Published Online
on January 2, 2007

A more recent version of this article appeared on January 16, 2007

This Article Full Text (PDF) All Versions of this Article: 115/2/236    most recent CIRCULATIONAHA.106.635409v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sievers, B. Articles by Kim, R. J. Search for Related Content PubMed PubMed Citation Articles by Sievers, B. Articles by Kim, R. J. Pubmed/NCBI databases Medline Plus Health Information Heart Attack MRI Scans Related Collections CT and MRI

Submitted on April 24, 2006
Accepted on October 19, 2006

Rapid Detection of Myocardial Infarction by Subsecond, Free-Breathing Delayed Contrast-Enhancement Cardiovascular Magnetic Resonance

Burkhard Sievers MD, Michael D. Elliott MD, Lynne M. Hurwitz MD, Timothy S.E. Albert MD, Igor Klem MD, Wolfgang G. Rehwald PhD, Michele A. Parker MS, Robert M. Judd PhD, and Raymond J. Kim MD^*

From Duke Cardiovascular Magnetic Resonance Center (B.S., M.D.E., L.M.H., T.S.E.A., I.K., W.G.R., M.A.P., R.M.J., R.J.K.), Department of Medicine (B.S., M.D.E., T.S.E.A., I.K., M.A.P., R.M.J., R.J.K.), and Department of Radiology (L.M.H., R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Medical Solutions, Chicago, Ill (W.G.R.).

^* To whom correspondence should be addressed. E-mail: Raymond.Kim{at}duke.edu.

Background--An ultrafast, delayed contrast-enhancement cardiovascular magnetic resonance technique that can acquire subsecond, "snapshot" images during free breathing (subsecond) is becoming widely available. This technique provides myocardial infarction (MI) imaging with complete left ventricular coverage in <30 seconds. However, the accuracy of this technique is unknown.

Methods and Results--We prospectively compared subsecond imaging with routine breath-hold delayed contrast-enhancement cardiovascular magnetic resonance (standard) in consecutive patients. Two cohorts with unambiguous standards of truth were prespecified: (1) patients with documented prior MI (n=135) and (2) patients without MI and with low likelihood of coronary disease (lowest Framingham risk category; n=103). Scans were scored masked to identity and clinical information. Sensitivity, specificity, and accuracy of subsecond imaging for MI diagnosis were 87%, 96%, and 91%, respectively. Compared with the standard technique (98%, 100%, 99%), the subsecond technique had modestly reduced sensitivity (P=0.0001), but specificity was excellent. Missed infarcts were generally small or subendocardial (87%). Overall, regional transmural extent of infarction scores were highly concordant (2083/2294; 91%); however, 51 of 337 regions (15%) considered predominantly infarcted (>50% transmural extent of infarction) by the standard technique were considered viable (25% transmural extent of infarction) by the subsecond technique. Quantitative analysis demonstrated moderately reduced contrast-to-noise ratios for subsecond imaging between infarct and remote myocardium (12.0±7.2 versus 20.1±6.6; P<0.0001) and infarct and left ventricular cavity (-2.5±2.7 versus 3.6±3.7; P<0.0001).

Conclusions--MI can be rapidly detected by subsecond delayed contrast-enhancement cardiovascular magnetic resonance during free breathing with high accuracy. This technique could be considered the preferred approach in patients who are more acutely ill or unable to hold their breath. However, compared with standard imaging, sensitivity is mildly reduced, and the transmural extent of infarction may be underestimated.

Key words: imaging • magnetic resonance imaging • myocardial infarction

This article has been cited by other articles:

				M. R. Patel, P. J. Cawley, J. F. Heitner, I. Klem, M. A. Parker, W. A. Jaroudi, T. J. Meine, J. B. White, M. D. Elliott, H. W. Kim, et al. Detection of Myocardial Damage in Patients With Sarcoidosis Circulation, November 17, 2009; 120(20): 1969 - 1977. [Abstract] [Full Text] [PDF]

				J. W. Weinsaft, R. J. Kim, M. Ross, D. Krauser, S. Manoushagian, T. M. LaBounty, M. D. Cham, J. K. Min, K. Healy, Y. Wang, et al. Contrast-Enhanced Anatomic Imaging as Compared to Contrast-Enhanced Tissue Characterization for Detection of Left Ventricular Thrombus J. Am. Coll. Cardiol. Img., August 1, 2009; 2(8): 969 - 979. [Abstract] [Full Text] [PDF]

				J. W. Weinsaft, H. W. Kim, D. J. Shah, I. Klem, A. L. Crowley, R. Brosnan, O. G. James, M. R. Patel, J. Heitner, M. Parker, et al. Detection of Left Ventricular Thrombus by Delayed-Enhancement Cardiovascular Magnetic Resonance: Prevalence and Markers in Patients With Systolic Dysfunction J. Am. Coll. Cardiol., July 8, 2008; 52(2): 148 - 157. [Abstract] [Full Text] [PDF]

				S. H. Rahimtoola, V. Dilsizian, C. M. Kramer, T. H. Marwick, and J.-L. J. Vanoverschelde Chronic ischemic left ventricular dysfunction from pathophysiology to imaging and its integration into clinical practice. J. Am. Coll. Cardiol. Img., July 1, 2008; 1(4): 536 - 555. [Abstract] [Full Text] [PDF]

				R. J. Kim, T. S.E. Albert, J. H. Wible, M. D. Elliott, J. C. Allen, J. C. Lee, M. Parker, A. Napoli, R. M. Judd, and for the Gadoversetamide Myocardial Infarction Imag Performance of Delayed-Enhancement Magnetic Resonance Imaging With Gadoversetamide Contrast for the Detection and Assessment of Myocardial Infarction: An International, Multicenter, Double-Blinded, Randomized Trial Circulation, February 5, 2008; 117(5): 629 - 637. [Abstract] [Full Text] [PDF]