(Circulation. 1996;94:3318-3326.)
© 1996 American Heart Association, Inc.
Articles |
Myocardial Gd-DTPA Kinetics Determine MRI Contrast Enhancement and Reflect the Extent and Severity of Myocardial Injury After Acute Reperfused Infarction
the Cardiology Division, Department of Medicine (R.J.K., J.A.C.L.), and the Division of Thoracic and Magnetic Resonance Imaging, Department of Radiology (R.M.J.), Johns Hopkins Hospital, Baltimore, Md, and the Department of Biophysics (E.-L.C.), University of Pennsylvania, Philadelphia.
Correspondence to Raymond J. Kim, MD, Cardiology Division, Carnegie 568, The Johns Hopkins Hospital, 600 North Wolfe St, Baltimore, MD 21287-6568. E-mail rkim@mri.jhu.edu.
Background Contrast medium–enhanced magnetic resonance images of acute, reperfused infarcts have shown hypoenhanced and hyperenhanced regions in areas of injured myocardium. The precise mechanisms that lead to these altered enhancement patterns are unknown. This study was designed to evaluate possible mechanisms and to relate altered enhancement patterns to myocardial perfusion and viability.
Methods and Results Thirteen rabbits underwent in situ coronary artery occlusion and reperfusion followed by isolated perfusion with cardioplegic solution. T1-weighted spin-echo images were acquired continuously during step changes in perfusate Gd-DTPA concentration. Regional blood flow was also measured by use of radioactive microspheres in all rabbits. There were marked differences in Gd-DTPA wash-in and washout time constants (wash-in, 0.8±0.1, 2.1±0.2, and 16.3±2.4 minutes, P<.001; washout, 1.6±0.1, 4.8±0.5, and 31.1±3.3 minutes, P<.001) in normal, infarct rim, and infarct core regions, respectively, resulting in differential enhancement of these regions. Microsphere flows in the infarct rim and core were 42.9±4.0% and 12.0±1.6% of normal myocardium and correlated well with washout time constants (r=.86, y=0.77x-0.002, P<.001), suggesting that these time constants index the severity of microvascular damage. In addition, spatial maps of washout time constants were produced. The extent of regions with abnormal time constants correlated well with triphenyltetrazolium chloride–determined infarct size (r=.94, y=0.95x+4.17, P<.001).
Conclusions In contrast-enhanced magnetic resonance images of acute, reperfused rabbit infarcts, differential image intensity is primarily due to regional differences in contrast agent wash-in and washout time constants. These regional differences in time constants also indicate the extent and severity of myocardial injury.
Key Words: magnetic resonance imaging • contrast media • myocardial infarction • reperfusion
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V. S. Lee, D. Resnick, S. S. Tiu, J. J. Sanger, C. A. Nazzaro, G. M. Israel, and O. P. Simonetti MR Imaging Evaluation of Myocardial Viability in the Setting of Equivocal SPECT Results with 99mTc Sestamibi Radiology, January 1, 2004; 230(1): 191 - 197. [Abstract] [Full Text] [PDF]
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J. C.C. Moon, B. Sachdev, A. G. Elkington, W. J. McKenna, A. Mehta, D. J. Pennell, P. J. Leed, and P. M. Elliott Gadolinium enhanced cardiovascular magnetic resonance in Anderson-Fabry disease: Evidence for a disease specific abnormality of the myocardial interstitium Eur. Heart J., December 1, 2003; 24(23): 2151 - 2155. [Abstract] [Full Text] [PDF]
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A. M. Beek, H. P. Kuhl, O. Bondarenko, J. W. R. Twisk, M. B. M. Hofman, W. G. van Dockum, C. A. Visser, and A. C. van Rossum Delayed contrast-enhanced magnetic resonance imaging for the prediction of regional functional improvement after acute myocardial infarction J. Am. Coll. Cardiol., September 3, 2003; 42(5): 895 - 901. [Abstract] [Full Text] [PDF]
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J. C. C. Moon, W. J. McKenna, J. A. McCrohon, P. M. Elliott, G. C. Smith, and D. J. Pennell Toward clinical risk assessment inhypertrophic cardiomyopathy withgadolinium cardiovascular magnetic resonance J. Am. Coll. Cardiol., May 7, 2003; 41(9): 1561 - 1567. [Abstract] [Full Text] [PDF]
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C. R. Weiss, A. H. Aletras, J. F. London, J. L. Taylor, F. H. Epstein, R. Wassmuth, R. S. Balaban, and A. E. Arai Stunned, Infarcted, and Normal Myocardium in Dogs: Simultaneous Differentiation by Using Gadolinium-enhanced Cine MR Imaging with Magnetization Transfer Contrast Radiology, March 1, 2003; 226(3): 723 - 730. [Abstract] [Full Text] [PDF]
