Pre-contrast ShMOLLI T1 mapping in cardiac AL amyloidosis
© Karamitsos et al; licensee BioMed Central Ltd. 2012
Published: 1 February 2012
Multi-organ disease with cardiac involvement carries a very poor prognosis in Systemic AL Amyloidosis. The risk of nephrogenic systemic fibrosis is a significant obstacle in assessing cardiac status using CMR in patients with systemic AL amyloidosis who have advanced renal failure. Measurement of myocardial T1 values has been limited until now, due to long breath-hold times. We have developed a robust and clinically applicable technique for diagnosing cardiac amyloidosis by measuring absolute myocardial T1 values using the single breath hold, Shortened Modified Look-Locker Inversion Recovery (ShMOLLI) sequence without gadolinium administration.
Thirty-five patients (23 males, 12 females, mean age 60 years) with systemic AL amyloidosis underwent conventional CMR scanning with cine imaging and late gadolinium imaging as well as ShMOLLI pre-contrast T1-mapping between both centres; all patients had an eGFR of >30ml/min. Myocardial T1 values from the basal septum in the apical 4-chamber view were measured and compared against cardiac biomarkers, and ECG data. Results were compared to normal controls (n=54). Conventional clinical assessment using the Mayo staging system ranked cardiac involvement as definite, probable and none.
Using the ShMOLLI sequence to measure absolute myocardial T1 times in patients with systemic AL amyloidosis is a safe and accurate method for determining the presence or otherwise of cardiac involvement by amyloid and it correlates well with currently accepted measures of cardiac dysfunction in amyloidosis.
GSK, SKP, VMF, MDR funded by the NIHR Oxford Biomedical Research Centre Programme.
This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.