RPS 703 - New techniques and clinical applications of CMR

Author Block: G. Lucchi, G. D. Aquaro, A. Marcucci, M. Lombardo, L. Faggioni, R. Lencioni, D. Cioni, E. Neri; Pisa/IT
Purpose: To evaluate Flip Angle Mapping (FAM) as a non-contrast alternative to Late Gadolinium Enhancement (LGE) for assessing ischemic core in acute myocardial infarction using balanced Steady-State Free Precession (bSSFP) MRI sequences.
Methods or Background: This study included 11 patients suspected of Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) and eight healthy controls. Two bSSFP datasets were acquired with flip angles of 15° and 60°, respectively. Signal intensity differences were mapped and compared to LGE images. Pathological areas were manually segmented on both FAM and LGE images. A statistical analysis was conducted to evaluate the correlation and concordance of the two methods in estimating the pathological area.
Results or Findings: The diagnosis of MINOCA was confirmed in five patients, while four others were diagnosed with myocarditis and two with Takotsubo syndrome. Comparison between FAM and LGE images showed a complete overlap of pathological areas. Linear regression analysis revealed a strong positive correlation between the extent of LGE and FAM abnormalities (r=0.99; p<0.001). Bland-Altman analysis confirmed good agreement between the two methods (mean difference: -0.3%; 95% limits of agreement: -4.3 to 3.6%).
Conclusion: These findings suggest that FAM could potentially replace LGE for acute myocardial damage assessment, dispensing with contrast agents. If validated in larger studies, FAM could represent a significant advancement in non-invasive cardiac imaging.
Limitations: No limitations were identified.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: The study is a methodological proof of principle.

Author Block: V. De Villedon De Naide¹, K. Narceau¹, B. Durand¹, T. Küstner², M. Villegas-Martinez¹, P. Jais¹, M. Stuber³, H. Cochet¹, A. Bustin¹; ¹Bordeaux/FR, ²Tübingen/DE, ³Lausanne/CH
Purpose: Multi-shot black-blood LGE imaging is increasingly being used to assess myocardial scars and overcome poor scar-blood contrast, often observed with conventional bright-blood LGE imaging. However, this method is time-consuming, requires multiple breath-holds, and is prone to residual motion artifacts. Here, we introduce a one-shot black-blood LGE sequence combined with image denoising to provide rapid, motion-free, and diagnostically accurate scar imaging.
Methods or Background: The 2D black-blood ECG-triggered LGE sequence acquires multiple single-shot short-axis images per slice using a non-selective 180° inversion pulse, followed by a T1-rho preparation. A dummy heartbeat is added between shots, for magnetization-recovery. Single-shot images are averaged to enhance quality. The proposed one-shot sequence eliminates dummy heartbeats and employs a patch-based low-rank denoising algorithm (PROST) to achieve image quality comparable to multi-shot techniques.
19 patients with ischemic heart disease underwent 1.5T CMR (Siemens Area) using reference PSIR and five-shot black-blood LGE imaging 12min after gadolinium injection. One-shot images were retrospectively selected from multi-shot datasets and were PROST-denoised.
A blinded radiologist graded diagnostic confidence, documented eventual residual motion artefact and extracted scar volume and signal intensities (blood, scar, remote myocardium) using Circle CVI42 for the three datasets.
Results or Findings: Acquisition times were in average 4min shorter for black-blood one-shot PROST compared to reference sequences. No statistically significant differences were observed between black-blood multi-shot and one-shot PROST in signal intensities or in scar detection, while scar volume agreement was excellent. Diagnostic confidence was rated good or excellent in 95% of black-blood multi-shot and 89% of one-shot PROST scans. No residual motion artefacts were found in black-blood one-shot PROST datasets.
Conclusion: Black-blood one-shot PROST provides rapid, motion-free, and diagnostically accurate scar imaging, offering a more efficient and patient-friendly solution.
Limitations: Prospecting testing is now warranted.
Funding for this study: This research was supported by funding from the French National Research Agency under grant agreement ANR-22-CPJ2-0009-01, and from the European Research Council (ERC) grant "SMHEART" under the European Union’s Horizon 2020 research and innovation programme (grant agreement No101076351).
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by the Biomedical Research Ethics Committee and all participants provided informed consent for participation.

