Splenic T1-mapping: a novel quantitative method for assessing adenosine stress adequacy for cardiovascular magnetic resonance

Alexander Liu, Rohan S. Wijesurendra, Rina Ariga, Masliza Mahmod, Eylem Levelt, Andreas Greiser, Mario Petrou, George Krasopoulos, John C. Forfar, Rajesh K. Kharbanda, Keith M. Channon, Stefan Neubauer, Stefan K. Piechnik, Vanessa M. Ferreira

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Perfusion cardiovascular magnetic resonance (CMR) performed with inadequate adenosine stress leads to false-negative results and suboptimal clinical management. The recently proposed marker of adequate stress, the "splenic switch-off" sign, detects splenic blood flow attenuation during stress perfusion (spleen appears dark), but can only be assessed after gadolinium first-pass, when it is too late to optimize the stress response. Reduction in splenic blood volume during adenosine stress is expected to shorten native splenic T1, which may predict splenic switch-off without the need for gadolinium. Methods: Two-hundred and twelve subjects underwent adenosine stress CMR: 1.5 T (n = 104; 75 patients, 29 healthy controls); 3 T (n = 108; 86 patients, 22 healthy controls). Native T1spleen was assessed using heart-rate-independent ShMOLLI prototype sequence at rest and during adenosine stress (140 μg/kg/min, 4 min, IV) in 3 short-axis slices (basal, mid-ventricular, apical). This was compared with changes in peak splenic perfusion signal intensity (ΔSIspleen) and the “splenic switch-off” sign on conventional stress/rest gadolinium perfusion imaging. T1spleen values were obtained blinded to perfusion ΔSIspleen, both were derived using regions of interest carefully placed to avoid artefacts and partial-volume effects. Results: Normal resting splenic T1 values were 1102 ± 66 ms (1.5 T) and 1352 ± 114 ms (3 T), slightly higher than in patients (1083 ± 59 ms, p = 0.04; 1295 ± 105 ms, p = 0.01, respectively). T1spleen decreased significantly during adenosine stress (mean ΔT1spleen ~ −40 ms), independent of field strength, age, gender, and cardiovascular diseases. While ΔT1spleen correlated strongly with ΔSIspleen (rho = 0.70, p < 0.0001); neither indices showed significant correlations with conventional hemodynamic markers (rate pressure product) during stress. By ROC analysis, a ΔT1spleen threshold of ≥ −30 ms during stress predicted the “splenic switch-off” sign (AUC 0.90, p < 0.0001) with sensitivity (90%), specificity (88%), accuracy (90%), PPV (98%), NPV (42%). Conclusions: Adenosine stress and rest splenic T1-mapping is a novel method for assessing stress responses, independent of conventional hemodynamic parameters. It enables prediction of the visual “splenic switch-off” sign without the need for gadolinium, and correlates well to changes in splenic signal intensity during stress/rest perfusion imaging. ΔT1spleen holds promise to facilitate optimization of stress responses before gadolinium first-pass perfusion CMR.

Original languageEnglish
Pages (from-to)1-10
Number of pages10
JournalJournal of Cardiovascular Magnetic Resonance
Volume19
Issue number1
DOIs
Publication statusPublished - 13 Jan 2017
Externally publishedYes

Fingerprint

Adenosine
Gadolinium
Magnetic Resonance Spectroscopy
Perfusion
Perfusion Imaging
Hemodynamics
Blood Volume
ROC Curve
Artifacts
Area Under Curve
Cardiovascular Diseases
Spleen
Heart Rate
Pressure
Sensitivity and Specificity

Keywords

  • Adenosine stress
  • Cardiovascular magnetic resonance
  • ShMOLLI
  • Splenic T1
  • Switch-off

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine
  • Family Practice

Cite this

Splenic T1-mapping : a novel quantitative method for assessing adenosine stress adequacy for cardiovascular magnetic resonance. / Liu, Alexander; Wijesurendra, Rohan S.; Ariga, Rina; Mahmod, Masliza; Levelt, Eylem; Greiser, Andreas; Petrou, Mario; Krasopoulos, George; Forfar, John C.; Kharbanda, Rajesh K.; Channon, Keith M.; Neubauer, Stefan; Piechnik, Stefan K.; Ferreira, Vanessa M.

