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Inflammatory reactions of the pericardium as measured with parametric mapping CMR

Session Poster session 2

Speaker Mareike Cramer

Event : EuroCMR 2019

  • Topic : imaging
  • Sub-topic : Cardiac Magnetic Resonance: Pericardium
  • Session type : Poster Session

Authors : M Gastl (Zurich,CH), J Sokolska (Zurich,CH), M Polacin (Zurich,CH), H Alkadhi (Zurich,CH), S Kozerke (Zurich,CH), R Manka (Zurich,CH)

Authors:
M Gastl1 , J Sokolska1 , M Polacin2 , H Alkadhi2 , S Kozerke3 , R Manka1 , 1University Heart Center - Zurich - Switzerland , 2University Hospital Zurich, Institute of Diagnostic and Interventional Radiology - Zurich - Switzerland , 3Swiss Federal Institute of Technology Zurich (ETH Zurich), Institute for Biomedical Engineering - Zurich - Switzerland ,

Citation:
European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii372

Background: Despite the improved spectrum of diagnostic tools and technical developments, diagnosis of pericardial inflammation can remain challenging. Cardiovascular magnetic resonance (CMR) is increasingly used to diagnose pericardial inflammation through the visualization of thickened pericardium, pericardial edema and contrast agent uptake. Unlike T1- and T2-weighted imaging, parametric mapping (T1 and T2 mapping) has emerged as an alternative to visualize and quantify focal and global changes of the myocardium. 
Purpose:To investigate the role of parametric mapping for the diagnosis of pericardial inflammation.
Methods:Twelve patients with suspected or known pericardial inflammation underwent CMR at a 1.5T system including T1/T2 black blood imaging with fat suppression (SPIR), T1/T2 mapping and a 3D gradient-spoiled fast-field-echo sequence for late gadolinium enhancement (LGE).  T1/T2 mapping was performed in end-diastole covering 3 short axis slices (T1: TR shortest, TE shortest, 11 images; T2-GraSE: TR 1 heartbeat, TE shortest, 9 echoes). The diagnosis of pericardial inflammation was made according to recent guidelines using LGE imaging and T1/T2 black blood. T1 and T2 measurements were pursued by manually drawing a region of interest (ROI) in the pericardium of all slices avoiding contamination by other cardiac structures, e.g. epicardial fat. 
Results:T1 mapping could be performed in all subjects, T2 maps could only be analysed in 5 patients. In addition to pericardial inflammation, 3 patients displayed myocardial involvement.  On average, the pericardium displayed a thickness of 6.7±2.0 mm. T1 values were 1394.7±318.8 ms and T2 values were 149.4±24.6 ms, which was above local reference and patients' myocardial values (Myocardial T1: 1031.5±42.1 ms, p=0.003; T2: 50.2±1.2 ms, p=0.001). Both, T1 and T2, did not show a correlation to the extent of the thickened pericardium. There was no correlation of T1/T2 to blood markers of inflammation and myocardial injury (CRP, troponin, CK).
Conclusions: Parametric T1 and T2 mapping was able to support the diagnosis of pericardial inflammation by T1/T2-weighted and LGE imaging. Because of partial volume effects of the healthy, thin pericardium, the implementation of normal values can be hampered.

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