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Perfusion MRI at rest in subacute and chronic myocardial infarct.
MedLine Citation:
PMID:  23401603     Owner:  NLM     Status:  Publisher    
BackgroundPerfusion magnetic resonance imaging (MRI) and delayed contrast-enhanced MRI (DE-MRI) serve as tools for tissue characterization.PurposeTo assess and compare semi-quantitative parameters of myocardial infarct (MI) in the subacute and chronic phase, and to correlate these parameters with qualitative enhancement analysis.Material and MethodsPerfusion MRI at rest and DE-MRI were performed in 63 patients with anterior wall MI at 2-3 weeks after revascularization and repeated after 6 months. Descriptive enhancement parameters of contrast arrival time, initial upslope, enhancement at normal tissue peak (TTP(n)) and wash-out slope, and kinetic tissue parameters rBF, K(trans), k(ep) and v(e) were calculated. Subacute infarct tissue was compared to normal myocardium and chronic infarct tissue. Patients were stratified at baseline according to a qualitative grading of hypoenhancement based on first-pass enhancement and presence of microvascular obstruction (MO) at perfusion MRI and on persistent MO at DE-MRI. The qualitative grade was correlated to semi-quantitative perfusion MRI parameters.ResultsInitial upslope, enhancement at TTPn, rBF, and k(ep) were decreased and wash-out slope and v(e) were increased in infarct tissue (P < 0.001 for all analyses). Infarct tissue v(e) decreased from baseline to 6 months (P = 0.045). At baseline infarct tissue with persistent MO revealed decreased K(trans) and delayed contrast arrival, and more pronounced decrease of enhancement at TTPn, rBF and k(ep) compared to other enhancement groups (P < 0.008 for pairwise analyses).ConclusionPerfusion is decreased in subacute reperfused infarct tissue compared to normal tissue. K(trans) is not decreased, consistent with increased surface area of the vascular bed of the subacute infarct. Infarct tissue v(e) is increased, and decreases with scarring. The presence of persistent MO correlates to more pronounced perfusion reduction and results in delayed contrast arrival, indicating microvascular collateral circulation.
Einar Hopp; Atle Bjørnerud; Ketil Lunde; Svein Solheim; Svend Aakhus; Harald Arnesen; Kolbjørn Forfang; Thor Edvardsen; Hans-Jørgen Smith
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-2-11
Journal Detail:
Title:  Acta radiologica (Stockholm, Sweden : 1987)     Volume:  -     ISSN:  1600-0455     ISO Abbreviation:  Acta Radiol     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-2-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8706123     Medline TA:  Acta Radiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Department of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet.
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