Author Block: P. Zhou, Z. Dong, S. Zhao; Beijing/CN
Purpose: Using endomyocardial biopsy as the reference standard, this study aimed to 1) evaluate the association between cardiac MRI (CMR) multiparameters and significant acute cardiac allograft rejection (SR), and 2) assess the incremental value of CMR multiparameters over conventional serum examinations for identifying SR in heart transplantation (HTx) recipients.
Methods or Background: HTx recipients with endomyocardial biopsy and healthy controls were prospectively recruited for CMR assessment. CMR feature tracking (CMR-FT) was performed to evaluate the left ventricular (LV) global strain in all three directions. The last serum examinations including N-terminal pro brain natriuretic peptide (NT-proBNP) before anti-rejection therapy were recorded. Participants were divided into 3 groups: control, SR (acute cellular rejection grade≥2R and/or antibody-mediated rejection [AMR] grade≥pAMR1), and NSR (non-SR).
Results or Findings: Finally, thirty controls (43.3±13.6 years, 26 male) and 51 HTx recipients comprising 23 SRs (48.6±12.6 years, 24 male) and 28 NSRs (42.7±14.9 years, 16 male) were enrolled for analysis. Compared with NSRs, SRs showed elevated NT-proBNP (7797.0±7527.6pg/ml vs 3334.6±5935.3pg/ml, p<.001), worse LV global longitudinal strain (GLS) (-9.7±3.1% vs -13.1±2.9%, p<.001), and increased native T1 (1384±80.1ms vs 1321±69.9ms, p<.001) and T2 values (50.9±2.7ms vs 45.7±4.3ms, p<.001). In multivariable analysis, LVGLS (OR=0.76, 95%CI, 0.59 to 0.98, p=.03) and T2 value (OR=1.35, 95%CI, 1.10 to 1.65, p=.01) were independently associated with SR after NT-proBNP adjustment. Furthermore, the likelihood ratio test showed LVGLS (p=.002) and T2 value (p<.001) had incremental value over NT-proBNP for identifying SR.
Conclusion: LV GLS and T2 value were independently associated with SR, providing incremental value for non-invasive identification of significant rejection in HTx recipients.
Limitations: Although a relatively small participant sample, this is a prospective and biopsy-proven study with comprehensive cardiac examinations, including T1 and T2 mapping of CMR.
Funding for this study: This study is supported by the National Key R&D Program of China (Nos. 2021YFF0501400 and 2021YFF0501404) and the Key Project of National Natural Science Foundation of China (No. 81930044).
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The ethics committee from Fuwai Hospital.

Author Block: D. Kravchenko¹, L. Bischoff¹, A. Isaak¹, T. Holderried¹, T. S. Emrich², A. Varga-Szemes², N. Mesropyan¹, D. Kütting¹, J. A. Luetkens¹; ¹Bonn/DE, ²Charleston, SC/US
Purpose: New chimeric antigen receptor (CAR)-T cell therapy has demonstrated advantages over traditional cancer therapies for treatment of highly refractory or relapsing hematological malignancies. Unfortunately, there is a paucity of data regarding cardiotoxic cardiac MRI (CMR) findings of therapy associated cytokine release syndrome (CRS).
Methods or Background: Consecutive patients were enrolled for CAR-T cell therapy and received a standard 1.5 T CMR examination consisting of functional cines, parametric mapping, late gadolinium enhancement (LGE), and featuring tracking strain, before therapy (baseline), during acute cytokine release syndrome (CRS; as determined by treating oncologist and lab parameters), and at 6-month follow-up (mean 184±20 days). Data was compared using RM-ANOVA with Tukey’s posthoc test.
Results or Findings: 29 patients were available for analysis (mean age 60±15 years, 23 males [79%]). The most common malignancy was diffuse large B-cell lymphoma (13 [45%]). CRS was observed at a median time of one day (IQR 1-2 days) after CAR T-cell therapy and reached a median degree of 1 (IQR 1-2). One patient passed away due to non-cardiac related CRS. One patient developed therapy associated heart failure. No new instances of LGE were observed in any cases. There were no differences from baseline to CRS or to follow-up scans for left ventricular ejection fraction (61±5 vs 60±6 vs 59±7%, p=0.39), T1 relaxation times (969±18 vs 988±26 vs 972±22 ms, p=0.11), T2 relaxation times (53.3±2.4 vs 54.0±3.0 vs 52.9±1.8 ms, p=0.36), global longitudinal strain (-16.3±2.2 vs -15.6±2.4 vs -14.9±2.8, p=0.18), global circumferential strain (-12.5±2.9 vs -13.0±2.7 vs -12.2±1.8, p=0.51), or global radial strain (28.3±12.5 vs 29.2±8.1 vs 30.5±6.0, p=0.67).
Conclusion: CAR T-cell therapy related low degree CRS does not produce significant myocardial changes on multiparametric CMR from baseline to acute CRS or follow-up.
Limitations: Small study size.
Funding for this study: None
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Ethikkommission der Medizinischen Fakultät Bonn
Geb. 74, 4. OG
Venusberg-Campus 1
53127 Bonn

