The apparent diffusion coefficient is strongly correlated with extracellular volume, a measure of myocardial fibrosis, and subclinical cardiomyopathy in patients with systemic lupus erythematosus

Abstract

Background Extracellular volume (ECV) has been histologically validated as a non-invasive quantitative index of myocardial fibrosis that does not require the use of contrast, which is contraindicated in patients with renal insufficiency. Purpose To evaluate the correlation between the contrast-free apparent diffusion coefficient (ADC) and ECV, an index of fibrosis. Material and Methods Twenty-four patients with systemic lupus erythematosus (SLE), who were predominantly women (mean age = 36 ± 12 years) and 12 normal participants (mean age = 38 ± 10 years) underwent cardiac magnetic resonance (CMR) via 3.0 T MR with T1 mapping. Diffusion-weighted imaging (DWI) and late gadolinium-enhanced (LGE) imaging served as the reference standards with which CMR was compared. The mean ADC, native T1, and ECV were calculated for each patient, and the correlations among these parameters were analyzed. Results Both SLE LGE-positive (LGE+) and SLE LGE-negative (LGE-) participants had higher native T1 values, ECV, and ADC than normal controls ( P < 0.05). SLE LGE+ participants exhibited a higher ECV (0.31 ± 0.02) and ADC (2.44 ± 0.32 × 10^-3 mm²/s) than SLE LGE- participants ( p < 0.05); however, SLE LGE+ and SLE LGE- participants had similar native T1 values (1227 ± 48.81 ms versus 1174.70 ± 95.80 ms, respectively; P > 0.05). ADC values were positively correlated with increased ECV (R² = 0.62) and native T1 values (R² = 0.28) in all participants. Conclusion ADC measurements are a suitable alternative to ECV that may be used to assess and quantify myocardial fibrosis in patients with SLE.

Keywords: Systemic lupus erythematosus; diffusion-weighted imaging (DWI); extracellular volume (ECV); late gadolinium-enhanced imaging; myocardial fibrosis; native T1.