Assessment of intramyocardial hemorrhage by T1-weighted cardiovascular magnetic resonance in reperfused acute myocardial infarction

Abstract

BackgroundIntramyocardialhemorrhage (IMH) reflects severe reperfusion injury in acute myocardial infarction. Non-invasive detection of IMH by cardiovascular magnetic resonance (CMR) may serve as a surrogate marker to evaluate the effect of preventive measures to reduce reperfusion injury and hence provide additional prognostic information. We sought to investigate whether IMH could be detected by CMR exploiting the T1 shortening effect of methemoglobin in an experimental model of acute myocardial infarction. The results were compared to T2-weighthed short tau inversion recovery (T2-STIR), and T2*-weighted(T2*W) sequences.Methods and resultsIMH was induced in ten 40 kg pigs by 50-min balloon occlusion of the mid LAD followed by reperfusion. Between 4–9 days (average 4.8) post-injury, the left ventricular myocardium was assessed by T1-weigthed Inversion Recovery(T1W-IR), T2-STIR, and T2*Wsequences. All CMR images were matched to histopathology and compared with the area of IMH. The difference between the size of the IMH area detected on T1W-IR images and pathology was −1.6 ± 11.3% (limits of agreement, -24%–21%), for the T2*W images the difference was −0.1 ± 18.3% (limitsof agreement, -36.8%–36.6%), and for T2-STIR the difference was 8.0 ± 15.5% (limits of agreement, -23%–39%). By T1W IR the diagnostic sensitivity of IMH was 90% and specificity 70%, for T2*W imaging the sensitivity was 70% and specificity 50%, and for T2-STIR sensitivity for imaging IMH was 50% and specificity 60%.ConclusionT1-weigthednon-contrast enhanced CMR detects IMH with high sensitivity and specificity and may become a diagnostic tool for detection of IMH in patients with myocardial infarction.

Contrast-enhanced Steady-state Free Precession in the Assessment of Hypertrophic Obstructive Cardiomyopathy after Alcohol Septal Ablation

“…This might be explained by the T 1 -shortening effect of some hemoglobin contents or by partial volume effect. 23 On ceSSFP imaging, MVO was hypointense to remote myocardium, possibly because of the severe hypoperfusion and coagulation of MVO. [11][12][13][14] The measurement of the signal ratio on LGE or ceSSFP imaging could be useful for differentiating between MVO and the area not successfully ablated.…”

Dimethyl Sulfoxide Reduces Microvascular Obstruction and Intramyocardial Hemorrhagein a Porcine Ischemia-Reperfusion Model

“…This time point was chosen since CMR detection of myocardial salvage is considered optimal at one week after AMI. 19,30 The choice of time point is transferable to the clinical setting of CMR evaluation of patients with AMI.…”

“…19 The sequence was navigator-gated, free-breathing and cardiac-triggered. The following imaging parameters were used: TR 3.5 ms, TE 1.13 ms, flip angle 30º, spatial resolution 1 mm × 1 mm in-plane, slice thickness 8 mm (over contiguous slices), FOV 320 mm × 320 mm and 14 slices.…”

“…[16][17][18] We hypothesised that reperfusion with DMSO following myocardial ischemia may diminish ischemia-reperfusion injury and reduce or even prevent the development of MVO and IMH. We tested this hypothesis in a porcine myocardial ischaemia-reperfusion model 19 using gross pathology and Cardiovascular Magnetic Resonance (CMR) imaging for validation.…”

Correlation of Electrocardiogram and Regional Cardiac Magnetic Resonance Imaging Findings in ST‐Elevation Myocardial Infarction: A Literature Review

“…46 T1 measures permit noninvasive detection of biologically and pathologically important processes related to excess water in edema, protein deposition, and other T1 altering substances such as lipid or iron in hemorrhage. [46][47][48][49][50] The ECV technique is sensitive to the distribution of the LV myocardium into its cellular and extracellular interstitial compartments. 47 Alterations in these compartments occurring from different physiologic and pathophysiologic biologic processes leading to fibrotic changes can be more easily detected with ECV than with LGE.…”