The Use of T1W BB Signal Intensity Difference Ratio In AssessingMyocardial Disease Involving Increasing Extracellular Volume:A Preliminary Study
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Published:
Sep 20, 2017
Keywords:
myocardium, extracellular volume (ECV), late gadolinium enhancement (LGE), MRI, T1 weighted black blood (T1W BB), Signal intensity (SI), Signal intensity difference
Main Article Content
Abstract
OBJECTIVE: To evaluate whether the new magnetic resonance imaging (MRI)technique related to T1 weighted black blood (T1W BB) signal intensity differenceratio between pre- and post- gadolinium contrast injection can serve as a potentialtechnique for use in differentiating normal and diseased myocardium involving theincreasing myocardial extracellular volume (ECV) in terms of sensitivity, specificityand accuracy in comparison with late gadolinium contrast enhancement (LGE) MRItechnique.
MATERIALS AND METHODS: A retrospective analysis was conducted for a pilotof a total of 14 patients with known and suspected myocardial disease who underwenta cardiovascular magnetic resonance (CMR) scan at Bangkok Heart Hospital, Bangkok,Thailand in the period from September 2016-April 2017. LGE MRI and Spin echo T1WBB MRI in both pre- and post- contrast injection were performed in all patents on shortaxis view in the same slice position and number of slices. The myocardial signal intensitymeasurement on the T1W BB in both pre- and post- contrast injection images wereacquired on short axis view at the same region of interest (contrast enhancement regionand negative enhancement) on LGE MRI images. T1 signal intensity difference ratio(SDR) between pre- and post- contrast were calculated in both LGE positive andnegative groups. The mean T1W BB signal intensity difference ratio value > 30% wasclassified as abnormal increased ECV myocardium.
RESULTS: The 14 study population have a mean age of 53.3±11.5 and are 64% male.Five were normal patients with negative LGE and nine were found to have myocardialdisease with positive LGE. A total of 61 sample slices on short axis view of theventricle of each T1W BB pre- and post- contrast were obtained from all patients, 31of 61 were from diseased myocardium with LGE positive scan and 30 were from normalmyocardium with a LGE negative scan. A myocardial T1 signal difference ratio > 30%was found in 2 of 30 slices of normal myocardium with the LGE negative group and 31of 31 slices of the LGE positive group. The mean signal difference ratio value of normaland diseased myocardium were 19.13±7.5 % and 41.4±7.6% respectively. The sensitivityand specificity and the accuracy of T1W BB difference ratio > 30% in differentiatingnormal from myocardium with involving increasing ECV were 100%, 93.3% and 96.7%(p=0.72) consecutively compared to the LGE MRI.
CONCLUSION: The use of T1W BB in assessing myocardial diseases with either afocal or diffuse involvement demonstrates a higher value ratio of extracellular spacepre- and post- contrast study of more than 30% indicating myocardial disease with 100%sensitivity and 93.3% in specificity and 96.7% accuracy that is shown to be comparableto gold standard LGE technique in detecting focal increasing myocardial ECV bystatistic chi-square test p =0.72 (not less than 0.05)
MATERIALS AND METHODS: A retrospective analysis was conducted for a pilotof a total of 14 patients with known and suspected myocardial disease who underwenta cardiovascular magnetic resonance (CMR) scan at Bangkok Heart Hospital, Bangkok,Thailand in the period from September 2016-April 2017. LGE MRI and Spin echo T1WBB MRI in both pre- and post- contrast injection were performed in all patents on shortaxis view in the same slice position and number of slices. The myocardial signal intensitymeasurement on the T1W BB in both pre- and post- contrast injection images wereacquired on short axis view at the same region of interest (contrast enhancement regionand negative enhancement) on LGE MRI images. T1 signal intensity difference ratio(SDR) between pre- and post- contrast were calculated in both LGE positive andnegative groups. The mean T1W BB signal intensity difference ratio value > 30% wasclassified as abnormal increased ECV myocardium.
RESULTS: The 14 study population have a mean age of 53.3±11.5 and are 64% male.Five were normal patients with negative LGE and nine were found to have myocardialdisease with positive LGE. A total of 61 sample slices on short axis view of theventricle of each T1W BB pre- and post- contrast were obtained from all patients, 31of 61 were from diseased myocardium with LGE positive scan and 30 were from normalmyocardium with a LGE negative scan. A myocardial T1 signal difference ratio > 30%was found in 2 of 30 slices of normal myocardium with the LGE negative group and 31of 31 slices of the LGE positive group. The mean signal difference ratio value of normaland diseased myocardium were 19.13±7.5 % and 41.4±7.6% respectively. The sensitivityand specificity and the accuracy of T1W BB difference ratio > 30% in differentiatingnormal from myocardium with involving increasing ECV were 100%, 93.3% and 96.7%(p=0.72) consecutively compared to the LGE MRI.
