Native T1 Mapping Principles — EECC MCQ
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Correct answer: A — Native T1 is a quantitative measure of the longitudinal relaxation time of myocardial tissue WITHOUT gadolinium contrast — it is elevated in fibrosis, oedema, amyloidosis, and inflammation, and reduced in iron overload and Fabry disease, enabling non-invasive tissue characterisation
Native (pre-contrast) T1 mapping measures the intrinsic longitudinal relaxation time of myocardial tissue at a pixel-by-pixel level, providing quantitative tissue characterisation without gadolinium. This is valuable because: (1) elevated native T1: fibrosis, oedema, inflammation, amyloidosis (highest T1 of any cardiomyopathy), and myocarditis; (2) reduced native T1: iron overload (haemochromatosis — iron shortens T1), Fabry disease (intracellular lipid accumulation shortens T1), and haemorrhage. The 2023 ESC Cardiomyopathy Guidelines recommend T1 mapping as part of the comprehensive CMR protocol for cardiomyopathy assessment. Advantages over LGE: (1) detects diffuse disease (LGE requires a 'normal' reference region); (2) no contrast needed (useful in severe CKD/contrast allergy); (3) quantitative (enables serial monitoring). Normal values are field-strength and sequence-dependent (~950-1050 ms at 1.5T).
Reference: SCMR/EACVI T1 Mapping Consensus; ESC (2023): Cardiomyopathies