Accurate identification of myocardial viability after myocardial infarction with novel manganese chelate-based MR imaging

Albumin-templated manganese carbonate nanoparticles for precise magnetic resonance imaging of acute myocardial infarction

Myocardial infarction (MI) is a major cause of death worldwide. Early and precise diagnosis of myocardial viability after MI is extremely important for effective treatment and prognosis evaluation. Herein, we developed the BSA-templated manganese carbonate (MnCO₃@BSA) nanoparticles as an MR imaging contrast agent for accurate detection of the infarcted regions. The chemophysical features, targeting capability toward the infarct, and biocompatibility were evaluated. The nanoparticles showed superior chemical stability. In vitro study suggested that the MnCO₃@BSA nanoparticles do not enter normal cardiomyocytes. MR imaging indicated that the MnCO₃@BSA with a high longitudinal (r₁) relaxivity of 5.84 mM^-1s^-1 at physiological condition specifically accumulated into the infarcted regions of myocardial ischemia/reperfusion (I/R) mice. In addition, the MnCO₃@BSA nanoparticles exhibited low cytotoxicity to cardiomyocytes, no damage to organs and good hemocompatibility. Thereby, the MnCO₃@BSA nanoparticles manifested great potential as an extracellular contrast agent of MR imaging for sensitive and specific detection of the infarcted regions during acute myocardial I/R injury.

Assessment of stunned and viable myocardium using manganese-enhanced MRI

OBJECTIVE

In a proof-of-concept study, to quantify myocardial viability in patients with acute myocardial infarction using manganese-enhanced MRI (MEMRI), a measure of intracellular calcium handling.

METHODS

Healthy volunteers (n=20) and patients with ST-elevation myocardial infarction (n=20) underwent late gadolinium enhancement (LGE) using gadobutrol and MEMRI using manganese dipyridoxyl diphosphate. Patients were scanned ≤7 days after reperfusion and rescanned after 3 months. Differential manganese uptake was described using a two-compartment model.

RESULTS

After manganese administration, healthy control and remote non-infarcted myocardium showed a sustained 25% reduction in T1 values (mean reductions, 288±34 and 281±12 ms). Infarcted myocardium demonstrated less T1 shortening than healthy control or remote myocardium (1157±74 vs 859±36 and 835±28 ms; both p<0.0001) with intermediate T1 values (1007±31 ms) in peri-infarct regions. Compared with LGE, MEMRI was more sensitive in detecting dysfunctional myocardium (dysfunctional fraction 40.5±11.9 vs 34.9%±13.9%; p=0.02) and tracked more closely with abnormal wall motion (r²=0.72 vs 0.55; p<0.0001). Kinetic modelling showed reduced myocardial manganese influx between remote, peri-infarct and infarct regions, enabling absolute discrimination of infarcted myocardium. After 3 months, manganese uptake increased in peri-infarct regions (16.5±3.5 vs 22.8±3.5 mL/100 g/min, p<0.0001), but not the remote (23.3±2.8 vs 23.0±3.2 mL/100 g/min, p=0.8) or infarcted (11.5±3.7 vs 14.0±1.2 mL/100 g/min, p>0.1) myocardium.

CONCLUSIONS

Through visualisation of intracellular calcium handling, MEMRI accurately differentiates infarcted, stunned and viable myocardium, and correlates with myocardial dysfunction better than LGE. MEMRI holds major promise in directly assessing myocardial viability, function and calcium handling across a range of cardiac diseases.

TRIAL REGISTRATION NUMBERS

NCT03607669; EudraCT number 2016-003782-25.

Safe and efficient magnetic resonance imaging of acute myocardial infarction with gadolinium-doped carbon dots

Aim: The magneto-fluorescent gadolinium-doped carbon dots (Gd-CDs) were developed as a cardiac MR imaging contrast agent to detect the infarcted myocardium on a myocardial ischemia/reperfusion (I/R) mice model. Materials & methods: The chemophysical features, cardiac MR imaging effect, biodistribution and biocompatibility of Gd-CDs were studied. Results: The ultrasmall size and good aqueous dispersibility endows Gd-CDs with high longitudinal relaxivity, intense fluorescence, excellent physiological stability and superior biocompatibility. More importantly, Gd-CDs preferentially target the infarcts as determined by the confocal microscopy and MR imaging on the I/R mice at the acute stage of myocardial infarction. Conclusion: Gd-CDs manifest great potential for development as an MR imaging contrast agent to facilitate accurate visualization and image-guided therapy of acute myocardial infarction.

Manganese threonine chelate-a new enteric contrast agent for MRI: a pilot study on rats

Enteric contrast agents are important in gastrointestinal MRI. However, no currently available agent is well established as the standard of care. In this study, in vitro relaxivities of manganese threonine chelate (Mn-Thr), a common nutritional food supplement, were measured at 1.5 T and 3 T with further investigation of its efficacy and safety in vivo as an enteric contrast agent. According to the calculated relaxivities, T₁ W and T₂ W TSE sequences of Mn-Thr solutions at different concentrations were acquired, and the optimal concentration for dark lumen imaging on both T₁ W and T₂ W images was determined in vitro. To validate the optimal concentration in vivo, eight Sprague-Dawley rats were randomly divided into two groups. Each group received rectal injection of either 2.00 g/L (about 3.80 mM) Mn-Thr or saline as an enteric contrast agent and underwent MRI. After a time interval of one week, the same procedures were repeated with the alternative contrast agent. Animals were sacrificed after the second MRI. Tissue manganese quantification and histopathological examination were obtained. Qualitative MR image quality assessments were performed and compared between Mn-Thr and saline. Measured T₁ and T₂ relaxivities of Mn-Thr were significantly higher than those of MnCl₂ in vitro (p < 0.05). At the concentration of 2.00 g/L (about 3.80 mM), Mn-Thr produced a dark lumen on T₁ W and T₂ W images both in vitro and in vivo. Compared with saline, Mn-Thr showed significantly more homogenous luminal signal and increased bowel wall conspicuity in image quality assessments. Tissue manganese concentrations were not significantly different between two groups. Histopathological examinations were normal in both groups. Our data suggest that Mn-Thr possesses favorable paramagnetic properties and can create a homogenous dark lumen on T₁ W and T₂ W images without obvious side effects in healthy rats. As a commercially available nutritional food supplement, Mn-Thr appears to be a promising enteric contrast agent for MRI.