Cardiovasc Imaging Asia.  2022 Jul;6(3):88-95. 10.22468/cvia.2022.00024.

Splenic T1-Mapping for Predicting Adenosine Stress Adequacy in Cardiac Magnetic Resonance Myocardial Perfusion Imaging: A Validation and Reproducibility Study

  • 1Department of Radiology & Imaging, Queen Elizabeth Hospital, Kowloon, Hong Kong, China
  • 2Department of Radiology, Hong Kong Children’s Hospital, Kowloon, Hong Kong, China
  • 3Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong Island, Hong Kong, China


Splenic switch-off (SSO) sign has been utilized as a surrogate marker of adequate stress but can only be assessed after first-pass perfusion imaging. A study previously reported that drop in T1 spleen ≥30 ms during adenosine infusion predicts presence of SSO, but this finding has not been externally validated. This study aimed to prospectively validate whether drop in T1 spleen ≥30 ms is a reliable marker of SSO and hence adequate stress, and to assess reproducibility of T1 spleen measurements.
Materials and Methods
Data of fifty consecutive patients undergoing stress cardiac magnetic resonance were prospectively collected. Native T1-maps were acquired at rest and at 2.5 min after adenosine infusion in short axis slices, followed by perfusion images at 3 min. To measure T1 spleen pre- and post-adenosine infusion, regions of interest were manually placed to include most splenic tissue. Adenosine stress adequacy was evaluated by visual SSO assessment and semi-quantitative splenic perfusion analysis.
A significant association was found between a drop in T1 spleen of ≥30 ms and SSO response (p<0.001). There was excellent correlation between SSO response and semiquantitative perfusion change in spleen (rho=0.847, p<0.001). Inter-observer and intra-observer agreement for measurement of ΔT1 spleen values were excellent, with intra-class correlation coefficients of 0.987 and 0.995, respectively. By receiver-operating characteristic analysis, the optimal cut-off value of ΔT1 spleen for predicting presence of SSO was -28 ms, with area under the curve=0.76 (p=0.002).
Splenic T1-mapping is accurate and reproducible for predicting SSO, potentially allowing optimization of adenosine dosage for adequate stress.


Magnetic resonance; Heart; Adenosine; Perfusion
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