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(Circulation. 2001;103:871.)
© 2001 American Heart Association, Inc.
Basic Science Reports |
Magnetic Resonance Characterization of the Peri-Infarction Zone of Reperfused Myocardial Infarction With Necrosis-Specific and Extracellular Nonspecific Contrast Media
From Departments of Radiology (M.S., G.L., M.F.W., J.B., C.B.H.), University of California, San Francisco, Calif, and Schering AG (H.-J.W.), Berlin, Germany.
Correspondence to Maythem Saeed, DVM, PhD, Department of Radiology, UCSF, 505 Parnassus Ave, L308, San Francisco, CA 94143-0628. E-mail Maythem.Saeed{at}radiology.ucsf.edu
Background—Because ischemically injured myocardium is frequently composed of viable and nonviable portions, a method to discriminate the two is useful for clinical management.
Methods and
Results—Ischemically injured myocardium was
characterized with extracellular nonspecific (Gd-DTPA) and
necrosis-specific (mesoporphyrin) MR contrast media in rats. Relaxation
rates (R1) were measured on day 1 and day 2 by inversion-recovery
echoplanar imaging. Spin-echo imaging was used to define
contrast-enhanced regions and regional wall thickening. Gadolinium
concentration, area at risk, and infarct size were measured at
postmortem examination. 
R1 ratio
(R1myocardium/R1blood)
after administration of Gd-DTPA was greater in ischemically injured
myocardium (1.20±0.15) than in normal myocardium (0.47±0.05,
P<0.05), which was attributed
to differences in gadolinium concentration and water content. The
Gd-DTPA–enhanced region on day 2 was larger (32.8±0.9%) than true
infarction as demonstrated by triphenyltetrazolium chloride (TTC)
(24.6±1.4%, P<0.001,
r=0.21). Bland-Altman analysis
revealed that the Gd-DTPA–enhanced region overestimated true infarct
size by 7.8±5.9%. On the other hand, the mesoporphyrin-enhanced
region (26.9±1.8%, P=NS,
r=0.87) and true infarct size
were identical. The difference in the areas demarcated by the 2 agents
is the peri-infarction. Systolic and diastolic MR images revealed no
wall thickening in the mesoporphyrin-enhanced region (0.3±3.3%) but
reduced thickening in the Gd-DTPA–enhanced rim (8.5±5.5%,
P<0.05).
Conclusions—The Gd-DTPA–enhanced region encompasses both viable and nonviable portions of the ischemically injured myocardium. The Gd-DTPA–enhanced area overestimated infarct size, but the mesoporphyrin-enhanced area matched true infarct size. The salvageable peri-infarction zone can be characterized with double-contrast–enhanced and functional MR imaging; the mismatched area of enhancement between the 2 agents shows residual wall thickening.
Key Words: magnetic resonance imaging • myocardial infarction
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