Analysis of First-Pass and Delayed Contrast-Enhancement Patterns of Dysfunctional Myocardium on MR Imaging

Sandstede, J.; Lipke, Claudia; Beer, Meinrad; Harre, Kerstin; Pabst, Thomas; Kenn, W.; Neubauer, Stefan; Hahn, Dietbert

doi:10.2214/ajr.174.6.1741737

Cited by 112 publications

(64 citation statements)

References 17 publications

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“…Recent clinical studies 5,6,11 suggest that normally enhanced dysfunctional myocardium can improve contractility after MI, whereas hypoenhanced myocardium remains dysfunctional. This has been demonstrated in the present study in a quantitative manner and is in agreement with pathological findings, which indicate that normally enhanced myocardium is noninfarcted, 4 whereas hypoenhanced myocardium represents necrotic tissue with microvascular damage and obstruction.…”

Section: Ce Mri For Prediction Of Segmental Functional Recoverymentioning

confidence: 99%

Accuracy of Contrast-Enhanced Magnetic Resonance Imaging in Predicting Improvement of Regional Myocardial Function in Patients After Acute Myocardial Infarction

et al. 2002

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Background-Contrast-enhanced (CE) MRI demonstrates a pattern of hypoenhancement early after contrast injection in acute myocardial infarction (MI) and a pattern of hyperenhancement late after contrast injection. Because the significance of these CE patterns for myocardial viability remains debated, we evaluated their diagnostic accuracy to quantitatively predict late functional improvement of regional contractility. Methods and Results-Twenty patients underwent CE and tagged MRI at 4 days and again at 7 months after acute MI.Resting circumferential shortening strain (Ecc) was analyzed in 24 segments per patient, and its improvement was correlated with the presence or absence of the CE patterns. Immediately after MI, 389 segments were considered dysfunctional because of having less than meanϮ2 SD Ecc of the remote region (Ϫ18Ϯ4%). At follow-up, significant improvement of Ecc occurred in 170 dysfunctional segments with normal CE (from Ϫ4Ϯ7% to Ϫ12Ϯ7%, PϽ0.001) but not in 60 segments with early hypoenhancement (from Ϫ2Ϯ6% to Ϫ6Ϯ9% Ecc, PϭNS). In 240 dysfunctional segments with delayed hyperenhancement, the improvement of Ecc (from Ϫ2Ϯ6% to Ϫ5Ϯ8%, PϽ0.001) decreased with increasing transmural extent of hyperenhancement. Receiver operating characteristic analysis demonstrated that absence of delayed hyperenhancement, compared with absence of early hypoenhancement, had better sensitivity (82% versus 19%, respectively; PϽ0.001) and accuracy (74% versus 49%, respectively; PϽ0.001) in predicting recovery of Ecc to any given level. Conclusions-Compared with lack of early hypoenhancement, lack of delayed hyperenhancement has better diagnostic accuracy in predicting functional improvement in dysfunctional segments. The early hypoenhanced regions, which represent only the fraction of infarcted tissue with concomitant microvascular obstruction, greatly underestimate the amount of irreversibly injured myocardium present after acute MI.

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Section: Ce Mri For Prediction Of Segmental Functional Recoverymentioning

confidence: 99%

Accuracy of Contrast-Enhanced Magnetic Resonance Imaging in Predicting Improvement of Regional Myocardial Function in Patients After Acute Myocardial Infarction

et al. 2002

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“…The classification techniques in the literature have typically relied on either visual inspection of images [6], which precludes quantitation, or manual delineation of the non-viable region [7,10], which can be time prohibitive. Semi-automatic segmentation techniques, based on the signal intensity characteristics of viable myocardium, have been used extensively in previous studies [8].…”