Author Block: Y. Fan, X. Zhu; Nan Jing/CN
Purpose: As a novel technique, left bundle branch pacing (LBBP) can achieve excellent resynchronization in patients with left bundle branch block（LBBB）. The study is to use cardiovascular magnetic resonance (CMR) to evaluate myocardial scars of different segments to predict the prognosis of patients with LBBB.
Methods or Background: Consecutive patients with LBBB, left ventricular ejection(LVEF)≤35% and who underwent CMR examination and successful LBBP were retrospectively enrolled. The myocardial scar of different segments is assessed by CMR. LVEF response was defined as a 15% increase in LVEF assessed by echocardiography at 6 months.
Results or Findings: Among 68 patients who were included，and 52 patients patients showed a favorable LVEF response . The responders had lower global, septal scar burden by CMR (P<0.001). The scar burden of AHA 8 is independently associated with the prognosis of LBBP ( AUC: 0.877 [95% CI: 0.782, 0.971]) and the linear equation was that ΔLVEF= -0.4161(scar burden) + 23.229 (r=-0.60,P＜0.001), indicating that each 1% increased in scar burden, LVEF decreased by 0.4161%. Moreover, the patterns of scar of AHA8 and the scar morphology are independent of the improvement of LVEF (P＞0.05).
Conclusion: The scar burden of AHA 8, as a common implantation area, can predict LVEF improvement. And we recommend to pay more attention to the extent of mycardial LGE rather than the patterns and morphology.
Limitations: The limitations are that firstly, it is a retrospective single-center investigation and it may lead to an inclusion bias in that some patients who did not undergo CMR before surgery were not included in the examination. Secondly, the study only investigated patients with low LVEF, and further confirmation is needed on the relationship between the prognosis of patients with high LVEF.
Funding for this study: Project supported by the Young Scientists Fund of the National Natural Science Foundation of China (No.82302163 )
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: Given that the study was retrospective, the committee has been waived.

Author Block: P. Gut¹, D. Kim², H. Cochet³, F. Sacher³, P. Jais³, M. Stuber¹, A. Bustin⁴; ¹Lausanne/CH, ²Northwestern/US, ³Pessac/FR, ⁴Bordeaux/FR
Purpose: Myocardial T2 mapping allows assessment of myocardial inflammation and edema, but is impacted by artefacts related to implantable cardioverter defibrillators (ICDs), leading to image artifacts and inacurate T2 values. This study aimed to integrate a wideband T2 preparation into a T2 mapping sequence and evaluate its performance against conventional T2 mapping in healthy subjects with and without ICDs.
Methods or Background: Three short-axis slices covering the heart at the basal, mid-ventricular, and apical levels were acquired in eight healthy volunteers (2 females, age: 26±6y) at 1.5T (MAGNETOM Aera, Siemens) during end-expiration in mid-diastole using both conventional and wideband T2 mapping, with and without an ICD taped below the left clavicle (~10 cm from the heart).

The T2 preparation module (duration=0, 27, 55ms) included two adiabatic hyperbolic secant refocusing pulses of 1.6 kHz (conventional) and 5.0 kHz (wideband). Common parameters included: resolution=1.4mmx1.4mm, slice thickness=8mm, FA=15°, GRAPPA x2, partial Fourier phase 6/8, TE/TR=2.09/3.95ms, readout bandwidth=1221Hz/pixel, FOV=360mmx287mm, and gradient recalled-echo (GRE) readout.

