1
|
Krishnamurthy R, Cheong B, Muthupillai R. Tools for cardiovascular magnetic resonance imaging. Cardiovasc Diagn Ther 2014; 4:104-25. [PMID: 24834409 DOI: 10.3978/j.issn.2223-3652.2014.03.06] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 02/08/2014] [Indexed: 12/31/2022]
Abstract
In less than fifteen years, as a non-invasive imaging option, cardiovascular MR has grown from a being a mere curiosity to becoming a widely used clinical tool for evaluating cardiovascular disease. Cardiovascular magnetic resonance imaging (CMRI) is now routinely used to study myocardial structure, cardiac function, macro vascular blood flow, myocardial perfusion, and myocardial viability. For someone entering the field of cardiac MR, this rapid pace of development in the field of CMRI might make it difficult to identify a cohesive starting point. In this brief review, we have attempted to summarize the key cardiovascular imaging techniques that have found widespread clinical acceptance. In particular, we describe the essential cardiac and respiratory gating techniques that form the backbone of all cardiovascular imaging methods. It is followed by four sections that discuss: (I) the gradient echo techniques that are used to assess ventricular function; (II) black-blood turbo spin echo (SE) methods used for morphologic assessment of the heart; (III) phase-contrast based techniques for the assessment of blood flow; and (IV) CMR methods for the assessment of myocardial ischemia and viability. In each section, we briefly summarize technical considerations relevant to the clinical use of these techniques, followed by practical information for its clinical implementation. In each of those four areas, CMRI is considered either as the benchmark imaging modality against which the diagnostic performance of other imaging modalities are compared against, or provides a complementary capability to existing imaging techniques. We have deliberately avoided including cutting-edge CMR imaging techniques practiced at few academic centers, and restricted our discussion to methods that are widely used and are likely to be available in a clinical setting. Our hope is that this review would propel an interested reader toward more comprehensive reviews in the literature.
Collapse
Affiliation(s)
- Ramkumar Krishnamurthy
- Department of Diagnostic and Interventional Radiology, CHI St. Luke's Health, Texas Medical Center, Houston, Texas 77030, USA
| | - Benjamin Cheong
- Department of Diagnostic and Interventional Radiology, CHI St. Luke's Health, Texas Medical Center, Houston, Texas 77030, USA
| | - Raja Muthupillai
- Department of Diagnostic and Interventional Radiology, CHI St. Luke's Health, Texas Medical Center, Houston, Texas 77030, USA
| |
Collapse
|
2
|
Chotenimitkhun R, Hundley WG. Pharmacological stress cardiovascular magnetic resonance. Postgrad Med 2011; 123:162-70. [PMID: 21566427 DOI: 10.3810/pgm.2011.05.2295] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Over the past decade, cardiovascular magnetic resonance (CMR) has evolved into a cardiac stress testing modality that can be used to diagnose myocardial ischemia using intravenous dobutamine or vasodilator perfusion agents such as adenosine or dipyridamole. Because CMR produces high-resolution tomographic images of the human heart in multiple imaging planes, it has become a highly attractive noninvasive testing modality for those suspected of having myocardial ischemia. The purpose of this article is to review the clinical, diagnostic, and prognostic utility of stress CMR testing for patients with (or suspected of having) coronary artery disease.
Collapse
Affiliation(s)
- Runyawan Chotenimitkhun
- Department of Internal Medicine, Cardiology Section, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1045, USA
| | | |
Collapse
|
3
|
Mandapaka S, Hundley WG. Dobutamine cardiovascular magnetic resonance: A review. J Magn Reson Imaging 2006; 24:499-512. [PMID: 16892202 DOI: 10.1002/jmri.20678] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Dobutamine cardiovascular magnetic resonance (DCMR) is useful for identifying myocardial ischemia and viability in patients with known or suspected coronary artery disease (CAD). This article reviews the performance and utility of DCMR, its association with dobutamine stress echocardiography (DSE), and areas of active investigative research.
