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Jada L, Holtackers RJ, Martens B, Nies HMJM, Van De Heyning CM, Botnar RM, Wildberger JE, Ismail TF, Razavi R, Chiribiri A. Quantification of myocardial scar of different etiology using dark- and bright-blood late gadolinium enhancement cardiovascular magnetic resonance. Sci Rep 2024; 14:5395. [PMID: 38443457 PMCID: PMC10914833 DOI: 10.1038/s41598-024-52058-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 01/12/2024] [Indexed: 03/07/2024] Open
Abstract
Dark-blood late gadolinium enhancement (LGE) has been shown to improve the visualization and quantification of areas of ischemic scar compared to standard bright-blood LGE. Recently, the performance of various semi-automated quantification methods has been evaluated for the assessment of infarct size using both dark-blood LGE and conventional bright-blood LGE with histopathology as a reference standard. However, the impact of this sequence on different quantification strategies in vivo remains uncertain. In this study, various semi-automated scar quantification methods were evaluated for a range of different ischemic and non-ischemic pathologies encountered in clinical practice. A total of 62 patients referred for clinical cardiovascular magnetic resonance (CMR) were retrospectively included. All patients had a confirmed diagnosis of either ischemic heart disease (IHD; n = 21), dilated/non-ischemic cardiomyopathy (NICM; n = 21), or hypertrophic cardiomyopathy (HCM; n = 20) and underwent CMR on a 1.5 T scanner including both bright- and dark-blood LGE using a standard PSIR sequence. Both methods used identical sequence settings as per clinical protocol, apart from the inversion time parameter, which was set differently. All short-axis LGE images with scar were manually segmented for epicardial and endocardial borders. The extent of LGE was then measured visually by manual signal thresholding, and semi-automatically by signal thresholding using the standard deviation (SD) and the full width at half maximum (FWHM) methods. For all quantification methods in the IHD group, except the 6 SD method, dark-blood LGE detected significantly more enhancement compared to bright-blood LGE (p < 0.05 for all methods). For both bright-blood and dark-blood LGE, the 6 SD method correlated best with manual thresholding (16.9% vs. 17.1% and 20.1% vs. 20.4%, respectively). For the NICM group, no significant differences between LGE methods were found. For bright-blood LGE, the 5 SD method agreed best with manual thresholding (9.3% vs. 11.0%), while for dark-blood LGE the 4 SD method agreed best (12.6% vs. 11.5%). Similarly, for the HCM group no significant differences between LGE methods were found. For bright-blood LGE, the 6 SD method agreed best with manual thresholding (10.9% vs. 12.2%), while for dark-blood LGE the 5 SD method agreed best (13.2% vs. 11.5%). Semi-automated LGE quantification using dark-blood LGE images is feasible in both patients with ischemic and non-ischemic scar patterns. Given the advantage in detecting scar in patients with ischemic heart disease and no disadvantage in patients with non-ischemic scar, dark-blood LGE can be readily and widely adopted into clinical practice without compromising on quantification.
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Affiliation(s)
- Lamis Jada
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom
- King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Robert J Holtackers
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom.
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Bibi Martens
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Hedwig M J M Nies
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Caroline M Van De Heyning
- GENCOR, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | - Rene M Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom
- Institute for Biological and Medical Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile
| | - Joachim E Wildberger
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Tevfik F Ismail
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom
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Nies HMJM, Gommers S, Bijvoet GP, Heckman LIB, Prinzen FW, Vogel G, Van De Heyning CM, Chiribiri A, Wildberger JE, Mihl C, Holtackers RJ. Histopathological validation of semi-automated myocardial scar quantification techniques for dark-blood late gadolinium enhancement magnetic resonance imaging. Eur Heart J Cardiovasc Imaging 2022; 24:364-372. [PMID: 35723673 PMCID: PMC9936958 DOI: 10.1093/ehjci/jeac107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS To evaluate the performance of various semi-automated techniques for quantification of myocardial infarct size on both conventional bright-blood and novel dark-blood late gadolinium enhancement (LGE) images using histopathology as reference standard. METHODS AND RESULTS In 13 Yorkshire pigs, reperfused myocardial infarction was experimentally induced. At 7 weeks post-infarction, both bright-blood and dark-blood LGE imaging were performed on a 1.5 T magnetic resonance scanner. Following magnetic resonance imaging (MRI), the animals were sacrificed, and histopathology was obtained. The percentage of infarcted myocardium was assessed per slice using various semi-automated scar quantification techniques, including the signal threshold vs. reference mean (STRM, using 3 to 8 SDs as threshold) and full-width at half-maximum (FWHM) methods, as well as manual contouring, for both LGE methods. Infarct size obtained by histopathology was used as reference. In total, 24 paired LGE MRI slices and histopathology samples were available for analysis. For both bright-blood and dark-blood LGE, the STRM method with a threshold of 5 SDs led to the best agreement to histopathology without significant bias (-0.23%, 95% CI [-2.99, 2.52%], P = 0.862 and -0.20%, 95% CI [-2.12, 1.72%], P = 0.831, respectively). Manual contouring significantly underestimated infarct size on bright-blood LGE (-1.57%, 95% CI [-2.96, -0.18%], P = 0.029), while manual contouring on dark-blood LGE outperformed semi-automated quantification and demonstrated the most accurate quantification in this study (-0.03%, 95% CI [-0.22, 0.16%], P = 0.760). CONCLUSION The signal threshold vs. reference mean method with a threshold of 5 SDs demonstrated the most accurate semi-automated quantification of infarcted myocardium, without significant bias compared to histopathology, for both conventional bright-blood and novel dark-blood LGE.
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Affiliation(s)
| | - Suzanne Gommers
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, PO Box 5800, AZ 6202, Maastricht, The Netherlands
| | - Geertruida P Bijvoet
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands,Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Luuk I B Heckman
- Department of Physiology, Maastricht University, Maastricht, The Netherlands
| | - Frits W Prinzen
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands,Department of Physiology, Maastricht University, Maastricht, The Netherlands
| | - Gaston Vogel
- Pie Medical Imaging, Maastricht, The Netherlands
| | - Caroline M Van De Heyning
- Department of Cardiology, Antwerp University Hospital and GENCOR, University of Antwerp, Antwerp, Belgium
| | - Amedeo Chiribiri
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
| | - Joachim E Wildberger
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands,Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, PO Box 5800, AZ 6202, Maastricht, The Netherlands
| | - Casper Mihl
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands,Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, PO Box 5800, AZ 6202, Maastricht, The Netherlands
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Katukuri N. Role of Cardiac MRI in Assessment of Myocardial Viability. Magn Reson Imaging 2019. [DOI: 10.5772/intechopen.85830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Paiman EHM, Lamb HJ. When should we use contrast material in cardiac MRI? J Magn Reson Imaging 2017; 46:1551-1572. [PMID: 28480596 DOI: 10.1002/jmri.25754] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/18/2017] [Indexed: 12/29/2022] Open
Abstract
At present, most of the cardiac magnetic resonance imaging (MRI) examinations rely on contrast-enhanced protocols, but noncontrast alternatives are emerging. Late gadolinium enhancement (LGE) imaging for the detection of myocardial scar can be considered the main cause for the embedding of cardiac MRI into the clinical routine. The novel noncontrast technique of native T1 mapping shows promise for tissue characterization in ischemic and nonischemic cardiomyopathy and may provide additional information over conventional LGE imaging. Technical issues, including measurements variability, still need to be resolved to facilitate a wide clinical application. Ischemia detection can be performed with contrast-based stress perfusion and contrast-free stress wall motion imaging. For coronary magnetic resonance angiography (MRA), protocols with and without contrast material have been developed. Research on coronary atherosclerotic plaque characterization has introduced new applications of contrast material. For MRA of the aorta, which traditionally relied on contrast administration, several noncontrast protocols have become available. This review provides an overview of when to use contrast material in cardiac and cardiac-related vascular MRI, summarizes the major imaging building blocks, and describes the diagnostic value of the available contrast-enhanced and noncontrast techniques. Contrast material in cardiac MRI should be used for LGE imaging for tissue characterization in ischemic or nonischemic cardiomyopathy and may be used for stress perfusion imaging for the detection of ischemia. In cardiac-related vascular MRI, use of contrast material should be avoided, unless high-quality angiography is required that cannot be obtained with noncontrast protocols. LEVEL OF EVIDENCE 5 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1551-1572.
