Comparison of Sensitivity and Specificity of T2 and Apparent Diffusion Coefficient Mapping in the Diagnosis of Cardiac Ischemia

Document Type : Original Article(s)

Authors

1 MSc Student of Medical Imaging, Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Assistant Professor, Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Cardiovascular Magnetic Resonance Imaging by using new quantitative mapping techniques such as T2 and ADC mapping, is a new approach to detect ischemia and myocardial edema. In this study, the sensitivity, specificity and diagnostic utility of ADC maps in diffusion imaging compared to T2 maps in the diagnosis of cardiac ischemia were investigated and compared.
Methods: This is a cross- sectional study that was conducted at Shiraz Peyvand Hospital using 3-Tesla MRI from February 2020 to March 2022 on 60 patients with cardiac ischemia an average of five days after the infarct. For this, images of T2 and ADC maps of the myocardium were obtained and compared. Cine images were used to check the function of the left ventricle, and the infarcted area of the myocardium was defined based on the Late Gadolinium Enhancement images.
Findings: In the analysis that was done with the segmentation of the left ventricle, the sensitivity and specificity of T2 maps were reported as 84% and 95%, and the sensitivity and specificity of ADC maps were reported as 88% and 97%, respectively.
Conclusion: Based on the evaluations, ADC maps showed higher sensitivity and specificity than T2 maps that are commonly used in the clinic, so their use is recommended to investigate ischemia in cardiac patients.

Keywords


  1. Sarrafzadegan N, Mohammmadifard N. Cardiovascular disease in Iran in the last 40 years: Prevalence, mortality, morbidity, challenges and strategies for cardiovascular prevention. Arch Iran Med 2019; 22(4): 204-10.
  2. Marzilli M, Crea F, Morrone D, Bonow RO, Brown DL, Camici PG, et al. Myocardial ischemia: From disease to syndrome. Int J Cardiol 2020; 314: 32-5.
  3. Lancellotti P, Dulgheru R, Go YY, Sugimoto T, Marchetta S, Oury C, et al. Stress echocardiography in patients with native valvular heart disease. Heart 2018; 104(10): 807-13.
  4. Zhao WK, Zhou Y, Xu TT, Wu Q. Ferroptosis: Opportunities and challenges in myocardial ischemia-reperfusion injury. Oxid Med Cell Longev 2021; 2021: 9929687.
  5. Batar FB, Eminovici G, Bebeselea AM, Manitiu I. Multimodality imaging in ischemic cardiomyopathy. Acta Univ Cibiniensis 2019; 71(1): 1-4.
  6. Gastl M, Lachmann V, Christidi A, Janzarik N, Veulemans V, Haberkorn S, et al. Cardiac magnetic resonance T2 mapping and feature tracking in athlete's heart and HCM. Eur Radiol 2021; 31(5): 2768-77.
  7. Giri S, Chung YC, Merchant A, Mihai G, Rajagopalan S, Raman SV, et al. T2 quantification for improved detection of myocardial edema. J Cardiovasc Magn Reson 2009; 11(1): 56.
  8. Granziera C, Wuerfel J, Barkhof F, Calabrese M, De Stefano N, Enzinger C, et al. Quantitative magnetic resonance imaging towards clinical application in multiple sclerosis. Brain 2021; 144(5): 1296-311.
  9. Jin J, Chen M, Li Y, Wang Y, Zhang S, Wang Z, et al. Detecting acute myocardial infarction by diffusion-weighted versus T2-weighted imaging and myocardial necrosis markers. Tex Heart Inst J 2016; 43(5): 383-91.
  10. Welsh CL, DiBella EV, Hsu EW. Higher-order motion-compensation for in vivo cardiac diffusion tensor imaging in rats. IEEE Trans Med Imaging 2015; 34(9): 1843-53.
  11. Moulin K, Croisille P, Feiweier T, Delattre BM, Wei H, Robert B, et al. In vivo free-breathing DTI & IVIM of the whole human heart using a real-time slice-followed SE-EPI navigator-based sequence: a reproducibility study in healthy volunteers. J Cardiovasc Magn Reson 2015; 17(1): P383.
  12. Abanador-Kamper N, Kamper L, Castello-Boerrigter L, Haage P, Seyfarth M. MRI findings in patients with acute coronary syndrome and unobstructed coronary arteries. Diagn Interv Radiol 2019; 25(1): 28-34.
  13. Wu MT, Su MY, Huang YL, Chiou KR, Yang P, Pan HB, et al. Sequential changes of myocardial microstructure in patients postmyocardial infarction by diffusion-tensor cardiac MR: correlation with left ventricular structure and function. Circ Cardiovasc Imaging 2009; 2(1): 32-40.
  14. Fernández-Jiménez R, Sánchez-González J, Agüero J, García-Prieto J, López-Martín GJ, García-Ruiz JM, et al. Myocardial edema after ischemia/reperfusion is not stable and follows a bimodal pattern: imaging and histological tissue characterization. J Am Coll Cardiol 2015; 65(4): 315-23.
  15. Kociemba A, Pyda M, Katulska K, Łanocha M, Siniawski A, Janus M, et al. Comparison of diffusion-weighted with T2-weighted imaging for detection of edema in acute myocardial infarction. J Cardiovasc Magn Reson 2013; 15(1): 90.
  16. Moulin K, Viallon M, Romero W, Chazot A, Mewton N, Isaaz K, et al. MRI of reperfused acute myocardial infarction edema: ADC quantification versus T1 and T2 mapping. Radiology 2020; 295(3): 542-9.