T1 Mapping for the Diagnosis of Acute Myocarditis Using CMR Comparison to T2-Weighted and Late Gadolinium Enhanced Imaging
T1 Mapping for the Diagnosis of Acute Myocarditis Using CMR Comparison to T2-Weighted and Late Gadolinium Enhanced Imaging
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DOI：
10.1016/j.jcmg.2013.03.008
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发表时间：
2013-10-01
影响因子：
14
通讯作者：
Neubauer, Stefan
中科院分区：
文献类型：
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作者：
Ferreira, Vanessa M.;Piechnik, Stefan K.;Neubauer, Stefan
本研究旨在测试与心脏磁共振（CMR）技术，如暗血T-2加权（T2 W）-CMR，亮血T2 W-CMR和晚期钆增强（LGE）imaging相比，天然T-1标测在急性心肌炎中的诊断性能。背景急性心肌炎的CMR诊断通常需要多种技术，包括T2 W，早期钆增强和LGE成像。新的技术，如T-1映射和明亮的血液T2 W-CMR也敏感的变化，自由水含量。我们假设，这些技术可以作为新的和潜在的上级诊断标准心肌炎。方法我们调查了50例疑似急性心肌炎（年龄42 +/- 16岁，22%的妇女）和45个对照组（年龄42 +/- 14岁，22%的妇女）。1.5-T时的CMR（自出现后中位数3天）包括：1）深色血液T2 W-CMR（短tau倒置恢复）; 2）亮血T2 W-CMR（心脏统一T-2水肿采集）; 3）天然T-1标测（缩短的改良look-locker倒置恢复）;和4）LGE。图像分析包括：1）心肌与骨骼肌的整体T-2信号强度比; 2）心肌T-1弛豫时间;结果与正常对照组相比，患者全身黑血T2 W-CMR T-2信号强度比值明显增高（1.73 +/- 0.27 vs. 1.56 +/- 0.15，p < 0.01），亮血T2 W-CMR（2.02 +/- 0.33 vs. 1.84 +/- 0.17，p < 0.01）和平均心肌T-1（1，010 +/- 65 ms vs. 941 +/- 18 ms，p < 0.01）。受试者操作特征分析显示诊断性能存在明显差异。每种方法的曲线下面积分别为：T-1标测（0.95）、LGE（0.96）、深色血T-2（0.78）和亮血T-2（0.76）。一个T-1截止990毫秒的敏感性，特异性和诊断准确性为90%，91%，和91%，respectively.CONCLUSIONS本地T-1映射作为一种新的标准检测急性心肌炎表现出良好的和上级的诊断性能相比，T2 W-CMR。与T2 W和LGE技术相比，它也具有更高的灵敏度，这可能在检测细微局灶性疾病和钆对比成像不可行时特别有用。(C)2013年美国心脏病学会基金会
OBJECTIVES This study sought to test the diagnostic performance of native T-1 mapping in acute myocarditis compared with cardiac magnetic resonance (CMR) techniques such as dark-blood T-2-weighted (T2W)-CMR, bright-blood T2W-CMR, and late gadolinium enhancement (LGE) imaging.BACKGROUND The diagnosis of acute myocarditis on CMR often requires multiple techniques, including T2W, early gadolinium enhancement, and LGE imaging. Novel techniques such as T-1 mapping and bright-blood T2W-CMR are also sensitive to changes in free water content. We hypothesized that these techniques can serve as new and potentially superior diagnostic criteria for myocarditis.METHODS We investigated 50 patients with suspected acute myocarditis (age 42 +/- 16 years; 22% women) and 45 controls (age 42 +/- 14 years; 22% women). CMR at 1.5-T (median 3 days from presentation) included: 1) dark-blood T2W-CMR (short-tau inversion recovery); 2) bright-blood T2W-CMR (acquisition for cardiac unified T-2 edema); 3) native T-1 mapping (shortened modified look-locker inversion recovery); and 4) LGE. Image analysis included: 1) global T-2 signal intensity ratio of myocardium compared with skeletal muscle; 2) myocardial T-1 relaxation times; and 3) areas of LGE.RESULTS Compared with controls, patients had significantly higher global T-2 signal intensity ratios by dark-blood T2W-CMR (1.73 +/- 0.27 vs. 1.56 +/- 0.15, p < 0.01), bright-blood T2W-CMR (2.02 +/- 0.33 vs. 1.84 +/- 0.17, p < 0.01), and mean myocardial T-1 (1,010 +/- 65 ms vs. 941 +/- 18 ms, p < 0.01). Receiver-operating characteristic analysis showed clear differences in diagnostic performance. The areas under the curve for each method were: T-1 mapping (0.95), LGE (0.96), dark-blood T-2 (0.78), and bright-blood T-2 (0.76). A T-1 cutoff of 990 ms had a sensitivity, specificity, and diagnostic accuracy of 90%, 91%, and 91%, respectively.CONCLUSIONS Native T-1 mapping as a novel criterion for the detection of acute myocarditis showed excellent and superior diagnostic performance compared with T2W-CMR. It also has a higher sensitivity compared with T2W and LGE techniques, which may be especially useful in detecting subtle focal disease and when gadolinium contrast imaging is not feasible. (C) 2013 by the American College of Cardiology Foundation