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Affiliation(s)
- Elisabeth H M Paiman
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Abstract
Noninvasive cardiac imaging is widely used to evaluate the presence of coronary artery disease. Recently, with improvements in imaging technology, noninvasive imaging has also been used for evaluation of the presence, severity, and prognosis of coronary artery disease. Coronary CT angiography and MRI of coronary arteries provide an anatomical assessment of coronary stenosis, whereas the hemodynamic significance of a coronary artery stenosis can be assessed by stress myocardial perfusion imaging, such as SPECT/PET and stress MRI. For appropriate use of multiple imaging modalities, the strengths and limitations of each modality are discussed in this review.
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Affiliation(s)
- Ran Heo
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY 10021
| | | | - Dan Kalra
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY 10021
| | - James K Min
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY 10021.
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Does CMR have an additive role over echo in evaluating ischemic LV dysfunction? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2013. [DOI: 10.1016/j.ejrnm.2013.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Kidambi A, Mather AN, Motwani M, Swoboda P, Uddin A, Greenwood JP, Plein S. The effect of microvascular obstruction and intramyocardial hemorrhage on contractile recovery in reperfused myocardial infarction: insights from cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2013; 15:58. [PMID: 23806080 PMCID: PMC3707770 DOI: 10.1186/1532-429x-15-58] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 06/19/2013] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Following acute myocardial infarction (AMI), microvascular obstruction (MO) and intramyocardial hemorrhage (IMH) adversely affect left ventricular remodeling and prognosis independently of infarct size. Whether this is due to infarct zone remodeling, changes in remote myocardium or other factors is unknown. We investigated the role of MO and IMH in recovery of contractility in infarct and remote myocardium. METHODS Thirty-nine patients underwent cardiovascular magnetic resonance (CMR) with T2-weighted and T2* imaging, late gadolinium enhancement (LGE) and myocardial tagging at 2, 7, 30 and 90 days following primary percutaneous coronary intervention for AMI. Circumferential strain in infarct and remote zones was stratified by presence of MO and IMH. RESULTS Overall, infarct zone strain recovered with time (p < 0.001). In the presence of MO with IMH and without IMH, epicardial strain recovered (p = 0.03, p < 0.01 respectively), but mid-myocardial or endocardial strain did not (mid-myocardium: p = 0.05, p = 0.12; endocardium: p = 0.27, p = 0.05, respectively). By day 90, infarcts with MO had more attenuated strain in all myocardial layers compared to infarcts without MO (p < 0.01); those with IMH were attenuated further (p < 0.01). Remote myocardial strain was similar across groups at all time-points (p > 0.2). Infarct transmural extent did not correlate with strain (p > 0.05 at each time point). In multivariable logistic regression, MO and IMH were the only significant independent predictors of attenuated 90-day infarct zone strain (p = 0.004, p = 0.011, respectively). CONCLUSIONS Strain improves within the infarct zone overall following reperfusion with or without MO or IMH. Mid-myocardial and endocardial infarct contractility is diminished in the presence of MO, and further in the presence of IMH. MO and IMH are greater independent predictors of infarct zone contractile recovery than infarct volume or transmural extent.
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Affiliation(s)
- Ananth Kidambi
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health & Therapeutics, University of Leeds, Leeds LS2 9JT, UK
| | - Adam N Mather
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health & Therapeutics, University of Leeds, Leeds LS2 9JT, UK
| | - Manish Motwani
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health & Therapeutics, University of Leeds, Leeds LS2 9JT, UK
| | - Peter Swoboda
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health & Therapeutics, University of Leeds, Leeds LS2 9JT, UK
| | - Akhlaque Uddin
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health & Therapeutics, University of Leeds, Leeds LS2 9JT, UK
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health & Therapeutics, University of Leeds, Leeds LS2 9JT, UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health & Therapeutics, University of Leeds, Leeds LS2 9JT, UK
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Abstract
Hybrid PET/magnetic resonance (MR) imaging, which combines the excellent anatomic information and functional MR imaging parameters with the metabolic and molecular information obtained with PET, may be superior to PET/computed tomography or MR imaging alone for a wide range of disease conditions. This review highlights potential clinical applications in neurologic, cardiovascular, and musculoskeletal disease conditions, with special attention to applications in oncologic imaging.
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Rischpler C, Nekolla SG, Dregely I, Schwaiger M. Hybrid PET/MR imaging of the heart: potential, initial experiences, and future prospects. J Nucl Med 2013; 54:402-15. [PMID: 23404088 DOI: 10.2967/jnumed.112.105353] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PET/CT and other combined scanners have in the past decade rapidly emerged as important research tools and are proving to be invaluable for improved diagnostics in routine nuclear medicine. The design of hybrid PET/MR scanners presented a formidable technical challenge, and only recently were these instruments introduced to the market. Initial expectations of the performance of these scanners have been high, notably because of the potential for superior tissue contrast inherent in the MR modality, as well as the potential for multiparametric functional imaging in conjunction with PET. However, the additional value and potential clinical role that these new systems might bring to the cardiac field have yet to be documented. This review presents a comparative summary of the existing applications for PET and MR in the field of cardiology and suggests potential cardiac applications exploiting unique properties of the newly introduced combined instrumentation.
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Affiliation(s)
- Christoph Rischpler
- Nuklearmedizinische Klinik und Poliklinik, Technische Universität München, Munich, Germany
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Cardiac computed tomography and magnetic resonance imaging: the clinical use from a cardiologist's perspective. J Thorac Imaging 2010; 25:194-203. [PMID: 20711035 DOI: 10.1097/rti.0b013e3181eaadac] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The introduction and continued evolution of cardiac computed tomography and magnetic resonance imaging have added considerable noninvasive diagnostic insight into a wide range of frequently encountered clinical cardiology scenarios. With an increasing range of imaging modalities, and multiple methods of image acquisition in each, a detailed understanding of the clinical question at hand is often necessary to select the proper study and make optimal use of imaging data. We review common cardiac issues from a clinician's perspective, along with the unique role to be played by computed tomography and magnetic resonance imaging in each condition. This review will hopefully facilitate a strong dialogue between imagers and managing clinicians, creating a shared knowledge of both the capabilities of imaging and the management challenges that treating clinicians face.
