Sub-theme: Standardisation of new cardiac MRI mapping techniques for immediate clinical applications

Cardiac MRI scans has superior capabilities of looking into the human heart and characterising the heart muscle compared to other cardiac imaging methods. It can tell us a lot of information, including whether there is swelling, inflammation, previous heart attacks or scars within the heart.

Our team at the University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR) has pioneered a new cardiac MRI technique called T1-mapping. T1-mapping generates a pixel-by-pixel T1-map of the heart, which can locate small areas of disease in a numerical manner, and does not require any injection of contrast agents or radiation. T1-mapping produces coloured MRI images which give additional information compared to traditional MRI images. Mapping the heart is widely considered to be the next era in the field of cardiac MRI.

MRI mapping techniques — Native T1 maps (using ShMOLLI [12]), all with the same colour scale. (a) healthy volunteer: the myocardium appears homogenously green and the blood is red; low T1 values (blue) from iron overload (c) and lipid storage in Fabry’s disease (c) (except the infero-lateral wall which is high); (d) and (e) represent with high T1 values (red) in amyloid (d) and in myocarditis (d); infarcted (acute infarction) area appears red f) – here basal anter-septum. (As originally published by Maestrini, V., Treibel, T.A., White, S.K. et al. Curr Cardiovasc Imaging Rep (2014) 7: 9287. doi:10.1007/s12410-014-9287-8)

The Oxford team is one of the pioneering leaders in this area with its own flagship T1-mapping method named ShMOLLI (Shortened Modified Look-Locker Inversion Recovery). The NIHR BRC had strongly supported the development of ShMOLLI from its conception in 2009, with more than 30 published papers since. In October 2013, ShMOLLI T1-mapping has successfully translated into standardised clinical cardiac MRI protocols as recognised by the Society for Cardiovascular Magnetic Resonance in just four years. It is also the designated T1-mapping technique for the UK Biobank imaging component aiming to study 100,000 subjects, with more than10,000 datasets acquired already. In 2016, the patent for ShMOLLI was granted, with all rights transferred to Siemens Medical.

However, there are many different T1-mapping techniques used by different centres, with different reference ranges and T1 values for the heart. This presents an obstacle for the method to be widely adopted in a universal manner, especially for clinical communication and decision making for individual patients.

The goal of this sub-theme is to successfully translate Oxford T1-mapping from a research tool to the bedside, applicable not only in our own centre, but nationally and internationally.

We will develop and provide practical support to T1-mapping to facilitate widespread dissemination. These will start from instruction manuals and multimedia presentations on patient scanning, to more technical aspects, such as phantom calibration to assure consistency of measurements with regard to the normal range of T1. We plan to address multiple combinations of manufacturer, platform and MRI sequence details, practical operation manuals and robust quality control systems and training. Advanced image analysis dedicated for visual diagnostics in the clinic would be an important goal for immediate clinical adoption.

It is envisaged that work from this subtheme will enable immediate translation of cardiac MRI T1-mapping for use in the every-day clinical setting for clinical decision-making in the individual patient, not only for NHS patients, but world-wide.