In: Journal of Cardiovascular Magnetic Resonance, Vol. 19, No. 1, 13.01.2017, p. 1-10.

Research output: Contribution to journalArticle

Liu, A, Wijesurendra, RS, Ariga, R, Mahmod, M, Levelt, E, Greiser, A, Petrou, M, Krasopoulos, G, Forfar, JC, Kharbanda, RK, Channon, KM, Neubauer, S, Piechnik, SK & Ferreira, VM 2017, 'Splenic T1-mapping: a novel quantitative method for assessing adenosine stress adequacy for cardiovascular magnetic resonance', Journal of Cardiovascular Magnetic Resonance, vol. 19, no. 1, pp. 1-10. https://doi.org/10.1186/s12968-016-0318-2
Liu, Alexander ; Wijesurendra, Rohan S. ; Ariga, Rina ; Mahmod, Masliza ; Levelt, Eylem ; Greiser, Andreas ; Petrou, Mario ; Krasopoulos, George ; Forfar, John C. ; Kharbanda, Rajesh K. ; Channon, Keith M. ; Neubauer, Stefan ; Piechnik, Stefan K. ; Ferreira, Vanessa M. / Splenic T1-mapping : a novel quantitative method for assessing adenosine stress adequacy for cardiovascular magnetic resonance. In: Journal of Cardiovascular Magnetic Resonance. 2017 ; Vol. 19, No. 1. pp. 1-10.
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author = "Alexander Liu and Wijesurendra, {Rohan S.} and Rina Ariga and Masliza Mahmod and Eylem Levelt and Andreas Greiser and Mario Petrou and George Krasopoulos and Forfar, {John C.} and Kharbanda, {Rajesh K.} and Channon, {Keith M.} and Stefan Neubauer and Piechnik, {Stefan K.} and Ferreira, {Vanessa M.}",
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TY - JOUR

T1 - Splenic T1-mapping

T2 - a novel quantitative method for assessing adenosine stress adequacy for cardiovascular magnetic resonance

AU - Liu, Alexander

AU - Wijesurendra, Rohan S.

AU - Ariga, Rina

AU - Mahmod, Masliza

AU - Levelt, Eylem

AU - Greiser, Andreas

AU - Petrou, Mario

AU - Krasopoulos, George

AU - Forfar, John C.

AU - Kharbanda, Rajesh K.

AU - Channon, Keith M.

AU - Neubauer, Stefan

AU - Piechnik, Stefan K.

AU - Ferreira, Vanessa M.

