Noninvasive Measurements of Infarct Size After Thrombolysis With a Necrosis-Avid MRI Contrast Agent

Pislaru, Sorin; Ni, Yicheng; Pislaru, Cristina; Bosmans, Hilde; Miao, Yi; Bogaert, Jan; Dymarkowski, Steven; Semmler, Willi; Marchal, Guy; Werf, Frans J. Van de

doi:10.1161/01.cir.99.5.690

Cited by 77 publications

(67 citation statements)

References 27 publications

(26 reference statements)

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“…1,2 Although the quality of these images has improved, 3 discrepant reports continue to appear in the literature concerning their physiological interpretation. 4 -10 Data from our laboratory 5,6 and others 10 suggest that hyperenhanced myocardial regions observed after administration of extracellular MRI contrast agents such as Gd-DTPA are exclusively associated with irreversible ischemic injury, whereas results from other laboratories suggest a less specific 8 or even contrary 4,7,9 interpretation. These issues must be resolved before the full potential of contrast MRI can be recognized.…”

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confidence: 99%

Myocardial Magnetic Resonance Imaging Contrast Agent Concentrations After Reversible and Irreversible Ischemic Injury

et al. 2002

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Background-Discrepant reports have been published recently regarding the relationship of contrast-enhanced magnetic resonance image intensities to reversible and irreversible ischemic injury. Unlike image intensities, contrast agent concentrations provide data independent of the MRI technique. We used electron probe x-ray microanalysis (EPXMA) to simultaneously examine concentrations of Gd, Na, P, S, Cl, K, and Ca over a range of myocardial injuries. Methods and Results-Reversible and irreversible injury were studied in 38 rabbits divided into 4 groups defined by occlusion and reperfusion time, as well as time the animals were euthanized. Gd-DTPA was administered, and the hearts were excised and rapidly frozen, cryosectioned, freeze-dried, and examined by EPXMA in up to 3 regions: remote, infarcted, and at risk but not infarcted. Infarcted regions were defined by anti-myoglobin antibody or triphenyltetrazolium chloride staining. Regions at risk were defined by fluorescent microparticles administered during occlusion. Compared with remote regions, in acutely infarcted regions, Gd was increased (235Ϯ24%, PϽ0.005) in the same 50ϫ100-m areas in which Na was increased (154Ϯ5%, PϽ0.001) and K was decreased (52Ϯ8%, PϽ0.001).Similarly, in chronically infarcted regions, Gd was increased (472Ϯ78%, PϽ0.001) in areas in which Na was increased (332Ϯ28%, PϽ0.001) and K was decreased (47Ϯ5%, PϽ0.001). Also compared with remote regions, however, concentrations of Gd, Na, and K were not elevated after reperfusion in regions that were at risk but not infarcted (PϭNS). Conclusions-Regional

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confidence: 99%

Myocardial Magnetic Resonance Imaging Contrast Agent Concentrations After Reversible and Irreversible Ischemic Injury

et al. 2002

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“…Mesoporphyrin provides accurate sizing of occlusive and reperfused infarctions. [17][18][19] The purpose of this study was (1) to characterize the peri-infarction zone in moderately injured myocardium by use of the combination of Gd-DTPA and mesoporphyrin MR contrast media and (2) to determine the function (wall thickening) of regions enhanced by Gd-DTPA and mesoporphyrin. The major hypothesis of this study is that the difference in the areas demarcated by the 2 agents is the salvageable border zone with reduced but residual contractile function.…”

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Magnetic Resonance Characterization of the Peri-Infarction Zone of Reperfused Myocardial Infarction With Necrosis-Specific and Extracellular Nonspecific Contrast Media

et al. 2001

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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.

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“…Therefore, extracellular contrast media may overestimate IS (12,13). On the other hand, it has been shown that the necrosis-specific MR contrast agent Gd-mesoporphyrin delineates only necrotic tissue and provides accurate measurement of IS (12)(13)(14)(15). This technique is less dependent on imaging time after Gd-mesoporphyrin injection due to persistent (24 hour) enhancement of acutely infarcted myocardium (13).…”

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The potential of contrast‐enhanced magnetic resonance imaging for predicting left ventricular remodeling

Watzinger

Lund

Higgins

et al. 2002

Magnetic Resonance Imaging

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Purpose: To determine whether the myocardial injury size on day 2 measured after gadolinium (Gd)-mesoporphyrin and Gd-diethylenetriamine-pentaacetic acid (DTPA) administration can be used for predicting left ventricular (LV) remodeling 8 weeks later, and to monitor the structural and functional changes in the infarct, peri-infarct rim, and remote myocardium in reperfused infarction using contrast-enhanced and functional magnetic resonance imaging (MRI). Materials and Methods:Myocardial infarction (MI) was induced in 27 rats by 1 hour of coronary occlusion/reperfusion. Rats were imaged 2 days and 8 weeks after MI using MRI to determine LV function and size of myocardial injury. All animals received 0.05 mmol/kg Gd-mesoporphyrin 12 hours before the first MRI. A subgroup of 13 rats received 0.3 mmol/kg Gd-DTPA in addition to Gd-mesoporphyrin, and seven rats received 0.05 mmol/kg Gd-mesoporphyrin 12 hours before the second MRI for detection of healed MI. True infarct size (IS) and LV mass were measured postmortem. LV volumes, mass, function, and wall thickness were determined in both imaging sessions.Results: A close correlation was found between contrastenhanced MRI and postmortem measurements for IS (r ϭ 0.94, P Ͻ 0.001 for Gd-mesoporphyrin; r ϭ 0.91, P Ͻ 0.001, N ϭ 13 for Gd-DTPA). IS measured on Gd-mesoporphyrinenhanced images correlated well with end-systolic LV volumes (r ϭ 0.68, P Ͻ 0.001) and ejection fraction (r ϭ Ϫ0.75, P Ͻ 0.001) 8 weeks after MI. Similar correlation with parameters of LV remodeling were found on Gd-DTPA-enhanced MRI. Healed infarcts showed no enhancement on Gd-mesoporphyrin-enhanced MRI. Conclusion:Contrast-enhanced MRI can be used as a noninvasive method for determining the initial size of myocardial injury and predicting later LV remodeling. MRI demonstrates the structural and functional changes in infarct, peri-infarct rim, and remote non-infarcted myocardium. The complementary use of functional and contrast-enhanced MRI may provide reliable assessment of therapeutic interventions to reduce IS and LV remodeling.

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Noninvasive Measurements of Infarct Size After Thrombolysis With a Necrosis-Avid MRI Contrast Agent

Cited by 77 publications

References 27 publications

Myocardial Magnetic Resonance Imaging Contrast Agent Concentrations After Reversible and Irreversible Ischemic Injury

Myocardial Magnetic Resonance Imaging Contrast Agent Concentrations After Reversible and Irreversible Ischemic Injury

Magnetic Resonance Characterization of the Peri-Infarction Zone of Reperfused Myocardial Infarction With Necrosis-Specific and Extracellular Nonspecific Contrast Media

The potential of contrast‐enhanced magnetic resonance imaging for predicting left ventricular remodeling

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