Performance of two Methods for Cardiac MRI Edema Mapping: Dual-Contrast Fast Spin-Echo and T₂ Prepared Balanced Steady State Free Precession

Abstract

Purpose To compare true positive and false negative results of myocardial edema mapping in two methods. Myocardial edema may be difficult to detect on cardiac MRI.

Materials and Methods 76 patients (age 59 ± 11 years, 15 female) with acute myocardial infarction (MI) and 10 healthy volunteers were prospectively included in this single-center study. 1.5 T cardiac MRI was performed in patients 2.5 days after revascularization (median) for edema mapping: Steady State Free Precession (SSFP) mapping sequence with T₂-preparation pulses (T₂prep); and dual-contrast Fast Spin-Echo (dcFSE) signal decay edema mapping. Late gadolinium enhancement (LGE) was used as the reference for expected edema in acute MI.

Results 311 myocardial segments in patients were acutely infarcted with mean T₂ 73 ms for T₂prep SSFP vs. 87 ms for dcFSE edema mapping. In healthy volunteers the mean T₂ was 56 ms for T₂prep SSFP vs. 50 ms for dcFSE edema mapping. Receiver operating characteristic (ROC) curve for T₂prep SSFP show area under the curve (AUC) 0.962, p < 0.0001, Youden index J 0.8266, associated criterion > 60 ms, sensitivity 94 %, specificity 89 %. dcFSE ROC AUC 0.979, p < 0.0001, J 0.9219, associated criterion > 64 ms, sensitivity 93 %, specificity 99 %.

Conclusion Both edema mapping methods indicate high-grade edema with high sensitivity. Nevertheless, edema in acute infarction may be focally underestimated in both mapping methods.

Key Points: 

• Sensitivity for edema detection is high for both methods.

• Edema may be focally underestimated by T₂prep SSFP edema mapping and dcFSE mapping.

Citation Format

• Krumm P, Martirosian P, Rath D et al. Performance of two Methods for Cardiac MRI Edema Mapping: Dual-Contrast Fast Spin-Echo and T₂ Prepared Balanced Steady State Free Precession. Fortschr Röntgenstr 2020; 192: 669 – 677

Zusammenfassung

Ziel Vergleich von richtig positiven und falsch negativen Werten bei myokardialem Ödem-Mapping zweier Methoden. Der Ödemnachweis mittels MRT kann schwierig sein.

Material und Methoden 76 Patienten (Alter 59 ± 11 Jahre, 15 weiblich) mit akutem Myokardinfarkt (MI) und 10 gesunde Probanden wurden prospektiv in diese am Einzelzentrum durchgeführte Studie eingeschlossen. Im Median 2,5 Tage nach Revaskularisation wurde eine Herz-MRT bei 1,5 T zum Ödem-Mapping durchgeführt: Eine Steady-State-Free-Precession (SSFP)-Mapping-Sequenz mit T₂-Präparationspulsen (T₂prep) sowie ein Dual-contrast-Fast-Spin-Echo (dcFSE)-Signalzerfall-Ödem-Mapping. Als Referenz für ein zu erwartendes Ödem im akut infarzierten Myokard wurde Late-Gadolinium-Enhancement (LGE) eingesetzt.

Ergebnisse 311 Myokardsegmente in Patienten waren akut infarziert, mit einem mittleren T₂ von 73 ms für T₂prep-SSFP vs. 87 ms für dcFSE-Ödem-Mapping. In gesunden Probanden war das mittlere myokardiale T₂ 56 ms für T₂prep-SSFP vs. 50 ms für dcFSE-Ödem-Mapping. Operationscharakteristiken eines Beobachters (ROC-Kurven) für T₂prep-SSFP zeigten eine Fläche unter der Optimierungskurve (AUC) von 0,962, p < 0,0001, Youden-Index J 0,8266, assoziierter Schwellenwert > 60 ms, Sensitivität 94 %, Spezifität 89 %. Für dcFSE war die ROC-AUC 0,979, p < 0,0001, J 0,9219, assoziierter Schwellenwert > 64 ms, Sensitivität 93 %, Spezifität 99 %.

Schlussfolgerung Beide Methoden zum Ödem-Mapping erfassen ein höhergradiges Ödem mit hoher Sensitivität. Dennoch kann ein Ödem mit beiden Mapping-Methoden auch bei akutem Infarkt fokal unterschätzt werden.

Kernaussagen: 

• Beide Methoden zeigen eine hohe Sensitivität zur Detektion eines Ödems.

• Ödeme können von T₂prep-SSFP und dcFSE-Mapping fokal unterschätzt werden.

Key words

heart - cardiac - imaging sequences - ischemia/infarction - edema - MR imaging

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