IRM de diffusion cardiaque dans l’infarctus du myocarde récent et chronique : expérience préliminaire

Cardiac diffusion-weighted MR imaging in recent, subacute, and chronic myocardial infarction: a pilot study

PURPOSE

To investigate the clinical feasibility of diffusion-weighted imaging (DWI) to detect recent myocardial infarction (MI) and to differentiate it from subacute and chronic MI, with late-gadolinium enhancement (LGE) sequence as reference. Furthermore, to measure variation of the myocardial apparent diffusion coefficient (ADC) according to the age of MI.

MATERIALS AND METHODS

Seventy-four MI patients were separated in 3 groups. Group A included 34 recent (< 8 days) MI patients; group B, 22 subacute (9-90 days) MI patients; group C, 18 chronic (> 90 days) MI patients; a fourth group (group D) included 24 controls. DWI and LGE images were acquired on a 1.5T system. DWI and LGE matched images were assessed visually by two blinded observers for hyperintense areas in corresponding segments.

RESULTS

Qualitative assessment of DWI compared with LGE images yielded a sensitivity of 97% and a specificity of 61%/14% to differentiate recent from chronic/subacute MI, respectively. The absolute ADCs (recent 0.00632 ± 0.00037 mm(2) /s, subacute 0.00639 ± 0.00035 mm(2) /s, chronic 0.00743 ± 0.00056 mm(2) /s, remote or normal 0.00895 ± 0.00019 mm(2) /s) and relative ADCs were significantly different between groups (P < 0.001) except between recent and subacute MIs.

CONCLUSION

DWI is a sensitive technique to diagnose recent MI. DWI MR sequences could help differentiate recent from chronic MI. From these preliminary results, one should expect DWI to be used in the triage of emergency patients with atypical chest pain, to clarify if an MI is present or not in just a few minutes.