Identification of myocardial diffuse fibrosis by 11 heartbeat MOLLI T mapping: averaging to improve precision and correlation with collagen volume fraction.

Objectives: Our objectives involved identifying whether repeated averaging in basal and mid left ventricular myocardial levels improves precision and correlation with collagen volume fraction for 11 heartbeat MOLLI T mapping versus assessment at a single ventricular level.

Materials And Methods: For assessment of T mapping precision, a cohort of 15 healthy volunteers underwent two CMR scans on separate days using an 11 heartbeat MOLLI with a 5(3)3 beat scheme to measure native T and a 4(1)3(1)2 beat post-contrast scheme to measure post-contrast T , allowing calculation of partition coefficient and ECV. To assess correlation of T mapping with collagen volume fraction, a separate cohort of ten aortic stenosis patients scheduled to undergo surgery underwent one CMR scan with this 11 heartbeat MOLLI scheme, followed by intraoperative tru-cut myocardial biopsy. Six models of myocardial diffuse fibrosis assessment were established with incremental inclusion of imaging by averaging of the basal and mid-myocardial left ventricular levels, and each model was assessed for precision and correlation with collagen volume fraction.

Results: A model using 11 heart beat MOLLI imaging of two basal and two mid ventricular level averaged T maps provided improved precision (Intraclass correlation 0.93 vs 0.84) and correlation with histology (R  = 0.83 vs 0.36) for diffuse fibrosis compared to a single mid-ventricular level alone. ECV was more precise and correlated better than native T mapping.

Conclusion: T mapping sequences with repeated averaging could be considered for applications of 11 heartbeat MOLLI, especially when small changes in native T /ECV might affect clinical management.