PMID- 24886708
OWN - NLM
STAT- MEDLINE
DCOM- 20141021
LR  - 20240117
IS  - 1532-429X (Electronic)
IS  - 1097-6647 (Print)
IS  - 1097-6647 (Linking)
VI  - 16
IP  - 1
DP  - 2014 May 23
TI  - Native T1-mapping detects the location, extent and patterns of acute myocarditis 
      without the need for gadolinium contrast agents.
PG  - 36
LID - 10.1186/1532-429X-16-36 [doi]
AB  - BACKGROUND: Acute myocarditis can be diagnosed on cardiovascular magnetic 
      resonance (CMR) using multiple techniques, including late gadolinium enhancement 
      (LGE) imaging, which requires contrast administration. Native T1-mapping is 
      significantly more sensitive than LGE and conventional T2-weighted (T2W) imaging 
      in detecting myocarditis. The aims of this study were to demonstrate how to 
      display the non-ischemic patterns of injury and to quantify myocardial 
      involvement in acute myocarditis without the need for contrast agents, using 
      topographic T1-maps and incremental T1 thresholds. METHODS: We studied 60 
      patients with suspected acute myocarditis (median 3 days from presentation) and 
      50 controls using CMR (1.5 T), including: (1) dark-blood T2W imaging; >(2) native 
      T1-mapping (ShMOLLI); (3) LGE. Analysis included: (1) global myocardial T2 signal 
      intensity (SI) ratio compared to skeletal muscle; (2) myocardial T1 times; (3) 
      areas of injury by T2W, T1-mapping and LGE. RESULTS: Compared to controls, 
      patients had more edema (global myocardial T2 SI ratio 1.71 +/- 0.27 
      vs.1.56 +/- 0.15), higher mean myocardial T1 (1011 +/- 64 ms vs. 946 +/- 23 ms) and 
      more areas of injury as detected by T2W (median 5% vs. 0%), T1 (median 32% vs. 
      0.7%) and LGE (median 11% vs. 0%); all p < 0.001. A threshold of T1 > 990 ms 
      (sensitivity 90%, specificity 88%) detected significantly larger areas of 
      involvement than T2W and LGE imaging in patients, and additional areas of injury 
      when T2W and LGE were negative. T1-mapping significantly improved the diagnostic 
      confidence in an additional 30% of cases when at least one of the conventional 
      methods (T2W, LGE) failed to identify any areas of abnormality. Using incremental 
      thresholds, T1-mapping can display the non-ischemic patterns of injury typical of 
      myocarditis. CONCLUSION: Native T1-mapping can display the typical non-ischemic 
      patterns in acute myocarditis, similar to LGE imaging but without the need for 
      contrast agents. In addition, T1-mapping offers significant incremental 
      diagnostic value, detecting additional areas of myocardial involvement beyond T2W 
      and LGE imaging and identified extra cases when these conventional methods failed 
      to identify abnormalities. In the future, it may be possible to perform 
      gadolinium-free CMR using cine and T1-mapping for tissue characterization and may 
      be particularly useful for patients in whom gadolinium contrast is 
      contraindicated.
FAU - Ferreira, Vanessa M
AU  - Ferreira VM
AD  - Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University 
      of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK. 
      vanessa.ferreira@cardiov.ox.ac.uk.
FAU - Piechnik, Stefan K
AU  - Piechnik SK
FAU - Dall'Armellina, Erica
AU  - Dall'Armellina E
FAU - Karamitsos, Theodoros D
AU  - Karamitsos TD
FAU - Francis, Jane M
AU  - Francis JM
FAU - Ntusi, Ntobeko
AU  - Ntusi N
FAU - Holloway, Cameron
AU  - Holloway C
FAU - Choudhury, Robin P
AU  - Choudhury RP
FAU - Kardos, Attila
AU  - Kardos A
FAU - Robson, Matthew D
AU  - Robson MD
FAU - Friedrich, Matthias G
AU  - Friedrich MG
FAU - Neubauer, Stefan
AU  - Neubauer S
LA  - eng
GR  - 088291/Wellcome Trust/United Kingdom
GR  - 090532/Wellcome Trust/United Kingdom
GR  - BHF_/British Heart Foundation/United Kingdom
GR  - MRC_/Medical Research Council/United Kingdom
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20140523
PL  - England
TA  - J Cardiovasc Magn Reson
JT  - Journal of cardiovascular magnetic resonance : official journal of the Society 
      for Cardiovascular Magnetic Resonance
JID - 9815616
RN  - 0 (Contrast Media)
SB  - IM
MH  - Acute Disease
MH  - Adult
MH  - Case-Control Studies
MH  - Contrast Media
MH  - Edema, Cardiac/diagnosis/pathology/physiopathology
MH  - England
MH  - Female
MH  - Humans
MH  - *Magnetic Resonance Imaging
MH  - Male
MH  - Middle Aged
MH  - Myocarditis/*diagnosis/pathology/physiopathology
MH  - Myocardium/*pathology
MH  - Predictive Value of Tests
MH  - Prospective Studies
MH  - Stroke Volume
MH  - *Ventricular Function, Left
PMC - PMC4041901
EDAT- 2014/06/03 06:00
MHDA- 2014/10/22 06:00
PMCR- 2014/05/23
CRDT- 2014/06/03 06:00
PHST- 2013/11/22 00:00 [received]
PHST- 2014/05/02 00:00 [accepted]
PHST- 2014/06/03 06:00 [entrez]
PHST- 2014/06/03 06:00 [pubmed]
PHST- 2014/10/22 06:00 [medline]
PHST- 2014/05/23 00:00 [pmc-release]
AID - S1097-6647(23)00090-X [pii]
AID - 1532-429X-16-36 [pii]
AID - 10.1186/1532-429X-16-36 [doi]
PST - epublish
SO  - J Cardiovasc Magn Reson. 2014 May 23;16(1):36. doi: 10.1186/1532-429X-16-36.