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CMR Parametric Mapping — EECC MCQ

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ModerateCardiac ImagingCMR Parametric MappingEECC

A 40-year-old woman with SLE presents with dyspnoea. Echocardiography shows LVEF 52% with a thickened mitral valve and moderate MR. The cardiologist requests a CMR with T1/T2 mapping. What additional information can parametric mapping provide beyond standard CMR?

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Correct answer: E — T1 and T2 mapping provide quantitative tissue characterisation: elevated T1 indicates fibrosis or infiltration, elevated T2 indicates oedema/inflammation, and ECV quantifies extracellular matrix expansion — all without the need for subjective visual assessment

Parametric mapping (T1, T2, ECV) represents a major advance in CMR tissue characterisation: (1) Native T1: elevated in fibrosis, oedema, infiltration (amyloidosis), and inflammation; reduced in iron overload and Fabry disease (lipid storage); (2) T2: elevated in acute myocardial oedema and inflammation (myocarditis, acute MI, transplant rejection); (3) ECV (calculated from pre/post-contrast T1): quantifies extracellular matrix expansion, elevated in diffuse fibrosis, amyloidosis, and oedema. Unlike LGE (which detects focal scar), mapping detects diffuse myocardial disease that LGE may miss. The 2023 ESC Cardiomyopathy Guidelines recommend T1/T2 mapping as part of the comprehensive CMR protocol.

Reference: ESC (2023): Cardiomyopathies Guidelines; SCMR/EACVI T1 Mapping Consensus