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Background  Cardiovascular magnetic resonance (CMR)–derived extracellular volume (ECV) requires a hematocrit (Hct) to correct contrast volume distributions in blood. However, the timely assessment of Hct can be challenging and has limited the routine clinical application of ECV. The goal of the present study was to evaluate whether ECV measurements lead to significant error if a venous Hct was unavailable on the day of CMR.    Methods  109 patients with CMR T1 mapping and two venous Hcts (Hct 0 : a Hct from the day of CMR, and Hct 1 : a Hct from a different day) were retrospectively identified. A synthetic Hct (Hct syn ) derived from native blood T1 was also assessed. The study used two different ECV methods, (1) a conventional method in which ECV was estimated from native and postcontrast T1 maps using a region-based method, and (2) an inline method in which ECV was directly measured from inline ECV mapping. ECVs measured with Hct 0 , Hct 1 , and Hct syn  were compared for each method, and the reference ECV (ECV 0 ) was defined using the Hct 0 . The error between synthetic (ECV syn ) and ECV 0 was analyzed for the two ECV methods.    Results  ECV measured using Hct 1  and Hct syn  were significantly correlated with ECV 0  for each method. No significant differences were observed between ECV 0  and ECV measured with Hct 1  (ECV 1 ; 28.4 ± 6.6% vs. 28.3 ± 6.1%, p = 0.789) and between ECV 0  and ECV calculated with Hct syn  (ECV syn ; 28.4 ± 6.6% vs. 28.2 ± 6.2%, p = 0.45) using the conventional method. Similarly, ECV 0  was not significantly different from ECV 1  (28.5 ± 6.7% vs. 28.5 ± 6.2, p = 0.801) and ECV syn  (28.5 ± 6.7% vs. 28.4 ± 6.0, p = 0.974) using inline method. ECV syn  values revealed relatively large discrepancies in patients with lower Hcts compared with those with higher Hcts.    Conclusions  Venous Hcts measured on a different day from that of the CMR examination can still be used to measure ECV. ECV syn  can provide an alternative method to quantify ECV without needing a blood sample, but significant ECV errors occur in patients with severe anemia.

Is a timely assessment of the hematocrit necessary for cardiovascular magnetic resonance–derived extracellular volume measurements?