The fractional distribution volumes of gadopentetate dimeglumine and 99mTc-DTPA are similar and indicate extracellular distribution in normal myocardium and intracellular as well as extracellular distribution in reperfused infarction. Because the failure of cells to exclude these agents is indicative of necrosis, contrast medium-enhanced MR imaging may be useful to quantify myocardial infarction.

Background-Because ischemically injured myocardium is frequently composed of viable and nonviable portions, a method to discriminate the two is useful for clinical management. Methods and Results-Ischemically injured myocardium was characterized with extracellular nonspecific (Gd-DTPA) and necrosis-specific (mesoporphyrin) MR contrast media in rats. Relaxation rates (R1) were measured on day 1 and day 2 by inversion-recovery echoplanar imaging. Spin-echo imaging was used to define contrast-enhanced regions and regional wall thickening. Gadolinium concentration, area at risk, and infarct size were measured at postmortem examination. ⌬R1 ratio (⌬R1 myocardium /⌬R1 blood ) after administration of Gd-DTPA was greater in ischemically injured myocardium (1.20Ϯ0.15) than in normal myocardium (0.47Ϯ0.05, PϽ0.05), which was attributed to differences in gadolinium concentration and water content. The Gd-DTPA-enhanced region on day 2 was larger (32.8Ϯ0.9%) than true infarction as demonstrated by triphenyltetrazolium chloride (TTC) (24.6Ϯ1.4%, PϽ0.001, rϭ0.21). Bland-Altman analysis revealed that the Gd-DTPA-enhanced region overestimated true infarct size by 7.8Ϯ5.9%. On the other hand, the mesoporphyrin-enhanced region (26.9Ϯ1.8%, PϭNS, rϭ0.87) and true infarct size were identical. The difference in the areas demarcated by the 2 agents is the peri-infarction. Systolic and diastolic MR images revealed no wall thickening in the mesoporphyrin-enhanced region (0.3Ϯ3.3%) but reduced thickening in the Gd-DTPA-enhanced rim (8.5Ϯ5.5%, PϽ0.05). Conclusions-The Gd-DTPA-enhanced region encompasses both viable and nonviable portions of the ischemically injured myocardium. The Gd-DTPA-enhanced area overestimated infarct size, but the mesoporphyrin-enhanced area matched true infarct size. The salvageable peri-infarction zone can be characterized with double-contrast-enhanced and functional MR imaging; the mismatched area of enhancement between the 2 agents shows residual wall thickening.

A non-invasive method for estimating regional myocardial contractility in vivo would be of great value in the design and evaluation of new surgical and medical strategies to treat and/or prevent infarction-induced heart failure. As a first step towards developing such a method, an explicit finite element (FE) model-based formal optimization of regional myocardial contractility in a sheep with left ventricular (LV) aneurysm was performed using tagged magnetic resonance (MR) images and cardiac catheterization pressures. From the tagged MR images, 3-dimensional (3D) myocardial strains, LV volumes and geometry for the animal-specific 3D FE model of the LV were calculated, while the LV pressures provided physiological loading conditions. Active material parameters (T max_B and T max_R ) in the non-infarcted myocardium adjacent to the aneurysm (borderzone) and in myocardium remote from the aneurysm were estimated by minimizing the errors between FE model-predicted and measured systolic strains and LV volumes using the successive response surface method for optimization. The significant depression in optimized T max_B relative to T max_R was confirmed by direct ex vivo force measurements from skinned fiber preparations. The optimized values of T max_B and T max_R were not overly sensitive to the passive material parameters specified. The computation time of less than 5 hours associated with our proposed method for estimating regional myocardial contractility in vivo makes it a potentially very useful clinical tool.

The fDV of MR contrast material in the periinfarcted rim was significantly (P <. 05) greater than that in the normal myocardium, but significantly less than that in the core of infarcted myocardium.

Good correlation and agreement with (201)Tl SPECT indicate DE MR imaging may be used to estimate infarct size 6 days after reperfused acute myocardial infarction. DE MR imaging is more sensitive for detection of inferior infarction than is (201)Tl SPECT. Patients with microvascular obstruction on FPE MR images have larger infarcts.

Infarct size 24% or more of the LV area constitutes an important threshold to predict remodeling. Patients with remodeling develop disproportionate infarct resorption.

The sizes of hyperenhanced regions displayed by using mesoporphyrin and gadopentetate dimeglumine differed from each other. The difference in size of the hyperenhanced region demarcated by mesoporphyrin and gadopentetate dimeglumine may provide an estimation of potentially salvageable myocardium.

Intramyocardially injected polymers can be used to reshape the aneurysmal left ventricle and might therefore be an approach for myocardial reconstruction and a potential option in treating chronic heart failure in human subjects.