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Background Robust CMR imaging is required for the delineation of myocardial area at risk (AAR), so that the success of reperfusion therapies can be evaluated. In this work, we investigate the performance of T1 mapping in assessing AAR one week post-STEMI, and explore the effect of microvascular obstruction (MVO) on T1 relaxation times. Methods CMR imaging was conducted on a Philips 3T Achieva MRI scanner. T2W-weighted spectral attenuated inversion recovery (T2WW-SPAIR), modified look-locker inversion recovery (MOLLI) T1 mapping and late gadolinium enhancement (LGE) sequences were applied as short axis stacks in 10 healthy volunteers and 62 STEMI patients. Receiver operator characteristic (ROC) analysis was applied to calculate a cut-off T1 to to discriminate AAR from normal myocardium. The presence of LGE was used as the positive ROC test state, while healthy myocardium, as measured in volunteers, was used as the negative ROC test state. For comparison with T1 mapping, the AAR was also measured on T2WW images using a threshold signal intensity > 2SD greater than remote. The derived myocardial edema volumes and salvage indices were compared between MVO+ and MVO- groups. Results For T1 mapping, ROC analysis gave a significantly larger area-under-the-curve (AUC) as compared to T2WWSPAIR for delineating myocardial edema (AUC = 0.89

MOLLI T1 mapping versus T2 W-SPAIR at 3T: myocardial area at risk measurements and the influence of microvascular obstruction