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Cardiac T1 mapping in congenital heart disease: bolus vs. infusion protocols for measurements of myocardial extracellular volume fraction

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Abstract

Myocardial extracellular volume fraction (ECV) reflecting diffuse myocardial fibrosis can be measured with T1 mapping cardiovascular magnetic resonance (CMR) before and after the application of a gadolinium-based extracellular contrast agent. The equilibrium between blood and myocardium contrast concentration required for ECV measurements can be obtained with a primed contrast infusion (equilibrium contrast-CMR). We hypothesized that equilibrium can also be achieved with a single contrast bolus to accurately measure diffuse myocardial fibrosis in patients with congenital heart disease (CHD). Healthy controls (n = 17; median age 24.0 years) and patients with CHD (n = 19; 25.0 years) were prospectively enrolled. Using modified Look-Locker inversion recovery T1 mapping before, 15 min after bolus injection, and during constant infusion of gadolinium-DOTA, T1 values were obtained for blood pool and myocardium of the left ventricle (LV), the interventricular septum (IVS), and the right ventricle (RV) in a single midventricular plane in short axis or in transverse orientation. ECV of LV, IVS and RV by bolus-only and bolus-infusion correlated significantly in CHD patients (r = 0.94, 0.95, and 0.74; p < 0.01, respectively) and healthy controls (r = 0.96, 0.89, and 0.64; p < 0.05, respectively). Bland–Altman plots revealed no significant bias between the techniques for any of the analyzed regions. ECV of LV and RV myocardium measured by bolus-only T1 mapping agrees well with bolus-infusion measurements in patients with CHD. The use of a bolus-only approach facilitates the integration of ECV measurements into existing CMR imaging protocols, allowing for assessment of diffuse myocardial fibrosis in CHD in clinical routine.

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Acknowledgements

We would like to thank Alireza Khasheei and Tiago Ferreira da Silva for technical support.

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Authors and Affiliations

  1. Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Nadya Al-Wakeel-Marquard, Sanaz Rastin, Frédéric Muench, Darach O h-Ici, Sevim Yilmaz, Felix Berger & Titus Kuehne

  2. DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany

    Nadya Al-Wakeel-Marquard, Felix Berger, Titus Kuehne & Daniel R. Messroghli

  3. Department of Pediatrics, Division of Cardiology, Charité - Universitaetsmedizin Berlin, Berlin, Germany

    Felix Berger & Titus Kuehne

  4. Department of Internal Medicine - Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany

    Frédéric Muench & Daniel R. Messroghli

  5. Department of Cardiology, Charité - Universitaetsmedizin Berlin, Berlin, Germany

    Daniel R. Messroghli

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  1. Nadya Al-Wakeel-Marquard
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  2. Sanaz Rastin
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Correspondence to Nadya Al-Wakeel-Marquard.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments. Informed consent was obtained from all individual participants included in the study and parents/guardians in case of participants aged <18 years.

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Al-Wakeel-Marquard, N., Rastin, S., Muench, F. et al. Cardiac T1 mapping in congenital heart disease: bolus vs. infusion protocols for measurements of myocardial extracellular volume fraction. Int J Cardiovasc Imaging 33, 1961–1968 (2017). https://doi.org/10.1007/s10554-017-1191-2

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  • DOI: https://doi.org/10.1007/s10554-017-1191-2

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