Respiratory Motion-Registered Isotropic Whole-Heart T2 Mapping in Patients With Acute Non-ischemic Myocardial Injury

Background: T-2 mapping is a magnetic resonance imaging technique that can be used to detect myocardial edema and inflammation. However, the focal nature of myocardial inflammation may render conventional 2D approaches suboptimal and make whole-heart isotropic 3D mapping desirable. While self-navigated 3D radial T-2 mapping has been demonstrated to work well at a magnetic field strength of 3T, it results in too noisy maps at 1.5T. We therefore implemented a novel respiratory motion-resolved compressed-sensing reconstruction in order to improve the 3D T-2 mapping precision and accuracy at 1.5T, and tested this in a heterogeneous patient cohort. Materials and Methods: Nine healthy volunteers and 25 consecutive patients with suspected acute non-ischemic myocardial injury (sarcoidosis, n = 19; systemic sclerosis, n = 2; acute graft rejection, n = 2, and myocarditis, n = 2) were included. The free-breathing T-2 maps were acquired as three ECG-triggered T-2-prepared 3D radial volumes. A respiratory motion-resolved reconstruction was followed by image registration of the respiratory states and pixel-wise T-2 mapping. The resulting 3D maps were compared to routine 2D T-2 maps. The T-2 values of segments with and without late gadolinium enhancement (LGE) were compared in patients. Results: In the healthy volunteers, the myocardial T-2 values obtained with the 2D and 3D techniques were similar (45.8 +/- 1.8 vs. 46.8 +/- 2.9 ms, respectively; P = 0.33). Conversely, in patients, T-2 values did differ between 2D (46.7 +/- 3.6 ms) and 3D techniques (50.1 +/- 4.2 ms, P = 0.004). Moreover, with the 2D technique, T-2 values of the LGE-positive segments were similar to those of the LGE-negative segments (T2LGE-= 46.2 +/- 3.7 vs. T2LGE+ = 47.6 +/- 4.1 ms; P = 0.49), whereas the 3D technique did show a significant difference (T2LGE- = 49.3 +/- 6.7 vs. T2LGE+ = 52.6 +/- 8.7 ms, P = 0.006). Conclusion: Respiratory motion-registered 3D radial imaging at 1.5T led to accurate isotropic 3D whole-heart T-2 maps, both in the healthy volunteers and in a small patient cohort with suspected non-ischemic myocardial injury. Significantly higher T-2 values were found in patients as compared to controls in 3D but not in 2D, suggestive of the technique's potential to increase the sensitivity of CMR at earlier stages of disease. Further study will be needed to demonstrate its accuracy.

Automated summary

This study introduces a method to improve the precision of 3D T-2 mapping at 1.5T and tested it in a diverse patient cohort. The results showed significantly higher T-2 values in patients compared to controls with the 3D technique, indicating greater sensitivity.