Identification of myocardial diffuse fibrosis by 11 heartbeat MOLLI T(1) 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 (1) mapping versus assessment at a single ventricular level. MATERIALS AND METHODS: For assessment of T (1) 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 (1) and a 4(1)3(1)2 beat post-contrast scheme to measure post-contrast T (1), allowing calculation of partition coefficient and ECV. To assess correlation of T (1) 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 (1) maps provided improved precision (Intraclass correlation 0.93 vs 0.84) and correlation with histology (R (2) = 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 (1) mapping. CONCLUSION: T (1) mapping sequences with repeated averaging could be considered for applications of 11 heartbeat MOLLI, especially when small changes in native T (1)/ECV might affect clinical management.