CONCLUSION: The use of T1W BB in assessing myocardial diseases with either afocal or diffuse involvement demonstrates a higher value ratio of extracellular spacepre- and post- contrast study of more than 30% indicating myocardial disease with 100%sensitivity and 93.3% in specificity and 96.7% accuracy that is shown to be comparableto gold standard LGE technique in detecting focal increasing myocardial ECV bystatistic chi-square test p =0.72 (not less than 0.05)
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Chaothawee L, Zhang S, Kaewchai P, Mapinta P, Keotmanoi R, Ngam-Maung B. The Use of T1W BB Signal Intensity Difference Ratio In AssessingMyocardial Disease Involving Increasing Extracellular Volume:A Preliminary Study. BKK Med J [Internet]. 2017 Sep. 20 [cited 2024 Apr. 20];13(2):19. Available from: https://he02.tci-thaijo.org/index.php/bkkmedj/article/view/221901
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References
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16. Kim RJ, Chen EL, Lima JA, et al. Myocardial Gd-DTPA kinetics determine MRI contrast enhancement and reflect the extent and severity of myocardial injury after acute reperfused infarction. Circulation 1996;94: 3318-26.
17. Wesbey GE, Higgins CB, McNamara MT, et al. Effect of gadolinium-DTPA on the magnetic relaxation times of normal and infarcted myocardium. Radiology 1984;153:165-9.
18. Simonetti OP, Kim RJ, Fieno DS, et al. An improved MR imaging technique for the visualization of myocardial infarction. Radiology 2001;218:215-23.
19. Mahrholdt H, Goedecke C, Wagner A, et.al. Cardiovascular magnetic resonance assessment of human myocarditis: a comparison to histology and molecular pathology. Circulation 2004;109(10):1250-8.
20. Haaf P, Garg P, Messroghli DR, et al. Cardiac T1 Mapping and Extracellular Volume (ECV) in clinical practice: a comprehensive review. J Cardiovasc Magn Reson 2017; 18: 89
2. Wesbey GE, Higgins CB, McNamara MT, et al. Effect of gadolinium-DTPA on the magnetic relaxation times of normal and infarcted myocardium. Radiology 1984;153:165-9.
3. Kim RJ, Fieno DS, Parrish TB, et al. Relationship of MRI delayed contrast enhancement to irreversible injury, infarct age, and contractile function. Circulation 1999;100(19):1992- 2002.
4. Kellman P, Wilson JR, Xue H, et al. Extracellular volume fraction mapping in the myocardium, part 2: initial clinical experience. J Cardiovasc Magn Reson 2012;14:64.
5. Schelbert EB, Hsu LY, Anderson SA, et al. Late gadoliniumenhancement cardiac magnetic resonance identifies postinfarction myocardial fibrosis and the border zone at the near cellular level in ex vivo rat heart. Circ Cardiovasc Imaging 2010;3: 743-52.
6. Mann DL, Bristow MR. Mechanisms and models in heart failure: the biomechanical model and beyond. Circulation 2005;111:2837-49.
7. Weber KT. Fibrosis and hypertensive heart disease. Curr Opin Cardiol 2000;15:264-72.
8. Sado DM, Flett AS, Moon JC. Novel imaging techniques for diffuse myocardial fibrosis. Future Cardiol 2011;7(5):643-50.
9. Puntmann VO, D’Cruz D, Smith Z, Pastor A, et al. Native myocardial T1 mapping by cardiovascular magnetic resonance imaging in subclinical cardiomyopathy in patients with systemic lupus erythematosus. Circ Cardiovasc Imaging 2013;6:295-301.
10. Sado DM, White SK, Piechnik SK, et.al. The identification and assessment of Anderson Fabry disease by cardiovascular magnetic resonance non-contrast myocardial T1 mapping. Circ Cardiovasc Imaging 2013;6: 392-8.
11. Messroghli DR, Niendorf T, Schulz-Menger J, et al. T1 mapping in patients with acute myocardial infarction. J Cardiovasc Magn Reson 2003;5:353-59.
12. Karamitsos TD, Piechnik SK, Banypersad SM, et al. Noncontrast T1 mapping for the diagnosis of cardiac amyloidosis. JACC Cardiovasc Imaging 2013;6:488-97.
13. Korb JP , Bryant RG. Magnetic Field Dependence of Proton Spin-Lattice Relaxation Times. Mag Reson Med 2002;48:21.
14. Croisille P, Revel D, Saeed M. Contrast agents and cardiac MR imaging of myocardial ischemia: from bench to bedside. Eur Radiol 2006;16:1951-63.
15. Wu KC, Zerhouni EA, Judd RM, et al. Prognostic significance of microvascular obstruction by magnetic resonance imaging in patients with acute myocardial infarction. Circulation 1998; 97(8):765-72.
16. Kim RJ, Chen EL, Lima JA, et al. Myocardial Gd-DTPA kinetics determine MRI contrast enhancement and reflect the extent and severity of myocardial injury after acute reperfused infarction. Circulation 1996;94: 3318-26.
17. Wesbey GE, Higgins CB, McNamara MT, et al. Effect of gadolinium-DTPA on the magnetic relaxation times of normal and infarcted myocardium. Radiology 1984;153:165-9.
18. Simonetti OP, Kim RJ, Fieno DS, et al. An improved MR imaging technique for the visualization of myocardial infarction. Radiology 2001;218:215-23.
19. Mahrholdt H, Goedecke C, Wagner A, et.al. Cardiovascular magnetic resonance assessment of human myocarditis: a comparison to histology and molecular pathology. Circulation 2004;109(10):1250-8.
20. Haaf P, Garg P, Messroghli DR, et al. Cardiac T1 Mapping and Extracellular Volume (ECV) in clinical practice: a comprehensive review. J Cardiovasc Magn Reson 2017; 18: 89