PY - 2017/1/13

Y1 - 2017/1/13

N2 - Background: Perfusion cardiovascular magnetic resonance (CMR) performed with inadequate adenosine stress leads to false-negative results and suboptimal clinical management. The recently proposed marker of adequate stress, the "splenic switch-off" sign, detects splenic blood flow attenuation during stress perfusion (spleen appears dark), but can only be assessed after gadolinium first-pass, when it is too late to optimize the stress response. Reduction in splenic blood volume during adenosine stress is expected to shorten native splenic T1, which may predict splenic switch-off without the need for gadolinium. Methods: Two-hundred and twelve subjects underwent adenosine stress CMR: 1.5 T (n = 104; 75 patients, 29 healthy controls); 3 T (n = 108; 86 patients, 22 healthy controls). Native T1spleen was assessed using heart-rate-independent ShMOLLI prototype sequence at rest and during adenosine stress (140 μg/kg/min, 4 min, IV) in 3 short-axis slices (basal, mid-ventricular, apical). This was compared with changes in peak splenic perfusion signal intensity (ΔSIspleen) and the “splenic switch-off” sign on conventional stress/rest gadolinium perfusion imaging. T1spleen values were obtained blinded to perfusion ΔSIspleen, both were derived using regions of interest carefully placed to avoid artefacts and partial-volume effects. Results: Normal resting splenic T1 values were 1102 ± 66 ms (1.5 T) and 1352 ± 114 ms (3 T), slightly higher than in patients (1083 ± 59 ms, p = 0.04; 1295 ± 105 ms, p = 0.01, respectively). T1spleen decreased significantly during adenosine stress (mean ΔT1spleen ~ −40 ms), independent of field strength, age, gender, and cardiovascular diseases. While ΔT1spleen correlated strongly with ΔSIspleen (rho = 0.70, p < 0.0001); neither indices showed significant correlations with conventional hemodynamic markers (rate pressure product) during stress. By ROC analysis, a ΔT1spleen threshold of ≥ −30 ms during stress predicted the “splenic switch-off” sign (AUC 0.90, p < 0.0001) with sensitivity (90%), specificity (88%), accuracy (90%), PPV (98%), NPV (42%). Conclusions: Adenosine stress and rest splenic T1-mapping is a novel method for assessing stress responses, independent of conventional hemodynamic parameters. It enables prediction of the visual “splenic switch-off” sign without the need for gadolinium, and correlates well to changes in splenic signal intensity during stress/rest perfusion imaging. ΔT1spleen holds promise to facilitate optimization of stress responses before gadolinium first-pass perfusion CMR.

AB - Background: Perfusion cardiovascular magnetic resonance (CMR) performed with inadequate adenosine stress leads to false-negative results and suboptimal clinical management. The recently proposed marker of adequate stress, the "splenic switch-off" sign, detects splenic blood flow attenuation during stress perfusion (spleen appears dark), but can only be assessed after gadolinium first-pass, when it is too late to optimize the stress response. Reduction in splenic blood volume during adenosine stress is expected to shorten native splenic T1, which may predict splenic switch-off without the need for gadolinium. Methods: Two-hundred and twelve subjects underwent adenosine stress CMR: 1.5 T (n = 104; 75 patients, 29 healthy controls); 3 T (n = 108; 86 patients, 22 healthy controls). Native T1spleen was assessed using heart-rate-independent ShMOLLI prototype sequence at rest and during adenosine stress (140 μg/kg/min, 4 min, IV) in 3 short-axis slices (basal, mid-ventricular, apical). This was compared with changes in peak splenic perfusion signal intensity (ΔSIspleen) and the “splenic switch-off” sign on conventional stress/rest gadolinium perfusion imaging. T1spleen values were obtained blinded to perfusion ΔSIspleen, both were derived using regions of interest carefully placed to avoid artefacts and partial-volume effects. Results: Normal resting splenic T1 values were 1102 ± 66 ms (1.5 T) and 1352 ± 114 ms (3 T), slightly higher than in patients (1083 ± 59 ms, p = 0.04; 1295 ± 105 ms, p = 0.01, respectively). T1spleen decreased significantly during adenosine stress (mean ΔT1spleen ~ −40 ms), independent of field strength, age, gender, and cardiovascular diseases. While ΔT1spleen correlated strongly with ΔSIspleen (rho = 0.70, p < 0.0001); neither indices showed significant correlations with conventional hemodynamic markers (rate pressure product) during stress. By ROC analysis, a ΔT1spleen threshold of ≥ −30 ms during stress predicted the “splenic switch-off” sign (AUC 0.90, p < 0.0001) with sensitivity (90%), specificity (88%), accuracy (90%), PPV (98%), NPV (42%). Conclusions: Adenosine stress and rest splenic T1-mapping is a novel method for assessing stress responses, independent of conventional hemodynamic parameters. It enables prediction of the visual “splenic switch-off” sign without the need for gadolinium, and correlates well to changes in splenic signal intensity during stress/rest perfusion imaging. ΔT1spleen holds promise to facilitate optimization of stress responses before gadolinium first-pass perfusion CMR.

KW - Adenosine stress

KW - Cardiovascular magnetic resonance

KW - ShMOLLI

KW - Splenic T1

KW - Switch-off

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