Myocardial Mapping in Systemic Sarcoidosis: A Comparison of Two Measurement Approaches

Abstract

Purpose To investigate if T1 and T2 mapping is able to differentiate between diseased and healthy myocardium in patients with systemic sarcoidosis, and to compare the standard mapping measurement (measurement within the whole myocardium of the midventricular short axis slice, SAX) to a more standardized method measuring relaxation times within the midventricular septum (ConSept).

Materials and Methods 24 patients with biopsy-proven extracardiac sarcoidosis and 17 healthy control subjects were prospectively enrolled in this study and underwent CMR imaging at 1.5 T including native T1 and T2 mapping. Patients were divided into patients with (LGE+) and without (LGE–) cardiac sarcoidosis. T1 and T2 relaxation times were compared between patients and controls. Furthermore, the SAX and the ConSept approach were compared regarding differentiation between healthy and diseased myocardium.

Results T1 and T2 relaxation times were significantly longer in all patients compared with controls using both the SAX and the ConSept approach (p < 0.05). However, LGE+ and LGE– patients showed no significant differences in T1 and T2 relaxation times regardless of the measurement approach used (ConSept/SAX) (p > 0.05). Direct comparison of ConSept and SAX T1 mapping showed high conformity in the discrimination between healthy and diseased myocardium (Kappa = 0.844).

Conclusion T1 and T2 mapping may not only enable noninvasive recognition of cardiac involvement in patients with systemic sarcoidosis but may also serve as a marker for early cardiac involvement of the disease allowing for timely treatment. ConSept T1 mapping represents an equivalent method for tissue characterization in this population compared to the SAX approach. Further studies including follow-up examinations are necessary to confirm these preliminary results.

Key Points: 

• Mapping may enable noninvasive recognition of cardiac involvement in patients with systemic sarcoidosis

• Mapping may serve as a marker for early cardiac involvement in patients with systemic sarcoidosis

• The ConSept approach can be used as an alternative measuring method in sarcoidosis patients

Citation Format

• Dabir D, Luetkens J, Kuetting D et al. Myocardial Mapping in Systemic Sarcoidosis: A Comparison of Two Measurement Approaches. Fortschr Röntgenstr 2021; 193: 68 – 76

Zusammenfassung

Ziel Untersuchung, ob T1- und T2-Mapping bei Patienten mit systemischer Sarkoidose zwischen krankem und gesundem Myokard unterscheidet. Vergleich der herkömmlichen Messmethode (Messung im gesamten mittventrikulären Myokard der kurzen Herzachse, SAX) mit einem standardisierteren Messansatz, bei dem die Relaxationszeiten ausschließlich im mittventrikulären Septum gemessen werden (ConSept).

Material und Methoden 24 Patienten mit bioptisch gesicherter extrakardialer Sarkoidose und 17 gesunde Probanden wurden prospektiv in diese Studie eingeschlossen und an einem 1,5-Tesla-Magneten unter anderem mittels nativem T1- und T2-Mapping untersucht. Patienten wurden im Rahmen der Auswertung unterteilt in Patienten mit (LGE+) und Patienten ohne späte myokardiale Kontrastmittelaufnahme (LGE–). Des Weiteren wurden die SAX- und die ConSept-Messmethode auf ihre Differenzierbarkeit zwischen gesundem und krankem Herzmuskelgewebe untersucht.

Ergebnisse Alle Patienten wiesen unabhängig von der gewählten Messmethode (ConSept bzw. SAX) signifikant längere T1- und T2-Relaxationszeiten im Vergleich zu den gesunden Probanden auf (p < 0,05). Jedoch zeigten sich keine signifikant unterschiedlichen Relaxationszeiten zwischen Patienten mit (LGE+) und ohne späte myokardiale Kontrastmittelaufnahme (LGE–), unabhängig von der gewählten Messmethode (ConSept/Sax) (p > 0,05). Der direkte Vergleich zwischen den Messmethoden ConSept und SAX zeigte beim T1-Mapping eine hohe Übereinstimmung in Bezug auf die Differenzierung zwischen krankem und gesundem Myokard (Kappa = 0,844).

Schlussfolgerung Mittels T1- und T2-Mapping ist es möglich, bei Patienten mit systemischer Sarkoidose zwischen krankem und gesundem Myokard zu unterscheiden. Darüber hinaus stellt das myokardiale Mapping einen möglichen Marker für die Früherkennung einer kardialen Beteiligung dar, was eine zeitgerechte Behandlung begünstigt. ConSept-T1-Mapping stellt einen gleichwertigen Messansatz zur SAX-Methode bei Sarkoidose-Patienten dar. Weitere Studien, inklusive Follow-up-Studien, sind notwendig, um diese vorläufigen Ergebnisse zu bestätigen.

Kernaussagen: 

• Mapping kann zwischen krankem und gesundem Myokard bei Patienten mit systemischer Sarkoidose unterscheiden

• Mapping könnte zur Früherkennung einer kardialen Sarkoidose beitragen

• ConSept-T1-Mapping stellt einen alternativen Messansatz zur SAX-Methode bei Sarkoidose-Patienten dar

Key words

sarcoidosis - CMR - T1 mapping - T2 mapping

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