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Lightfoot JC, D'Agostino RB, Hamilton CA, Jordan J, Torti FM, Kock ND, Jordan J, Workman S, Hundley WG. Novel approach to early detection of doxorubicin cardiotoxicity by gadolinium-enhanced cardiovascular magnetic resonance imaging in an experimental model. Circ Cardiovasc Imaging 2010; 3:550-8. [PMID: 20622140 DOI: 10.1161/circimaging.109.918540] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND We sought to determine whether cardiovascular magnetic resonance measures of gadolinium (Gd) signal intensity (SI) within the left ventricular myocardium are associated with future changes in left ventricular ejection fraction (LVEF) after receipt of doxorubicin (DOX). METHODS AND RESULTS Forty Sprague-Dawley rats were divided into 3 groups scheduled to receive weekly intravenous doses of normal saline (n = 7), 1.5 mg/kg DOX (n = 19), or 2.5 mg/kg DOX (n = 14). Magnetic resonance determinations of LVEF and myocardial Gd-SI were performed before and at 2, 4, 7, and 10 weeks after DOX initiation. During treatment, animals were euthanized at different time points so that histopathologic assessments of the left ventricular myocardium could be obtained. Within-group analyses were performed to examine time-dependent relations between Gd-SI and primary events (deterioration in LVEF or an unanticipated death). Six of 19 animals receiving 1.5 mg/kg DOX and 10 of 14 animals receiving 2.5 mg/kg DOX experienced a primary event; no normal saline animals experienced a primary event. In animals with a primary event, histopathologic evidence of myocellular vacuolization occurred (P = 0.04), and the Gd-SI was elevated relative to baseline at the time of the event (P < 0.0001) and during the measurement period before the event (P = 0.0001). In all animals (including normal saline) without an event, measures of Gd-SI did not differ from baseline. CONCLUSIONS After DOX, low serial measures of Gd-SI predict an absence of an LVEF drop or unanticipated death. An increase in Gd-SI after DOX forecasts a subsequent drop in LVEF as well as histopathologic evidence of intracellular vacuolization consistent with DOX cardiotoxicity.
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Affiliation(s)
- James C Lightfoot
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Abstract
Cardiovascular MRI can assess multiple markers of myocardial viability in a single examination. Its accuracy is at least equivalent to, if not superior to, that of other currently available noninvasive imaging techniques, including positron emission tomography. The greater spatial resolution afforded by cardiovascular MRI, especially with the delayed-enhancement MRI (DE-MRI) technique, combined with the breadth and depth of correlative pathologic data, makes cardiovascular MRI a particularly powerful tool for detecting viable and irreversibly damaged myocardium. A wealth of clinical data exist, including data from multicenter efforts, to establish DE-MRI as a new gold standard in myocardial viability assessment. As the high accuracy and broad scope of DE-MRI are recognized, the technique will gain wider clinical use for analysis of dysfunctional myocardium and be integrated into the diagnostic and therapeutic algorithm.
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Nekolla SG, Martinez-Moeller A, Saraste A. PET and MRI in cardiac imaging: from validation studies to integrated applications. Eur J Nucl Med Mol Imaging 2009; 36 Suppl 1:S121-30. [PMID: 19104798 DOI: 10.1007/s00259-008-0980-1] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Positron emission tomography (PET) is the gold standard for non-invasive assessment of myocardial viability and allows accurate detection of coronary artery disease by assessment of myocardial perfusion. Magnetic resonance imaging (MRI) provides high resolution anatomical images that allow accurate evaluation of ventricular structure and function together with detection of myocardial infarction. OBJECTIVE Potential hybrid PET/MR tomography may potentially facilitate the combination of information from these imaging modalities in cardiology. Furthermore, the combination of anatomical MRI images with the high sensitivity of PET for detecting molecular targets may extent the application of these modalities to the characterization of atherosclerotic plaques and to the evaluation of angiogenetic or stem cell therapies, for example. DISCUSSION This article reviews studies using MRI and PET in parallel to compare their performance in cardiac applications together with the potential benefits and applications provided by hybrid PET/MRI systems.
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Affiliation(s)
- Stephan G Nekolla
- Nuklearmedizinische Klinik und Poliklinik, Technischen Universität München, München, Germany.
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Ruzsics B, Surányi P, Kiss P, Brott BC, Elgavish A, Simor T, Elgavish GA. Head-to-head comparison between delayed enhancement and percent infarct mapping for assessment of myocardial infarct size in a canine model. J Magn Reson Imaging 2008; 28:1386-92. [DOI: 10.1002/jmri.21571] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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Contrast-enhanced cardiac MRI before coronary artery bypass surgery: impact of myocardial scar extent on bypass flow. Eur Radiol 2008; 18:2756-64. [DOI: 10.1007/s00330-008-1066-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Revised: 04/12/2008] [Accepted: 05/20/2008] [Indexed: 10/21/2022]
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Lim P, Pasquet A, Gerber B, D'Hondt AM, Vancraeynest D, Guéret P, Vanoverschelde JLJ. Is Postsystolic Shortening a Marker of Viability in Chronic Left Ventricular Ischemic Dysfunction? Comparison with Late Enhancement Contrast Magnetic Resonance Imaging. J Am Soc Echocardiogr 2008; 21:452-7. [DOI: 10.1016/j.echo.2007.09.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Indexed: 10/22/2022]
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Gerber BL, Raman SV, Nayak K, Epstein FH, Ferreira P, Axel L, Kraitchman DL. Myocardial first-pass perfusion cardiovascular magnetic resonance: history, theory, and current state of the art. J Cardiovasc Magn Reson 2008; 10:18. [PMID: 18442372 PMCID: PMC2387155 DOI: 10.1186/1532-429x-10-18] [Citation(s) in RCA: 165] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Accepted: 04/28/2008] [Indexed: 01/11/2023] Open
Abstract
In less than two decades, first-pass perfusion cardiovascular magnetic resonance (CMR) has undergone a wide range of changes with the development and availability of improved hardware, software, and contrast agents, in concert with a better understanding of the mechanisms of contrast enhancement. The following review provides a perspective of the historical development of first-pass CMR, the developments in pulse sequence design and contrast agents, the relevant animal models used in early preclinical studies, the mechanism of artifacts, the differences between 1.5T and 3T scanning, and the relevant clinical applications and protocols. This comprehensive overview includes a summary of the past clinical performance of first-pass perfusion CMR and current clinical applications using state-of-the-art methodologies.
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Affiliation(s)
- Bernhard L Gerber
- Department of Cardiovascular Diseases, Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Subha V Raman
- Davis Heart and Lung Research Institute, Division of Cardiovascular Medicine, Ohio State University, Columbus, OH, USA
| | - Krishna Nayak
- Ming Hsieh Department of Electrical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Frederick H Epstein
- Departments of Radiology and Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Pedro Ferreira
- National Heart and Lung Institute, Imperial College, London, UK
| | - Leon Axel
- Department of Radiology, New York University Medical Center, New York, NY, USA
| | - Dara L Kraitchman
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University, School of Medicine, Baltimore, MD, USA
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Contrast-enhanced magnetic resonance imaging in the assessment of myocardial infarction and viability. J Nucl Cardiol 2007; 15:105-17. [PMID: 18242487 DOI: 10.1007/bf02976902] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Contrast-enhanced magnetic resonance imaging (MRI) can be used to visualize the transmural extent of myocardial infarction with high spatial resolution. The aim of this review is to provide an overview of the use of contrast-enhanced MRI for characterization of ischemic myocardial injury in comparison to other imaging methods and its relevance in clinical syndromes related to coronary artery disease. Infarcted myocardium appears hyperenhanced compared with normal myocardium when imaged by a delayed-enhancement MRI technique with the use of an inversion-prepared T(1)-weighted sequence after injection of gadolinium chelates, such as gadolinium-diethylenetriamine pentaacetic acid. Experimental and clinical studies indicate that the extent of delayed enhancement is reproducible and closely correlates with the size of myocardial necrosis or infarct scar as determined by established in vitro and in vivo methods. Furthermore, MRI appears to be more sensitive than other imaging methods in detecting small subendocardial infarctions. The transmural extent of delayed enhancement potentially predicts functional outcome after revascularization in acute myocardial infarction and chronic ischemic heart disease, indicating that it can accurately discriminate between infarction and dysfunctional but viable myocardium. Further experience from clinical trials is needed to understand the association of delayed enhancement with clinical outcomes.
