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Journal of Cardiovascular Magnetic Resonance
Published in: Journal of Cardiovascular Magnetic Resonance 1/2015

Open Access 01-12-2015 | Research

Gadolinium free cardiovascular magnetic resonance with 2-point Cine balanced steady state free precession

Authors: Tori A. Stromp, Steve W. Leung, Kristin N. Andres, Linyuan Jing, Brandon K. Fornwalt, Richard J. Charnigo, Vincent L. Sorrell, Moriel H. Vandsburger

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2015

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Abstract

Background

Cardiovascular magnetic resonance (CMR) of ventricular structure and function is widely performed using cine balanced steady state free precession (bSSFP) MRI. The bSSFP signal of myocardium is weighted by magnetization transfer (MT) and T1/T2-relaxation times. In edematous and fibrotic tissues, increased T2 and reduced MT lead to increased signal intensity on images acquired with high excitation flip angles. We hypothesized that acquisition of two differentially MT-weighted bSSFP images (termed 2-point bSSFP) can identify tissue that would enhance with gadolinium similar to standard of care late gadolinium enhancement (LGE).

Methods

Cine bSSFP images (flip angles of 5° and 45°) and native-T1 and T2 maps were acquired in one mid-ventricular slice in 47 patients referred for CMR and 10 healthy controls. Afterwards, LGE images and post-contrast T1 maps were acquired and gadolinium partition coefficient (GPC) was calculated. Maps of ΔS/So were calculated as (S45-S5)/S5*100 (%), where Sflip_angle is the voxel signal intensity.

Results

Twenty three patients demonstrated areas of myocardial hyper-enhancement with LGE. In enhanced regions, ΔS/So, native-T1, T2, and GPC were heightened (p < 0.05 vs. non-enhanced tissues). ΔS/So, native-T1, and T2 all demonstrated association with GPC, however the association was strongest for ΔS/So. Bland-Altman analysis revealed a slight bias towards larger volume of enhancement with ΔS/So compared to LGE, and similar transmurality. Subjective analysis with 2-blinded expert readers revealed agreement between ΔS/So and LGE of 73.4 %, with false positive detection of 16.7 % and false negative detection of 15.2 %.

