BS43 A new collagen III-specific MRI imaging probe to assess cardiac fibrosis

Heart failure (HF) has reached epidemic proportions, affecting approximately 64 million people globally and is the main cause of death and disability.1 Myocardial fibrosis, characterised by changes in the amount and/or distribution of collagen I and III, impairs cardiac function and relates to adverse outcomes of HF.2 3 Clinically, we rely on indirect or surrogate measurements of collagen in the myocardium and current targeted molecular imaging probes are limited to collagen I. Here, we report the discovery of a peptide selective for collagen III and a strategy to develop an imaging probe with superior properties for in vivo molecular magnetic resonance imaging (MRI) applications. A small peptide was screened and selected from a library of peptides with potential to bind to collagen identified based on protein-protein interaction studies. The peptide was conjugated to a DOTA-chelator and labelled with Europium [Eu(III)] for in vitro binding assays; gallium (68Ga) for in vivo PET/CT biodistribution; and gadolinium [Gd(III)] for in vivo MRI studies. The probe was further modified to increase the number of Gd(III) per peptide (from one to four) to amplify and prolong the MRI signal. The probe was validated using a surgical mouse model of myocardial infarction (MI). In vivo MRI was performed at days 10 and 21 post-MI (n=7). Imaging findings were validated with tissue analysis. A negative control probe, carrying a scrambled peptide sequence was used. All MRI experiments were performed at a 3 Tesla clinical MRI scanner. In vitro binding assays showed that the probe has a good affinity towards collagen III (Kd= 5.2±1.3µM) that is in the ideal range for a molecular imaging probe.4 Lack of binding of the scrambled probe (negative control) proved the specificity our probe (figure 1A). In vivo PET/CT biodistribution showed favourable pharmacokinetics with fast blood clearance and no unspecific binding (figure 1B). In vivo cardiac MRI showed selective late gadolinium enhancement (LGE) of the fibrotic scar at day 10 which decreased by day 21. This observation is expected as collagen III naturally gets replaced by collagen I at the later stages of cardiac fibrosis. The imaging data are validated histologically showing co-localisation of the MRI signal with collagen III (green colour) at day 10 and reduction of collagen III at day 21 (figure 2). Importantly, no enhancement was observed using the negative control probe and a clinically approved non-collagen targeting probe (Gadovist). We have developed a new molecular imaging probe specific for collagen type III. Using this probe, we have successfully imaged - previously undetectable - collagen III in cardiac fibrosis. This approach may enable early detection and characterisation of cardiac fibrosis in vivo allowing staging of disease and monitoring of therapie

Myocardial T1, T2, T2*, and fat fraction quantification via low-rank motion-corrected cardiac MR fingerprinting

PURPOSE: Develop a novel 2D cardiac MR fingerprinting (MRF) approach to enable simultaneous T1, T2, T2*, and fat fraction (FF) myocardial tissue characterization in a single breath‐hold scan. METHODS: Simultaneous, co‐registered, multi‐parametric mapping of T1, T2, and FF has been recently achieved with cardiac MRF. Here, we further incorporate T2* quantification within this approach, enabling simultaneous T1, T2, T2*, and FF myocardial tissue characterization in a single breath‐hold scan. T2* quantification is achieved with an eight‐echo readout that requires a long cardiac acquisition window. A novel low‐rank motion‐corrected (LRMC) reconstruction is exploited to correct for cardiac motion within the long acquisition window. The proposed T1/T2/T2*/FF cardiac MRF was evaluated in phantom and in 10 healthy subjects in comparison to conventional mapping techniques. RESULTS: The proposed approach achieved high quality parametric mapping of T1, T2, T2*, and FF with corresponding normalized RMS error (RMSE) T1 = 5.9%, T2 = 9.6% (T2 values <100 ms), T2* = 3.3% (T2* values <100 ms), and FF = 0.8% observed in phantom scans. In vivo, the proposed approach produced higher left‐ventricular myocardial T1 values than MOLLI (1148 vs 1056 ms), lower T2 values than T2‐GraSE (42.8 vs 50.6 ms), lower T2* values than eight‐echo gradient echo (GRE) (35.0 vs 39.4 ms), and higher FF values than six‐echo GRE (0.8 vs 0.3 %) reference techniques. The proposed approach achieved considerable reduction in motion artifacts compared to cardiac MRF without motion correction, improved spatial uniformity, and statistically higher apparent precision relative to conventional mapping for all parameters. CONCLUSION: The proposed cardiac MRF approach enables simultaneous, co‐registered mapping of T1, T2, T2*, and FF in a single breath‐hold for comprehensive myocardial tissue characterization, achieving higher apparent precision than conventional methods