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Topriceanu CC, Pierce I, Moon JC, Captur G. T 2 and T 2⁎ mapping and weighted imaging in cardiac MRI. Magn Reson Imaging 2022; 93:15-32. [PMID: 35914654 DOI: 10.1016/j.mri.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/20/2022] [Accepted: 07/20/2022] [Indexed: 11/29/2022]
Abstract
Cardiac imaging is progressing from simple imaging of heart structure and function to techniques visualizing and measuring underlying tissue biological changes that can potentially define disease and therapeutic options. These techniques exploit underlying tissue magnetic relaxation times: T1, T2 and T2*. Initial weighting methods showed myocardial heterogeneity, detecting regional disease. Current methods are now fully quantitative generating intuitive color maps that do not only expose regionality, but also diffuse changes - meaning that between-scan comparisons can be made to define disease (compared to normal) and to monitor interval change (compared to old scans). T1 is now familiar and used clinically in multiple scenarios, yet some technical challenges remain. T2 is elevated with increased tissue water - oedema. Should there also be blood troponin elevation, this oedema likely reflects inflammation, a key biological process. T2* falls in the presence of magnetic/paramagnetic materials - practically, this means it measures tissue iron, either after myocardial hemorrhage or in myocardial iron overload. This review discusses how T2 and T2⁎ imaging work (underlying physics, innovations, dependencies, performance), current and emerging use cases, quality assurance processes for global delivery and future research directions.
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Affiliation(s)
- Constantin-Cristian Topriceanu
- Cardiac MRI Unit, Barts Heart Centre, West Smithfield, London, UK; UCL Institute of Cardiovascular Science, University College London, London, UK; UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Iain Pierce
- Cardiac MRI Unit, Barts Heart Centre, West Smithfield, London, UK; UCL Institute of Cardiovascular Science, University College London, London, UK
| | - James C Moon
- Cardiac MRI Unit, Barts Heart Centre, West Smithfield, London, UK; UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Gabriella Captur
- Cardiac MRI Unit, Barts Heart Centre, West Smithfield, London, UK; UCL Institute of Cardiovascular Science, University College London, London, UK; UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK; The Royal Free Hospital, Centre for Inherited Heart Muscle Conditions, Cardiology Department, Pond Street, Hampstead, London, UK.
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Arcari L, Tini G, Camastra G, Ciolina F, De Santis D, Russo D, Caruso D, Danti M, Cacciotti L. Cardiac Magnetic Resonance Imaging in Immune Check-Point Inhibitor Myocarditis: A Systematic Review. J Imaging 2022; 8:jimaging8040099. [PMID: 35448226 PMCID: PMC9027245 DOI: 10.3390/jimaging8040099] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/31/2022] [Accepted: 04/03/2022] [Indexed: 12/02/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) are a family of anticancer drugs in which the immune response elicited against the tumor may involve other organs, including the heart. Cardiac magnetic resonance (CMR) imaging is increasingly used in the diagnostic work-up of myocardial inflammation; recently, several studies investigated the use of CMR in patients with ICI-myocarditis (ICI-M). The aim of the present systematic review is to summarize the available evidence on CMR findings in ICI-M. We searched electronic databases for relevant publications; after screening, six studies were selected, including 166 patients from five cohorts, and further 86 patients from a sub-analysis that were targeted for a tissue mapping assessment. CMR revealed mostly preserved left ventricular ejection fraction; edema prevalence ranged from 9% to 60%; late gadolinium enhancement (LGE) prevalence ranged from 23% to 83%. T1 and T2 mapping assessment were performed in 108 and 104 patients, respectively. When available, the comparison of CMR with endomyocardial biopsy revealed partial agreement between techniques and was higher for native T1 mapping amongst imaging biomarkers. The prognostic assessment was inconsistently assessed; CMR variables independently associated with the outcome included decreasing LVEF and increasing native T1. In conclusion, CMR findings in ICI-M include myocardial dysfunction, edema and fibrosis, though less evident than in more classic forms of myocarditis; native T1 mapping retained the higher concordance with EMB and significant prognostic value.
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Affiliation(s)
- Luca Arcari
- Cardiology Unit, Madre Giuseppina Vannini Hospital, 00177 Rome, Italy; (G.C.); (L.C.)
- Correspondence: ; Tel.: +39-0624291416
| | - Giacomo Tini
- Cardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza-University of Rome, 00100 Rome, Italy; (G.T.); (D.R.)
| | - Giovanni Camastra
- Cardiology Unit, Madre Giuseppina Vannini Hospital, 00177 Rome, Italy; (G.C.); (L.C.)
| | - Federica Ciolina
- Radiology Unit, Madre Giuseppina Vannini Hospital, 00177 Rome, Italy; (F.C.); (M.D.)
| | - Domenico De Santis
- Radiology Unit, Department of Medical Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, Sapienza-University of Rome, 00100 Rome, Italy; (D.D.S.); (D.C.)
| | - Domitilla Russo
- Cardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza-University of Rome, 00100 Rome, Italy; (G.T.); (D.R.)
| | - Damiano Caruso
- Radiology Unit, Department of Medical Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, Sapienza-University of Rome, 00100 Rome, Italy; (D.D.S.); (D.C.)
| | - Massimiliano Danti
- Radiology Unit, Madre Giuseppina Vannini Hospital, 00177 Rome, Italy; (F.C.); (M.D.)
| | - Luca Cacciotti
- Cardiology Unit, Madre Giuseppina Vannini Hospital, 00177 Rome, Italy; (G.C.); (L.C.)
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Crea F. Sodium-glucose co-transporter inhibitors, iron therapy, and checkpoint inhibitors: new clinical and translational pieces of the heart failure puzzle. Eur Heart J 2021; 42:4871-4875. [PMID: 34932800 DOI: 10.1093/eurheartj/ehab857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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