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Surányi P, Kiss P, Ruzsics B, Brott BC, Simor T, Elgavish A, Baker RA, Saab-Ismail NH, Elgavish GA. In vivo myocardial tissue kinetics of Gd(ABE-DTTA), a tissue-persistent contrast agent. Magn Reson Med 2007; 58:55-64. [PMID: 17659616 DOI: 10.1002/mrm.21249] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The phenomenological tissue kinetics of Gd(ABE-DTTA) was investigated in myocardial infarction (MI). Reperfused infarction was generated by balloon catheter in closed-chest canines (N=11). Forty-eight hours thereafter, inversion-recovery (IR)-prepared fast gradient-echo control images were acquired with varying inversion times (TIs). Precontrast R(1) maps were calculated from the TI dependence of signal intensity (SI) using nonlinear curve fitting. Then 0.05 mmol/kg Gd(ABE-DTTA) was administered I.V. In 11 dogs postcontrast R(1) maps were generated at 24 hr and 48 hr postcontrast. In five dogs measurements were also repeated at 108 hr and 12 days. In one dog early measurement was carried out at 4 hr. Delta R(1) values for blood and viable and infarcted myocardium were calculated at each time point by subtracting the precontrast R(1) from the postcontrast R(1). Gd(ABE-DTTA) showed significant, progressive accumulation into infarcts during the first 2 days (k(in)=0.39 hr(-1)) and a delayed clearance (k(out) = 0.005 hr(-1)). Among the time points sampled, the maximum infarct Delta R(1) was detected at 48 hr (1.72 s(-1)). Contrast agent (CA) in infarcted tissue was detectable for 12 days. Clearance from blood and viable myocardium occurred in parallel and was completed by 108 hr. Gd(ABE-DTTA) displays slow, tissue-persistent kinetics and partly intravascular, partly extravascular characteristics. It demonstrates high affinity for infarcted myocardium and induces highlighting of infarcts between 4 hr and 12 days following administration.
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Affiliation(s)
- Pál Surányi
- Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Elgavish Paramagnetics Inc., Birmingham, Alabama, USA
| | - Pál Kiss
- Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Elgavish Paramagnetics Inc., Birmingham, Alabama, USA
| | - Balazs Ruzsics
- Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Brigitta C Brott
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tamás Simor
- Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Elgavish Paramagnetics Inc., Birmingham, Alabama, USA
| | - Ada Elgavish
- Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Elgavish Paramagnetics Inc., Birmingham, Alabama, USA
| | - Robert A Baker
- Animal Resources Program, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Gabriel A Elgavish
- Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Elgavish Paramagnetics Inc., Birmingham, Alabama, USA
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Duffy KJ, Ferrari VA. Prognosis following acute myocardial infarction: insights from cardiovascular magnetic resonance. Curr Cardiol Rep 2007; 9:57-62. [PMID: 17362686 DOI: 10.1007/s11886-007-0011-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Acute myocardial infarction and its sequelae are the leading cause of death in the United States. Diagnostic imaging of myocardial infarction in both acute and chronic settings provides valuable prognostic information for clinical decision making. Cardiovascular MRI is unique in its ability to offer several different methods for predicting prognosis with regard to viability and future cardiovascular events. These MRI methods, which include dobutamine MRI, perfusion imaging, and delayed contrast-enhanced MRI, can assess contractile function and reserve, microvascular obstruction, and scar characterization, respectively. Future work will further characterize how cardiovascular MRI can assess prognosis as these emerging technologies become incorporated in routine clinical practice.
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Affiliation(s)
- Kevin J Duffy
- Hospital of the University of Pennsylvania, 3400 Spruce Street, Cardiology, 9 Gates Building, Philadelphia, PA 19104, USA
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Barmeyer AA, Stork A, Bansmann M, Muellerleile K, Heuer M, Bavastro M, Adam G, Meinertz T, Lund GK. Prediction of myocardial recovery by dobutamine magnetic resonance imaging and delayed enhancement early after reperfused acute myocardial infarction. Eur Radiol 2007; 18:110-8. [PMID: 17701182 DOI: 10.1007/s00330-007-0728-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2007] [Revised: 06/18/2007] [Accepted: 07/06/2007] [Indexed: 12/29/2022]
Abstract
The purpose was to study dobutamine magnetic resonance cine imaging (DOB-MRI) and delayed myocardial contrast enhancement (DE) early after reperfused acute myocardial infarction (AMI) for the predicion of segmental myocardial recovery and to find the optimal dose of dobutamine. Fifty patients (56+/-12 years, 42 males) with reperfused AMI underwent DOB-MRI and DE studies 3.5 (1-19) days after reperfusion. In DOB-MRI systolic wall thickening (SWT) was measured in 18 segments at rest and during dobutamine at 5, 10 and 20 microg*kg(-1)*min(-1). Dysfunctional segments were identified and the extent of DE was measured for each segment. Segmental recovery was examined after 8 (5-15) months. Two hundred-forty-eight segments were dysfunctional with presence of DE in 193. DOB-MRI showed the best prediction of recovery at 10 microg*kg(-1)*min(-1) of dobutamine with sensitivity of 67%, specificity of 63% and accuracy of 66% using a cut-off value for SWT of 2.0 mm. DE revealed a sensitivity of 68%, specificity of 65% and accuracy of 67% using a cut-off value of 46%. Combined analysis of DOB-MRI and DE did not improve diagnostic performance. Early prediction of segmental myocardial recovery after AMI is possible with DOB-MRI and DE. No improvement is achieved by dobutamine >10 microg*kg(-1)*min(-1) or a combination of DOB-MRI and DE.
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Affiliation(s)
- Achim A Barmeyer
- Clinic of Cardiology/Angiology, University Heart-Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
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24
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Habis M, Capderou A, Ghostine S, Daoud B, Caussin C, Riou JY, Brenot P, Angel CY, Lancelin B, Paul JF. Acute Myocardial Infarction Early Viability Assessment by 64-Slice Computed Tomography Immediately After Coronary Angiography. J Am Coll Cardiol 2007; 49:1178-85. [PMID: 17367662 DOI: 10.1016/j.jacc.2006.12.032] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2006] [Revised: 11/28/2006] [Accepted: 12/21/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Early evaluation of myocardial viability in acute myocardial infarction is useful to guide therapy. Therefore, we assessed 64-slice computed tomography (CT) immediately after coronary angiography in this setting. BACKGROUND Recent preliminary studies have shown the promising usefulness of late hyperenhancement multislice computed tomography (MSCT) for non-viability assessment. METHODS Thirty-six patients admitted for a first acute myocardial infarction had a coronary angiogram early after admission followed by 64-slice CT without iodine reinjection. The 16 segments of the left ventricle depicted by the American Society of Echocardiography were graded: no, subendocardial, or transmural hyperenhancement. No or subendocardial hyperenhancement were expected to reflect viability. Two to 4 weeks later, the same segments' contractility was evaluated at rest. Low-dose dobutamine echocardiography was performed in case of akinetic segment at rest. RESULTS Mean delay between coronary angiography and MSCT was 24 +/- 11 min (range 7 to 51 min). We compared 576 segments evaluated by each method. Agreement was noted for 560 segments (97%) and disagreement for 16 segments (3%). Thus, 64-slice CT after coronary angiography for an acute myocardial infarction had 98% sensitivity, 94% specificity, 97% accuracy, and 99% positive and 79% negative predictive values for detecting viable myocardial segments at a very early stage of an acute myocardial infarction. On a per-patient analysis, sensitivity, specificity, accuracy, and positive and negative predictive values were 92%, 100%, 94%, and 100% and 85%, respectively. CONCLUSIONS A 64-slice CT after coronary angiography for an acute myocardial infarction is a promising method for early evaluation of viable myocardium.
