Gadolinium free cardiovascular magnetic resonance with 2-point Cine balanced steady state free precession

Tori A. Stromp, Steve W. Leung, Kristin N. Andres, Linyuan Jing, Brandon K. Fornwalt, Richard J. Charnigo, Vincent L. Sorrell, Moriel H. Vandsburger

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

Background: Cardiovascular magnetic resonance (CMR) of ventricular structure and function is widely performed using cine balanced steady state free precession (bSSFP) MRI. The bSSFP signal of myocardium is weighted by magnetization transfer (MT) and T1/T2-relaxation times. In edematous and fibrotic tissues, increased T2 and reduced MT lead to increased signal intensity on images acquired with high excitation flip angles. We hypothesized that acquisition of two differentially MT-weighted bSSFP images (termed 2-point bSSFP) can identify tissue that would enhance with gadolinium similar to standard of care late gadolinium enhancement (LGE). Methods: Cine bSSFP images (flip angles of 5°and 45°) and native-T1 and T2 maps were acquired in one mid-ventricular slice in 47 patients referred for CMR and 10 healthy controls. Afterwards, LGE images and post-contrast T1 maps were acquired and gadolinium partition coefficient (GPC) was calculated. Maps of ΔS/So were calculated as (S45-S5)/S5∗100 (%), where Sflip-angle is the voxel signal intensity. Results: Twenty three patients demonstrated areas of myocardial hyper-enhancement with LGE. In enhanced regions, ΔS/So, native-T1, T2, and GPC were heightened (p < 0.05 vs. non-enhanced tissues). ΔS/So, native-T1, and T2 all demonstrated association with GPC, however the association was strongest for ΔS/So. Bland-Altman analysis revealed a slight bias towards larger volume of enhancement with ΔS/So compared to LGE, and similar transmurality. Subjective analysis with 2-blinded expert readers revealed agreement between ΔS/So and LGE of 73.4 %, with false positive detection of 16.7 % and false negative detection of 15.2 %. Conclusions: Gadolinium free 2-point bSSFP identified tissue that enhances at LGE with strong association to GPC. Our results suggest that with further development, MT-weighted CMR could be used similar to LGE for diagnostic imaging.

Original languageEnglish
Article number90
JournalJournal of Cardiovascular Magnetic Resonance
Volume17
Issue number1
DOIs
StatePublished - Oct 29 2015

Bibliographical note

Funding Information:
We thank Vrinda Sardana MD, Joseph Jenkins, John Green, Rebecca Egli and Dimmi Jackson RN for their help in patient care and image acquisition. This work was supported by the National Center for Advancing Translational Sciences at the National Institutes of Health through grant number UL1TR000117 (supporting R.C.). S.W.L. and M.H.V. are supported through KL2TR000116. M.H.V is also supported by the American Heart Association National Affiliate (Dallas, TX) through grant number 14CRP20380071. There are no relationships with industry.

Publisher Copyright:
© 2015 Stromp et al.

Keywords

  • Cardiomyopathy
  • Cardiovascular magnetic resonance
  • Infarction
  • Myocardium
  • Remodeling

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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