Abstract
PurposeX-ray coronary angiography (XCA) is the current gold standard for the assessment of lumen encroaching coronary stenosis but XCA does not allow for early detection of rupture-prone vulnerable plaques, which are thought to be the precursor lesions of most acute myocardial infarctions (AMI) and sudden death. The aim of this study was to investigate the potential of delayed contrast-enhanced magnetic resonance coronary vessel wall imaging (CE-MRCVI) for the detection of culprit lesions in the coronary arteries.Methods16 patients (13 male, age 61.9±8.6 years) presenting with sub-acute MI underwent CE-MRCVI within 24-72h prior to invasive XCA. CE-MRCVI was performed using a T1-weighted 3D gradient echo inversion recovery sequence (3D IR TFE) 40±4 minutes following the administration of 0.2 mmol/kg gadolinium-diethylenetriamine-pentaacetic acid (DTPA) on a 3T MRI scanner equipped with a 32-channel cardiac coil.Results14 patients were found to have culprit lesions (7x LAD, 1xLCX, 6xRCA) as identified by XCA. Quantitative CE-MRCVI correctly identified the culprit lesion location with a sensitivity of 79% and excluded culprit lesion formation with a specificity of 99%. The contrast to noise ratio (CNR) of culprit lesions (9.7±4.1) significantly exceeded CNR values of segments without culprit lesions (2.9±1.9, p<0.001).ConclusionCE-MRCVI allows the selective visualization of culprit lesions in patients immediately after myocardial infarction (MI). The pronounced contrast uptake in ruptured plaques may represent a surrogate biomarker of plaque activity and/or vulnerability.
Highlights
Despite improvements in prevention, diagnosis and treatment, cardiovascular disease remains the leading cause of morbidity and mortality in Western industrialized nations and in developing countries
Contrast enhanced (CE)-MRCVI was performed using a T1-weighted 3D gradient echo inversion recovery sequence (3D IR T2prep fast GRE (TFE)) 40±4 minutes following the administration of 0.2 mmol/kg gadolinium-diethylenetriamine-pentaacetic acid (DTPA) on a 3T magnetic resonance imaging (MRI) scanner equipped with a 32-channel cardiac coil
CE-MRCVI allows the selective visualization of culprit lesions in patients immediately after myocardial infarction (MI)
Summary
Diagnosis and treatment, cardiovascular disease remains the leading cause of morbidity and mortality in Western industrialized nations and in developing countries. Whereas atherosclerosis alone is rarely fatal, sudden luminal thrombosis, superimposed on a ruptured or eroded atherosclerotic plaque, precipitates life threatening clinical events such as acute coronary syndromes and stroke [1,2,3]. Plaques thought to cause luminal thrombosis are referred to as vulnerable plaques These types of plaques in most cases are so-called thin-cap fibroatheromas (TCFA). Various clinical studies using conventional invasive coronary angiography, intra-vascular ultrasound (IVUS), and cardiac computed tomography[5,6,7] have confirmed a strong relationship between atherosclerotic disease burden and risk for adverse events, there is no conclusive evidence that individual plaque assessment improves the prediction of acute coronary event risk compared to established risk factors, such as the extent and severity of coronary artery disease [8,9]
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