BACKGROUND: T2w-CMR is used widely to assess myocardial edema. Quantitative 
T1-mapping is also sensitive to changes in free water content. We hypothesized 
that T1-mapping would have a higher diagnostic performance in detecting acute 
edema than dark-blood and bright-blood T2w-CMR.
METHODS: We investigated 21 controls (55 ± 13 years) and 21 patients 
(61 ± 10 years) with Takotsubo cardiomyopathy or acute regional myocardial edema 
without infarction. CMR performed within 7 days included cine, T1-mapping using 
ShMOLLI, dark-blood T2-STIR, bright-blood ACUT2E and LGE imaging. We analyzed 
wall motion, myocardial T1 values and T2 signal intensity (SI) ratio relative to 
both skeletal muscle and remote myocardium.
RESULTS: All patients had acute cardiac symptoms, increased Troponin I 
(0.15-36.80 ug/L) and acute wall motion abnormalities but no LGE. T1 was 
increased in patient segments with abnormal and normal wall motion compared to 
controls (1113 ± 94 ms, 1029 ± 59 ms and 944 ± 17 ms, respectively; p < 0.001). 
T2 SI ratio using STIR and ACUT2E was also increased in patient segments with 
abnormal and normal wall motion compared to controls (all p < 0.02). Receiver 
operator characteristics analysis showed that T1-mapping had a significantly 
larger area-under-the-curve (AUC = 0.94) compared to T2-weighted methods, 
whether the reference ROI was skeletal muscle or remote myocardium 
(AUC = 0.58-0.89; p < 0.03). A T1 value of greater than 990 ms most optimally 
differentiated segments affected by edema from normal segments at 1.5 T, with a 
sensitivity and specificity of 92 %.
CONCLUSIONS: Non-contrast T1-mapping using ShMOLLI is a novel method for 
objectively detecting myocardial edema with a high diagnostic performance. 
T1-mapping may serve as a complementary technique to T2-weighted imaging for 
assessing myocardial edema in ischemic and non-ischemic heart disease, such as 
quantifying area-at-risk and diagnosing myocarditis.