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Review
. 2017 Jul;22(4):431-440.
doi: 10.1007/s10741-017-9616-5.

T2 mapping and T2* imaging in heart failure

A S Lota  1 , P D Gatehouse  1 , R H Mohiaddin  2
Affiliations
Review

T2 mapping and T2* imaging in heart failure

A S Lota et al. Heart Fail Rev. 2017 Jul.

Abstract

Cardiovascular magnetic resonance (CMR) is a versatile imaging modality that enables aetiological assessment and provides additional information to that of standard echocardiography in a significant proportion of patients with heart failure. In addition to highly accurate and reproducible assessment of ventricular volumes and replacement fibrosis, multiparametric mapping techniques have rapidly evolved to further expand the diagnostic and prognostic applications in various conditions ranging from acute inflammatory and ischaemic cardiomyopathy, to cardiac involvement in systemic diseases such as sarcoidosis and iron overload cardiomyopathy. In this review, we discuss the established role of T2* imaging and rapidly evolving clinical applications of myocardial T2 mapping as quantitative adjuncts to established qualitative imaging techniques.

Keywords: Inflammatory cardiomyopathy; Iron overload; Myocarditis; Sarcoidosis; T2 mapping; Transplant rejection.

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Conflict of interest statement

Funding

ASL is supported by the Alexander Jansons Foundation and British Heart Foundation [FS/17/21/32712].

Conflict of interest

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Standard Lake Louise Criteria for acute myocarditis showing focal regions of myocardial oedema on T2-STIR, reactive hyperaemia on early gadolinium enhancement (EGE) and myocyte necrosis/fibrosis on late enhancement (LGE) in the inferolateral wall (arrowed)
Fig. 2
Fig. 2
Principles of T2 mapping with different T2 preparatory durations with a long repetition time between the used cardiac cycles, crucial to allow as complete T1 recovery as possible, followed by reconstruction of the transverse relaxation curve in each pixel assuming satisfactory registration. T2 is defined as the time in milliseconds by which the transverse magnetisation has decayed to 37% of the original value. Many distorting factors are not illustrated, and many T2 mapping sequences ‘fill the gaps’ with gradient activity without RF, so that the patient does not consider the scan complete and start breathing too early
Fig. 3
Fig. 3
T2* transverse relaxation curves in three separate patients with mild >14 ms (a), moderate 10–14 ms (b) and severe <6 ms (c) iron overload. Black blood T2* imaging is used rather than white blood due to superior reproducibility and reduced imaging artefact [61]
Fig. 4
Fig. 4
T2-STIR and T2 mapping at the basal short-axis level in a patient with acute myocarditis affecting the inferoseptal wall. Some caution would be required in cardiac walls adjoining the lung, particularly the inferolateral wall, due to B0 distortion effects in some types of sequence, particularly at 3-T field strengths. The late gadolinium enhancement image is provided for reference
See this image and copyright information in PMC

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