Sebastian Bohnen1, Ulf K Radunski2, Gunnar K Lund3, Enver Tahir4, Maxim Avanesov5, Christian Stehning6, Bernhard Schnackenburg7, Gerhard Adam8, Stefan Blankenberg9, Kai Muellerleile10. 1. University Medical Center Hamburg-Eppendorf, University Heart Center, General and Interventional Cardiology, Hamburg, Germany. Electronic address: s.bohnen@uke.de. 2. University Medical Center Hamburg-Eppendorf, University Heart Center, General and Interventional Cardiology, Hamburg, Germany. Electronic address: u.radunski@uke.de. 3. University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology, Hamburg, Germany. Electronic address: glund@uke.de. 4. University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology, Hamburg, Germany. Electronic address: e.tahir@uke.de. 5. University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology, Hamburg, Germany. Electronic address: m.avanesov@uke.de. 6. Philips Research, Hamburg, Germany. Electronic address: christian.stehning@philips.com. 7. Philips Healthcare Germany, Hamburg, Germany. Electronic address: bernhard.schnackenburg@philips.com. 8. University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology, Hamburg, Germany. Electronic address: g.adam@uke.de. 9. University Medical Center Hamburg-Eppendorf, University Heart Center, General and Interventional Cardiology, Hamburg, Germany. Electronic address: s.blankenberg@uke.de. 10. University Medical Center Hamburg-Eppendorf, University Heart Center, General and Interventional Cardiology, Hamburg, Germany. Electronic address: kamuellerleile@uke.de.
Abstract
BACKGROUND: T1 mapping is a promising diagnostic tool to improve the diagnostic accuracy of cardiovascular magnetic resonance (CMR) in patients with suspected myocarditis. However, there are currently no data on the potential influence of slice orientation on the diagnostic performance of CMR. Thus, we compared the diagnostic performance of global myocardial T1 and extracellular volume (ECV) values to differentiate patients with myocarditis from healthy individuals between different slice orientations. METHODS: This study included 48 patients with clinically defined myocarditis and 13 healthy controls who underwent CMR at 1.5T. A modified Look-Locker inversion-recovery (MOLLI) sequence was used for T1 mapping before and 15min after administration of 0.075mmol/kg Gadolinium-BOPTA. T1 mapping was performed on three short and on three long axes slices, respectively. Native T1, post-contrast T1 and extracellular volume (ECV) -BOPTA maps were calculated using a dedicated plug-in written for the OsiriX software and compared between the mean value of three short-axes slices (3SAX), the central short-axis (1SAX), the mean value of three long-axes slices (3LAX), the four-chamber view (4CH), the three-chamber view (3CH) and the two-chamber view (2CH). RESULTS: There were significantly lower native T1 values on 3LAX (1081ms (1037-1131ms)) compared to 3SAX (1107ms (1069-1143ms), p=0.0022) in patients with myocarditis, but not in controls (1026ms (1009-1059ms) vs. 1039ms (1023-1055ms), p=0.2719). The areas under the curve (AUC) to discriminate between myocarditis and healthy controls by native myocardial T1 were 0.85 (p<0.0001) on 3SAX, 0.85 (p<0.0001) on 1SAX, 0.76 (p=0.0002) on 3LAX, 0.70 (p=0.0075) on 4CH, 0.72 (p=0.0020) on 3CH and 0.75 (p=0.0003) on 2CH. The AUCs for ECV-BOPTA were 0.83 (p<0.0001) on 3 SAX, 0.82 (p<0.0001) on 1SAX, 0.77 (p=0.0005) on 3LAX, 0.71 (p=0.0079) on 4CH, 0.69 (p=0.0371) on 3CH and 0.75 (p=0.0006) on 2CH. CONCLUSION: Native T1 and ECV-BOPTA on short axes slices provide a better diagnostic performance in myocarditis than long axes slices since long axes slices seem to underestimate native myocardial T1 in myocarditis. T1 mapping in suspected myocarditis can be restricted to a single mid-ventricular short-axis slice without a significant loss in diagnostic performance.