Collapse
Affiliation(s)
- Sangeeta Mandapaka
- Cardiology Section, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA
| | | |
Collapse
|
4
|
Schvartzman PR, Srichai MB, Grimm RA, Obuchowski NA, Hammer DF, McCarthy PM, Kasper JM, White RD. Nonstress delayed-enhancement magnetic resonance imaging of the myocardium predicts improvement of function after revascularization for chronic ischemic heart disease with left ventricular dysfunction. Am Heart J 2003; 146:535-41. [PMID: 12947375 DOI: 10.1016/s0002-8703(03)00318-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The extent of myocardial scarring of the left ventricle (LV) is important in patients with chronic ischemic heart disease (CIHD). With delayed-enhancement magnetic resonance imaging (DE-MRI), scarred myocardium (hyper-enhanced) is easily distinguishable from viable (dark) myocardium. This investigation assessed the use of DE-MRI for predicting functional improvement after coronary artery bypass grafting (CABG) in patients with CIHD and significant LV dysfunction. METHODS The patient population (n = 29) with CIHD and LV dysfunction (ejection fraction 28% +/- 10%) underwent both DE-MRI, to delineate scarred regions before revascularization, and echocardiography (Echo), to assess segmental function before and after CABG (interval 188 +/- 57 days). Using a 16-segment model, LV myocardium was semiquantitatively analyzed for scarring based on DE-MRI and for improvements in resting function by pre- and post-CABG Echo. RESULTS Before CABG, 82% of targeted myocardial segments had abnormal contraction; 78% showed scarring, including 38% with greater than mild amounts (25%-100%). Normal contraction was found in 18% of segments before revascularization; scarred areas were identified in 42%, 84% of which had, at most, minimal amounts (0%-24%). Of segments with pre-CABG dysfunction, 82% with no evidence of scar recovered, compared to only 18% with > or =50% scarring. Amount of hyper-enhancement was a very good indicator of improvement of function, especially at the > or =50%/segment threshold; overall accuracy was 0.74 (95% CI 0.66-0.82, P <.001). CONCLUSIONS In patients with CIHD and significant LV dysfunction, DE-MRI can predict likelihood of functional improvement after revascularization.
Collapse
Affiliation(s)
- Paulo R Schvartzman
- Department of Radiology (Section of Cardiovascular Imaging), Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Schmidt MA, Starling MR. Physiologic assessment of left ventricular systolic and diastolic performance. Curr Probl Cardiol 2000; 25:827-908. [PMID: 11153466 DOI: 10.1067/mcd.2000.110699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- M A Schmidt
- Division of Cardiology, University of Michigan Medical Center, Cardiology Section, Ann Arbor Veterans Administration Medical Center, Ann Arbor, Michigan
| | | |
Collapse
|
6
|
Hundley WG, Kizilbash AM, Afridi I, Franco F, Peshock RM, Grayburn PA. Effect of contrast enhancement on transthoracic echocardiographic assessment of left ventricular regional wall motion. Am J Cardiol 1999; 84:1365-8, A8-9. [PMID: 10614810 DOI: 10.1016/s0002-9149(99)00577-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The use of contrast-enhanced transthoracic echocardiography to evaluate left ventricular regional wall motion was determined by comparison of echocardiographic data with assessments obtained by magnetic resonance imaging. When left ventricular endocardial segments are well visualized after contrast enhancement, the ability to determine normal versus abnormal endocardial thickening with echocardiography is similar to cine magnetic resonance imaging.
Collapse
Affiliation(s)
- W G Hundley
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas 75235-9047, USA
| | | | | | | | | | | |
Collapse
|
7
|
Balzer P, Furber A, Delépine S, Rouleau F, Lethimonnier F, Morel O, Tadéi A, Jallet P, Geslin P, le Jeune JJ. Regional assessment of wall curvature and wall stress in left ventricle with magnetic resonance imaging. THE AMERICAN JOURNAL OF PHYSIOLOGY 1999; 277:H901-10. [PMID: 10484409 DOI: 10.1152/ajpheart.1999.277.3.h901] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Left ventricular functional abnormalities are associated with regional increases of wall stress and modifications of wall curvature. This study describes the integration of the short-axis and long-axis wall curvatures for determining peak systolic wall stress. Quantification was realized with cine magnetic resonance imaging (MRI) from the location of the endocardial and epicardial borders of the left ventricle on pairs of consecutive short-axis sections. Fifteen normal volunteers were subjected to cine MRI, and different methods of calculating peak systolic wall stress were compared. A short-axis analysis showed a 55 +/- 13% increase of the circumferential mean of the peak systolic wall stress between apical and basal sections. Regarding the curvature, no significant increase of wall stress was observed except on the septal wall (31 +/- 18%). Short-axis studies proved to be insufficient for determining the regional variations of left ventricular wall stress and for providing normal reference values for the location of abnormal regions in patients.
