Key result
Early post-contrast T1 mapping does not improve myocarditis detection compared to late imaging, as focal myocardial abnormalities were more conspicuous late (ECV difference 5.3 vs 4.0%-points, P=0.002).
Why the study?
The importance of timing for post-contrast imaging had not been evaluated using T1 mapping to detect myocarditis.
Does early post-contrast T1 mapping improve the detection of myocarditis compared to late post-contrast imaging in patients referred for myocarditis evaluation?
Observational (n=38)
Does early post-contrast T1 mapping improve the detection of myocarditis compared to late post-contrast imaging in patients referred for myocarditis evaluation?
Absolute Event Rate: 4% vs 5.3%
p-value: p=0.002
Quantitative evaluation by T1 mapping demonstrates that early post-contrast imaging does not improve myocarditis detection compared to late imaging, with focal abnormalities being more conspicuous late.
Early vs late T1 mapping performs similarly for myocarditis detection; leaves open optimal timing in prospective studies.
Summary Background Cardiovascular magnetic resonance (CMR) of myocarditis may include early gadolinium enhancement (EGE) and global relative enhancement (GRE) by T 1 ‐weighted images acquired before and early after contrast administration. However, the importance of timing for post‐contrast imaging has not been evaluated using T 1 mapping. We aimed to improve the understanding of the contrast mechanisms by evaluating whether early or late post‐contrast T 1 mapping was better at detecting myocarditis. Methods Controls and patients referred to evaluate myocarditis underwent 1·5T CMR. T 1 mapping was performed before, and 3 min (early) and 21 min (late) after intravenous contrast (0·2 mmol kg −1 ). Extracellular volume fraction (ECV) and the GRE and EGE equivalents by T 1 mapping were calculated. Focally affected myocardium in myocarditis was defined as increased native T 1 compared to remote myocardium. Results The GRE equivalent by T 1 mapping was higher in myocarditis ( n = 19) compared to controls ( n = 19) both early ( P <0·001) and late ( P <0·001). While remote myocardium in myocarditis had higher enhancement relative to skeletal muscle compared to controls early ( P = 0·002) and late ( P <0·001), ECV of skeletal muscle was lower compared to controls both early ( P = 0·03) and late ( P = 0·004), and remote myocardial ECV did not differ from controls early ( P = 0·37) or late ( P = 0·52). The difference in ECV between affected and remote myocardium was higher late compared to early by 5·3 ± 0·7 versus 4·0 ± 0·6%‐points ( P = 0·002). Conclusion Quantitative evaluation by T 1 mapping shows that early post‐contrast imaging does not improve the detection of myocarditis compared to late post‐contrast imaging. Focal myocardial abnormalities were more conspicuous late post‐contrast.
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Lundin et al. (2019) conducted an observational in Myocarditis (n=38). Early post-contrast T1 mapping (3 min) vs. Late post-contrast T1 mapping (21 min) was evaluated on Difference in extracellular volume fraction (ECV) between affected and remote myocardium (p=0.002). Early post-contrast T1 mapping does not improve myocarditis detection compared to late imaging, as focal myocardial abnormalities were more conspicuous late (ECV difference 5.3 vs 4.0%-points, P=0.002).
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