Can Spleen T1 Mapping Be Used as a Marker of Adenosine Response in Cardiac MRI?

Q: What are the key findings of this study?

Splenic T1 value change (ΔT1 spleen) from rest to adenosine stress identified splenic switch-off with 80% sensitivity, 75% specificity, and an AUC of 81.2% (95% CI 66.7%–95.8%, p=0.001).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Suspected or known coronary artery disease undergoing adenosine stress perfusion cardiac magnetic resonance (n=47). Intervention: Splenic T1 mapping (MOLLI sequence) at rest and during intravenous adenosine stress (140 μg/kg/min) to calculate ΔT1 spleen vs. Visual assessment of splenic switch-off on contrast first-pass perfusion images (reference standard) and semi-quantitative signal intensity change (ΔSI spleen). Primary outcome: Diagnostic classification of splenic switch-off (positive vs. failed switch-off) using ΔT1 spleen compared against visual assessment of first-pass perfusion images (AUC 81.2% (sensitivity 80%, specificity 75%), 95% CI 66.7%-95.8%, p=0.001).

Q: What does this research mean for the field?

Splenic T1 value change from rest to adenosine stress identifies splenic switch-off during cardiac stress MRI with 80% sensitivity, 75% specificity, and an AUC of 81.2%. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Sergio Solis-Barquero; Ana Ezponda; Verónica Aramendía‐Vidaurreta; Marta Vidorreta; Marina Pascual; Gorka Bastarrika; María A. Fernández‐Seara

doi:10.1002/nbm.70430

October 29, 2026NMR in BiomedicineOpen Access

Can Spleen T1 Mapping Be Used as a Marker of Adenosine Response in Cardiac MRI?

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Key result

Splenic ΔT1 identifies adenosine-induced splenic switch-off with an AUC of ~81%.

AUC 81.2% (sensitivity 80%, specificity 75%)
95% CI 66.7%-95.8%
P=0.001
n=47

Figures

Graphical abstract published by NMR in Biomedicine — Graphical abstract · Published by NMR in Biomedicine · CC BY

Why the study?

Existing data on using splenic T1 mapping to quantitatively assess splenic switch-off during adenosine stress cardiac MRI are limited.

Can splenic T1 mapping changes from rest to stress (ΔT1 spleen) accurately identify splenic switch-off as a marker of adenosine response in patients with suspected or known coronary artery disease undergoing stress perfusion cardiac MRI?

Key Points

To investigate whether splenic T1 mapping can quantitatively assess splenic switch-off as a marker of adequate adenosine stress response during cardiac magnetic resonance imaging.
Evaluated 47 patients with suspected coronary artery disease who had visible spleens during 1.5 T adenosine stress perfusion cardiac magnetic resonance imaging.
Used visual assessment of first-pass perfusion images as the reference standard for splenic switch-off and measured splenic signal intensity changes (ΔSI).
Calculated splenic T1 differences between rest and stress (ΔT1 spleen) and analyzed diagnostic performance using receiver operating characteristic (ROC) curves.
Visual splenic switch-off occurred in 74.5% (n=35/47) of patients, with a significant decrease in splenic T1 values between rest and stress only in the switch-off group (p < 0.001; median ΔT1 -35.2 ms vs 10.3 ms in failed switch-off, p = 0.001).
Splenic ΔT1 separated switch-off from failed switch-off with 80% sensitivity, 75% specificity, and an AUC of 81.2% (95% CI: 66.7%–95.8%), showing a weak positive correlation with first-pass ΔSI (ρ s = 0.37, p = 0.01).
Among non-coronary artery disease controls, stress myocardial blood flow was higher in patients with splenic switch-off than in those with failed switch-off (median 2.0 vs 1.1 mL/g/min, p = 0.04), while myocardial perfusion reserve did not differ significantly (p = 0.10).

Study Design

Type

Cohort (n=47)

Blinding

Researchers analyzing T1 maps were blinded to subject clinical data and the T1 map condition (rest or stress)

Multicenter

No

Structured PICO

Can splenic T1 mapping changes from rest to stress (ΔT1 spleen) accurately identify splenic switch-off as a marker of adenosine response in patients with suspected or known coronary artery disease undergoing stress perfusion cardiac MRI?

P

Population

47 adults (mean age 66 years in the 53 studied cohort, 25.5% female in the analyzed cohort) with suspected or known coronary artery disease undergoing 1.5 T adenosine stress perfusion CMR at a single center in Spain.

E

Exposure

Quantitative splenic native T1 mapping using a single-slice (mid-ventricular short-axis) modified Look-Locker inversion recovery (MOLLI 5(3)3(0)) sequence at 1.5 T at rest and ~3 minutes into fixed-dose intravenous adenosine infusion (140 μg/kg/min) prior to gadolinium contrast administration to measure rest-to-stress T1 change (ΔT1 spleen).

