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CLINICAL RESEARCH: CARDIAC IMAGING

Effects of Time, Dose, and Inversion Time for Acute Myocardial Infarct Size Measurements Based on Magnetic Resonance Imaging-Delayed Contrast Enhancement

Anja Wagner, MD^_*, Heiko Mahrholdt, MD, Louise Thomson, MD^_*, Stefan Hager, MD, Gabriel Meinhardt, MD, Wolfgang Rehwald, PhD^_*, Michele Parker, MS, RN^_*, Dipan Shah, MD, Udo Sechtem, MD, Raymond J. Kim, MD^_*,1 and Robert M. Judd, PhD^_*,1,_*

^_* Duke Cardiovascular MR Center, Durham, North Carolina
Robert Bosch Medical Center, Stuttgart, Germany
Nashville Cardiovascular MRI Institute, Nashville, Tennessee.

Manuscript received October 3, 2005; revised manuscript received November 29, 2005, accepted January 2, 2006.

^_* Reprint requests and correspondence: Dr. Robert M. Judd, Duke Cardiovascular Magnetic Resonance Center, Duke University Health System, P.O. Box 3934, Durham, North Carolina, 27710. (Email: Robert.Judd{at}dcmrc.mc.duke.edu).

OBJECTIVES: This study sought to investigate the influence of time, dose, and inversion time (TI) and their interactions on myocardial infarct size measurements to establish the foundation for a standardized protocol for multicenter trials.

BACKGROUND: There is growing interest in using magnetic resonance imaging (MRI) infarct size measurements as an end point in clinical trials. However, no standardized protocol exists, and there are limited data concerning the effects of time, contrast agent dose, and TI.

METHODS: First, we determined the influence of postcontrast imaging time (5 to 40 min), contrast agent dose (0.1 vs. 0.2 mmol/kg), TI, and their interactions in an animal model (n = 14). Second, we tested whether the findings of the animal study apply to patients and are generalizable. Therefore, we retested the diagnostic window in a multicenter study. A total of 48 patients with first acute myocardial infarction (AMI) from three centers were imaged twice (5 and 30 min) after injection of 0.15 mmol/kg gadolinium diethylenetriamine-pentaacetate using an adjusted TI.

RESULTS: The animal study showed that the infarct size is independent of time and dose (p = 0.9 and p = 0.16, respectively) using an adjusted TI. Using a fixed TI, however, infarct size is a function of time and dose (p = 0.0001 and p = 0.01, respectively). The multicenter study showed that MRI 1 (16.9 ± 12% of left ventricle) was not statistically different from MRI 2 (16.4 ± 12% of left ventricle, p = NS) with no difference between sites (p = NS).

CONCLUSIONS: The AMI size can be measured with MRI using a contrast dose between 0.1 and 0.2 mmol/kg and a time window of 5 to 30 min after contrast administration, provided that the TI is adjusted.

Abbreviations and Acronyms   AMI = acute myocardial infarction   LV = left ventricle/ventricular   MRI = magnetic resonance imaging   SPECT = single-photon emission computed tomographic   TI = inversion time   TTC = triphenyltetrazolium chloride

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