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Differentiation of recently infarcted myocardium from chronic myocardial scar: the value of contrast-enhanced SSFP-based cine MR imaging.

Kim KA, Seo JB, Do KH, Heo JN, Lee YK, Song JW, Lee JS, Song KS, Lim TH - Korean J Radiol (2006 Jan-Mar)

Bottom Line: The SI of the infarcted myocardium on the CE-cine MRI was compared with that of the normal myocardium on the same image.The area of abnormal SI on the CE-cine MRI was compared with the area of hyperenhancement on the DCE MRI.This study showed the different SI patterns between recently infarcted myocardium and chronic scar on the CE-cine MRI.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

ABSTRACT
The purpose of this study is to demonstrate whether the signal intensity (SI) of myocardial infarction (MI) on contrast enhanced (CE)-cine MRI is useful for differentiating recently infarcted myocardium from chronic scar. This study included 24 patients with acute MI (36-84 years, mean age: 57) and 19 patients with chronic MI (44-80 years, mean age: 64). The diagnosis of acute MI was based on the presence of typical symptoms, i.e. elevation of the cardiac enzymes and the absence of any remote infarction history. The diagnosis of chronic MI was based on a history of MI or coronary artery disease of more than one month duration and on the absence of any recent MI within the previous six months. Retrospectively, the ECG-gated breath-hold cine imaging was performed in the short axis plane using a segmented, balanced, turbo-field, echo-pulse sequence two minutes after the administration of Gd-DTPA at a dose of 0.2 mmol/kg body weight. Delayed contrast-enhanced MRI (DCE MRI) in the same plane was performed 10 to 15 minutes after contrast administration, and this was served as the gold standard of reference. The SI of the infarcted myocardium on the CE-cine MRI was compared with that of the normal myocardium on the same image. The area of abnormal SI on the CE-cine MRI was compared with the area of hyperenhancement on the DCE MRI. The area of high SI on the CE-cine MRI was detected in 23 of 24 patients with acute MI (10 with homogenous high SI, 13 high SI with subendocardial low SI, and one with iso SI). The area of high SI on the CE-cine MRI was larger than that seen on the DCE MRI (p < 0.05). In contrast, the areas of chronic MI were seen as iso-SI with thin subendocardial low SI on the CE-cine MR in all the chronic MI patients. The presence of high SI on both the CE-cine MRI and the DCE MRI is more sensitive (95.8%) for determining the age of a MI than the presence of myocardial thinning (66.7%). This study showed the different SI patterns between recently infarcted myocardium and chronic scar on the CE-cine MRI. CE-cine MRI is thought to be quite useful for determining the age of myocardial infarction, in addition to its utility for assessing myocardial contractility.

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The MR scan obtained in a 62-year-old male who was scheduled for coronary bypass surgery. The contrast-enhanced cine MR scan on the mid-diastolic phase (A) shows an area of low signal intensity lining the subendocardial surface of the interventricular septum (arrows). The lesion is seen as having high signal intensity on the delayed contrast-enhanced MR imaging (B).
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Figure 3: The MR scan obtained in a 62-year-old male who was scheduled for coronary bypass surgery. The contrast-enhanced cine MR scan on the mid-diastolic phase (A) shows an area of low signal intensity lining the subendocardial surface of the interventricular septum (arrows). The lesion is seen as having high signal intensity on the delayed contrast-enhanced MR imaging (B).

Mentions: All of the MRIs of the acute and chronic MI patients showed hyperenhancement on the DCE MRI. The areas of the acute MIs were shown as homogeneous high SI in 13 patients (Fig. 1), high SI with internal low SI in ten patients (Fig. 2), and as iso-SI in one patient on the CE-cine MRI. In contrast, the areas of chronic MI were seen as having low signal intensity on the CE-cine MRI (Fig. 3) in all patients (Table 1). In eight patients with acute MI, the end diastolic thickness of the infarcted areas was less than 6 mm, but in 16 patients, it was equal to or greater than 6 mm. For the chronic MI, the thickness of the infarcted area was less than 6 mm in all except one patient. If the height of the SI on CE-cine MRI was used as a diagnostic criterion, the sensitivity for the detection of acute MI was 95.8%. If a thickness equal to or greater than 6 mm for the acute infarcted myocardium was used as a diagnostic criterion, the sensitivity was 66.7%.