C

Comparator

Visual assessment of splenic switch-off on bSSFP gadolinium (0.75 mmol/kg gadobutrol) first-pass perfusion images by expert consensus (reference standard), and semi-quantitative splenic perfusion signal intensity change (ΔSI spleen).

O

Outcome

Diagnostic performance (ROC AUC, sensitivity, specificity) and group differences of splenic T1 change from rest to stress (ΔT1 spleen) in classifying positive vs. failed splenic switch-off during a single adenosine stress CMR session.surrogate

Main Result

Effect estimate: AUC 81.2% (sensitivity 80%, specificity 75%) (95% CI 66.7%-95.8%)

Absolute Event Rate: -35.2% vs 10.3%

p-value: p=0.001

Splenic native T1 mapping during adenosine stress CMR can quantitatively detect splenic switch-off (AUC 81.2%) prior to contrast administration, offering a potential real-time marker of vasodilator response adequacy.

Limitations

Relatively small sample size (n=47 analyzed; n=12 in failed switch-off group; n=28 non-CAD controls), which may have reduced statistical power
Single-center study performed only at 1.5 T using a specific MOLLI 5(3)3(0) sequence
Notable variability in optimal ΔT1 spleen thresholds compared with previously published studies, requiring protocol standardization before clinical adoption
Blood pressure and patient-reported symptom data were not recorded for research purposes
Relatively small sample size (n=47 analyzed, with only n=12 in the failed switch-off group and n=28 in the non-CAD control subgroup), reducing statistical power
Threshold obtained by Youden index (≥5.5 ms change) was notably lower in magnitude than previously published thresholds, requiring validation in larger cohorts
Potential heart rate dependency and T1 underestimation inherent to the MOLLI sequence
Single-center study at 1.5 T; blood pressure and symptom data were not recorded for research analysis

Implication

Splenic ΔT1 may quantify splenic switch-off during adenosine stress CMR; leaves open prospective validation before clinical adoption.

Abstract

Splenic switch‐off, defined as the visible reduction in splenic perfusion during adenosine stress, can be used as a marker of adequate adenosine response in cardiac stress MRI studies, which can be assessed after the study. Moreover, there is some evidence regarding the use of T1 mapping for the evaluation of splenic switch‐off during the study. The aim of this work is to further investigate splenic T1 mapping as a method for quantitatively assessing splenic switch‐off, given the limited existing data. Patients with suspected coronary artery disease were scanned at 1.5 T with the routine clinical protocol for stress perfusion cardiac magnetic resonance (CMR), including a T1 mapping sequence at rest and during adenosine stress. Visual assessment of first‐pass images was used as the reference standard for detecting splenic switch‐off. Semi‐quantitative analysis of splenic perfusion was performed based on the signal intensity curves and signal changes (ΔSI) were calculated. T1 maps were used to obtain T1 value changes in the spleen from rest to stress (ΔT1 spleen ). Statistical analysis was assessed using an align rank transform followed by a mixed analysis of variance, with Bonferroni corrected post hoc tests. A total of 74.5% ( n = 35/47) of analyzed patients experienced splenic switch‐off according to the visual assessment. Statistically significant differences were found in splenic T1 between rest and stress only in the switch‐off group ( p < 0.001), with lower T1 values during stress. There was significant positive weak correlation (ρ s = 0.37, p = 0.01) between splenic ΔT1 and ΔSI based on first‐pass. ROC curves demonstrated that ΔT1 spleen classified the failed switch‐off and positive switch‐off groups with a specificity of 75% and a sensitivity of 80% (AUC: 81.2%, 95% CI: 66.7%–95.8%). This work indicates that the splenic T1 value change has the potential to identify splenic switch‐off during adenosine stress CMR in a clinical population.

Discussion

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Cite This Study

Solis-Barquero et al. (2026) conducted a cohort in Suspected or known coronary artery disease undergoing adenosine stress perfusion cardiac magnetic resonance (n=47). Splenic T1 mapping (MOLLI sequence) at rest and during intravenous adenosine stress (140 μg/kg/min) to calculate ΔT1 spleen vs. Visual assessment of splenic switch-off on contrast first-pass perfusion images (reference standard) and semi-quantitative signal intensity change (ΔSI spleen) was evaluated on Diagnostic classification of splenic switch-off (positive vs. failed switch-off) using ΔT1 spleen compared against visual assessment of first-pass perfusion images (AUC 81.2% (sensitivity 80%, specificity 75%), 95% CI 66.7%-95.8%, p=0.001). Splenic T1 value change (ΔT1 spleen) from rest to adenosine stress identified splenic switch-off with 80% sensitivity, 75% specificity, and an AUC of 81.2% (95% CI 66.7%–95.8%, p=0.001).

synapsesocial.com/papers/6ae585034c46c197bbab3172 https://doi.org/10.1002/nbm.70430

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Can Spleen T1 Mapping Be Used as a Marker of Adenosine Response in Cardiac MRI?

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Can Spleen T1 Mapping Be Used as a Marker of Adenosine Response in Cardiac MRI?

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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