T1 Mapping In Differentiating Healthy And Pathological Myocardium

BACKGROUND: This study aimed to identify the optimal measurement location and technique for native T1 mapping to establish a standardized approach. We evaluated the diagnostic performance of various T1 mapping measurement approaches by comparing non-ischemic dilated cardiomyopathy (NIDCM) and hypertrophic cardiomyopathy (HCM) cohorts with a control group. METHODS: We retrospectively reviewed patients who underwent 1.5T cardiac magnetic resonance (CMR) with standardized protocol functional sequences, T1 mapping, and late gadolinium enhancement (LGE) between November 2016 and January 2023. A total of 143 subjects (61 NIDCM, 60 HCM, and 22 controls) were grouped based on CMR findings. Native T1 mapping images were acquired in basal, midventricular, and apical short-axis slices. Regions of interest were drawn in both the whole left ventricular myocardium (SAX) and the interventricular septum. Diagnostic yield and optimal cut-off values for native T1 were investigated. RESULTS: Native T1 values were significantly higher than the control group for six different measurement approaches (p<0.05). Basal SAX and basal septal measurements provided the highest diagnostic accuracy values for both groups. Statistical analysis revealed that T1 values could differentiate between healthy and diseased myocardium, with a diagnostic accuracy of 86% for NIDCM and 73.4% for HCM. Furthermore, T1 values correlated with measures of global systolic function and left ventricular remodeling. CONCLUSION: Our study shows that native T1 mapping using a streamlined single-slice acquisition with a septal measurement technique achieves diagnostic performance comparable to multi-slice protocols while reducing measurement heterogeneity. This optimization facilitates a time-efficient workflow and improves patient comfort without compromising diagnostic accuracy.