Differentiation of recently infarcted myocardium from chronic myocardial scar: the value of contrast-enhanced SSFP-based cine MR imaging.

Kim KA, Seo JB, Do KH, Heo JN, Lee YK, Song JW, Lee JS, Song KS, Lim TH - Korean J Radiol (2006 Jan-Mar)

The MR scan obtained in a 62-year-old male who was scheduled for coronary bypass surgery. The contrast-enhanced cine MR scan on the mid-diastolic phase (A) shows an area of low signal intensity lining the subendocardial surface of the interventricular septum (arrows). The lesion is seen as having high signal intensity on the delayed contrast-enhanced MR imaging (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2667572&req=5

Figure 3: The MR scan obtained in a 62-year-old male who was scheduled for coronary bypass surgery. The contrast-enhanced cine MR scan on the mid-diastolic phase (A) shows an area of low signal intensity lining the subendocardial surface of the interventricular septum (arrows). The lesion is seen as having high signal intensity on the delayed contrast-enhanced MR imaging (B).
Mentions: All of the MRIs of the acute and chronic MI patients showed hyperenhancement on the DCE MRI. The areas of the acute MIs were shown as homogeneous high SI in 13 patients (Fig. 1), high SI with internal low SI in ten patients (Fig. 2), and as iso-SI in one patient on the CE-cine MRI. In contrast, the areas of chronic MI were seen as having low signal intensity on the CE-cine MRI (Fig. 3) in all patients (Table 1). In eight patients with acute MI, the end diastolic thickness of the infarcted areas was less than 6 mm, but in 16 patients, it was equal to or greater than 6 mm. For the chronic MI, the thickness of the infarcted area was less than 6 mm in all except one patient. If the height of the SI on CE-cine MRI was used as a diagnostic criterion, the sensitivity for the detection of acute MI was 95.8%. If a thickness equal to or greater than 6 mm for the acute infarcted myocardium was used as a diagnostic criterion, the sensitivity was 66.7%.

Bottom Line: The SI of the infarcted myocardium on the CE-cine MRI was compared with that of the normal myocardium on the same image.The area of abnormal SI on the CE-cine MRI was compared with the area of hyperenhancement on the DCE MRI.This study showed the different SI patterns between recently infarcted myocardium and chronic scar on the CE-cine MRI.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

ABSTRACT
The purpose of this study is to demonstrate whether the signal intensity (SI) of myocardial infarction (MI) on contrast enhanced (CE)-cine MRI is useful for differentiating recently infarcted myocardium from chronic scar. This study included 24 patients with acute MI (36-84 years, mean age: 57) and 19 patients with chronic MI (44-80 years, mean age: 64). The diagnosis of acute MI was based on the presence of typical symptoms, i.e. elevation of the cardiac enzymes and the absence of any remote infarction history. The diagnosis of chronic MI was based on a history of MI or coronary artery disease of more than one month duration and on the absence of any recent MI within the previous six months. Retrospectively, the ECG-gated breath-hold cine imaging was performed in the short axis plane using a segmented, balanced, turbo-field, echo-pulse sequence two minutes after the administration of Gd-DTPA at a dose of 0.2 mmol/kg body weight. Delayed contrast-enhanced MRI (DCE MRI) in the same plane was performed 10 to 15 minutes after contrast administration, and this was served as the gold standard of reference. The SI of the infarcted myocardium on the CE-cine MRI was compared with that of the normal myocardium on the same image. The area of abnormal SI on the CE-cine MRI was compared with the area of hyperenhancement on the DCE MRI. The area of high SI on the CE-cine MRI was detected in 23 of 24 patients with acute MI (10 with homogenous high SI, 13 high SI with subendocardial low SI, and one with iso SI). The area of high SI on the CE-cine MRI was larger than that seen on the DCE MRI (p < 0.05). In contrast, the areas of chronic MI were seen as iso-SI with thin subendocardial low SI on the CE-cine MR in all the chronic MI patients. The presence of high SI on both the CE-cine MRI and the DCE MRI is more sensitive (95.8%) for determining the age of a MI than the presence of myocardial thinning (66.7%). This study showed the different SI patterns between recently infarcted myocardium and chronic scar on the CE-cine MRI. CE-cine MRI is thought to be quite useful for determining the age of myocardial infarction, in addition to its utility for assessing myocardial contractility.

Show MeSH
Related in: MedlinePlus