Collapse
Affiliation(s)
- P Balzer
- Department of Biophysics, University Hospital of Angers, 49033 Angers Cedex 01, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Furber A, Balzer P, Cavaro-Ménard C, Croué A, Da Costa E, Lethimonnier F, Geslin P, Tadéi A, Jallet P, Le Jeune JJ. Experimental validation of an automated edge-detection method for a simultaneous determination of the endocardial and epicardial borders in short-axis cardiac MR images: application in normal volunteers. J Magn Reson Imaging 1998; 8:1006-14. [PMID: 9786136 DOI: 10.1002/jmri.1880080503] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The goal of this study was to put together several techniques of image segmentation to provide a reliable assessment of the left ventricular mass with short-axis cardiac MR images. No initial manual input was required for this process based on region growing, gradient detection, and adaptive thresholding. A comparison between actual mass and automatic assessment was implemented with 9 minipigs that underwent spin-echo MR imaging. Fifteen normal volunteers were studied with a fast-gradient-echo sequence. The automatic segmentation was then controlled by three trained observers. Actual mass and automatic segmentation were strongly correlated (r = .97 with P < .01). For normal volunteers, the standard error of estimation of the automatic assessment (12 g) compared well with the average myocardial mass (120 +/- 30 g) and the interobserver reproducibility of the manual assessment (9 g). These results allow the application of this method to the quantification of the left ventricular function and mass in clinical practice.
Collapse
Affiliation(s)
- A Furber
- Department of Cardiology, The University Hospital of Angers, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
|
10
|
Selker HP, Zalenski RJ, Antman EM, Aufderheide TP, Bernard SA, Bonow RO, Gibler W, Hagen MD, Johnson P, Lau J, McNutt RA, Ornato J, Schwartz J, Scott JD, Tunick PA, Weaver W. Echocardiagram. Ann Emerg Med 1997. [DOI: 10.1016/s0196-0644(97)70310-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
11
|
van der Wall EE, Vliegen HW, de Roos A, Bruschke AV. Magnetic resonance techniques for assessment of myocardial viability. J Cardiovasc Pharmacol 1996; 28 Suppl 1:S37-44. [PMID: 8891869 DOI: 10.1097/00005344-199600003-00006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In general, the following three standards for myocardial viability can be used: (a) preserved coronary flow (adequate perfusion); (b) preserved wall motion (systolic wall thickening); and (c) preserved metabolism (metabolic integrity). The current magnetic resonance (MR) techniques provide a great potential to measure all three standards of viability. Adequate perfusion can be assessed by spin-echo MR imaging and/or ultrafast MR imaging, systolic wall thickening by cine MR imaging, and the presence of metabolic integrity can be determined by MR spectroscopy. These noninvasive and versatile techniques have led to an increasing interest and research in recent years. Particular strengths of the MR techniques are: the inherent three-dimensional data acquisition without radiation exposure; the intrinsic soft-tissue contrast that allows tissue characterization; the excellent spatial resolution (in the 1- to 2-mm range), which permits the evaluation of regional abnormalities; multitomographic imaging capabilities that allow acquisition of cardiac images in any plane; the inherent sensitivity to blood and wall motion; and the potential for in vivo measurement of myocardial metabolism using MR spectroscopy. This review article demonstrates that MR techniques might play a growing role in the assessment of myocardial viability.
Collapse
Affiliation(s)
- E E van der Wall
- Department of Cardiology, University Hospital Leiden, The Netherlands
| | | | | | | |
Collapse
|
12
|
|
13
|
Waggoner AD, Davis C. Quantitative Echoca rdiograpy Part III. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 1995. [DOI: 10.1177/875647939501100602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A comprehensive two-dimensional echocardiographic examination provides useful information that is superior to MT-mode regarding left ventricular chamber sizes and systolic performance, including ejection fraction. Although we rely on visual estimates, quantitative measurements can be particularly valuable in patients with mild or moderate left ventricular systolic dysfunction. Measurements of left ventricular mass by two-dimensional echocardiography is supenror to Ml-mode to detect left ventricular hypertrophy. Two-dimensional echocardiography combined with pulsed Doppler echocardiography can be used to accurately measure stroke volume and to assess changes during medical therapy or after interventions. Future work is needed to assess the significance of continuous-wave Doppler-derived rate of pressure change in patients with mitral regurgitation.
