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CLINICAL RESEARCH: CARDIAC IMAGING

Quantitative measurement of infarct size by contrast-enhanced magnetic resonance imaging early after acute myocardial infarction

Comparison with single-photon emission tomography using Tc^99m-sestamibi

Tareq Ibrahim, MD^*, Stephan G. Nekolla, PhD, Mira Hörnke, Hubertus P. Bülow, MD, Josef Dirschinger, MD^*, Albert Schömig, MD^* and Markus Schwaiger, MD, FACC^,*

^* Deutsches Herzzentrum München and 1. Medizinische Klinik des Klinikums Rechts der Isar, Technische Universität München, Munich, Germany
Nuklearmedizinische Klinik und Poliklinik der Technischen Universität München, Munich, Germany

Manuscript received December 14, 2003; revised manuscript received September 7, 2004, accepted October 12, 2004.

^* Reprint requests and correspondence: Dr. Markus Schwaiger, Nuklearmedizinische Klinik der Technischen Universität München, Ismaningerstr. 22, D 81675 München, Germany (Email: m.schwaiger{at}lrz.tu-muenchen.de).

OBJECTIVES: The aim of this research was to evaluate kinetics and extent of myocardial contrast enhancement (CE) in comparison with single-photon emission computed tomography (SPECT) early after acute myocardial infarction (AMI).

BACKGROUND: Quantification of infarct size serves as a surrogate end point in evaluating new therapies of AMI. Contrast-enhanced magnetic resonance imaging (CeMRI) of the myocardium is a promising new method for identification of irreversible tissue injury.

METHODS: A total of 33 patients were examined by CeMRI and SPECT 7 ± 2 days after AMI and successful coronary intervention. After gadolinium-diethylenetraimine pentaacetic acid injection (0.2 mmol/kg), continuous short-axis slices of the left ventricle (LV) were acquired every 7 min up to 42 min using different inversion times (TI). Myocardial CE at each imaging time point was quantified and compared with corresponding SPECT perfusion defect.

RESULTS: All patients showed myocardial CE in the infarct region. A constant TI for CeMRI resulted in a decrease of signal intensity and extent of CE on late acquisitions. With TI adjustment, infarct image intensity peaked at 21 min with a contrast of 478% of remote myocardium and remained at this level up to 42 min after contrast injection (437%); CE extent was stable over time and agreed well with SPECT within an average difference of 3% of the LV myocardium, yielding the best correlation at 28 min (r = 0.86).

CONCLUSIONS: In patients after AMI and successful reperfusion, CE is stable over time and matches well with SPECT perfusion defect; CeMRI under standardized conditions can accurately assess myocardial infarct size in vivo and may be attractive for serving as a surrogate end point early after AMI.

Abbreviations and Acronyms   AMI = acute myocardial infarction   CE = contrast enhancement   CeMRI = contrast-enhanced magnetic resonance imaging   CK = creatine kinase   EF = ejection fraction   Gd-DTPA = gadolinium-diethylenetriamine pentaacetic acid   LV = left ventricle/ventricular   MI = myocardial infarction   MRI = magnetic resonance imaging   SPECT = single-photon emission computed tomography   TI = inversion time

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