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Affiliation(s)
- Michel Habis
- Department of Cardiology, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France.
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25
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Abstract
Detection of viable myocardium in patients with left ventricular dysfunction has become an increasingly important guide to prognosis and treatment. This article reviews the current status and future potential for the application of modalities to assess myocardial viability. Imaging and other techniques that are reviewed are myocardial perfusion imaging by single-photon-emission computed tomography, positron-emission tomography, echocardiography, cardiac magnetic resonance technology, computed tomography and catheter-based endocardial mapping.
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Affiliation(s)
- Ashraf Hamdan
- Department of Cardiology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
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Bove CM, DiMaria JM, Voros S, Conaway MR, Kramer CM. Dobutamine Response and Myocardial Infarct Transmurality: Functional Improvement after Coronary Artery Bypass Grafting—Initial Experience. Radiology 2006; 240:835-41. [PMID: 16926330 DOI: 10.1148/radiol.2403051150] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The Investigational Review Board approved the protocol, and all patients provided signed informed consent. The protocol was compliant with HIPAA. The purpose of the study was to prospectively test the hypothesis that addition of low-dose dobutamine and quantification of inotropic reserve in segments with 1%-50% infarct transmurality (IT) would improve the predictive value for functional recovery after revascularization in chronic infarction. Fifteen patients with multivessel coronary artery disease and left ventricular systolic dysfunction were enrolled prior to coronary artery bypass grafting (CABG). Late gadolinium-enhanced cardiac magnetic resonance (MR) imaging was used to assess IT. The percentage of wall thickening was measured with cine cardiac MR imaging at rest and during infusion of 10 (microg . kg(-1))/min dobutamine. Repeat cardiac MR imaging was performed 20 weeks +/- 4 (standard error) later. Functional parameters according to segment were compared before and after CABG by using F tests with repeated-measures models. In segments with 1%-50% IT, similar functional recovery was noted in those with 1%-25% or 26%-50% IT. However, in the same segments, those that improved with dobutamine to normal range demonstrated greater improvement in the percentage of wall thickening (22% +/- 4) after revascularization than those that did not (9% +/- 4) (P < .04). In 1%-50% IT, a normal dobutamine response helps differentiate segments with greater functional recovery after CABG.
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Affiliation(s)
- Christina M Bove
- Departments of Medicine, Cardiovascular Division, Health Evaluation Sciences, and Radiology, University of Virginia Health System, University of Virginia, Lee St, Box 800170, Charlottesville, VA 22908, USA
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Zoni A, Knoll P, Gherli T. Microvascular obstruction after successful fibrinolytic therapy in acute myocardial infarction. Comparison of reteplase vs reteplase+abciximab: A cardiovascular magnetic resonance study. Heart Int 2006; 2:54. [PMID: 21977252 PMCID: PMC3184656 DOI: 10.4081/hi.2006.54] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND.: About one third of patients with TIMI 3 after reperfusion have evidence of microvascular obstruction (MO) which represents an independent predictor of myocardial wall rupture. This explains all efforts made to prevent MO. Magnetic resonance imaging (MRI) has proved to be particularly useful in detecting MO. The aim of this study was to evaluate with MRI if different fibrinolytic regimens in acute myocardial infarction display different effects on left ventricle (LV) volumes and ejection fraction (EF), as well as on myocardial infarct size (MIsz) and MO. METHODS.: Twenty male patients, mean age 58 years, affected by acute myocardial infarction, ten anterior and ten inferior, were treated with: full dose reteplase in ten, and half dose reteplase plus full dose abciximab (R+Abcx) in the other ten patients. In the fourth day after hospital admission, MRI STIR T2 images were used to quantify MIsz, while 2dflash cineloops were used after the injection of gadolinium, to quantify LV volumes, EF and to detect MO. RESULTS.: LV EF was higher in R+Abcx 51±10 than in reteplase 41±8. MIsz was similar in both treatment groups: however a close relationship was present between MIsz and EF in the reteplase group indicating that the greater the MIsz the lower the EF. In R+Abcx this relationship was no longer present, suggesting a protective effect of the drug on microcirculation. In fact extensive MO was present in 25% of all cases, 80% of which in the reteplase group while only 20% in R+Abcx. CONCLUSION.: R+Abcx prevents MO: compared to traditional fibrinolytic therapy it allows better LV function and most likely improved long term survival.
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Affiliation(s)
- Antonello Zoni
- Heart Department, University Hospital of Parma, Parma - Italy
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28
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Crean A, Merchant N. MR perfusion and delayed enhancement imaging in the heart. Clin Radiol 2006; 61:225-36. [PMID: 16488204 DOI: 10.1016/j.crad.2005.09.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2004] [Revised: 09/10/2005] [Accepted: 09/12/2005] [Indexed: 11/18/2022]
Abstract
Cardiac magnetic resonance imaging is rapidly emerging as an exciting and important technique for the investigation of congenital and acquired heart disease. This article focuses in particular on recent developments in the field of adenosine stress myocardial perfusion as well as addressing the many applications of 'delayed enhancement' imaging.
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Affiliation(s)
- A Crean
- Department of Cardiovascular MRI, University Hospitals' Network, Toronto, Ont., Canada.
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29
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Graham JJ, Lederman RJ, Dick AJ. Magnetic resonance imaging and its role in myocardial regenerative therapy. Regen Med 2006; 1:347-55. [PMID: 17465788 DOI: 10.2217/17460751.1.3.347] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
There has been extensive interest recently in cardiac stem cell therapy. Current research has been hampered by differences in cell type, methods of delivery and efficacy evaluation. In this article we review the use of magnetic resonance imaging in this growing area and argue that it is well suited to all areas of myocardial regeneration: from patient identification, through cell delivery and tracking of appropriately labeled cells, to evaluation of therapeutic effect. Potential future advances are discussed including magnetic resonance imaging-guided intervention suites and the use of higher field strength magnets for cell tracking.