Conclusions

Gadolinium free 2-point bSSFP identified tissue that enhances at LGE with strong association to GPC. Our results suggest that with further development, MT-weighted CMR could be used similar to LGE for diagnostic imaging.
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Literature
1.
Vandsburger M, Epstein F. Emerging MRI Methods in Translational Cardiovascular Research. J of Cardiovasc Trans Res. 2011;4(4):477–92.CrossRef
2.
Wu KC, Weiss RG, Thiemann DR, Kitagawa K, Schmidt A, Dalal D, et al. Late Gadolinium Enhancement by Cardiovascular Magnetic Resonance Heralds an Adverse Prognosis in Nonischemic Cardiomyopathy. J Am Coll Cardiol. 2008;51(25):2414–21.PubMedCentralCrossRefPubMed
3.
Kellman P, Wilson J, Xue H, Bandettini WP, Shanbhag SM, Druey KM et al. Extracellular volume fraction mapping in the myocardium, part 2: initial clinical experience. J Cardiovasc Magn Reson. 2012;14(64).
4.
Kellman P, Wilson J, Xue H, Ugander M, Arai AE. Extracellular volume fraction mapping in the myocardium, part 1: evaluation of an automated method. J Cardiovasc Magn Reson. 2012;14(64).
5.
Wong TC, Piehler KM, Kang IA, Kadakkal A, Kellman P, Schwartzman DS, et al. Myocardial extracellular volume fraction quantified by cardiovascular magnetic resonance is increased in diabetes and associated with mortality and incident heart failure admission. Eur Heart J. 2014;35(10):657–64.PubMedCentralCrossRefPubMed
6.
Broome DR. Nephrogenic systemic fibrosis associated with gadolinium based contrast agents: A summary of the medical literature reporting. Eur J Radiol. 2008;66(2):230–4.CrossRefPubMed
7.
Giri S, Chung Y-C, Merchant A, Mihai G, Rajagopalan S, Raman S, et al. T2 quantification for improved detection of myocardial edema. J Cardiovasc Magn Reson. 2009;11(1):56.PubMedCentralCrossRefPubMed
8.
Verhaert D, Thavendiranathan P, Giri S, Mihai G, Rajagopalan S, Simonetti OP, et al. Direct T2 Quantification of Myocardial Edema in Acute Ischemic Injury. J Am Coll Cardiol Img. 2011;4(3):269–78.CrossRef
9.
Bull S, White SK, Piechnik SK, Flett AS, Ferreira VM, Loudon M, et al. Human non-contrast T1 values and correlation with histology in diffuse fibrosis. Heart. 2013;99(13):932–7.PubMedCentralCrossRefPubMed
10.
Ferreira VM, Piechnik SK, Dall'Armellina E, Karamitsos TD, Francis JM, Ntusi N, et al. T1 Mapping for the Diagnosis of Acute Myocarditis Using CMR: Comparison to T2-Weighted and Late Gadolinium Enhanced Imaging. J Am Coll Cardiol Img. 2013;6(10):1048–58.CrossRef
11.
Puntmann VO, Voigt T, Chen Z, Mayr M, Karim R, Rhode K, et al. Native T1 Mapping in Differentiation of Normal Myocardium From Diffuse Disease in Hypertrophic and Dilated Cardiomyopathy. J Am Coll Cardiol Img. 2013;6(4):475–84.CrossRef
12.
Baksi AJ, Pennell DJ. T1 Mapping in Heart Failure: From Technique to Prognosis, Toward Altering Outcome. Circulation: Cardiovasc Imag. 2013;6(6):861–3.
13.
14.
Moon J, Messroghli D, Kellman P, Piechnik S, Robson M, Ugander M, et al. Myocardial T1 mapping and extracellular volume quantification: a Society for Cardiovascular Magnetic Resonance (SCMR) and CMR Working Group of the European Society of Cardiology consensus statement. J Cardiovasc Magn Reson. 2013;15(1):92.PubMedCentralCrossRefPubMed
15.
Roujol S, Weingärtner S, Foppa M, Chow K, Kawaji K, Ngo LH, et al. Accuracy, Precision, and Reproducibility of Four T1 Mapping Sequences: A Head-to-Head Comparison of MOLLI, ShMOLLI, SASHA, and SAPPHIRE. Radiology. 2014;272(3):683–9.PubMedCentralCrossRefPubMed
16.
Dabir D, Child N, Kalra A, Rogers T, Gebker R, Jabbour A, et al. Reference values for healthy human myocardium using a T1 mapping methodology: results from the International T1 Multicenter cardiovascular magnetic resonance study. J Cardiovasc Magn Reson. 2014;16(1):69.PubMedCentralCrossRefPubMed
17.
Fitts M, Breton E, Kholmovski EG, Dosdall DJ, Vijayakumar S, Hong KP, et al. Arrhythmia insensitive rapid cardiac T1 mapping pulse sequence. Magn Reson Med. 2013;70(5):1274–82.CrossRefPubMed
18.
Rogers T, Puntmann V. T1 mapping - beware regional variations. Eur Heart J Cardiovascular Imaging. 2014;15(11):1302.CrossRef
19.
Sado DM, White SK, Piechnik SK, Banypersad SM, Treibel T, Captur G, et al. Identification and Assessment of Anderson-Fabry Disease by Cardiovascular Magnetic Resonance Noncontrast Myocardial T1 Mapping. Circulation: Cardiovasc Imag. 2013;6(3):392–8.
20.
Thompson RB, Chow K, Khan A, Chan A, Shanks M, Paterson I, et al. T1 Mapping With Cardiovascular MRI Is Highly Sensitive for Fabry Disease Independent of Hypertrophy and Sex. Circulation: Cardiovasc Imag. 2013;6(5):637–45.
21.
Weber OM, Speier P, Scheffler K, Bieri O. Assessment of magnetization transfer effects in myocardial tissue using balanced steady-state free precession (bSSFP) cine MRI. Magn Reson Med. 2009;62(3):699–705.CrossRefPubMed
22.
Zhou X, Rundell V, Liu Y, Tang R, Shah S, Zuehlsdorff S, et al. On the mechanisms enabling myocardial edema contrast in bSSFP-based imaging approaches. Magn Reson Med. 2011;66(1):187–91.CrossRefPubMed
23.
Kumar A, Beohar N, Arumana JM, Larose E, Li D, Friedrich MG, et al. CMR Imaging of Edema in Myocardial Infarction Using Cine Balanced Steady-State Free Precession. J Am Coll Cardiol Img. 2011;4(12):1265–73.CrossRef
24.
Sibley CT, Noureldin RA, Gai N, Nacif MS, Liu S, Turkbey EB et al. T1 Mapping in Cardiomyopathy at Cardiac MR: Comparison with Endomyocardial Biopsy. Radiology. 2012;265(3):724–32.
25.
Wong TC, Piehler K, Meier CG, Testa SM, Klock AM, Aneizi AA, et al. Association Between Extracellular Matrix Expansion Quantified by Cardiovascular Magnetic Resonance and Short-Term Mortality. Circulation. 2012;126(10):1206–16.PubMedCentralCrossRefPubMed
26.
Mascherbauer J, Marzluf BA, Tufaro C, Pfaffenberger S, Graf A, Wexberg P, et al. Cardiac Magnetic Resonance Postcontrast T1 Time Is Associated With Outcome in Patients With Heart Failure and Preserved Ejection Fraction. Circulation: Cardiovasc Imag. 2013;6(6):1056.
27.
Salerno M, Janardhanan R, Jiji RS, Brooks J, Adenaw N, Mehta B et al. Comparison of methods for determining the partition coefficient of gadolinium in the myocardium using T1 mapping. J Cardiovasc Magn Reson. 2013:217–24.
28.
Liu C-Y, Liu Y-C, Wu C, Armstrong A, Volpe GJ, van der Geest RJ, et al. Evaluation of Age-Related Interstitial Myocardial Fibrosis With Cardiac Magnetic Resonance Contrast-Enhanced T1 Mapping: MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol. 2013;62(14):1280–7.CrossRefPubMed
29.
Ferreira V, Piechnik S, Dall'Armellina E, Karamitsos T, Francis J, Choudhury R, et al. Non-contrast T1-mapping detects acute myocardial edema with high diagnostic accuracy: a comparison to T2-weighted cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2012;14(1):42.PubMedCentralCrossRefPubMed
30.
Messroghli DR, Radjenovic A, Kozerke S, Higgins DM, Sivananthan MU, Ridgway JP. Modified Look-Locker inversion recovery (MOLLI) for high-resolution T1 mapping of the heart. Magn Reson Med. 2004;52(1):141–6.CrossRefPubMed
Metadata
Title
Gadolinium free cardiovascular magnetic resonance with 2-point Cine balanced steady state free precession
Authors
Tori A. Stromp
Steve W. Leung
Kristin N. Andres
Linyuan Jing
Brandon K. Fornwalt
Richard J. Charnigo
Vincent L. Sorrell
Moriel H. Vandsburger
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Journal of Cardiovascular Magnetic Resonance / Issue 1/2015
Electronic ISSN: 1532-429X
DOI
https://doi.org/10.1186/s12968-015-0194-1

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