T2 maps were reconstructed using a 2-parameter (M0 and T2) fitting model. Myocardial T2 values were manually extracted in 16 heart segments. Statistical analyses were performed using repeated measures ANOVA and Bonferroni correction.
Results or Findings: Without ICD, T2 values were not significantly different between conventional (mean: mean: 43.5, SD: 2.21) and wideband sequences (mean: 44.0, SD: 2.15) (P=0.111). With ICD, conventional T2 values significantly decreased (mean: 36.4, SD: 5.91) (P<0.01), especially in apical anterior, apical inferior, mid-ventricular anterior, and basal anterior segments. Wideband T2 values remained unchanged (mean: 42.7, SD: 1.91) (P=0.377).
Conclusion: Wideband T2 mapping effectively reduces ICD-related artifacts, providing more accurate myocardial T2 values than conventional T2 mapping.
Limitations: The study was conducted solely on healthy individuals. Validation in clinical populations is warrented.
Funding for this study: This research was supported by funding from the French National Research Agency under grant agreements Equipex MUSIC ANR-11-EQPX-0030, ANR-22-CPJ2-0009-01, ANR-21-CE17-0034-01, and Programme d’Investissements d’Avenir ANR-10-IAHU04-LIRYC, and from the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation program (grant agreement 101076351).
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: The study was approved by the Biomedical Research Ethics Committee and all participants provided informed consent for participation.

Author Block: X. Jia, S. Zhao; Beijing/CN
Purpose: Based on current guidelines, only a few dilated cardiomyopathy (DCM) patients with left ventricular ejection fraction (LVEF) <35% receive appropriate implantable cardioverter-defibrillator therapy, leading to increased medical costs and patient complications. We explored the predictive value of LV remodeling index (LVRI) for ventricular tachyarrhythmia (VTA) in nonischemic DCM with LVEF <35%.
Methods or Background: In this retrospective single-center study, consecutive nonischemic DCM patients with LVEF <35% (n=271) who underwent cardiac magnetic resonance (CMR) imaging were followed up for VTA events, including sustained ventricular tachycardia, ventricular fibrillation/flutter, sudden cardiac death (SCD), and aborted SCD. The newly derived LVRI was defined as the cubic root of the LV end-diastolic volume divided by the maximal LV wall thickness. Competing risk regression analysis and Kaplan-Meier analysis were used to evaluate the association of LVRI with VTA.
Results or Findings: During a median follow-up of 71 months (interquartile range: 17–134 months), 35 (12.9%, mean age 46.7 years, 27 males) participants reached VTA events. The presence of late gadolinium enhancement (LGE) (62.9% vs. 60.2%, p=0.761) and LVEF (23.3±6 vs. 21.9±10.3, p=0. 197) were not significantly different between the patients with and without VTA events. Kaplan-Meier curve analysis showed that participants with LVRI ≥7.5 were more likely to experience VTA (p<0.0001). In the multiple competing risk analysis, when heart transplantation and heart failure-related death were counted as competing risks, LV mass index (hazard ratio [HR], 0.983; 95% confidence interval [CI]: 0.968-0.999; p=0.033) and LVRI ≥7.5 (HR, 2.496; 95% CI: 1.213-5.138; p=0.013) were observed as the independent predictors of VTA after adjusting for age, sex and left bundle branch block.
Conclusion: In the cohort of patients with nonischemic DCM with LVEF <35%, CMR-assessed LVRI ≥7.5 was an independent predictor of VTA events.
Limitations: Not applicable.
Funding for this study: Funding was received from the National Key R&D Program of China (No. 2021YFF0501400, 2021YFF0501404); Key Project of National Natural Science Foundation of China (No. 81930044).
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study received institutional review board approval and written informed consent was obtained from all participants.