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Affiliation(s)
- John J Graham
- Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Holmström M, Vesterinen P, Hänninen H, Sillanpää MA, Kivistö S, Lauerma K. Noninvasive analysis of coronary artery disease with combination of MDCT and functional MRI. Acad Radiol 2006; 13:177-85. [PMID: 16428053 DOI: 10.1016/j.acra.2005.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2005] [Revised: 10/03/2005] [Accepted: 10/06/2005] [Indexed: 11/30/2022]
Abstract
RATIONALE AND OBJECTIVES We evaluated the diagnostic accuracy of an eight-row multidetector computed tomography coronary angiography (MDCT-CA) in detecting high-grade (>50%) stenoses in the three main coronary arteries in patients with coronary artery disease (CAD). Side branches were excluded. We correlated magnetic resonance imaging (MRI) findings of the myocardium with MDCT-CA of the coronary arteries. MATERIALS AND METHODS Fourteen CAD patients underwent conventional coronary angiography (CCA), MDCT-CA, and MRI. We determined the calcium burden with non-enhanced MDCT scan. Then MDCT-CA was performed after intravenous contrast injection during a single breathhold. The left ventricular (LV) MR cine imaging was assessed at rest and perfusion defects were observed during pharmacologic stress after contrast administration. Delayed contrast-enhanced MRI was performed to picture infarctions. RESULTS MDCT-CA had sensitivity 82%, specificity 94%, positive predictive value 79%, and negative predictive value 95% of stenoses of more than 50% in the main coronary arteries when compared with CCA. LV wall dysfunction, perfusion defects, and infarctions were detected in 50%-78% of sectors assigned to calcifications or stenoses, but also in sectors supplied by normally perfused coronary arteries. CONCLUSIONS CCA and MDCT-CA revealed comparable results in evaluating stenotic lesions above 50% in the main subepicardial coronary branches. There were no significant correlations between the degree of stenosis or calcification at MDCT-CA and the MR findings, but the combined information of MDCT-CA and MRI showed the variability of myocardial changes in regions perfused by significantly stenosed, calcified, and normal main coronary arteries.
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Affiliation(s)
- Miia Holmström
- Department of Radiology, Helsinki University Central Hospital, Haartmaninkatu 4, Helsinki 00029 HUS, Finland.
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31
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Kolipaka A, Chatzimavroudis GP, White RD, O'Donnell TP, Setser RM. Segmentation of non-viable myocardium in delayed enhancement magnetic resonance images. Int J Cardiovasc Imaging 2006; 21:303-11. [PMID: 16015446 DOI: 10.1007/s10554-004-5806-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2004] [Accepted: 10/13/2004] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate six algorithms for segmenting non-viable left ventricular (LV) myocardium in delayed enhancement (DE) magnetic resonance imaging (MRI). METHODS Twenty-three patients with known chronic ischemic heart disease underwent DE-MRI. DE images were first manually thresholded using an interactive region-filling tool to isolate non-viable myocardium. Then, six thresholding algorithms, based on the image intensity characteristics of either LV blood pool (BP), viable LV myocardium, or both, were applied to each image. For the Mean-2SD(BP) algorithm, thresholds were equal to the mean BP intensity minus twice its standard deviation. For the Mean + 2SD(Semi), Mean + 3SD(Semi), Mean + 2SD(Auto), and Mean + 3SD(Auto) algorithms, thresholds equaled the mean intensity of viable myocardium plus twice (or thrice, as denoted by the name) the standard deviation of intensity (subscripts denote how these values were determined: automatic or semi-automatic). For the Minimum Intensity algorithm, the threshold equaled the minimum intensity between the BP and LV myocardium mean intensities. Percent Scar was defined as the ratio of non-viable to total myocardial pixels in each image. Agreement between each algorithm and manual thresholding was assessed using Bland-Altman analysis. RESULTS Mean Percent Scar was 25 +/- 16% by manual thresholding. Five of the six algorithms demonstrated mean bias within +/-3% (all except Mean+2SD(Auto)); however, limits of agreement (LoA) were large in general (range 12-36%). The best overall agreement was demonstrated by the Mean + 2SD(Semi) (bias, 0%; LoA, 12%) and Mean + 3SD(Semi)(bias, -3%; LoA, 14%) algorithms. CONCLUSION On average, five of the six algorithms proved satisfactory for clinical implementation; however, in some images, manual correction of automatic results was necessary.
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Affiliation(s)
- Arunark Kolipaka
- Section of Cardiovascular Imaging, Division of Radiology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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32
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Zoni A, Knoll P, Gherli T. Microvascular Obstruction after Successful Fibrinolytic Therapy in Acute Myocardial Infarction. Comparison of Reteplase vs Reteplase+Abciximab: A Cardiovascular Magnetic Resonance Study. Heart Int 2006. [DOI: 10.1177/182618680600200109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Antonello Zoni
- Heart Department, University Hospital of Parma, Parma - Italy
| | - Peter Knoll
- Division of Cardiology, General Hospital of Bolzano - Italy
| | - Tiziano Gherli
- Heart Department, University Hospital of Parma, Parma - Italy
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Azevedo CF, Cheng S, Lima JAC. Cardiac imaging to identify patients at risk for developing heart failure after myocardial infarction. Curr Heart Fail Rep 2005; 2:183-8. [PMID: 16332311 DOI: 10.1007/bf02696648] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The development of heart failure (HF) after acute myocardial infarction (MI) is recognized as a major complication that leads to a significant increase in morbidity and mortality. Given the availability of effective treatments for improving both quality of life and survival for patients at increased risk for developing HF after MI, early identification of these individuals is critical. Noninvasive cardiac imaging offers a detailed characterization of two important pathophysiological processes related to the development of HF post-MI: left ventricular (LV) remodeling and LV functional recovery. Cardiovascular MRI has recently emerged as the preferred noninvasive imaging modality because of its ability to provide the most comprehensive and informative evaluation of these processes. In addition to allowing for an accurate and reproducible longitudinal follow-up of LV volumes and mass, MRI also offers information on infarct size, the presence of microvascular obstruction, and the transmural extent of infarct scar, all of which are valuable parameters that can assist in identifying patients at risk for developing HF after MI.
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Affiliation(s)
- Clerio F Azevedo
- Division of Cardiology, Blalock 524, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
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Setser RM, Chung YC, Weaver JA, Stillman AE, Simonetti OP, White RD. Effect of inversion time on delayed-enhancement magnetic resonance imaging with and without phase-sensitive reconstruction. J Magn Reson Imaging 2005; 21:650-5. [PMID: 15834903 DOI: 10.1002/jmri.20323] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To evaluate the consistency and inversion time (TI) independence of phase-sensitive reconstruction (PSIR) delayed-enhancement (DE) MRI in a clinical setting. MATERIALS AND METHODS Mid-ventricular short-axis DE images were acquired in 25 patients using three TIs: 1) optimized to null viable myocardium, 2) 50 msec less than optimal TI, and 3) 50 msec greater than optimal TI. At each TI, images were acquired with PSIR and without magIR. In each image, percent scar was computed as the ratio of nonviable to total pixels in the left ventricle (LV). RESULTS In the magIR images, percent scar was 23% +/- 15% (optimal), 11% +/- 11% (short), and 22% +/- 15% (long). In PSIR images, percent scar was 25% +/- 15% (optimal), 22% +/- 15% (short), and 22% +/- 14% (long). Percent scar was significantly underestimated in magIR images with short TI, but no statistically significant difference in percent scar was observed at the optimal or long TIs. CONCLUSION DE-MRI is a robust imaging technique for clinical use. PSIR provided consistent image quality independently of TI, at least over the range of TIs evaluated in this study. However, neither image quality nor scar appearance in the PSIR images was significantly different from that in the magIR images when TI was at or above the null point of viable myocardium.
