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Estimating extraction fraction and blood flow by combining first-pass myocardial perfusion and T1 mapping results
Journal article   Open access

Estimating extraction fraction and blood flow by combining first-pass myocardial perfusion and T1 mapping results

Devavrat Likhite, Promporn Suksaranjit, Ganesh Adluru, Brent Wilson and Edward DiBella
Quantitative imaging in medicine and surgery, Vol.7(5), pp.480-495
10/01/2017
DOI: 10.21037/qims.2017.08.07
PMCID: PMC5682397
PMID: 29184761
url
https://europepmc.org/articles/pmc5682397View
Published (Version of record) Open Access

Abstract

Background: Quantifying myocardial perfusion is complicated by the complexity of pharmacokinetic model being used and the reliability of perfusion parameter estimates. More complex modeling provides more information about the underlying physiology, but too many parameters in complex models introduce a new problem of reliable estimation. To overcome the problem of multiple parameters, we have developed a technique that combines knowledge from two different cardiac magnetic resonance (MR) imaging techniques: dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and T1 mapping. Using extracellular volume (ECV) estimates from T1 mapping may allow more robust model parameter estimates. Methods: Simulations and human scans were performed. The myocardial perfusion scans used an ungated saturation recovery prepared TurboFLASH pulse sequence. Four short-axis (SA) slices were acquired after a single saturation pulse with a saturation recovery time of similar to 25 ms before the first slice. Gadoteridol was injected and similar to 240 frames were acquired over a minute with shallow breathing and no electrocardiograph (ECG) gating. This was followed 20 +/- 5 minutes later by an injection of regadenoson to induce hyperemia. The data were acquired using an under-sampled golden angle radial acquisition. Modified look-locker inversion recovery (MOLLI) T1 mapping was performed in 3 slices pre-and post-contrast. The preand post-contrast T1 maps were used for ECV estimation. Quantification of perfusion was done using a 4-parameter model with additional information about ECV supplied during model fitting. Phase contrast scans of the coronary sinus (CS) were acquired at rest and immediately after the stress perfusion acquisition to estimate global flow. Results: Without ECV information, the 5-parameter model fails to converge to a unique solution and often gives incorrect estimates for the perfusion parameters. The myocardial blood flow (MBF) estimates during rest and stress were 0.9 +/- 0.1 and 2.3 +/- 0.6 mL/min/g, respectively. The extraction fraction estimates were 0.49 +/- 0.04 and 0.34 +/- 0.05 during rest and stress, respectively. Conclusions: These results show that it is possible to successfully fit a dynamic perfusion model with an extraction fraction parameter by using information from T1 mapping scans. This hybrid approach is especially important when the 5-parameter model alone fails to converge on a unique solution. This work is a good example of exploiting information overlaps between various cardiac MR imaging techniques.
 Life Sciences & Biomedicine Radiology, Nuclear Medicine & Medical Imaging Science & Technology

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