CLINICAL RESEARCH: DELAYED ENHANCEMENT MAGNETIC RESONANCE
Discrimination of Myocardial Acute and Chronic (Scar) Infarctions on Delayed Contrast Enhanced Magnetic Resonance Imaging With Intravascular Magnetic Resonance Contrast Media
Maythem Saeed, DVM, PhD*,*,
Oliver Weber, PhD*,
Randall Lee, MD, PhD ,
Loi Do, BS*,
Alastair Martin, PhD*,2,
David Saloner, PhD*,
Philip Ursell, MD ,
Philippe Robert, PhD ,1,
Claire Corot, PhD,1 and
Charles B. Higgins, MD, FACC*
* Department of Radiology, University of California San Francisco, San Francisco, California
Department of Medicine/Cardiology, University of California San Francisco, San Francisco, California
Department of Pathology, University of California San Francisco, San Francisco, California
Guerbet-Group, Paris, France.
Manuscript received November 9, 2005;
revised manuscript received January 26, 2006,
accepted March 1, 2006.
* Reprint requests and correspondence: Dr. Maythem Saeed, Department of Radiology, University of California San Francisco, 513 Parnassus Avenue, HSW 207B, San Francisco, California 94134-0628. (Email: Maythem.Saeed{at}radiology.UCSF.edu).
OBJECTIVES: The purpose of this study was to examine the potential of intravascular gadolinium (Gd)-chelates in discriminating acute from chronic myocardial infarctions (MIs).
BACKGROUND: A potential limitation of delayed contrast enhanced magnetic resonance imaging with standard extracellular Gd-chelates is its inability to distinguish acute from chronic MIs.
METHODS: Eight pigs with MIs were studied at 3 days and 8 weeks. Inversion recovery gradient echo (IR-GRE), T1-turbo spin echo (TSE), and T2-TSE images were acquired before and after administration of intravascular and extracellular Gd-chelates. Triphenyltetrazolium chloride (TTC) was used to delineate infarctions at postmortem. Masson’s trichrome and Biotinylated Bandeiria simplicifolia Isolectin B4 stains were used to characterize scarred myocardium. Analysis of variance was used to compare signal intensity (SI) ratios and determine differences in infarct extent.
RESULTS: The intravascular agent produced differential enhancement of acute infarctions at 3 days (SI ratio 5.8 ± 1.3) but not at 8 weeks (1.6 ± 0.4, p < 0.01). The extracellular agent provided differential enhancement of both acute (SI ratio 7.7 ± 1.4) and chronic (7.5 ± 0.9) infarctions. The extents of enhanced regions in acute infarctions were not different after intravascular (16.0 ± 1.3%) or extracellular (17.1 ± 1.7%) agents; at 8 weeks the extent of extracellular enhanced and TTC regions were smaller (13.2 ± 1.4% and 12.0 ± 1.5%, respectively). Masson’s trichrome stain demonstrated dense scar tissue, signaling the complete healing of infarction. The vascular stain showed that scar tissue contained fewer microvessels oriented in a haphazard array.
CONCLUSIONS: The combination of intravascular and extracellular Gd-chelates discriminates acute from chronic infarctions on delayed images. This double contrast agent approach can be used to determine the age and extent of infarctions.
|
Abbreviations and Acronyms
| | AMI = acute myocardial infarction | | D = Dalton | | Gd = gadolinium | | IR-GRE = inversion recovery gradient echo | | LV = left ventricle/ventricular | | MI = myocardial infarction | | MRI = magnetic resonance imaging | | SI = signal intensity | | TE = echo time | | TR = repetition time | | TSE = turbo spin echo | | TTC = triphenyltetrazolium chloride |
|
This article has been cited by other articles:
|
|
|
|
 
K. G. Ordovas and C. B. Higgins
Delayed Contrast Enhancement on MR Images of Myocardium: Past, Present, Future
Radiology,
November 1, 2011;
261(2):
358 - 374.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Carlsson, D. Saloner, A. J. Martin, P. C. Ursell, and M. Saeed
Heterogeneous Microinfarcts Caused by Coronary Microemboli: Evaluation with Multidetector CT and MR Imaging in a Swine Model
Radiology,
March 1, 2010;
254(3):
718 - 728.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. W. Kim, A. Farzaneh-Far, and R. J. Kim
Cardiovascular Magnetic Resonance in Patients With Myocardial Infarction: Current and Emerging Applications
J. Am. Coll. Cardiol.,
January 5, 2010;
55(1):
1 - 16.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. M. Sherif, A. Saraste, E. Weidl, A. W. Weber, T. Higuchi, S. Reder, T. Poethko, G. Henriksen, D. Casebier, S. Robinson, et al.
Evaluation of a Novel 18F-Labeled Positron-Emission Tomography Perfusion Tracer for the Assessment of Myocardial Infarct Size in Rats
Circ Cardiovasc Imaging,
March 1, 2009;
2(2):
77 - 84.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Carlsson, M. Wilson, A. J. Martin, and M. Saeed
Myocardial Microinfarction after Coronary Microembolization in Swine: MR Imaging Characterization
Radiology,
March 1, 2009;
250(3):
703 - 713.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Saeed, A. Martin, A. Jacquier, M. Bucknor, D. Saloner, L. Do, P. Ursell, H. Su, Y. W. Kan, and C. B. Higgins
Permanent Coronary Artery Occlusion: Cardiovascular MR Imaging Is Platform for Percutaneous Transendocardial Delivery and Assessment of Gene Therapy in Canine Model
Radiology,
November 1, 2008;
249(2):
560 - 571.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Saeed, A. Martin, P. Ursell, L. Do, M. Bucknor, C. B. Higgins, and D. Saloner
MR Assessment of Myocardial Perfusion, Viability, and Function after Intramyocardial Transfer of VM202, a New Plasmid Human Hepatocyte Growth Factor in Ischemic Swine Myocardium
Radiology,
October 1, 2008;
249(1):
107 - 118.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Saeed, D. Saloner, A. Martin, L. Do, O. Weber, P. C. Ursell, A. Jacquier, R. Lee, and C. B. Higgins
Adeno-associated Viral Vector-Encoding Vascular Endothelial Growth Factor Gene: Effect on Cardiovascular MR Perfusion and Infarct Resorption Measurements in Swine
Radiology,
May 1, 2007;
243(2):
451 - 460.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