Author Block: J. Erley, D. G. Aydemir, K. Muellerleile, E. Cavus, G. Adam, M. Meyer, E. Tahir; Hamburg/DE
Purpose: To analyze the effect of waist-to-hip ratio (WHR) and body mass index (BMI) on cardiac structure and function using magnetic resonance imaging (CMR).
Methods or Background: The Hamburg City Health Study (HCHS) is a population-based cohort study. Individuals between 45-74 years of age underwent 3T CMR. Subjects with cardiac diseases (e.g., coronary artery disease, myocardial infarction), and previous cardiac interventions were excluded. Linear regression models were conducted, adjusted for age and sex.
Results or Findings: 1671 subjects (41% female, mean age 64±8 years) were analyzed. Median WHR was 0.95 [interquartile range: 0.88; 1.01] and median BMI was 26.2kg/m² [23.8; 29.2]. Concerning BMI cut-off values, 44% of subjects were overweight (BMI 25-29.9kg/m²) and 20% obese (BMI ≥ 30kg/m²). According to the WHR, 81% of subjects were obese (WHR ≥0.85 in females and 0.90 in males). An increase in WHR was associated with a 5.2% [0.1-10.2] higher left ventricular (LV) ejection fraction (p=0.044), and a 43.6g [27.6; 59.5] higher LV end-diastolic mass (EDM) (p<0.001), but lower LV and right ventricular (RV) end-diastolic volumes (EDV) (LV: -37.3ml [-57.4; -17.3], p<0.001; RV: -34.0ml [-56.0; -12.1], p=0.002) and end-systolic volumes (LV: -18.7ml [-28.5; -8.8], p<0.001; RV: -16.0ml [-28.8;-3.1], p=0.015), leading to lower stroke volumes (SV) (LV: -18.5ml [-32.2;-4.7], p=0.008; RV: -18.8ml [-33.6;-4.1], p=0.013). An increase in BMI was associated with a 1.9g [0.2; 2.2] higher LVEDM (p<0.001), higher EDV (LV: 0.5ml [0.2; 0.9], p=0.002; RV: 0.4ml [0.1; 0.7], p=0.047) and a 0.4ml [0.2; 0.7] higher LVSV (p<0.001).
Conclusion: An increase in WHR is associated with a higher left ventricular mass and lower volumes as a sign of concentric remodeling, while an increase in BMI is associated with ventricular dilatation.
Limitations: Analyses are not adjusted for other cardiovascular risk factors.
Funding for this study: The HCHS is supported by the Innovative medicine initiative (IMI) under Grant No. 116074, by the Fondation Leducq under Grant Number 16 CVD 03, by the euCanSHare Grant Agreement No. 825903-euCanSHare H2020 and the DFG under project Grant TH1106/5-1; AA93/2-1. The DIFE provides the licence for the Food Frequency and Physical activity. Technical equipment is provided by SIEMENS according to a contract for 12 years as well as by the Schiller AG on a loan basis for 6 years and by Topcon on a loan basis from 2017 until 2022. The Hamburg City Health Study is additionally supported by an unrestricted Grant (2017–2022) by Bayer. Project-related analyses are supported by Amgen, Astra Zeneca, BASF, Deutsche Gesetzliche Unfallversicherung (DGUV), DKFZ, DZHK, Novartis, Seefried Stiftung and Unilever. The study is further supported by donations from the “Förderverein zur Förderung der HCHS e.V.”, TEPE (2014) and Boston Scientific (2016). A current list of the supporters is online available on www.uke.de/hchs.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by the local ethics committee of the medical association in Hamburg.

Author Block: A. Fortunati, D. Fazzini, S. Papa, M. Alì, F. Darvizeh, F. Secchi; Milan/IT
Purpose: Lipomatous hypertrophy of the atrial septum is a benign anomaly, consisting in a fatty infiltration of the interatrial septum with sparing of the fossa ovalis and typically associated with elderly. This retrospective study aim to define the prevalence of LHAS through cardiac magnetic resonance and its correlation with age or functional biventricular parameters.
Methods or Background: A retrospective analysis of 621 patients who underwent CMR from March 2020 to March 2022 was performed, with the following inclusion criteria: the presence of a 4-chamber sequence and the presence of volume analysis. All images were reviewed by a reader to evaluate the presence of LHAS. The atrial septum thickness was measured, and the functional biventricular parameters retrieved from the clinical report. The statistical analysis was conducted using the Spearman’s correlation test.
Results or Findings: Among the 619 patients included in the study, 241 patients were found with LHAS and 150 showed lipomatous deposition of the upper half of the atrial septum with a mean thickness of the atrial septum of 3 mm. A significant negative correlation was found between the degree of LHAS and left ventricle end-diastolic volume (r = -0.21, p<0.001) and systolic volume (r = -0.20, p<0.001). A significant negative correlation was also recognized between the degree of LHAS and right ventricle end-diastolic volume (r = -0.25, p<0.001) and systolic volume (r = -0.18, p<0.001).
Conclusion: LHAS reached a 39% prevalence. Findings confirm a significant negative correlation between LHAS and biventricular end-diastolic volumes according to a consecutive reduction of atrial and ventricular volumes to offset the volumetric increase of atrial septum and a progressive increase of LHAS disease prevalence with age.
Limitations: The study has some limitations due to its monocentric nature and the relatively small sample size.
Funding for this study: None
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The local Ethics Committee approved this retrospective study.