Collapse
Affiliation(s)
- Alan D. Waggoner
- Barnes and Jewish Hospitals, Cardiac Diagnostic Lab, One Barnes Hospital Plaa. St. Louis, MO 63110
| | - Cris Davis
- Krannert Institute of Cardiology, Indiana University Medical Center, Indianapolis, Indiana
| |
Collapse
|
14
|
Abstract
The cardiovascular applications of nuclear magnetic resonance (MR) techniques in coronary artery disease have increased considerably in recent years. Technical advantages of MR imaging in comparison with other techniques are the excellent spatial resolution, the characterization of myocardial tissue, and the potential for three-dimensional imaging. This allows the accurate assessment of left ventricular mass and volume, the differentiation of infarcted tissue from normal myocardial tissue, and the determination of systolic wall thickening and regional wall motion abnormalities. Myocardial perfusion, metabolism, and inducible myocardial ischemia with the use of pharmacological stress also can be assessed by MR techniques. Future technical improvements in real-time imaging and development of noninvasive visualization of the coronary arteries and coronary artery bypasses will constitute a tremendous progress in clinical cardiology. Early detection and flow assessment of stenosed coronary arteries by MR angiography with the use of flow velocity measurements may outweigh the cost inherent to the MR imaging procedure. A particular strength of the MR technique is the potential to encompass cardiac anatomy, perfusion, function, metabolism, and coronary angiography in a single test. The replacement of multiple diagnostic tests with one MR test may have major effects on cardiovascular healthcare economics.
Collapse
Affiliation(s)
- E E van der Wall
- Department of Cardiology, University Hospital Leiden, The Netherlands
| | | | | | | |
Collapse
|
15
|
Vliegen HW, de Roos A, Bruschke AV, van der Wall EE. Magnetic resonance techniques for the assessment of myocardial viability: clinical experience. Am Heart J 1995; 129:809-18. [PMID: 7900635 DOI: 10.1016/0002-8703(95)90333-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- H W Vliegen
- Department of Cardiology, University Hospital Leiden, The Netherlands
| | | | | | | |
Collapse
|
16
|
Interactive drawing of the left ventricular borders from cine magnetic resonance images. ACTA ACUST UNITED AC 1994. [DOI: 10.1007/bf01709795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
17
|
|
18
|
Krauss XH, van der Wall EE, van der Laarse A, Doornbos J, Matheijssen NA, de Roos A, Blokland JA, van Voorthuisen AE, Bruschke AV. Magnetic resonance imaging of myocardial infarction: correlation with enzymatic, angiographic, and radionuclide findings. Am Heart J 1991; 122:1274-83. [PMID: 1950989 DOI: 10.1016/0002-8703(91)90566-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Spin-echo cardiac magnetic resonance imaging studies were performed in 20 patients with a first 7- to 14-day-old (mean 10) myocardial infarction. The magnetic resonance imaging findings were compared with coronary angiography (14 patients), myocardial enzyme release (18 patients), radionuclide angiography (19 patients), and thallium-201 perfusion scintigraphy (19 patients). Regional T2 relaxation times determined from the signal intensities at echo times 30 msec and 90 msec were significantly prolonged in the infarcted areas. Based on abnormal T2 times for every patient, a regional and a total myocardial damage score was determined. The infarct-related artery was correctly identified in 93% of patients by magnetic resonance imaging, in 79% of patients by thallium-201 scintigraphy, and in 62% of patients by radionuclide angiography. The total damage score correlated well with enzymatic infarct size (r = 0.75, p less than 0.001). The correlation between left ventricular end-systolic volume index determined by magnetic resonance imaging and by radionuclide angiography was r = 0.89 (p less than 0.002). The left ventricular end-systolic volume index correlated significantly with enzymatic infarct size (r = 0.72, p less than 0.001), total damage score (r = 0.68, p less than 0.002), and radionuclide left ventricular ejection fraction (r = -0.68, p less than 0.002). Correlations between the magnetic resonance damage score and the thallium-201 perfusion score were r = 0.60 (p less than 0.01) for the exercise images, and r = 0.72 (p less than 0.001) for the redistribution images. This study shows that spin-echo magnetic resonance imaging is quite comparable with the established noninvasive imaging modalities currently used in patients with acute myocardial infarction.
