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Pooled summary of native T1 value and extracellular volume with MOLLI variant sequences in normal subjects and patients with cardiovascular disease

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Abstract

T1 mapping by cardiac magnetic resonance (CMR) allows detection of abnormal myocardium. A number of myocardial abnormalities affects the signal captured in T1 mapping. We performed a systematic review and meta-analysis of native T1 and extracellular volume (ECV) in subjects with and without cardiac disease (1) to determine the normal ranges of T1 values and ECV by sequences as well as parameters influencing them, and (2) to summarize the differences in T1 values and ECV of the diseases relative to the normal ranges. Three databases (EMBASE, SCOPUS, and MEDLINE) were systematically searched for native T1 time and ECV. Only human studies with a sample size of ≥ 20 subjects were included. A random effect model was used to pool data. The 69 selected articles included 1954 healthy subjects and 3186 with disease. T1 of normal healthy was different among MOLLI variants: in 1.5T sequences, ShMOLLI had the shortest (944 ms [95% confidence interval 925, 963]), followed by MOLLI 3(3)3(3)5 flip-angle 50°, 967 [959, 975] and flip-angle 35°, 969 [951, 988]. 3T had longer T1 than 1.5T by approximately 100–200 ms. ECV of the normal healthy was consistent among the studies (ranging from 25 to 27%), irrespective of subjects’ factors, sequences, vendors, and contrast type. Many diseases demonstrated longer native T1 than normal subjects, but T1 was shorter in Fabry disease and iron overload. In contrast, all disease states showed either normal or increased ECV. Diagnostic accuracy of native T1 time was minimally affected by the difference in the sequences. ECV is less influenced by methodology than T1 time among normal subjects. Different myocardial diseases are associated with shorter or longer T1 times, whereas ECV is consistently increased independent of the underlying pathophysiology.

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Abbreviations

AS:

Aortic stenosis

CI:

Confidence interval

CMR:

Cardiac magnetic resonance

ECV:

Extracellular volume fraction

HCM:

Hypertrophy cardiomyopathy

LVEDVi:

Left ventricular end-diastolic ejection fraction indexed

LVEF:

Left ventricular ejection fraction

MOLLI:

Modified look-locker imaging

PRISMA:

Systematic reviews and meta-analysis

ShMOLLI:

Shortened modified look-locker imaging

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Acknowledgements

The authors thank Ms Elizabeth Seymour, for her support in systematic review.

Disclosures

KN is supported by an award from the Select Foundation, which had no role for the preparation of this manuscript.

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Authors and Affiliations

  1. Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia

    Ha Q. Vo, Thomas H. Marwick & Kazuaki Negishi

  2. Baker Heart and Diabetes Institute, Melbourne, Australia

    Thomas H. Marwick

  3. Sydney Medical School Nepean, Faculty of Medicine and Health, Charles Perkins Centre Nepean, Nepean Clinical School, The University of Sydney, Level 5, South Block, PO Box 63, Penrith, NSW, 2751, Australia

    Kazuaki Negishi

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  1. Ha Q. Vo
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  2. Thomas H. Marwick
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  3. Kazuaki Negishi
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Correspondence to Kazuaki Negishi.

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Vo, H.Q., Marwick, T.H. & Negishi, K. Pooled summary of native T1 value and extracellular volume with MOLLI variant sequences in normal subjects and patients with cardiovascular disease. Int J Cardiovasc Imaging 36, 325–336 (2020). https://doi.org/10.1007/s10554-019-01717-3

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  • DOI: https://doi.org/10.1007/s10554-019-01717-3

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