T2 mapping - myocardium

T2 mapping is a magnetic resonance imaging techniqueused to calculate the T2 times of a certain tissue and display them voxel-vice on a parametric map. It has been used for tissue characterization of the myocardium ^1-5 and has been investigated for cartilage ^6,7 and other tissues ⁴.

The T2 time, also referred to as the spin-spin or transverse relaxation, is a time constant for the decay of transverse magnetization ^1-3 and is tissue-specific in regard to its ability to differentiate normal from abnormal ^5,6.

Alterations in the T2 time is not specific for a single disease, but reflect changes in tissue composition and can be used to receive further valuable information about certain disease processes and together with other parameters or in the context of a certain clinical scenario ¹. This can help in the diagnosis of a disease or the assessment of disease activity ¹ or its repair ⁶.

T2 values reflect water content in the respective tissue⁴ and within the myocardium T2 maps are mainly used for the evaluation of myocardial oedema in the context of myocardial inflammation or myocardial infarction, but also in other pathologies ^1,4.

Methodology

T2 mapping has been conducted with T2 turbo spin multi-echo (T2-TSE) ^2,5, T2 prepared steady-state free precession (T2p-SFFP) ^2,5,8,9, as well as T2 gradient spin echo mapping sequences (T2-GraSE) ^10,11.  No matter which acquisition technique used a series of co-registered images is acquired with different T2 echo times ^1-4,6-8.

T2 values can then be computed pixel-wise from a signal intensity versus echo time curve fitting model ^1-3,12. The variation of other weight factors, e.g. T1 off-resonance, needs to be corrected if not negligible small and displacement between the images of the series should be avoided, in order to get accurate values ^1,12.

The respective voxels can then be quantified and evaluated on the basis of normal reference values in diffuse disease. In focal disease, the voxels can be compared to the spared healthy myocardium.

Advantages vs other T2w images

T2-mapping offers potential for more objective detection and quantification of myocardial oedema than standard black-blood T2 and STIR image, which are often of limited value due to susceptibility or slow-motion artefacts and have limited value for quantitative evaluation ^1,2,9.

Interpretation

T2 time is related to the water content of the respective tissue, hence the myocardium and thus prolonged T2 reflects myocardial oedema ^1-4,9.

Myocardial T2 tends to decrease at higher magnetic field strength ¹³.

Clinical applications

T2-mapping can detect and assess myocardial oedema in a variety of cardiac pathologies including ^{1-5,8,10,15-17}:

• acute coronary syndrome/myocardial infarction
  • specifically differentiation of an acute coronary syndrome from a myocardial scar of an old infarctioninfarct
  • assessing the area at risk
  • assessment of myocardial salvage after reperfusion
• myocarditis
• cardiac sarcoidosis
  • assessing disease activity
• Tako-tsubo cardiomyopathy
• heart transplant rejection
• cardiac amyloidosis

In addition, it is of some use in the following pathologies due to low values ^1,3:

• iron overload cardiomyopathy
• myocardial haemorrhage

Normal values

Normal values of T2 times differ depending on magnetic field strength (1,5 and 3 Tesla), acquisition sequence (T2-SSFP, GraSE). Because of variations between scanners the primary use of a local reference range is recommended ^1,4 and if a local reference range is not available quantitative results should not be clinically reported ^1,4.

See also

• myocardial mapping
• T1 mapping
• T2* mapping
• myocardial oedema