BACKGROUND: T1 mapping is a promising diagnostic tool to improve the diagnostic accuracy of cardiovascular magnetic resonance (CMR) in patients with suspected myocarditis. However, there are currently no data on the potential influence of slice orientation on the diagnostic performance of CMR. Thus, we compared the diagnostic performance of global myocardial T1 and extracellular volume (ECV) values to differentiate patients with myocarditis from healthy individuals between different slice orientations. METHODS: This study included 48 patients with clinically defined myocarditis and 13 healthy controls who underwent CMR at 1.5T. A modified Look-Locker inversion-recovery (MOLLI) sequence was used for T1 mapping before and 15min after administration of 0.075mmol/kg Gadolinium-BOPTA. T1 mapping was performed on three short and on three long axes slices, respectively. Native T1, post-contrast T1 and extracellular volume (ECV) -BOPTA maps were calculated using a dedicated plug-in written for the OsiriX software and compared between the mean value of three short-axes slices (3SAX), the central short-axis (1SAX), the mean value of three long-axes slices (3LAX), the four-chamber view (4CH), the three-chamber view (3CH) and the two-chamber view (2CH). RESULTS: There were significantly lower native T1 values on 3LAX (1081ms (1037-1131ms)) compared to 3SAX (1107ms (1069-1143ms), p=0.0022) in patients with myocarditis, but not in controls (1026ms (1009-1059ms) vs. 1039ms (1023-1055ms), p=0.2719). The areas under the curve (AUC) to discriminate between myocarditis and healthy controls by native myocardial T1 were 0.85 (p<0.0001) on 3SAX, 0.85 (p<0.0001) on 1SAX, 0.76 (p=0.0002) on 3LAX, 0.70 (p=0.0075) on 4CH, 0.72 (p=0.0020) on 3CH and 0.75 (p=0.0003) on 2CH. The AUCs for ECV-BOPTA were 0.83 (p<0.0001) on 3 SAX, 0.82 (p<0.0001) on 1SAX, 0.77 (p=0.0005) on 3LAX, 0.71 (p=0.0079) on 4CH, 0.69 (p=0.0371) on 3CH and 0.75 (p=0.0006) on 2CH. CONCLUSION: Native T1 and ECV-BOPTA on short axes slices provide a better diagnostic performance in myocarditis than long axes slices since long axes slices seem to underestimate native myocardial T1 in myocarditis. T1 mapping in suspected myocarditis can be restricted to a single mid-ventricular short-axis slice without a significant loss in diagnostic performance.
Authors: Karuna M Das; Taleb Al Mansoori; Ali Al Shamisi; Usama Mh AlBastaki; Klaus V Gorkom; Jamal Aldeen Alkoteesh Journal: Diagnostics (Basel) Date: 2022-04-20
Authors: Paaladinesh Thavendiranathan; Lili Zhang; Amna Zafar; Zsofia D Drobni; Syed S Mahmood; Marcella Cabral; Magid Awadalla; Anju Nohria; Daniel A Zlotoff; Franck Thuny; Lucie M Heinzerling; Ana Barac; Ryan J Sullivan; Carol L Chen; Dipti Gupta; Michael C Kirchberger; Sarah E Hartmann; Jonathan W Weinsaft; Hannah K Gilman; Muhammad A Rizvi; Bojan Kovacina; Caroline Michel; Gagan Sahni; Ana González-Mansilla; Antonio Calles; Francisco Fernández-Avilés; Michael Mahmoudi; Kerry L Reynolds; Sarju Ganatra; Juan José Gavira; Nahikari Salterain González; Manuel García de Yébenes Castro; Raymond Y Kwong; Michael Jerosch-Herold; Otavio R Coelho-Filho; Jonathan Afilalo; Eduardo Zataraín-Nicolás; A John Baksi; Bernd J Wintersperger; Oscar Calvillo-Arguelles; Stephane Ederhy; Eric H Yang; Alexander R Lyon; Michael G Fradley; Tomas G Neilan Journal: J Am Coll Cardiol Date: 2021-03-30 Impact factor: 24.094