Parametric Mapping in Paediatric Magnetic Resonance Imaging

Overview

Magnetic resonance imaging (MRI) is increasingly an important tool for diagnosis and management of cardiac diseases in children. One of the uses of MRI is tissue characterisation, in which the signal characteristics of the cardiac muscle (myocardium) can be determined with special techniques, known as parametric mapping. There is increasing evidence that parametric mapping may be able to identify regions of scarring in the myocardium, or detection of oedema/inflammation in the setting. This in turn can help predict disease course and add value to the management of patients. There is also evidence that other structures that are visualised in parametric mapping aside from the heart (e.g. liver and spleen) can also help improve diagnostic accuracy and guide management. Currently the majority of studies describing the use of parametric mapping is focused on adults, with limited data on its use in children. The parametric mapping values can also differ amongst different machines, so calibration with normal subjects are also required.

Study Type

  • Study Type: Observational [Patient Registry]
  • Study Design
    • Time Perspective: Prospective
  • Study Primary Completion Date: June 30, 2022

Detailed Description

Magnetic resonance Imaging (MRI) can provide tissue characterisation without radiation and need for invasive biopsy. Parametric mapping techniques (T1 mapping, extracellular volume fraction, T2 mapping, T2* mapping) are methods of quantitative analysis of tissue properties, and are currently commercially available. T1 mapping, extracellular volume fraction (ECV) and T2* mapping provides knowledge about the tissue properties of the myocardium, interstitium and adjacent structures,and can provide information for diagnosis of fibrosis, inflammatory and infiltrative diseases. T2 mapping is useful for assessing oedema, which may be useful in monitoring disease activity such as myocarditis. Parametric mapping has proven clinical utility in iron deposition, amyloid disease, Anderson-Fabry disease and myocarditis. In addition to assessment of cardiac muscle, tissue characterisation can also be performed in adjacent organs that are included in the field of view of parametric mapping (e.g. liver and spleen). Parametric mapping may provide important diagnostic information for decision making, patient monitoring and management planning. The investigators aim to 1. recruit healthy volunteers as controls to establish normal local reference ranges for parametric mapping values 2. recruit patients undergoing clinically indicated cardiac MRI to perform parametric mapping, and compare the parametric mapping values between normal controls and patients.

Interventions

  • Diagnostic Test: MRI parametric mapping
    • Magnetic resonance (MR) sequences (T1 mapping, T2 mapping, T2* mapping, ECV mapping) to determine the MR signal characteristics of the body

Arms, Groups and Cohorts

  • Healthy Volunteers
    • Healthy volunteers Recruited from the public Patients who have scheduled imaging scans for non-cardiac reasons and without a prior history or suspected history of cardiac disease
  • Children undergoing clinically indicated cardiac MRI
    • Patients who are scheduled to have a clinically indicated cardiac MRI

Clinical Trial Outcome Measures

Primary Measures

  • Parametric mapping values of normal subjects and patients
    • Time Frame: through study completion, up to 2 years
    • Parametric mapping values are generated upon completion of the MR sequence

Participating in This Clinical Trial

Inclusion Criteria

  • Healthy volunteers – Paediatric patients <=18 years of age with suspected or confirmed cardiac disease undergoing clinically indicated MRI Exclusion Criteria:

  • Unstable or uncooperative patients that cannot tolerate MRI – Patients with contraindications for MRI (e.g. patients with implanted devices that are not MRI compatible)

Gender Eligibility: All

Minimum Age: N/A

Maximum Age: 18 Years

Are Healthy Volunteers Accepted: Accepts Healthy Volunteers

Investigator Details

  • Lead Sponsor
    • Hong Kong Children’s Hospital
  • Provider of Information About this Clinical Study
    • Principal Investigator: Kenneth CHEUNG, Associate Consultant – Hong Kong Children’s Hospital
  • Overall Contact(s)
    • Kenneth Cheung, MBBS, +852 35136084, cky630a@ha.org.hk

References

Messroghli DR, Moon JC, Ferreira VM, Grosse-Wortmann L, He T, Kellman P, Mascherbauer J, Nezafat R, Salerno M, Schelbert EB, Taylor AJ, Thompson R, Ugander M, van Heeswijk RB, Friedrich MG. Clinical recommendations for cardiovascular magnetic resonance mapping of T1, T2, T2* and extracellular volume: A consensus statement by the Society for Cardiovascular Magnetic Resonance (SCMR) endorsed by the European Association for Cardiovascular Imaging (EACVI). J Cardiovasc Magn Reson. 2017 Oct 9;19(1):75. doi: 10.1186/s12968-017-0389-8. Erratum In: J Cardiovasc Magn Reson. 2018 Feb 7;20(1):9.

Kim PK, Hong YJ, Im DJ, Suh YJ, Park CH, Kim JY, Chang S, Lee HJ, Hur J, Kim YJ, Choi BW. Myocardial T1 and T2 Mapping: Techniques and Clinical Applications. Korean J Radiol. 2017 Jan-Feb;18(1):113-131. doi: 10.3348/kjr.2017.18.1.113. Epub 2017 Jan 5.

Riesenkampff E, Messroghli DR, Redington AN, Grosse-Wortmann L. Myocardial T1 mapping in pediatric and congenital heart disease. Circ Cardiovasc Imaging. 2015 Feb;8(2):e002504. doi: 10.1161/CIRCIMAGING.114.002504. No abstract available.

Anderson LJ. Assessment of iron overload with T2* magnetic resonance imaging. Prog Cardiovasc Dis. 2011 Nov-Dec;54(3):287-94. doi: 10.1016/j.pcad.2011.07.004.

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