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Affiliation(s)
- Randolph M Setser
- Section of Cardiovascular Imaging, Division of Radiology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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35
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Hunold P, Schlosser T, Vogt FM, Eggebrecht H, Schmermund A, Bruder O, Schüler WO, Barkhausen J. Myocardial late enhancement in contrast-enhanced cardiac MRI: distinction between infarction scar and non-infarction-related disease. AJR Am J Roentgenol 2005; 184:1420-6. [PMID: 15855089 DOI: 10.2214/ajr.184.5.01841420] [Citation(s) in RCA: 155] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Our objective was to assess and compare the patterns of late enhancement (LE) in contrast-enhanced cardiac MRI caused by myocardial infarction and different myocardial diseases that are not related to ischemic infarction. MATERIALS AND METHODS A total of 811 consecutive contrast-enhanced cardiac MRI studies performed for different indications were reviewed for left ventricular myocardial LE after gadopentetate dimeglumine administration. MRI studies were performed on a 1.5-T scanner using an inversion recovery turbo FLASH sequence (TR/TE, 8/4 msec; flip angle, 25 degrees). The LE pattern of ischemic infarction scar was compared with that in nonischemic myocardial disease. RESULTS LE was found in 421 (52%) patients. In all patients with myocardial infarction, LE included the subendocardial layer. Nineteen patients without history of myocardial infarction and angiographically excluded coronary artery disease showed different patterns of LE caused by myocarditis, sarcoidosis, arrhythmogenic right ventricular dysplasia, cardiomyopathy, endomyocardial fibrosis, and iatrogenic scars after biopsy, ablation of septal hypertrophy, and myocardial laser revascularization. CONCLUSION LE in contrast-enhanced cardiac MRI is not specific for ischemic infarction. LE in ischemic infarction always involves the subendocardial layer, whereas it does not necessarily do so in other myocardial diseases. Therefore, if LE omit the subendocardial layer, different nonischemic myocardial diseases have to be considered. The pattern of LE might be helpful for the differential diagnosis of myocardial disease and in distinguishing it from ischemic disease.
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Affiliation(s)
- Peter Hunold
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany.
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Abstract
Patients with ischemic heart disease may have left ventricular (LV) dysfunction due to reversible or irreversible causes. The ability to distinguish viable myocardium with dysfunction due to a reversible etiology (hibernation, stunning) from nonviable scar is critical for determining proper management of the patient. Cardiovascular magnetic resonance (CMR) is a technique that has been established to be useful for the detection of myocardial viability and advancements in the field promise to further increase its utility. In this review we describe the features of CMR that make it suited for this purpose and outline promising developments that may soon make CMR the reference standard for viability assessment.
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Affiliation(s)
- Steven G Lloyd
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, 35294, USA.
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37
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Prakash A, Powell AJ, Krishnamurthy R, Geva T. Magnetic resonance imaging evaluation of myocardial perfusion and viability in congenital and acquired pediatric heart disease. Am J Cardiol 2004; 93:657-61. [PMID: 14996605 DOI: 10.1016/j.amjcard.2003.11.045] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2003] [Revised: 11/10/2003] [Accepted: 11/10/2003] [Indexed: 12/21/2022]
Abstract
This study examined the feasibility and potential clinical utility of magnetic resonance imaging (MRI) evaluation of myocardial perfusion (first-pass contrast enhancement) and viability (myocardial delayed enhancement) in 30 patients with congenital and acquired pediatric heart disease. Good agreement was found between MRI evaluation of myocardial perfusion and viability and analysis of segmental wall motion as well as coronary angiography (n = 10) and single photon emission computed tomography (n = 6).
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Affiliation(s)
- Ashwin Prakash
- Department of Radiology, Children's Hospital, Boston, Massachusetts 02115, USA
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Pujadas S, Reddy GP, Lee JJ, Higgins CB. Magnetic resonance imaging in ischemic heart disease. Semin Roentgenol 2003; 38:320-9. [PMID: 14621374 DOI: 10.1016/s0037-198x(03)00054-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Sandra Pujadas
- Department of Radiology, Suite M396, 505 Parnassus Avenue, Box 0628, University of California, San Francisco, San Francisco, CA 94143-0628, USA
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Setser RM, Bexell DG, O'Donnell TP, Stillman AE, Lieber ML, Schoenhagen P, White RD. Quantitative assessment of myocardial scar in delayed enhancement magnetic resonance imaging. J Magn Reson Imaging 2003; 18:434-41. [PMID: 14508780 DOI: 10.1002/jmri.10391] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
PURPOSE To characterize the extent and distribution of left ventricular myocardial scar in delayed enhancement magnetic resonance imaging (MRI). MATERIALS AND METHODS Delayed enhancement images from 18 patients were categorized into three groups based on myocardial scar appearance: discrete myocardial infarction (N = 10), diffuse fibrosis (N = 4), and circumferential endocardial scarring (N = 4). Images were segmented manually by two observers (twice by one observer) to identify nonviable myocardium. Scar was characterized by the following morphologic parameters: the relative area of nonviable myocardium (Percent Scar); a measure of scar cohesion (Patchiness); and the extent to which scar traversed the ventricle wall (Trans>50). RESULTS The three scar parameters successfully discriminated between patient groups, although no one parameter was able to differentiate between all groups. The average bias between readers was approximately 3% for each parameter, and the average bias between repeated measurements was 1%. In addition, five patients exhibited regions of nonhyperenhanced nonviable myocardium that were expected to show hyperenhancement based upon their location within the infarct zone and appearance on cine images. CONCLUSION Quantitative characterization of myocardial scar showed good interobserver and intraobserver agreement. However, the appearance of nonhyperenhanced scar in chronic ischemia is problematic for segmentation of delayed enhancement images.
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Affiliation(s)
- Randolph M Setser
- Department of Radiology, Cardiovascular Imaging Section, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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Beek AM, Kühl HP, Bondarenko O, Twisk JWR, Hofman MBM, van Dockum WG, Visser CA, van Rossum AC. Delayed contrast-enhanced magnetic resonance imaging for the prediction of regional functional improvement after acute myocardial infarction. J Am Coll Cardiol 2003; 42:895-901. [PMID: 12957439 DOI: 10.1016/s0735-1097(03)00835-0] [Citation(s) in RCA: 266] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES We evaluated whether delayed contrast-enhanced magnetic resonance imaging (DCE-MRI) using an extracellular contrast agent could predict improvement of dysfunctional but viable myocardium after acute reperfused myocardial infarction (MI). BACKGROUND The transmural extent of hyperenhancement at DCE-MRI has been related to improvement of function in reperfused MI. However, evidence is still limited, and earlier reports have produced conflicting results regarding the significance of contrast patterns after infarction. METHODS Thirty patients (mean age 59 +/- 11 years, 27 males) underwent cine MRI and DCE-MRI 7 +/- 3 days after a first reperfused acute MI and follow-up cine MRI at 13 +/- 3 weeks. Segmental wall thickening and segmental extent of hyperenhancement were scored in 1,689 segments. RESULTS Of 500 dysfunctional segments, 273 (55%) improved at follow-up. There was no difference in likelihood of improvement or complete functional recovery between segments with 0% and 1% to 25% hyperenhancement. The likelihood of improvement of segments without hyperenhancement was 2.9, 14.3, and 20 times higher than that of segments with 26% to 50%, 51% to 75%, and >75% hyperenhancement, respectively (p < 0.001). The likelihood of complete functional recovery of segments without hyperenhancement was 3.8, 11.1, and 50 times higher than that of segments with 26% to 50%, 51% to 75%, and >75% hyperenhancement, respectively (p < 0.001). CONCLUSIONS In patients with recent reperfused MI, functional improvement of stunned myocardium is predicted by DCE-MRI.