Author Block: D. Zhou, M. Lu, Y. Wang; Beijing/CN
Purpose: Magnetic resonance imaging (MRI)-derived arrhythmogenic substrate is indicative of sudden cardiac death (SCD) in patients with non-ischemic cardiomyopathy (NICM). A key issue that needs to be addressed is what extent of T1 mapping metric contributes to the prognosis for SCD over late gadolinium enhancement (LGE).
Methods or Background: A total of 837 NICM patients who underwent T1 mapping MRI were consecutively enrolled in this study. The primary endpoint is a composite of SCD-related events, including SCD, appropriate implantable cardioverter-defibrillator shock and resuscitated cardiac arrest.
Results or Findings: Over a median follow-up of 58.3 months, 78 patients reached the primary endpoint, and 198 patients reached the secondary endpoint. In the adjusted analysis, LGE ≥ 7.2%(HR: 4.748, p < 0.001), extracellular volume (ECV) fraction ≥ 31.8% (HR: 2.913, p = 0.001), and native T1 z-score ≥ 2.1 (HR: 1.686, p = 0.035) were associated with SCD-related events. Patients with LGE (-) and ECV ≥ 31.8% were at higher risk of experiencing SCD events compared to those with ECV < 31.8% and LGE between 0-7.2% or mid-wall/focal LGE. Patients stratified by LGE ≥ 7.2% exhibited a high risk of experiencing SCD-related events with an annual event rate of 4.65%, regardless of ECV. Patients with LVEF > 35%, LGE < 7.2%, and ECV < 31.8 exhibited an actual low risk of SCD with an annual event rate of 0.2%.
Conclusion: LGE ≥ 7.2% was strongly associated with high SCD risk, superior to LGE distribution and pattern. ECV serves a crucial role in differentiating patients at low to moderate risk, particularly those with negative LGE or focal/mid-wall LGE.
Limitations: This is a retrospective study.
Funding for this study: High-level research projects of the National Health Commission (2022-GSP-QZ-5)
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Fuwai Hospital

Author Block: V. De Villedon De Naide¹, E. Gerbaud¹, B. Durand¹, M. Villegas-Martinez¹, A. I. Schmid², P. Jais¹, M. Stuber³, H. Cochet¹, A. Bustin¹; ¹Bordeaux/FR, ²Vienn/AT, ³Lausanne/CH
Purpose: CMR imaging enables post-infarction risk-stratification by identifying prognostic markers, such as infarct size (IS), the presence of microvascular obstruction (MVO), ejection fraction, area-at-risk (AAR) and myocardial salvage (MS). However, collecting these markers requires the use of several MRI sequences. Here, we propose a unified 'one-click' sequence jointly collecting scar, MVO, and MS information for seamless planning, fast acquisition, and enhanced image quantification and analysis in the acute STEMI population.
Methods or Background: The proposed 2D whole-heart SPOT-MAPPING acquisition is a single-shot breath-held sequence gathering black- and bright-blood LGE images, averaged for optimal measurement of IS and MVO. For the bright-blood shots, a T2 preparation module with increasing duration is used to generate a T2 map for myocardial tissue quantification (MS and AAR). Seven patients with acute STEMI underwent CMR (1.5T Siemens). Pre-contrast T2 maps and post-contrast PSIR, SPOT and SPOT-MAPPING images were collected in a random order 12 after injection of gadolinium. Left ventricular wall and scar contours were drawn by a radiologist using Circle CVI42. Prognostic markers were extracted according to literature, along with T2 values in remote and injured myocardium. Acquisition times were recorded.
Results or Findings: Acquisition times for PSIR, SPOT, T2 mapping and proposed SPOT-MAPPING were 10, 10, 13 and 10 heartbeats per slice, respectively. No significant differences were found between SPOT-MAPPING and PSIR for IS and between SPOT-MAPPING and T2 mapping for AAR, and T2 values. By imaging both IS and AAR in a co-registered fashion, SPOT-MAPPING enabled the measurement of the MS and the MVO.
Conclusion: SPOT-MAPPING enables easy planning, fast acquisition and enhanced image quantification and analysis for patients with acute STEMI.
Limitations: Further validation in a larger cohort is warranted, as SPOT-MAPPING clinical application is still in its early stages.
Funding for this study: This research was supported by funding from the French National Research Agency under grant agreement ANR-22-CPJ2-0009-01, and from the European Research Council (ERC) grant "SMHEART" under the European Union’s Horizon 2020 research and innovation programme (grant agreement No101076351).
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by the Biomedical Research Ethics Committee and all participants provided informed consent for participation.