The developing role of magnetic resonance contrast media in the detection of ischemic heart disease.

Abstract

Recent developments in magnetic resonance (MR) imaging have opened up new avenues in the investigation of cardiovascular physiology. Inherent signal intensity of any tissue on MR images depends largely on proton concentration as well as longitudinal (T1) and transverse (T2) relaxation times. Myocardial contrast can be manipulated by using specific MR pulse sequences which are selectively sensitive to differences in any one of these parameters. Paramagnetic metal complexes are used as contrast media in MR imaging to enhance the inherent contrast. Contrast media in MR imaging are not directly visible but change the magnetic properties of other nuclei in close proximity, such as those of the water hydrogen. The signal of water can be altered by the contrast medium in different ways, either by changing the relaxation times or through bulb susceptibility effects, or both. The role of MR contrast media for quantitative characterization of ischemic heart disease has advanced considerably in the past 10 years. Conventional MR imaging techniques following the administration of contrast media are useful for identifying and sizing myocardial infarctions and for distinguishing between occlusive and reperfused myocardial infarctions as well as reversible (stunned) and irreversible injuries. Recent results suggest that contrast-enhanced MR imaging can also be used to identify dead cells in reperfused ischemically injured myocardium. The recently developed fast MR imaging techniques, with the aid of MR contrast media as a perfusion indicator, may be useful in estimating regional myocardial perfusion and blood volume. The assessment of capillary circulation or myocardial perfusion may be used for evaluating the extent of hypoperfusion and treatment efficacy. Experimental and clinical perfusion studies indicate that perfusion-sensitive MR imaging detects compromised myocardium (area at risk). Combining myocardial perfusion imaging with the anatomic and functional information provided by other MR imaging sequences could make MR imaging a comprehensive noninvasive technique for the evaluation of ischemic heart disease.