Native T1 Mapping for Myocardial Infarction

SEE PAGE 1019 C ardiac magnetic resonance (CMR) late gadolinium enhancement (LGE) (1) is the current clinical gold standard modality for evaluation of focal fibrosis and scar in patients with an ischemic or a nonischemic cardiomyopathy. LGE requires administration of an exogenous gadoliniumbased contrast agent, which accumulates in the scar region. LGE imaging is commonly performed using an inversion recovery sequence 10 to 20 min after contrast injection to visualize myocardial scar. Patients are often referred for CMR examination for assessment of scar and myocardial perfusion, which both require gadolinium. As a result, over 80% of CMR examinations are performed with gadolinium. Gadolinium contrast agents were considered very safe and were commonly used at double and even triple doses. In 2006, there were reports of nephrogenic systemic fibrosis, a systemic and potentially fatal scleroderma-like illness, in patients with moderate to severe renal dysfunction who had received gadolinium (2,3). However, with the new restriction for the use of gadolinium contrast in patients with compromised renal function, no recent cases of nephrogenic systemic fibrosis have been reported. Most patients now undergoing contrast CMR must undergo additional testing for kidney function. This testing adds another layer of cost and patient