baars, Emma N.; Brouwer, Wessel P.; Beek, Aernout M.; Hofman, Mark B.M.; Niessen, Hans W.M.; Rossum, Albert C. van; Marcu, C

doi:10.1161/circimaging.112.973438

Cited by 50 publications

(30 citation statements)

References 5 publications

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“…This suggests that blood correction helps in determining the true biological variability in myocardial T1 values, making it easier to differentiate pathological myocardial T1 values from normal myocardial T1 values. Native T1 mapping has shown diagnostic promise in amyloidosis [5, 43], as native myocardial T1 increases with amyloid deposition and inflammation [44]. Amyloidosis can be apparent in late gadolinium enhancement (LGE) images, but the patterns are often diffuse and globally distributed [45].…”

Section: Discussionmentioning

confidence: 99%

Blood correction reduces variability and gender differences in native myocardial T1 values at 1.5 T cardiovascular magnetic resonance – a derivation/validation approach

Nickander

Lundin

Abdula

et al. 2016

Journal of Cardiovascular Magnetic Resonance

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BackgroundMyocardial native T1 measurements are likely influenced by intramyocardial blood. Since blood T1 is both variable and longer compared to myocardial T1, this will degrade the precision of myocardial T1 measurements. Precision could be improved by correction, but the amount of correction and the optimal blood T1 variables to correct with are unknown. We hypothesized that an appropriate correction would reduce the standard deviation (SD) of native myocardial T1.MethodsConsecutive patients (n = 400) referred for CMR with known or suspected heart disease were split into a derivation cohort for model construction (n = 200, age 51 ± 18 years, 50% male) and a validation cohort for assessing model performance (n = 200, age 48 ± 17 years, 50% male). Exclusion criteria included focal septal abnormalities. A Modified Look-Locker inversion recovery sequence (MOLLI, 1.5 T Siemens Aera) was used to acquire T1 and T1* maps. T1 and T1* maps were used to measure native myocardial T1, and blood T1 and T1*. A multivariate linear regression correction model was implemented using blood measurement of R1 (1/T1), R1* (1/T1*) or hematocrit. The correction model from the derivation cohort was applied to the validation cohort, and assessed for reduction in variability with the F-test.ResultsBlood [LV + RV] mean R1, mean R1* and hematocrit correlated with myocardial T1 (Pearson’s r, range 0.37 to 0.45, p < 0.05 for all) in both the derivation and validation cohorts respectively, suggesting that myocardial T1 measurements are influenced by intramyocardial blood. Mean myocardial native T1 did not differ between the derivation and validation cohorts (1030 ± 42.6 ms and 1023 ± 45.2 ms respectively, p = 0.07). In the derivation cohort, correction using blood mean R1 and mean R1* yielded a decrease in myocardial T1 SD (45.2 ms to 36.6 ms, p = 0.03).When the model from the derivation cohort was applied to the validation cohort, the SD reduction was maintained (39.3 ms, p = 0.049). This 13% reduction in measurement variability leads to a 23% reduction in sample size to detect a 50 ms difference in native myocardial T1.ConclusionsCorrecting native myocardial T1 for R1 and R1* of blood improves the precision of myocardial T1 measurement by ~13%, and could consequently improve disease detection and reduce sample size needs for clinical research.

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Section: Discussionmentioning

confidence: 99%

Blood correction reduces variability and gender differences in native myocardial T1 values at 1.5 T cardiovascular magnetic resonance – a derivation/validation approach

Nickander

Lundin

Abdula

et al. 2016

Journal of Cardiovascular Magnetic Resonance

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“…In the last decade, cardiac magnetic resonance (CMR) has emerged as a robust imaging technique that provides detailed information about the presence, location, and distribution of hypertrophy, as well as visualization of cardiac amyloid infiltration with late gadolinium enhancement (LGE) imaging and measurement of cardiac amyloid burden with T1 mapping and extracellular volume (ECV) (12)(13)(14)(15)(16)(17)(18). One retrospective study in patients with cardiac amyloidosis (n = 51) suggested that a high proportion of patients have morphological phenotypes that differ from the classical description of concentric symmetric hypertrophy (19) but the amyloidosis type was not specified.…”

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confidence: 99%

Magnetic Resonance in Transthyretin Cardiac Amyloidosis

Martinez‐Naharro

Treibel

Abdel‐Gadir

et al. 2017

Journal of the American College of Cardiology

343

231

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“…The measurement of the T1 value has become easier through T1 mapping; consequently, the use of T1 mapping for the diagnosis of cardiac amyloidosis has recently been reported. In primary amyloid light-chain amyloidosis the T1 value is increased in non-contrast T1 mapping [35][36][37] and T1 mapping shows an increased extracellular matrix size in the myocardium due to amyloid deposition [35][36][37] (Fig. 7).…”

Section: Amyloidosismentioning

confidence: 99%

CT and MRI evaluation of cardiac complications in patients with hematologic diseases: a pictorial review

Kim

Jung

Kim

et al. 2015

Int J Cardiovasc Imaging

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Cardiac complications with hematologic diseases are not uncommon but it is difficult to diagnose, due to non-specific clinical symptoms. Prompt recognition of these potentially fatal complications by cardiac computed tomography (CT) or cardiac magnetic resonance imaging (MRI) may help to direct clinicians to specific treatments according to causes. Thrombosis is often related to central venous catheter use and is usually located at the catheter tip near the atrial wall. Differentiation of thrombosis from normal structure is possible with CT and, distinction of a thrombus from a tumor is possible on a delayed enhancement MRI with a long inversion time (500-600 ms). Granulocytic sarcoma of the heart is indicated by an infiltrative nature with involvement of whole layers of myocardium on CT and MRI. MRI with T2* mapping is useful in evaluating myocardial iron content in patients with hemochromatosis. Diffuse subendocardial enhancement is typically observed on delayed MRIs in patients with cardiac amyloidosis. T1 mapping is an emerging tool to diagnose amyloidosis. Myocardial abscess can occur due to an immunocompromised status. CT and MRI show loculated lesions with fluid density and concomitant rim-like contrast enhancement. Awareness of CT and MRI findings of cardiac complications of hematologic diseases can be helpful to physicians for clinical decision making and treatment.

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T1 Mapping Shows Increased Extracellular Matrix Size in the Myocardium Due to Amyloid Depositions

Cited by 50 publications

References 5 publications

Blood correction reduces variability and gender differences in native myocardial T1 values at 1.5 T cardiovascular magnetic resonance – a derivation/validation approach

Blood correction reduces variability and gender differences in native myocardial T1 values at 1.5 T cardiovascular magnetic resonance – a derivation/validation approach

Magnetic Resonance in Transthyretin Cardiac Amyloidosis

CT and MRI evaluation of cardiac complications in patients with hematologic diseases: a pictorial review

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