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S. S. Lee, H. W. Goo, S. B. Park, C. H. Lim, G. Gong, J. B. Seo, and T.-H. Lim MR Imaging of Reperfused Myocardial Infarction: Comparison of Necrosis-Specific and Intravascular Contrast Agents in a Cat Model Radiology, March 1, 2003; 226(3): 739 - 747. [Abstract] [Full Text] [PDF]
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B. L. Gerber, J. Garot, D. A. Bluemke, K. C. Wu, and J. A.C. Lima Accuracy of Contrast-Enhanced Magnetic Resonance Imaging in Predicting Improvement of Regional Myocardial Function in Patients After Acute Myocardial Infarction Circulation, August 27, 2002; 106(9): 1083 - 1089. [Abstract] [Full Text] [PDF]
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E. C. Perin, G. V. Silva, R. Sarmento-Leite, A. L.S. Sousa, M. Howell, R. Muthupillai, B. Lambert, W. K. Vaughn, and S. D. Flamm Assessing Myocardial Viability and Infarct Transmurality With Left Ventricular Electromechanical Mapping in Patients With Stable Coronary Artery Disease: Validation by Delayed-Enhancement Magnetic Resonance Imaging Circulation, August 20, 2002; 106(8): 957 - 961. [Abstract] [Full Text] [PDF]
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H. Mahrholdt, A. Wagner, R.M. Judd, and U. Sechtem Assessment of myocardial viability by cardiovascular magnetic resonance imaging Eur. Heart J., April 2, 2002; 23(8): 602 - 619. [Full Text] [PDF]
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C. Klein, S. G. Nekolla, F. M. Bengel, M. Momose, A. Sammer, F. Haas, B. Schnackenburg, W. Delius, H. Mudra, D. Wolfram, et al. Assessment of Myocardial Viability With Contrast-Enhanced Magnetic Resonance Imaging: Comparison With Positron Emission Tomography Circulation, January 15, 2002; 105(2): 162 - 167. [Abstract] [Full Text] [PDF]
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J. N. Oshinski, Z. Yang, J. R. Jones, J. F. Mata, and B. A. French Imaging Time After Gd-DTPA Injection Is Critical in Using Delayed Enhancement to Determine Infarct Size Accurately With Magnetic Resonance Imaging Circulation, December 4, 2001; 104(23): 2838 - 2842. [Abstract] [Full Text] [PDF]
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B. L. Gerber, C. E. Rochitte, D. A. Bluemke, J. A. Melin, P. Crosille, L. C. Becker, and J. A.C. Lima Relation Between Gd-DTPA Contrast Enhancement and Regional Inotropic Response in the Periphery and Center of Myocardial Infarction Circulation, August 28, 2001; 104(9): 998 - 1004. [Abstract] [Full Text] [PDF]
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S. J. Flacke, S. E. Fischer, and C. H. Lorenz Measurement of the Gadopentetate Dimeglumine Partition Coefficient in Human Myocardium in Vivo: Normal Distribution and Elevation in Acute and Chronic Infarction Radiology, March 1, 2001; 218(3): 703 - 710. [Abstract] [Full Text]
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C. M. Kramer, W. J. Rogers Jr., S. Mankad, T. M. Theobald, D. L. Pakstis, and Y.-L. Hu Contractile reserve and contrast uptake pattern by magnetic resonance imaging and functional recovery after reperfused myocardial infarction J. Am. Coll. Cardiol., November 15, 2000; 36(6): 1835 - 1840. [Abstract] [Full Text] [PDF]
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D. S. Fieno, R. J. Kim, E.-L. Chen, J. W. Lomasney, F. J. Klocke, and R. M. Judd Contrast-enhanced magnetic resonance imaging of myocardium at risk: Distinction between reversible and irreversible injury throughout infarct healing J. Am. Coll. Cardiol., November 15, 2000; 36(6): 1985 - 1991. [Abstract] [Full Text] [PDF]
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C. E. Rochitte, R. J. Kim, H. B. Hillenbrand, E.-l. Chen, and J. A. C. Lima Microvascular Integrity and the Time Course of Myocardial Sodium Accumulation After Acute Infarction Circ. Res., October 13, 2000; 87(8): 648 - 655. [Abstract] [Full Text] [PDF]
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J. J. W. Sandstede, C. Lipke, M. Beer, K. Harre, T. Pabst, W. Kenn, S. Neubauer, and D. Hahn Analysis of First-Pass and Delayed Contrast-Enhancement Patterns of Dysfunctional Myocardium on MR Imaging: Use in the Prediction of Myocardial Viability Am. J. Roentgenol., June 1, 2000; 174(6): 1737 - 1740. [Abstract] [Full Text]
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