Abstract
PurposeIn cardiac MRI (cMRI) injection of contrast medium may be performed prior to the acquisition of cine steady-state free precession (SSFP) imaging to speed up the protocol and avoid delay before late Gadolinium enhancement (LGE) imaging. Aim of this study was to evaluate whether a condensed clinical protocol with contrast cine SSFP imaging is able to detect early microvascular obstruction (MO) and determine the infarct size compared to the findings of LGE inversion recovery sequences.Materials and MethodsThe study complies with the Declaration of Helsinki and was performed following approval by the ethic committee of the University of Erlangen-Nuremberg. Written informed consent was obtained from every patient. 68 consecutive patients (14 females/54 males) with acute ST-elevation myocardial infarction (STEMI) treated by percutaneous coronary revascularization were included in this study. CMRI was performed 6.6±2 days after symptom onset and MO and infarct size in early contrast SSFP cine imaging were compared to LGE imaging.ResultsMO was detected in 47/68 (69%) patients on cine SSFP and in 41/68 (60%) patients on LGE imaging. In 6 patients MO was found on cine SSFP imaging but was not detectable on LGE imaging. Infarct size on cine SSFP showed a strong agreement to LGE imaging (intraclass correlation coefficient [ICC] of 0.96 for enddiastolic, p<0.001 and 0.96 for endsystolic, p<0.001 respectively). Significant interobserver agreement was found measuring enddiastolic and endsystolic infarct size on cine SSFP imaging (p<0.01).ConclusionsIn patients after STEMI infarct size and presence of MO can be detected with contrast cine SSFP imaging. This could be an option in patients who are limited in their ability to comply with the demands of a cMRI protocol.
Highlights
Primary percutaneous coronary intervention (PCI) is the treatment of choice in acute myocardial infarction (AMI) to recover normal blood flow by recanalisation of the occluded artery to reduce the extent of myocardial necrosis [1,2]
In 6 patients microvascular obstruction (MO) was found on cine steady-state free precession (SSFP) imaging but was not detectable on late Gadolinium enhancement (LGE) imaging
Infarct size on cine SSFP showed a strong agreement to LGE imaging
Summary
Primary percutaneous coronary intervention (PCI) is the treatment of choice in acute myocardial infarction (AMI) to recover normal blood flow by recanalisation of the occluded artery to reduce the extent of myocardial necrosis [1,2]. Because of its excellent contrast and good spatial resolution gadolinium enhanced cardiac MRI (cMRI) is considered as the reference standard for the detection and assessment of MO and infarct volume [9]. Apart from late enhancement (LGE) imaging, which is commonly used to identify MO, there are several other imaging techniques to visualize MO in the early course after contrast administration. They include first pass perfusion with single-shot saturation recovery gradient-echo pulse sequences or early enhancement imaging with 3D inversion recovery gradient-echo sequences. To shorten the study duration standard cine steady-state free precession (SSFP) MRI imaging can be obtained after injection of contrast medium without loss of accuracy for regional and global LV ventricular function [10]
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