Einar Hopp1, Atle Bjørnerud2, Ketil Lunde3, Svein Solheim4, Svend Aakhus3, Harald Arnesen5, Kolbjørn Forfang3, Thor Edvardsen6, Hans-Jørgen Smith7. 1. Department of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet Faculty of Medicine, University of Oslo, Oslo einar.hopp@oslo-universitetssykehus.no. 2. The Intervention Centre, Oslo University Hospital, Rikshospitalet Department of Physics, University of Oslo. 3. Department of Cardiology, Oslo University Hospital, Rikshospitalet. 4. Department of Cardiology, Oslo University Hospital, Ullevål, Norway. 5. Faculty of Medicine, University of Oslo, Oslo Department of Cardiology, Oslo University Hospital, Ullevål, Norway. 6. Faculty of Medicine, University of Oslo, Oslo Department of Cardiology, Oslo University Hospital, Rikshospitalet. 7. Department of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet Faculty of Medicine, University of Oslo, Oslo.
Abstract
BACKGROUND:Perfusion magnetic resonance imaging (MRI) and delayed contrast-enhanced MRI (DE-MRI) serve as tools for tissue characterization. PURPOSE: To 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 METHODS: Perfusion 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 (TTPn) 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. RESULTS:Initial 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). CONCLUSION: Perfusion 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.
RCT Entities:
BACKGROUND: Perfusion magnetic resonance imaging (MRI) and delayed contrast-enhanced MRI (DE-MRI) serve as tools for tissue characterization. PURPOSE: To 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 METHODS: Perfusion 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 (TTPn) 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. RESULTS: Initial 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). CONCLUSION: Perfusion 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.
Authors: Anne Bethke; Limalanathan Shanmuganathan; Geir Øystein Andersen; Jan Eritsland; David Swanson; Nils Einar Kløw; Pavel Hoffmann Journal: Eur Radiol Date: 2018-07-06 Impact factor: 5.315
Authors: Anne Bethke; Limalanathan Shanmuganathan; Christian Shetelig; David Swanson; Geir Øystein Andersen; Jan Eritsland; Nils Einar Kløw; Pavel Hoffmann Journal: PLoS One Date: 2018-11-09 Impact factor: 3.240