Usefulness of T2 ratio in the diagnosis and prognosis of cardiac amyloidosis using cardiac MR imaging.
OBJECTIVE
To detect if a difference of T2 ratio, defined as the signal intensity (SI) of the myocardium divided by the SI of the skeletal muscle on T2-weigthed cardiac magnetic resonance (CMR) imaging, exists between patients with systemic amyloidosis, by comparison to control subjects. To determine if a relationship exists between T2 ratio and the overall mortality.


METHODS
CMR imaging examinations of 73 consecutive patients (48 men, 25 women; mean age, 63 years±15[SD]) with amyloidosis and suspicion of CA and 27 control subjects were retrospectively analyzed after institutional review board approval. Final diagnosis of CA was retained in case of histological confirmation of CA, typical pattern of CA on imaging and/or positivity of99Technetium-hydroxymethylene diphosphonate scintigraphy. Patients were divided in 2 groups according to the presence or the absence of CA. T2 ratios were calculated in patients with and those without CA and in control subjects with using analysis of variance. Prognostic value of T2 ratio was studied with a Kaplan-Meier curve.


RESULTS
Thirty-five patients (51%) had CA and 33 (49%) were free from CA. T2 ratio was lower in patients with CA (1.18±0.29) than in patients without cardiac involvement (1.37±0.35) (P=0.03) and control subjects (1.45±0.24) (P=0.004). A T2 ratio of 1.36 was the best threshold value for predicting CA with a sensitivity of 63% and a specificity of 73%. Kaplan-Meier analysis showed a significant relationship between a shortened overall survival and a T2 ratio<1.36.


CONCLUSIONS
Patients with CA exhibit lower T2 ratio on CMR imaging by comparison with patients free of CA and control subjects.
Radiology Department, Henri-Mondor Hospital, Paris Est Créteil University, Assistance publique-Hôpitaux de Paris, 94010 Créteil, France.
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Legou
Radiology Department, Henri-Mondor Hospital, Paris Est Créteil University, Assistance publique-Hôpitaux de Paris, 94010 Créteil, France.
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Tacher
Amyloid Network, Henri-Mondor Hospital, Paris Est Créteil University, 94010 Créteil, France; Cardiology Department, Henri-Mondor Hospital, Paris Est Créteil University, Assistance publique-Hôpitaux de Paris, 94010 Créteil, France.
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Damy
Amyloid Network, Henri-Mondor Hospital, Paris Est Créteil University, 94010 Créteil, France; Neurology department, Henri-Mondor Hospital, Paris Est Créteil University, Assistance publique-Hôpitaux de Paris, 94010 Créteil, France.
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Planté-Bordeneuve
Nuclear Medecine department, Henri-Mondor Hospital, Paris Est Créteil University, Assistance publique-Hôpitaux de Paris, 94010 Créteil, France.
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Rappeneau
Pathology department, Henri-Mondor Hospital, Paris Est Créteil University, Assistance publique-Hôpitaux de Paris, 94010 Créteil, France.
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Benhaiem
Nuclear Medecine department, Henri-Mondor Hospital, Paris Est Créteil University, Assistance publique-Hôpitaux de Paris, 94010 Créteil, France.
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Rosso
Nuclear Medecine department, Henri-Mondor Hospital, Paris Est Créteil University, Assistance publique-Hôpitaux de Paris, 94010 Créteil, France.
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Itti
Radiology Department, Henri-Mondor Hospital, Paris Est Créteil University, Assistance publique-Hôpitaux de Paris, 94010 Créteil, France.
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Luciani
Radiology Department, Henri-Mondor Hospital, Paris Est Créteil University, Assistance publique-Hôpitaux de Paris, 94010 Créteil, France.
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Kobeiter
Radiology Department, Henri-Mondor Hospital, Paris Est Créteil University, Assistance publique-Hôpitaux de Paris, 94010 Créteil, France.
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Rahmouni
Radiology Department, Henri-Mondor Hospital, Paris Est Créteil University, Assistance publique-Hôpitaux de Paris, 94010 Créteil, France; Amyloid Network, Henri-Mondor Hospital, Paris Est Créteil University, 94010 Créteil, France. Electronic address: jean-francois.deux@hmn.aphp.fr.
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Deux
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000686:Amyloidosis / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D003287:Contrast Media; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D021621:Imaging, Three-Dimensional; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008536:Meglumine; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D009942:Organometallic Compounds; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013669:Technetium Tc 99m Medronate / Q000031:analogs & derivatives
D003287:Contrast Media; D009942:Organometallic Compounds; D019275:Radiopharmaceuticals; D008536:Meglumine; C024226:technetium Tc 99m hydroxymethylene diphosphonate; C072417:gadoterate meglumine; D013669:Technetium Tc 99m Medronate
Cardiac amyloidosis; Cardiac magnetic resonance imaging; T2 ratio; Tissue characterization