Abstract 696: Contrast Enhanced Magnetic Resonance Imaging of Culprit Lesions in Patients With Acute Coronary Syndrome
Background: X-Ray Angiography (XRA) is the gold standard for the assessment of lumen narrowing coronary stenosis, which typically underlies stable coronary artery disease. However, XRA cannot distinguish between stable and vulnerable plaque, which is thought to be the precursor lesion of most acute myocardial infarctions (MI) and death. Development of a non-invasive technique that can detect the culprit lesion immediately after MI may eventually prove useful for prospective identification of vulnerable plaque.
Purpose: The aim of the study was to evaluate whether contrast enhanced magnetic resonance imaging (CE-MRI) could detect the culprit lesion in patients with a recent ACS (troponin T >1.0).
Method and Results: 14 patients (13 male) were imaged within 24 –72h after presenting with ACS prior to XRA. Following coronary lumen imaging and contrast injection, CE-MRI of the coronary artery wall was performed using a T1-weighted 3D gradient echo inversion recovery sequence (3D IR TFE). CE-MRI (fig. a⇓ and fused with magnetic resonance angiography, fig. b⇓) allowed selective visualization of the culprit lesion in 9 of 10 patients (4x LAD, one missed, 2xLCX, 4xRCA) confirmed by XRA (fig. c⇓) +/− intravascular ultrasound (IVUS). Contrast uptake in the culprit lesion was significantly increased as compared to overall vessel wall contrast uptake (32.3±7.9 vs. 7.9±3.6, p<0.01). In 4 patients, no culprit lesion was identified by XRA, IVUS or CE-MRI.
Conclusion: CE-MRI allows selective visualization of the culprit lesion in patients after MI. This technique may be useful for prospective detection of vulnerable plaque.