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Rapidly Reversible Myocardial Edema in Patients with Acromegaly: Assessment with Ultrafast T2 Mapping in a Single-Breath-Hold MRI Sequence

Hervé Gouya1, Olivier Vignaux1, Patrick Le Roux2, Philippe Chanson3, Jérome Bertherat4, Xavier Bertagna4 and Paul Legmann1

1 Department of Radiology, Hôpital Cochin, 27 rue du Faubourg Saint-Jacques, 75679 Paris Cedex 14, France.
2 Global Applied Science Laboratory, GE Healthcare, Buc, France.
3 Department of Endocrinology, University Paris XI, Hôpital Bicètre, Le Kremlin-Bicètre, France.
4 Department of Endocrinology, Université René Descartes, Hôpital Cochin, Paris, France.


Figure 1
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  		Fig. 1A —Experimental single-breath-hold sequence. Ultrafast experimental single-breath-hold single-shot fast spin-echo MRI T2 map obtained with generic Carr-Purcell-Meiboom-Gill sequence. Top line represents spikes in radiofrequency pulses that are in reality selective. Next two lines depict read gradient Gx and encoding gradient waveforms as function of time. Phase-encoding waveform Gy(1) pertains only to first acquisition. Three acquisitions for obtaining three effective echoes are performed in this example. Last two acquisitions are depicted only by their encoding waveforms Gy(2) and Gy(3), radiofrequency and read gradient being kept constant between acquisitions. Signal acquisition periods are represented by rectangles positioned between half-sine encoding and rewinding impulses. Principle of proposed protocol is to shift by a certain number of echo spaces (two echo spaces in this example) acquisition windows and encoding waveform from one acquisition to next, increasing effective echo time by same amount of time. To guarantee that recovery of longitudinal magnetization is not perturbed, sufficient number of dummy echoes (four echoes in this example) with no encoding or signal acquisition are added at end of original Carr-Purcell-Meiboom-Gill sequence. Sequence thus is always of same length and produces same overall action on longitudinal magnetization, ensuring images are void of variable T1 contrast enhancement.

 

Figure 2
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  		Fig. 1B —Experimental single-breath-hold sequence. 35-year-old man with acromegaly disease. Short-axis black-blood single-shot fast spin-echo MR images with incremental TEs ranging from 10 (B) to 90 (J) milliseconds.

 

Figure 3
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  		Fig. 1C —Experimental single-breath-hold sequence. 35-year-old man with acromegaly disease. Short-axis black-blood single-shot fast spin-echo MR images with incremental TEs ranging from 10 (B) to 90 (J) milliseconds.

 

Figure 4
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  		Fig. 1D —Experimental single-breath-hold sequence. 35-year-old man with acromegaly disease. Short-axis black-blood single-shot fast spin-echo MR images with incremental TEs ranging from 10 (B) to 90 (J) milliseconds.

 

Figure 5
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  		Fig. 1E —Experimental single-breath-hold sequence. 35-year-old man with acromegaly disease. Short-axis black-blood single-shot fast spin-echo MR images with incremental TEs ranging from 10 (B) to 90 (J) milliseconds.

 

Figure 6
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  		Fig. 1F —Experimental single-breath-hold sequence. 35-year-old man with acromegaly disease. Short-axis black-blood single-shot fast spin-echo MR images with incremental TEs ranging from 10 (B) to 90 (J) milliseconds.

 

Figure 7
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  		Fig. 1G —Experimental single-breath-hold sequence. 35-year-old man with acromegaly disease. Short-axis black-blood single-shot fast spin-echo MR images with incremental TEs ranging from 10 (B) to 90 (J) milliseconds.

 

Figure 8
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  		Fig. 1H —Experimental single-breath-hold sequence. 35-year-old man with acromegaly disease. Short-axis black-blood single-shot fast spin-echo MR images with incremental TEs ranging from 10 (B) to 90 (J) milliseconds.

 

Figure 9
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  		Fig. 1I —Experimental single-breath-hold sequence. 35-year-old man with acromegaly disease. Short-axis black-blood single-shot fast spin-echo MR images with incremental TEs ranging from 10 (B) to 90 (J) milliseconds.

 

Figure 10
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  		Fig. 1J —Experimental single-breath-hold sequence. 35-year-old man with acromegaly disease. Short-axis black-blood single-shot fast spin-echo MR images with incremental TEs ranging from 10 (B) to 90 (J) milliseconds.

 

Figure 11
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  		Fig. 2 —Graph shows averaged myocardial T2 values in control group and patients with acromegaly before and after treatment.

 

Figure 12
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  		Fig. 3 —Graph shows relation between myocardial T2 values and serum levels of growth hormone for all patients before (triangles) and after (squares) treatment. T2 = 60.3 + 0.2 growth hormone.

 

Figure 13
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  		Fig. 4 —Graph shows relation between myocardial T2 values and serum levels of insulinlike growth factor 1 (IGF-1) for all patients before (triangles) and after (squares) treatment. T2 = 55.2 + 0.1 IGF-1.

 

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