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Affiliation(s)
- Aernout M Beek
- Department of Cardiology, Vrije Universiteit Medical Center, De Boelelaan 1117, 1007 MB Amsterdam, The Netherlands.
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Kühl HP, Beek AM, van der Weerdt AP, Hofman MBM, Visser CA, Lammertsma AA, Heussen N, Visser FC, van Rossum AC. Myocardial viability in chronic ischemic heart disease: comparison of contrast-enhanced magnetic resonance imaging with (18)F-fluorodeoxyglucose positron emission tomography. J Am Coll Cardiol 2003; 41:1341-8. [PMID: 12706930 DOI: 10.1016/s0735-1097(03)00158-x] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES We sought to compare contrast-enhanced magnetic resonance imaging (ceMRI) with nuclear metabolic imaging for the assessment of myocardial viability in patients with chronic ischemic heart disease and left ventricular (LV) dysfunction. BACKGROUND Contrast-enhanced MRI has been shown to identify scar tissue in ischemically damaged myocardium. METHODS Twenty-six patients with chronic coronary artery disease and LV dysfunction (mean ejection fraction 31 +/- 11%) underwent (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET), technetium-99m tetrofosmin single-photon emission computed tomography (SPECT), and ceMRI. In a 17-segment model, the segmental extent of hyperenhancement (SEH) by ceMRI, defined as the relative amount of contrast-enhanced tissue per myocardial segment, was compared with segmental FDG and tetrofosmin uptake by PET and SPECT. RESULTS In severely dysfunctional segments (n = 165), SEH was 9 +/- 14%, 33 +/- 25% (p < 0.05), and 80 +/- 23% (p < 0.05) in segments with normal metabolism/perfusion, metabolism/perfusion mismatch, and matched defects, respectively. Segmental glucose uptake by PET was inversely correlated to SEH (r = -0.86, p < 0.001). By receiver operator characteristic curve analysis, the area under the curve was 0.95 for the differentiation between viable and non-viable segments. At a cutoff value of 37%, SEH optimally differentiated viable from non-viable segments defined by PET. Using this threshold, the sensitivity and specificity of ceMRI to detect non-viable myocardium as defined by PET were 96% and 84%, respectively. CONCLUSIONS Contrast-enhanced MRI allows assessment of myocardial viability with a high accuracy, compared with FDG-PET, in patients with chronic ischemic heart disease and LV dysfunction.
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Affiliation(s)
- Harald P Kühl
- Medical Clinic I, University Hospital, Aachen, Germany
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Denney TS, Gerber BL, Yan L. Unsupervised reconstruction of a three-dimensional left ventricular strain from parallel tagged cardiac images. Magn Reson Med 2003; 49:743-54. [PMID: 12652546 DOI: 10.1002/mrm.10434] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A new algorithm, called the Unsupervised Tag ExTraction and Heart strain(E) Reconstruction (UNTETHER) algorithm, is presented for quantifying three-dimensional (3D) myocardial strain in tagged cardiac MR images. Five human volunteers and five postinfarct patients were imaged. 3D strains measured by UNTETHER and a user-supervised technique were compared. Each study was analyzed in 49 +/- 8 min with UNTETHER, compared to approximately 4 hr with the user-supervised technique. For pooled human data, the correlation coefficient between the two methods for circumferential shortening (E(cc)) was r = 0.91 at the mid-wall (P < 0.0005). UNTETHER is capable of measuring wall motion abnormalities resulting from coronary artery disease, and has the potential to overcome the main limitations (time and user-supervision requirements) to routine clinical use of tagged cardiac MRI.
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Affiliation(s)
- Thomas S Denney
- Department of Electrical and Computer Engineering, Auburn University, 200 Broun Hall, Auburn, AL 36849-5201.
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Decking UKM, Pai VM, Wen H, Balaban RS. Does binding of Gd-DTPA to myocardial tissue contribute to late enhancement in a model of acute myocardial infarction? Magn Reson Med 2003; 49:168-71. [PMID: 12509833 DOI: 10.1002/mrm.10324] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The long-lasting signal enhancement by Gd-DTPA in areas of myocardial infarction has been conventionally explained by low perfusion and an enhanced Gd distribution volume. To test whether binding of Gd to myocardial constituents is an additional factor contributing to this effect, Gd-DTPA was allowed to equilibrate between homogenized porcine myocardial tissue and physiological saline. The relaxation rate (1/T(1)) of homogenate samples (n = 61) increased in proportion (r(2) = 0.98) to the Gd concentration (0.025-0.5 mM) of the surrounding medium, with no evidence for augmented uptake. The diffusion-limited uptake was only slightly more rapid than the subsequent Gd-release. The amount of Gd released was in line with all of the Gd-DTPA in the homogenate participating in water proton relaxation. The data from this acute myocardial infarction model do not support the notion that Gd-DTPA binding in the early stages of myocardial damage contributes to delayed enhancement.
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Affiliation(s)
- Ulrich K M Decking
- Laboratory of Cardiac Energetics, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
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Jesús Jiménez Borreguero L, Ruiz-Salmerón R. Valoración de la viabilidad miocárdica en pacientes prerrevascularización. Rev Esp Cardiol (Engl Ed) 2003. [DOI: 10.1016/s0300-8932(03)76943-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Magnetic resonance imaging (MRI) provides a noninvasive way to evaluate the biomechanical dynamics of the heart. MRI can provide spatially registered tomographic images of the heart in different phases of the cardiac cycle, which can be used to assess global cardiac function and regional endocardial surface motion. In addition, MRI can provide detailed information on the patterns of motion within the heart wall, permitting calculation of the evolution of regional strain and related motion variables within the wall. These show consistent patterns of spatial and temporal variation in normal subjects, which are affected by alterations of function due to disease. Although still an evolving technique, MRI shows promise as a new method for research and clinical evaluation of cardiac dynamics.
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Affiliation(s)
- Leon Axel
- Department of Radiology, University of Pennsylvania, Philadelphia 19104, USA.
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Cherryman GR, Pirovano G, Kirchin MA. Gadobenate dimeglumine in MRI of acute myocardial infarction: results of a phase III study comparing dynamic and delayed contrast enhanced magnetic resonance imaging with EKG, (201)Tl SPECT, and echocardiography. Invest Radiol 2002; 37:135-45. [PMID: 11882793 DOI: 10.1097/00004424-200203000-00006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the safety and utility of gadobenate dimeglumine as a magnetic resonance (MR) contrast agent in patients with acute myocardial infarction (MI). METHODS One hundred three patients with acute MI received intravenous bolus gadobenate dimeglumine (0.05 mmol/kg) during MR examination. Dynamic and delayed T1-weighted spin-echo postcontrast images were compared with precontrast images, EKG, resting (201)Tl SPECT and echocardiography. RESULTS Gadobenate dimeglumine was well tolerated. Dynamic imaging with gadobenate dimeglumine was more sensitive (72% vs 56%) than delayed spin echo imaging (P < 0.001). No difference in specificity was seen (98% vs 99%). (201)Tl SPECT was a sensitive (96%) test, but was not specific (63%). Echocardiography was not sensitive (32%), but was specific (92%). CONCLUSION The intravenous use of gadobenate dimeglumine, at a bolus dose of 0.05 mmol/kg, is safe in patients with an acute MI. Dynamic contrast enhanced MR imaging has moderate sensitivity and high specificity for demonstrating infarct.
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Affiliation(s)
- Graham R Cherryman
- University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
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