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Hammer-Hansen S, Bandettini WP, Hsu LY, Leung SW, Shanbhag S, Mancini C, Greve AM, Køber L, Thune JJ, Kellman P, Arai AE. Mechanisms for overestimating acute myocardial infarct size with gadolinium-enhanced cardiovascular magnetic resonance imaging in humans: a quantitative and kinetic study. Eur Heart J Cardiovasc Imaging 2015; 17:76-84. [PMID: 25983233 PMCID: PMC4684160 DOI: 10.1093/ehjci/jev123] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/16/2015] [Indexed: 12/15/2022] Open
Abstract
Aims It remains controversial whether cardiovascular magnetic resonance imaging with gadolinium only enhances acutely infarcted or also salvaged myocardium. We hypothesized that enhancement of salvaged myocardium may be due to altered extracellular volume (ECV) and contrast kinetics compared with normal and infarcted myocardium. If so, these mechanisms could contribute to overestimation of acute myocardial infarction (AMI) size. Methods and results Imaging was performed at 1.5T ≤ 7 days after AMI with serial T1 mapping and volumetric early (5 min post-contrast) and late (20 min post-contrast) gadolinium enhancement imaging. Infarcts were classified as transmural (>75% transmural extent) or non-transmural. Patients with non-transmural infarctions (n = 15) had shorter duration of symptoms before reperfusion (P = 0.02), lower peak troponin (P = 0.008), and less microvascular obstruction (P < 0.001) than patients with transmural infarcts (n = 22). The size of enhancement at 5 min was greater than at 20 min (18.7 ± 12.7 vs. 12.1 ± 7.0%, P = 0.003) in non-transmural infarctions, but similar in transmural infarctions (23.0 ± 10.0 vs. 21.9 ± 9.9%, P = 0.21). ECV of salvaged myocardium was greater than normal (39.5 ± 5.8 vs. 24.1 ± 3.1%) but less than infarcted myocardium (50.5 ± 6.0%, both P < 0.001). In kinetic studies of non-transmural infarctions, salvaged and infarcted myocardium had similar T1 at 4 min but different T1 at 8–20 min post-contrast. Conclusion The extent of gadolinium enhancement in AMI is modulated by ECV and contrast kinetics. Image acquisition too early after contrast administration resulted in overestimation of infarct size in non-transmural infarctions due to enhancement of salvaged myocardium.
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Affiliation(s)
- Sophia Hammer-Hansen
- Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, Department of Health and Human Services, National Institutes of Health, Building 10, Room B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061, USA Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark
| | - W Patricia Bandettini
- Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, Department of Health and Human Services, National Institutes of Health, Building 10, Room B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061, USA
| | - Li-Yueh Hsu
- Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, Department of Health and Human Services, National Institutes of Health, Building 10, Room B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061, USA
| | - Steve W Leung
- Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, Department of Health and Human Services, National Institutes of Health, Building 10, Room B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061, USA Department of Medicine and Radiology, Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
| | - Sujata Shanbhag
- Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, Department of Health and Human Services, National Institutes of Health, Building 10, Room B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061, USA
| | - Christine Mancini
- Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, Department of Health and Human Services, National Institutes of Health, Building 10, Room B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061, USA
| | - Anders M Greve
- Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, Department of Health and Human Services, National Institutes of Health, Building 10, Room B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061, USA
| | - Lars Køber
- Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark
| | - Jens Jakob Thune
- Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark
| | - Peter Kellman
- Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, Department of Health and Human Services, National Institutes of Health, Building 10, Room B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061, USA
| | - Andrew E Arai
- Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, Department of Health and Human Services, National Institutes of Health, Building 10, Room B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061, USA
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