Section: Related Workmentioning

confidence: 99%

Quantification of Delayed Enhancement MR Images

Dikici

O’Donnell

Setser

et al. 2004

Medical Image Computing and Computer-Assisted Intervention – MICCAI 2004

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Abstract. Delayed Enhancement MR is an imaging technique by which nonviable (dead) myocardial tissues appear with increased signal intensity. The extent of non-viable tissue in the left ventricle (LV) of the heart is a direct indicator of patient survival rate. In this paper we propose a two-stage method for quantifying the extent of non-viable tissue. First, we segment the myocardium in the DEMR images. Then, we classify the myocardial pixels as corresponding to viable or non-viable tissue. Segmentation of the myocardium is challenging because we cannot reliably predict its intensity characteristics. Worse, it may be impossible to distinguish the infracted tissues from the ventricular blood pool. Therefore, we make use of MR Cine images acquired in the same session (in which the myocardium has a more predictable appearance) in order to create a prior model of the myocardial borders. Using image features in the DEMR images and this prior we are able to segment the myocardium consistently. In the second stage of processing, we employ a Support Vector Machine to distinguish viable from non-viable pixels based on training from an expert.

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“…Recent clinical studies 14,16,17 demonstrated that normoenhanced dysfunctional myocardium can spontaneously improve contractility after MI, whereas myocardium with early hypoenhancement remains dysfunctional. This is in agreement with pathological findings that indicated that normally enhanced myocardium is noninfarcted, 5 whereas hypoenhanced myocardium represents necrotic tissue afflicted by microvascular damage and obstruction.…”

Section: Ce Mri For Myocardial Viabilitymentioning

confidence: 99%

Relation Between Gd-DTPA Contrast Enhancement and Regional Inotropic Response in the Periphery and Center of Myocardial Infarction

Gerber

Rochitte

Bluemke³

et al. 2001

Circulation

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Background-Gd-DTPA contrast-enhanced (CE) MRI identifies patterns of early hypoenhancement and delayed hyperenhancement in acute myocardial infarction, but their clinical significance for the prediction of myocardial viability remains controversial. Therefore, we closely examined the relationship between these CE patterns and regional inotropic response to low-dose dobutamine infusion at a regional level. Methods and Results-Thirteen dogs underwent CE and tagged MRI at rest and during 5 g · kg Ϫ1 · min Ϫ1 dobutamine 48 hours after MI. CE patterns and 3D regional strains were measured in 96 segments per animal. Segments were categorized as being normofunctional (nϭ828) if resting circumferential shortening was within the range of remote myocardium, or dysfunctional (nϭ420) if not. Inotropic response in resting dysfunctional segments was assessed according to CE patterns. Significant improvement of radial thickening (from ϩ12Ϯ1% [meanϮSEM] to ϩ22Ϯ2%, PϽ0.05) and circumferential shortening (from ϩ1Ϯ1% to Ϫ5Ϯ1%, PϽ0.05) strains occurred in dysfunctional myocardium with normal CE pattern but not in myocardium with early hypoenhancement. Delayed hyperenhanced myocardium displayed a more complex behavior. Circumferential stretching improved in the peripheral regions (from ϩ4Ϯ1% to Ϫ2Ϯ2%, PϽ0.05), where the infarct was nontransmural (38Ϯ3% transmurality), but not in centrally hyperenhanced regions (from ϩ4Ϯ1% to ϩ1Ϯ1% PϭNS), where the infarct was 66Ϯ3% transmural. Conclusions-Inotropic reserve was confined to dysfunctional myocardium with normal contrast enhancement but not to myocardium with early hypoenhancement. Inotropic response in delayed hyperenhanced myocardium is influenced by transmurality of necrosis. These observations support the use of CE MRI for the clinical detection of myocardial viability.

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Analysis of First-Pass and Delayed Contrast-Enhancement Patterns of Dysfunctional Myocardium on MR Imaging

Abstract: Evidence of delayed hyperenhancement of dysfunctional myocardium may be used to predict lack of mechanical improvement or nonviability, whereas the lack of hyperenhancement can be correlated with improvement of regional contractility or viability after revascularization.

Cited by 112 publications

References 17 publications

Accuracy of Contrast-Enhanced Magnetic Resonance Imaging in Predicting Improvement of Regional Myocardial Function in Patients After Acute Myocardial Infarction

Accuracy of Contrast-Enhanced Magnetic Resonance Imaging in Predicting Improvement of Regional Myocardial Function in Patients After Acute Myocardial Infarction

Quantification of Delayed Enhancement MR Images

Relation Between Gd-DTPA Contrast Enhancement and Regional Inotropic Response in the Periphery and Center of Myocardial Infarction

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