Guan Wang1,2, Sang-Eun Lee3,4, Qi Yang1,5, Vignesh Sadras1, Suraj Patel1, Hsin-Jung Yang1, Behzad Sharif1,6, Avinash Kali1, Ivan Cokic1,6, Guoxi Xie7, Mourad Tighiouart8, Jeremy Collins9, Debiao Li1,10,6, Daniel S Berman1,11,10,6, Hyuk-Jae Chang3, Rohan Dharmakumar1,11,6. 1. Department of Biomedical Sciences, Biomedical Imaging Research Institute (G.W., Q.Y., V.S., S.P., H.-J.Y., B.S., A.K., I.C., D.L., D.S.B., R.D.), Cedars-Sinai Medical Center, Los Angeles, CA. 2. Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang (G.W.). 3. Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea (S.-E.L., H.-J.C.). 4. Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, South Korea (S.-E.L.). 5. Department of Radiology, Xuanwu Hospital, Beijing, China (Q.Y.). 6. Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (B.S., I.C., D.L., D.S.B., R.D.). 7. Guangzhou Medical University, China (G.X.). 8. Biostatistics and Bioinformatics Research Center (M.T.), Cedars-Sinai Medical Center, Los Angeles, CA. 9. Department of Radiology, Mayo Clinic, Rochester (J.C.). 10. Department of Imaging (D.L., D.S.B.), Cedars-Sinai Medical Center, Los Angeles, CA. 11. Cedars-Sinai Heart Institute (D.S.B., R.D.), Cedars-Sinai Medical Center, Los Angeles, CA.
Abstract
BACKGROUND: Preclinical studies and pilot patient studies have shown that chronic infarctions can be detected and characterized from cardiac magnetic resonance without gadolinium-based contrast agents using native-T1 maps at 3T. We aimed to investigate the diagnostic capacity of this approach for characterizing chronic myocardial infarctions (MIs) in a multi-center setting. METHODS: Patients with a prior MI (n=105) were recruited at 3 different medical centers and were imaged with native-T1 mapping and late gadolinium enhancement (LGE) at 3T. Infarct location, size, and transmurality were determined from native-T1 maps and LGE. Sensitivity, specificity, receiver-operating characteristic metrics, and inter- and intraobserver variabilities were assessed relative to LGE. RESULTS: Across all subjects, T1 of MI territory was 1621±110 ms, and remote territory was 1225±75 ms. Sensitivity, specificity, and area under curve for detecting MI location based on native-T1 mapping relative to LGE were 88%, 92%, and 0.93, respectively. Native-T1 maps were not different for measuring infarct size (native-T1 maps: 12.1±7.5%; LGE: 11.8±7.2%, P=0.82) and were in agreement with LGE (R2=0.92, bias, 0.09±2.6%). Corresponding inter- and intraobserver assessments were also highly correlated (interobserver: R2=0.90, bias, 0.18±2.4%; and intraobserver: R2=0.91, bias, 0.28±2.1%). Native T1 maps were not different for measuring MI transmurality (native-T1 maps: 49.1±15.8%; LGE: 47.2±19.0%, P=0.56) and showed agreement (R2=0.71; bias, 1.32±10.2%). Corresponding inter- and intraobserver assessments were also in agreement (interobserver: R2=0.81, bias, 0.1±9.4%; and intraobserver: R2=0.91, bias, 0.28±2.1%, respectively). While the overall accuracy for detecting MI with native-T1 maps at 3T was high, logistic regression analysis showed that MI location was a prominent confounder. CONCLUSIONS: Native-T1 mapping can be used to image chronic MI with high degree of accuracy, and as such, it is a viable alternative for scar imaging in patients with chronic MI who are contraindicated for LGE. Technical advancements may be needed to overcome the imaging confounders that currently limit native-T1 mapping from reaching equivalent detection levels as LGE.
BACKGROUND: Preclinical studies and pilot patient studies have shown that chronic infarctions can be detected and characterized from cardiac magnetic resonance without gadolinium-based contrast agents using native-T1 maps at 3T. We aimed to investigate the diagnostic capacity of this approach for characterizing chronic myocardial infarctions (MIs) in a multi-center setting. METHODS:Patients with a prior MI (n=105) were recruited at 3 different medical centers and were imaged with native-T1 mapping and late gadolinium enhancement (LGE) at 3T. Infarct location, size, and transmurality were determined from native-T1 maps and LGE. Sensitivity, specificity, receiver-operating characteristic metrics, and inter- and intraobserver variabilities were assessed relative to LGE. RESULTS: Across all subjects, T1 of MI territory was 1621±110 ms, and remote territory was 1225±75 ms. Sensitivity, specificity, and area under curve for detecting MI location based on native-T1 mapping relative to LGE were 88%, 92%, and 0.93, respectively. Native-T1 maps were not different for measuring infarct size (native-T1 maps: 12.1±7.5%; LGE: 11.8±7.2%, P=0.82) and were in agreement with LGE (R2=0.92, bias, 0.09±2.6%). Corresponding inter- and intraobserver assessments were also highly correlated (interobserver: R2=0.90, bias, 0.18±2.4%; and intraobserver: R2=0.91, bias, 0.28±2.1%). Native T1 maps were not different for measuring MI transmurality (native-T1 maps: 49.1±15.8%; LGE: 47.2±19.0%, P=0.56) and showed agreement (R2=0.71; bias, 1.32±10.2%). Corresponding inter- and intraobserver assessments were also in agreement (interobserver: R2=0.81, bias, 0.1±9.4%; and intraobserver: R2=0.91, bias, 0.28±2.1%, respectively). While the overall accuracy for detecting MI with native-T1 maps at 3T was high, logistic regression analysis showed that MI location was a prominent confounder. CONCLUSIONS: Native-T1 mapping can be used to image chronic MI with high degree of accuracy, and as such, it is a viable alternative for scar imaging in patients with chronic MI who are contraindicated for LGE. Technical advancements may be needed to overcome the imaging confounders that currently limit native-T1 mapping from reaching equivalent detection levels as LGE.
Entities:
Keywords:
area under curve; contrast media; gadolinium; magnetic resonance imaging; myocardial infarction
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