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How to do T1 mapping and ECV

Non-Invasive Imaging

 In “Approaches to measure T1”, Dr. Stefan Piechnik provided a historical overview of T1-mapping methods, highlighting milestones towards an exponential rise in clinical studies. Dr. Piechnik discussed 3 review papers, pointing out there is still little consensus on which is the “best”T1-mapping technique. Saturation-based T1-mapping techniques hold promise. There is no “true” in-vivo myocardial T1. Technical accuracy does not equal to superiority in diagnosing disease. Further evidence on clinical applicability of T1-mapping is needed.
In “T1-mapping: is it good enough?”, Dr. Andrew Arai  reviewed recent clinical evidence of native T1-mapping in diagnosing a range of cardiac diseases. Dr Arai emphasized the diagnostic value over prognostic value of a clinical test. Consideration must be also given to justifying cost to regulatory bodies like FDA. From these perspectives, T1-mapping is good enough.
In “ECV or native T1?”, Dr. Erik Schelbert reviewed evidence supporting the prognostic value of ECV and the concept of the vulnerable interstitium. Native T1 does not currently have evidence that it can characterize the interstitium, given that edema is a confounder. In many cases, since gadolinium is given for LGE imaging, obtaining incremental information on the myocardial interstitium is of value.
In “Clinical T1-mapping: latest developments, consensus and disputes”, Dr. Daniel Messroghli reviewed the developmental steps for a new technique towards clinical application. Novel approaches to T1-mapping include segmented and free-breathing techniques. Recent clinical validation studies were reviewed. T1-mapping is now beyond technical development, showing progression towards validation in several upcoming large scale, multicentre studies, which are important.


How to do T1 mapping and ECV

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.