Collapse
Affiliation(s)
- X H Krauss
- Department of Cardiology, University Hospital Leiden, The Netherlands
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
van der Wall EE, de Roos A, van Voorthuisen AE, Bruschke AV. Magnetic resonance imaging: a new approach for evaluating coronary artery disease? Am Heart J 1991; 121:1203-20. [PMID: 2008844 DOI: 10.1016/0002-8703(91)90683-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- E E van der Wall
- Department of Cardiology, University Hospital, Leiden, The Netherlands
| | | | | | | |
Collapse
|
20
|
|
21
|
Affiliation(s)
- R L Popp
- Cardiology Division, Stanford University School of Medicine, CA 94305
| |
Collapse
|
22
|
van Dijkman PR, van der Wall EE, de Roos A, Doornbos J, van der Laarse A, Matheijssen NA, van Rossum AC, van Voorthuisen AE, Bruschke AV. Gadolinium-enhanced magnetic resonance imaging in acute myocardial infarction. Eur J Radiol 1990; 11:1-9. [PMID: 2397723 DOI: 10.1016/0720-048x(90)90094-r] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
To evaluate the usefulness of the paramagnetic contrast agent Gadolinium-DTPA (diethylenetriaminepentaacetic acid) in Magnetic Resonance Imaging of acute myocardial infarction, we studied a total of 45 patients with a first acute myocardial infarction by ECG-gated magnetic resonance imaging before and after intravenous administration of 0.1 mmol/kg Gadolinium-DTPA. All patients received thrombolytic treatment by intravenous streptokinase. The magnetic resonance imaging studies were performed after a mean of 88 h (range 15-241) after the acute onset of acute myocardial infarction. Five patients without evidence of cardiac disease served as controls. Spin-echo measurements (TE 30 ms) were made using a Philips Gyroscan (0.5 Tesla) or a Teslacon II (0.6 Tesla). The 45 patients were divided into four groups of patients. In Group I (5 patients) Gadolinium-DTPA improved the detection of myocardial infarction by Gadolinium-DTPA. In Group II (20 patients) the magnetic resonance imaging procedure was repeated every 10 min for up to 40 min following administration of Gadolinium-DTPA. Optimal contrast enhancement was obtained 20-25 min after Gadolinium-DTPA. In Group III (27 patients) signal intensities were significantly higher in the patients who underwent the magnetic resonance imaging study more than 72 h (mean 120) after the acute event, suggesting increased accumulation of Gadolinium-DTPA in a more advanced stage of the infarction process. In Group IV (45 patients) Gadolinium-DTPA was administered in an attempt to distinguish between reperfused and nonreperfused myocardial areas after thrombolytic treatment for acute myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- P R van Dijkman
- Department of Cardiology, University Hospital Leiden, The Netherlands
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Lotan CS, Cranney GB, Bouchard A, Bittner V, Pohost GM. The value of cine nuclear magnetic resonance imaging for assessing regional ventricular function. J Am Coll Cardiol 1989; 14:1721-9. [PMID: 2584562 DOI: 10.1016/0735-1097(89)90023-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Previous nuclear magnetic resonance (NMR) imaging studies to assess left ventricular function have used multiple axial planes, which are compromised by partial volume effects and are time consuming to acquire and analyze. Accordingly, an imaging approach using cine NMR and planes aligned with the true cardiac axes of the left ventricle was developed in views comparable with left ventricular cineangiography. Cine NMR imaging was used to assess regional wall motion and was validated by comparison with biplane left ventricular cineangiography. Fifty-nine patients underwent cineangiographic and NMR studies within 72 h. A poor quality NMR study precluded analysis in 4. leaving a study group of 55 patients (mean age 58 +/- 12: 17 women). Cine NMR movie loops were acquired in two long-axis planes: 1) right anterior oblique plane, parallel to the septum, and 2) four chamber orthogonal plane, perpendicular to the septum (this view is comparable to the angiographic left anterior oblique view). To assess regional wall motion, the left ventricle in both cine NMR and cineangiographic images was divided into five segments and graded on a five point grading scale from 3 for normal through 0 for akinesia and -1 for dyskinesia. Regional wall thickening was used qualitatively to aid in the analysis of wall motion. For the 275 segments compared in the right anterior oblique view, agreement was within one grade in 263 (95.6%) of 275 segments, whereas absolute agreement was observed in 171 (62%) of 275 segments. In the left anterior oblique view, of 200 segments evaluated, agreement within one grade was achieved in 184 segments (92%) and agreement was complete in 132 (66%).(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- C S Lotan
