Over the past two decades cardiac MRI has evolved into a powerful non-invasive imaging modality for the detection and characterization of heart disease. Although well-known markers of heart disease, such as perfusion and viability, using MRI have been successfully validated against nuclear methods in multi-center studies, and are routinely used in the clinical area, recent advances in cardiac MRI, particularly those that employ other aspects of MR relaxometry, are pointing to exciting new directions. In this presentation we will focus on T2 and T2* MRI, which often are realized as key components of cardiac MRI exams for generating exquisite soft-tissue image contrasts in the assessment of heart disease without the use of exogenous contrast agents.To date, T2 and T2* MRI have been successfully used for the diagnosis and prognosis of multiple disease processes, including inflammatory diseases such as myocarditis and non-ischemic heart disease such as thalassemia. Over the past decade, the utility of T2 and T2* MRI has expanded for diagnosis of other cardiac indications and prognostication of disease, as well as the assessment of therapeutic efficacies to improve the associated health outcomes. The goals of this presentation are to: (a) outline key cardiac MRI approaches used for T2 and T2* imaging;(b) describe the recent advances in T2 and T2* imaging; and (c) summarize the evolving T2- and T2*-based cardiac MRI-based biomarkers that are being actively studied for improving the clinical management of heart disease .To this end, we will first review the basic principles of T2 and T2*-weighted imaging with brief descriptions of spin-echo and gradient-echo imaging. We will then transition into T2 and T2* mapping, where we will examine the key benefits parameter mapping offers over weighted imaging. At this point, we will briefly examine common image artifacts that confound T2 and T2* mapping, such as motion and off-resonance artifacts. Subsequently, we will review the new imaging strategies developed to improve spatial coverage, time-resolved imaging, along with the state-of-the-art approaches for addressing cardiac and respiratory motion. In this context we will consider the importance of field strength, particularly the benefits 3.0T offers over 1.5T, and the approaches used to mitigate the challenges posed by the higher field strength. We will then consider specific applications, such as myocardial edema in the setting of myocardial infarction and blood-oxygen-level dependent MRI, where T2-based cardiac MRI has been shown to valuable. Next, we will review the applications of T2*-based MRI with a key focus on its use in myocardial iron overloading in non-ischemic heart disease and intramyocardial hemorrhage in ischemic heart disease. At this point, we will examine the overarching parallels between T2 and T2* imaging approaches, common pitfalls and subtleties and identify the optimal imaging parameter (T2 vs T2*) that can accurately characterize the myocardium with relevant clinical examples. In the final part of the presentation, we will look at the broader clinical picture of how T2 and T2* imaging are being used today, the existing limitations and how they can be improved (a) from the technical standpoint and (b) their use in the clinical setting.

Acknowledgements

No acknowledgement found.