title: Endogenous assessment of chronic myocardial infarction with T(1ρ)-mapping in patients.
abstract: BACKGROUND
  Detection of cardiac fibrosis based on endogenous magnetic resonance (MR) characteristics of the myocardium would yield a measurement that can provide quantitative information, is independent of contrast agent concentration, renal function and timing. In ex vivo myocardial infarction (MI) tissue, it has been shown that a significantly higher T(1ρ) is found in the MI region, and studies in animal models of chronic MI showed the first in vivo evidence for the ability to detect myocardial fibrosis with native T(1ρ)-mapping. In this study we aimed to translate and validate T(1ρ)-mapping for endogenous detection of chronic MI in patients.
  
  
  METHODS
  We first performed a study in a porcine animal model of chronic MI to validate the implementation of T(1ρ)-mapping on a clinical cardiovascular MR scanner and studied the correlation with histology. Subsequently a clinical protocol was developed, to assess the feasibility of scar tissue detection with native T(1ρ)-mapping in patients (n = 21) with chronic MI, and correlated with gold standard late gadolinium enhancement (LGE) CMR. Four T1ρ-weighted images were acquired using a spin-lock preparation pulse with varying duration (0, 13, 27, 45 ms) and an amplitude of 750 Hz, and a T(1ρ)-map was calculated. The resulting T(1ρ)-maps and LGE images were scored qualitatively for the presence and extent of myocardial scarring using the 17-segment AHA model.
  
  
  RESULTS
  In the animal model (n = 9) a significantly higher T(1ρ) relaxation time was found in the infarct region (61 ± 11 ms), compared to healthy remote myocardium (36 ± 4 ms) . In patients a higher T(1ρ) relaxation time (79 ± 11 ms) was found in the infarct region than in remote myocardium (54 ± 6 ms). Overlap in the scoring of scar tissue on LGE images and T(1ρ)-maps was 74%.
  
  
  CONCLUSIONS
  We have shown the feasibility of native T(1ρ)-mapping for detection of infarct area in patients with a chronic myocardial infarction. In the near future, improvements on the T(1ρ)-mapping sequence could provide a higher sensitivity and specificity. This endogenous method could be an alternative for LGE imaging, and provide additional quantitative information on myocardial tissue characteristics.
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100 3582 CX, Utrecht, The Netherlands. j.w.m.oorschot@umcutrecht.nl.
authors.forename: Joep W M
authors.initials: JW
authors.lastname: van Oorschot
authors.forename: Hamza
authors.initials: H
authors.lastname: El Aidi
authors.forename: Sanne J
authors.initials: SJ
authors.lastname: Jansen of Lorkeers
authors.forename: Johannes M I H
authors.initials: JM
authors.lastname: Gho
authors.forename: Martijn
authors.initials: M
authors.lastname: Froeling
authors.forename: Fredy
authors.initials: F
authors.lastname: Visser
authors.forename: Steven A J
authors.initials: SA
authors.lastname: Chamuleau
authors.forename: Pieter A
authors.initials: PA
authors.lastname: Doevendans
authors.forename: Peter R
authors.initials: PR
authors.lastname: Luijten
authors.forename: Tim
authors.initials: T
authors.lastname: Leiner
authors.forename: Jaco J M
authors.initials: JJ
authors.lastname: Zwanenburg
mesh_terms: D000328:Adult; D000818:Animals; D016022:Case-Control Studies; D003287:Contrast Media; D004195:Disease Models, Animal; D005240:Feasibility Studies; D005260:Female; D005355:Fibrosis; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology*; D009942:Organometallic Compounds; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013318:Stroke Volume; D013552:Swine; D016277:Ventricular Function, Left; D055815:Young Adult
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C090600:gadobutrol