Native T1 Mapping by 3-T CMR Imaging for Characterization of Chronic Myocardial Infarctions

Avinash Kali; Eui-Young Choi; Behzad Sharif; Young Jin Kim; Xiaoming Bi; Bruce Spottiswoode; Ivan Cokic; Hsin-Jung Yang; Mourad Tighiouart; Antonio Hernandez Conte; Debiao Li; Daniel S Berman; Byoung Wook Choi; Hyuk-Jae Chang; Rohan Dharmakumar

doi:10.1016/j.jcmg.2015.04.018

Native T1 Mapping by 3-T CMR Imaging for Characterization of Chronic Myocardial Infarctions

JACC Cardiovasc Imaging. 2015 Sep;8(9):1019-1030. doi: 10.1016/j.jcmg.2015.04.018. Epub 2015 Aug 19.

Authors

Affiliations

¹ Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California; Department of Bioengineering, University of California, Los Angeles, California.
² Division of Cardiology, Yonsei University College of Medicine, Seoul, South Korea.
³ Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California.
⁴ Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea.
⁵ MR Research & Development, Siemens Healthcare, Los Angeles, California.
⁶ MR Research & Development, Siemens Healthcare, Chicago, Illinois.
⁷ Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, California.
⁸ Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California.
⁹ Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California; Department of Bioengineering, University of California, Los Angeles, California; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California.
¹⁰ Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California; Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
¹¹ Division of Cardiology, Yonsei University College of Medicine, Seoul, South Korea. Electronic address: hjchang@yuhs.ac.
¹² Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California; Department of Bioengineering, University of California, Los Angeles, California; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California; Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: rohandkumar@csmc.edu.

PMID: 26298071
DOI: 10.1016/j.jcmg.2015.04.018

Abstract

Objectives: The purpose of this study was to investigate whether native T1 maps at 3-T can reliably characterize chronic myocardial infarctions (MIs) in patients with prior ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI).

Background: Late gadolinium enhancement (LGE) cardiac magnetic resonance is the gold standard for characterizing chronic MIs, but it is contraindicated in patients with end-stage chronic kidney disease.

Methods: Native T1 and LGE images were acquired at 3-T in patients with prior STEMI (n = 13) and NSTEMI (n = 12) at a median of 13.6 years post-MI. Infarct location, size, and transmurality were measured using mean ± 5 SDs thresholding criterion from LGE images and T1 maps and compared against one another. Independent reviewers assessed visual conspicuity of MIs on LGE images and T1 maps.

Results: Native T1 maps and LGE images were not different for measuring infarct size (STEMI: p = 0.46; NSTEMI: p = 0.27) and transmurality (STEMI: p = 0.13; NSTEMI: p = 0.21) using thresholding criterion. Using thresholding criterion, good agreement was observed between LGE images and T1 maps for measuring infarct size (STEMI: bias = 0.6 ± 3.1%; R(2) = 0.93; NSTEMI: bias = -0.4 ± 4.4%; R(2) = 0.85) and transmurality (STEMI: bias = 2.0 ± 4.2%; R(2) = 0.89; NSTEMI: bias = -2.7 ± 7.9%; R(2) = 0.68). Sensitivity and specificity of T1 maps for detecting chronic MIs based on thresholding criterion were 89% and 98%, respectively (STEMI), and 87% and 95%, respectively (NSTEMI). Relative to LGE images, the mean visual conspicuity score for detecting chronic MIs was significantly lower for T1 maps (p < 0.001 for both cases). Median infarct-to-remote myocardium contrast-to-noise ratio was 2.5-fold higher for LGE images relative to T1 maps (p < 0.001). Sensitivity and specificity of T1 maps for visual detection were 60% and 86%, respectively (STEMI), and 64% and 91% (NSTEMI), respectively.

Conclusions: Chronic MIs in STEMI and NSTEMI patients can be reliably characterized using threshold-based detection on native T1 maps at 3-T. Visual detection of chronic MIs on native T1 maps in both patient populations has high specificity, but modest sensitivity.

Keywords: chronic myocardial infarction; native T(1) mapping; viability imaging.

Publication types

Comparative Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Chronic Disease
Contrast Media
Female
Humans
Image Interpretation, Computer-Assisted / methods*
Magnetic Resonance Imaging, Cine / methods*
Male
Middle Aged
Myocardial Infarction / diagnosis*
Myocardial Infarction / pathology
Myocardium / pathology*
Observer Variation
Organometallic Compounds
Predictive Value of Tests
Reproducibility of Results
Time Factors

Substances

Contrast Media
Organometallic Compounds
gadobutrol

Grants and funding

HL091989/HL/NHLBI NIH HHS/United States