Cardiac Intravoxel Incoherent Motion Diffusion‐Weighted Magnetic Resonance Imaging With T1 Mapping to Assess Myocardial Perfusion and Fibrosis in Systemic Sclerosis: Association with Cardiac Events From a Prospective Cohort Study

BACKGROUND: Myocardial involvement may occur during systemic sclerosis (SSc) and lead to impaired myocardial contraction and/or arrhythmia. Cardiac magnetic resonance imaging (CMRI) is used for noninvasive characterization of myocardium. We aimed to evaluate the interest of CMRI with intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) and T1 mapping to assess myocardial microvascular and interstitium impairment in SSc. PATIENTS AND METHODS: Single-center prospective study of 40 consecutive patients with SSc. CMRI with IVIM DWI and T1 mapping sequences were performed in all patients on a 3T system. RESULTS: T1 values were higher in SSc than in healthy controls, and higher T1 values were associated with diffuse cutaneous SSc (dcSSc), immunological pattern associated with dcSSc forms, higher mRSS and higher frequency of interstitial lung disease. T1 was correlated with mRSS (r=+0.32, P=0.04) and forced vital capacity (r=-0.34, P=0.048), and tended to be correlated with total lung capacity (r=-0.30, P=0.07). Lower values of f coefficient, associated with decreased tissue perfusion, were associated with less frequent use of vasodilators and more frequent use of glucocorticoids. f coefficient was inversely correlated with T1 (r=-0.31, P=0.02). Finally, higher T1 values were associated with cardiac events (log-rank test for trend P=0.03). CONCLUSION: This study shows the interest of CMRI with T1 mapping sequences and IVIM DWI in SSc to assess myocardial involvement. Increased T1 values, potentially suggesting microscopic fibrosis, was more frequently observed in patients with dcSSc and was associated with interstitial lung disease, and with more frequent cardiac events during follow-up.