Published online before print May 3, 2004, doi: 10.1161/01.CIR.0000127428.10985.C6
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(Circulation. 2004;109:2411-2416.)
© 2004 American Heart Association, Inc.
Clinical Investigation and Reports |
Delayed Enhancement and T2-Weighted Cardiovascular Magnetic Resonance Imaging Differentiate Acute From Chronic Myocardial Infarction
From Franz-Volhard-Klinik, Helios-Klinikum Berlin, Kardiologie, Charité Campus Berlin-Buch, Humboldt-Universität zu Berlin, Berlin, Germany (H.A.-A., A.Z., J.S.-M., A.J.T., D.M., A.K., M.G., R.D., M.G.F.); Radiology Department, Cairo University, Cairo, Egypt (H.A.-A.); and Baker Medical Research Institute, Melbourne, Australia (A.J.T.).
Correspondence to Matthias G. Friedrich, MD, FESC, Franz-Volhard-Klinik, Kardiologie, Helios-Klinikum Berlin, Charité, Campus Berlin-Buch, Humboldt-Universitaet zu Berlin, Wiltbergstr 50, D-13125, Berlin, Germany. E-mail friedrich{at}fvk-berlin.de
Received July 9, 2003; de novo received December 1, 2003; revision received February 19, 2004; accepted February 25, 2004.
Background— Delayed enhancement (DE) cardiovascular magnetic resonance (CMR) detects acute and chronic myocardial infarction (MI) by visualizing contrast media accumulation in infarcted segments. T2-weighted CMR depicts infarct-related myocardial edema as a marker of acute but not chronic myocardial injury. We investigated the clinical utility of an approach combining both techniques to differentiate acute from chronic MI.
Methods and Results— Seventy-three MI patients were studied in 2 groups. Group A consisted of 15 acute MI patients who were studied twice, on day 1 and 3 months after MI. In group B, 58 patients with acute or chronic MI underwent 1 CMR scan. T2-weighted and DE images of matched slices were acquired on a 1.5-T system. In group A, quantitative segmental and region of interest-based analyses were performed to observe signal changes between the acute and chronic phases. In group B, T2-weighted and DE images were examined visually by 2 blinded observers for the presence or absence of hyperintense areas in corresponding segments. For infarct localization, coronary angiography and/or ECG changes served as the reference standard. In group A, the contrast-to-noise ratio on T2-weighted images dropped in the infarcted segments from 2.7±1.1 on day 1 to 0.1±1.2 after 3 months (P<0.0001). There was no significant change in contrast-to-noise ratio in DE images (1.9±1.5 versus 1.3±1.0; P=NS). The qualitative assessment of T2-weighted and DE images in group B yielded a specificity of 96% to differentiate acute from chronic lesions.
Conclusions— An imaging approach combining DE and T2-weighted CMR accurately differentiates acute from chronic MI.
Key Words: edema • magnetic resonance imaging • myocardial infarction
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