- Department of Medicine, University of Alabama, Birmingham
| | | | | | | | | |
Collapse
|
24
|
|
25
|
Johnston DL, Mulvagh SL, Cashion RW, O'Neill PG, Roberts R, Rokey R. Nuclear magnetic resonance imaging of acute myocardial infarction within 24 hours of chest pain onset. Am J Cardiol 1989; 64:172-9. [PMID: 2741827 DOI: 10.1016/0002-9149(89)90452-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The present study was intended to establish the feasibility, safety and usefulness of conventional spin-echo nuclear magnetic resonance (NMR) imaging for the detection of acute myocardial infarction within 24 hours of the onset of chest pain. Monitoring facilities were established in the NMR imaging suite that provided the same level of reliability and safety found in a standard coronary care unit. An imaging protocol was developed that allowed the acquisition of a complete study in 30 minutes while providing useful information about mechanical function and myocardial tissue contrast. Eighteen postthrombolysis patients were imaged within 21 +/- 2 hours of chest pain onset. No patient developed recurrent chest pain or arrhythmias in the NMR imaging suite. Relatively T2-weighted spin-echo images (echo time = 60 ms; repetition time = heart rate) provided interpretable images in 16 patients. Fourteen normal subjects were imaged for comparison. Thirteen of 16 patients had an increase in signal intensity in the region of the infarction. Regional wall thickening was assessed using a floating endocardial centroid technique. Wall motion abnormalities detected by NMR corresponded to those noted by 2-dimensional echocardiography and contrast angiography. Sensitivity, specificity and accuracy for the detection of infarction were 93, 80 and 87%, respectively, when signal intensity and wall thickening abnormalities were combined. In summary, NMR imaging is feasible in patients with acute myocardial infarction within 24 hours of chest pain onset. The study can be conducted safely and it provides useful information about acute myocardial infarction.
Collapse
Affiliation(s)
- D L Johnston
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | | | | | | | | | | |
Collapse
|
26
|
Krauss XH, Van der Wall EE, Doornbos J, Blokland JA, Postema S, de Roos A, Van der Laarse A, Cats VM, Van Voorthuisen AE, Bruschke AV. Value of magnetic resonance imaging in patients with a recent myocardial infarction: comparison with planar thallium-201 scintigraphy. Cardiovasc Intervent Radiol 1989; 12:119-24. [PMID: 2507144 DOI: 10.1007/bf02577373] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The diagnostic accuracy of spin-echo Magnetic Resonance (MR) imaging in the detection and localization of a recent myocardial infarction (mean 4 days old) was compared to planar thallium-201 scintigraphy in 20 patients with a documented myocardial infarction. A control group of 10 subjects underwent a similar MR imaging procedure without thallium-201 scintigraphy. T1-weighted MR images (TE 30 msec) showed abnormal thinning of the infarcted left ventricular wall during systole (less than 50% of the opposite wall) in 11 patients (55%). On T2-weighted multi-echo MR images, (TE 30-60-90-120 msec) abnormally increased signal intensity was found in 17 patients and coincided with the location of the infarction. Thallium-201 scintigraphy detected the infarction in 18 patients. Comparison of T2-MR imaging and thallium-201 scintigraphy showed concordant findings in 82% of the left ventricular segments. In 9% of segments, thallium uptake was reduced with normal T2-MR and in 9% we found a normal thallium uptake with abnormal T2-MR findings. In all subjects of the control group, T1-MR images were normal, and only one subject showed increased signal intensity on T2-MR images. We conclude that the diagnostic accuracy of MR imaging in detecting a myocardial infarction is similar to that of T1-201 scintigraphy.
