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Dose correction for post-contrast T1 mapping of the heart: the MESA study

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Abstract

Post-contrast myocardial T1 (T1myo,c) values have been shown to be sensitive to myocardial fibrosis. Recent studies have shown differences in results obtained from T1myo,c and extracellular volume fraction (ECV) with respect to percentage fibrosis. By exploring the relationship between blood plasma volume and T1myo,c, the underlying basis for the divergence can be explained. Furthermore, dose administration based on body mass index (BMI), age and gender can mitigate the divergence in results. Inter-subject comparison of T1myo,c required adjustment for dose (in mmol/kg), time and glomerular filtration rate. Further adjustment for effective dose based on lean muscle mass reflected by blood/plasma volume was performed. A test case of 605 subjects from the MESA study who had undergone pre- and post-contrast T1 mapping was studied. T1myo,c values were compared between subjects with and without metabolic syndrome (MetS), between smoking and non-smoking subjects, and subjects with and without impaired glucose tolerance, before and after dose adjustment based on plasma volume. Comparison with ECV (which is dose independent), pre-contrast myocardial T1 and blood normalized myocardial T1 values was also performed to validate the correction. There were significant differences in T1myo,c (post plasma volume correction) and ECV between current and former smokers (p value 0.017 and 0.01, respectively) but not T1myo,c prior to correction (p = 0.12). Prior to dose adjustment for plasma volume, p value was <0.001 for T1myo,c between MetS and non-MetS groups and was 0.13 between subjects with and without glucose intolerance; after adjustment for PV, p value was 0.63 and 0.99. Corresponding ECV p values were 0.44 and 0.99, respectively. Overall, ECV results showed the best agreement with PV corrected T1myo,c (mean absolute difference in p values = 0.073) and pre-contrast myocardial T1 in comparison with other measures (T1myo,c prior to correction, blood/plasma T1 value normalized myocardium). Weight-based contrast dosing administered in mmol/kg results in a bias in T1 values which can lead to erroneous conclusions. After adjustment for lean muscle mass based on plasma volume, results from T1myo,c were in line with ECV derived results. Furthermore, the use of a modified equivalent dose adjusted for BMI, age, sex and hematocrit can be adopted for quantitative imaging.

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Acknowledgments

This work was supported by the NIH Clinical Center intramural research program.

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Authors and Affiliations

  1. Radiology and Imaging Sciences (RAD&IS), National Institutes of Health/Clinical Center, 9000 Rockville Pike, Bldg 10, Bethesda, MD, 20892, USA

    Neville D. Gai, Veit Sandfort, Songtao Liu & David A. Bluemke

  2. Johns Hopkins Medicine, Baltimore, MD, USA

    João A. C. Lima

  3. NIBIB, Bethesda, MD, USA

    David A. Bluemke

Authors
  1. Neville D. Gai
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  2. Veit Sandfort
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Correspondence to Neville D. Gai.

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All human studies in this work were approved by the individual institutional review boards and were therefore performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All subjects gave informed consent prior to their inclusion in the study.

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Gai, N.D., Sandfort, V., Liu, S. et al. Dose correction for post-contrast T1 mapping of the heart: the MESA study. Int J Cardiovasc Imaging 32, 271–279 (2016). https://doi.org/10.1007/s10554-015-0754-3

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  • DOI: https://doi.org/10.1007/s10554-015-0754-3

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