BACKGROUND: Current cardiovascular magnetic resonance (CMR) methods, such as 
late gadolinium enhancement (LGE) and oedema imaging (T2W) used to depict 
myocardial ischemia, have limitations. Novel quantitative T1-mapping techniques 
have the potential to further characterize the components of ischemic injury. In 
patients with myocardial infarction (MI) we sought to investigate whether 
state-of the art pre-contrast T1-mapping (1) detects acute myocardial injury, 
(2) allows for quantification of the severity of damage when compared to 
standard techniques such as LGE and T2W, and (3) has the ability to predict long 
term functional recovery.
METHODS: 3T CMR including T2W, T1-mapping and LGE was performed in 41 patients 
[of these, 78% were ST elevation MI (STEMI)] with acute MI at 12-48 hour after 
chest pain onset and at 6 months (6M). Patients with STEMI underwent primary PCI 
prior to CMR. Assessment of acute regional wall motion abnormalities, acute 
segmental damaged fraction by T2W and LGE and mean segmental T1 values was 
performed on matching short axis slices. LGE and improvement in regional wall 
motion at 6M were also obtained.
RESULTS: We found that the variability of T1 measurements was significantly 
lower compared to T2W and that, while the diagnostic performance of acute 
T1-mapping for detecting myocardial injury was at least as good as that of 
T2W-CMR in STEMI patients, it was superior to T2W imaging in NSTEMI. There was a 
significant relationship between the segmental damaged fraction assessed by 
either by LGE or T2W, and mean segmental T1 values (P < 0.01). The index of 
salvaged myocardium derived by acute T1-mapping and 6M LGE was not different to 
the one derived from T2W (P = 0.88). Furthermore, the likelihood of improvement 
of segmental function at 6M decreased progressively as acute T1 values increased 
(P < 0.0004).
CONCLUSIONS: In acute MI, pre-contrast T1-mapping allows assessment of the 
extent of myocardial damage. T1-mapping might become an important complementary 
technique to LGE and T2W for identification of reversible myocardial injury and 
prediction of functional recovery in acute MI.