Collapse
Affiliation(s)
- X H Krauss
- Department of Cardiology, University Hospital, Leiden, The Netherlands
| | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
van Dijkman PR, Doornbos J, de Roos A, van der Laarse A, Postema S, Matheijssen NA, Bruschke AV, van Voorthuisen AE, Cats VM, van der Wall EE. Improved detection of acute myocardial infarction by magnetic resonance imaging using gadolinium-DTPA. INTERNATIONAL JOURNAL OF CARDIAC IMAGING 1989; 5:1-8. [PMID: 2614075 DOI: 10.1007/bf01745226] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
To assess the value of the paramagnetic contrast agent Gadolinium (Gd)-DTPA in Magnetic Resonance Imaging (MRI) of acute myocardial infarction (AMI), we studied 20 patients with a first AMI by ECG-gated MRI before and after intravenous administration of 0.15 mmol/kg Gd-DTPA. The MRI studies were performed after a mean of 98 hours (range 15-241) after the acute onset of AMI. Spin-echo measurements (TE 30 msec) were made using a Philips Gyroscan (0.5 Tesla). After performing the baseline MRI scans, the MRI procedure was repeated every 10 minutes for up to 40 minutes following injection of Gd-DTPA. In 18 (90%) patients contrast enhancement in the infarcted myocardial areas was observed after Gd-DTPA. In these patients intensity versus region curves, derived from 9 to 11 adjacent myocardial regions of interest, showed increased signal intensities in the infarcted areas after administration of Gd-DTPA. The precontrast signal intensity ratio between infarcted and normal myocardium was 1.14 +/- 0.15 (mean +/- SD); the postcontrast ratios at 10 minutes were 1.41 +/- 0.21 (P less than 0.05), at 20 minutes 1.61 +/- 0.19 (P less than 0.01), at 30 minutes 1.43 +/- 0.20 (P less than 0.05), and at 40 minutes 1.33 +/- 0.20 (P = NS). It is concluded that MRI using the contrast agent Gd-DTPA significantly improves the visualization and detection of infarcted myocardial areas in patients with AMI and that optimal contrast enhancement is obtained 20 minutes after administration of Gd-DTPA.
Collapse
Affiliation(s)
- P R van Dijkman
- Department of Cardiology, University Hospital Leiden, The Netherlands
| | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
BOUCHARD ALAIN, LOTAN CHAIM, CRANNEY GREGORY, POHOST GERALDM. Assessment of Myocardial Ischemia and Infarction by Nuclear Magnetic Resonance. Echocardiography 1988. [DOI: 10.1111/j.1540-8175.1988.tb00274.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
29
|
White RD, Holt WW, Cheitlin MD, Cassidy MM, Ports TA, Lim AD, Botvinick EH, Higgins CB. Estimation of the functional and anatomic extent of myocardial infarction using magnetic resonance imaging. Am Heart J 1988; 115:740-8. [PMID: 3354402 DOI: 10.1016/0002-8703(88)90873-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This study assesses magnetic resonance (MR) imaging for the evaluation of both the functional and anatomic extent of damage to the left ventricle (LV) from myocardial infarction (MI). This was accomplished by blinded region-of-interest analysis of 36 MR examinations (orthogonal-transaxial, electrocardiographically-gated, multiphasic, single spin-echo) for determination of ejection fraction (EF) and relative MI volume (i.e., percent of total LV myocardial volume). Comparison of the results was then made with a measure of global residual LV function (i.e., score quotient or SQ) derived from segmental scoring of LV wall motion on a two-dimensional echocardiogram (Echo) and with an EF value from a left ventriculogram (LVG), both performed relatively concurrently with MR. Significant (p less than 0.01) overall correlations were noted between MR-EF and both Echo-SQ (r = 0.56) and LVG-EF (r = 0.78), and these relationships were relatively stronger when MI was located in the right coronary artery (RCA) than when it was found in the left anterior descending (LAD) distribution (e.g., MR-EF compared with LVG-EF: r = 0.87, p less than 0.05 for RCA; and r = 0.48, p = NS for LAD). The best expression of relative MI volume appeared to be based upon absolute volume of regionally-thinned LV wall multiplied by a correction factor for its residual contractility and then the addition of a volume correcting for the amount of regional wall thinning by necrosis (i.e., "total-Fxn" MI volume).(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- R D White
- Department of Radiology, University of California-San Francisco
| | | | | | | | | | | | | | | |
Collapse
|