Reperfusion Hemorrhage Following Acute Myocardial Infarction: Assessment with T2* Mapping and Effect on Measuring the Area at Risk

O’Regan, Declan P; Ahmed, Rizwan; Karunanithy, Narayan; Neuwirth, Clare; Tan, Yvonne; Durighel, Giuliana; Hajnal, Joseph V.; Nadra, Imad; Corbett, Simon; Cook, Stuart A.

doi:10.1148/radiol.2503081154

Cited by 96 publications

(83 citation statements)

References 35 publications

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“…On the basis of patient and proof-of-concept animal studies, we showed that acute reperfusion myocardial hemorrhage is better characterized with T2*-based cardiac MR imaging than it is with T2-based cardiac MR imaging. This observation is consistent with previous reports, which have suggested that hemorrhage and edema have counteracting influences on T2 (and T2-weighted) images (16,30,32). It is expected that our findings here can be instrumental in furthering our understanding of the role of reperfusion hemorrhage in patients.…”

Section: Cardiac Imaging: Acute Reperfusion Myocardial Hemorrhagesupporting

confidence: 93%

Detection of Acute Reperfusion Myocardial Hemorrhage with Cardiac MR Imaging: T2 versus T2*

Kali¹,

Tang

Kumar³

et al. 2013

Radiology

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Purpose:To evaluate T2 and T2* changes in acute reperfused hemorrhagic and nonhemorrhagic myocardial infarctions and to determine which technique is more suitable in the detection of intramyocardial hemorrhage at 1.5 T. Materials and Methods:Patient studies were approved by the institutional review board and were HIPAA compliant. Patients (n = 14, three women) with first ST-elevation myocardial infarction underwent cardiac magnetic resonance (MR) imaging 3 days after angioplasty. T2* maps, T2 short inversion time inversion-recovery (STIR) images, and late gadolinium enhancement (LGE) images were acquired. Animal studies were approved by the institutional animal care and use committee. Canines (n = 20) were subjected to ischemia-reperfusion injury, and cardiac MR imaging was performed 5 days after reperfusion. T2* and T2 maps and T2 STIR and LGE images were acquired. Repeated-measures analysis of variance or the Friedman test was used to compare T2 and T2* changes in patients with hemorrhagic infarctions and those with nonhemorrhagic infarctions. Results:Relative to remote myocardium, mean T2* of hemorrhagic infarctions was 54% 6 13 (standard deviation) lower in patients (15.9 msec 6 4.5 vs 35.2 msec 6 2.1, P , .001) and 40% 6 10 lower in canines (23.0 msec 6 4.0 vs 39.3 msec 6 2.5, P , .001). Mean T2* of nonhemorrhagic infarctions was marginally elevated by 6% 6 2.5 (37.8 msec 6 2.5, P = .021) in patients and by 8% 6 5 (44.6 msec 6 4.8, P = .012) in canines. In contrast, mean T2 STIR signal intensity (SI) of both hemorrhagic infarctions and nonhemorrhagic infarctions was higher than that in remote myocardium both in patients (hemorrhagic: 37% 6 19, P , .001; nonhemorrhagic: 78% 6 27, P , .001) and in canines (hemorrhagic: 42% 6 22, P , .001; nonhemorrhagic: 65% 6 22, P , .001). Consistent with STIR SI findings, mean T2 of both hemorrhagic (62.0 msec 6 4.9) and nonhemorrhagic (71.7 msec 6 7.3) infarctions in canines was elevated relative to mean T2 of remote myocardium (52.1 msec 6 4.8) by 18% 6 9 and 38% 6 13, respectively (P , .001 for both). Conclusion

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Section: Cardiac Imaging: Acute Reperfusion Myocardial Hemorrhagesupporting

confidence: 93%

Detection of Acute Reperfusion Myocardial Hemorrhage with Cardiac MR Imaging: T2 versus T2*

Kali¹,

Tang

Kumar³

et al. 2013

Radiology

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“…[15][16][17][18] Although histological proof of the specificity of hypointense cores for IMH is still awaited, hypointense core regions of infarcted myocardium in T2-weighted and T2*-weighted CMR have been associated with hemorrhagic infarcts, because breakdown products of hemoglobin have paramagnetic effects and thereby shorten T2-relaxation times. [7][8][9][10][11]13,14,19,20 Thus, CMR might be a powerful tool to assess the occurrence and extent of reperfusion injury in humans and to determine its relation to the AAR, salvaged myocardium, infarct size, and MO.…”

Section: Clinical Perspective On P 362mentioning

confidence: 99%

“…11 The technique of T2* imaging has been validated histopathologically in animal and ex vivo studies as an effective method for quantifying reperfusion hemorrhage as well as myocardial iron overload and has been successfully applied in humans. 11,14,28 -31 Advantages of T2*-CMR include its more sensitive detection of the susceptibility effects of IMH than spin-echo imaging.…”

Section: Hypointense Infarct Core In T2-weighted Cmrmentioning

confidence: 99%

Prognostic Value and Determinants of a Hypointense Infarct Core in T2-Weighted Cardiac Magnetic Resonance in Acute Reperfused ST-Elevation–Myocardial Infarction

Eitel

Kubusch

Strohm

et al. 2011

Circ: Cardiovascular Imaging

181

146

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Background-A hypointense core of infarcted myocardium in T2-weighted cardiovascular MRI (CMR) has been used as a noninvasive marker for intramyocardial hemorrhage. However, the clinical significance of such findings not yet been established. The aim of this study was to evaluate determinants and prognostic impact of a hypointense infarct core in T2-weighted CMR images, studied in patients after acute, reperfused ST-elevation-myocardial infarction. Methods and Results-We analyzed 346 patients with ST-elevation-myocardial infarction undergoing primary angioplasty Ͻ12 hours after symptoms onset. T2-weighted, contrast-enhanced CMR was used for assessment of the area at risk, myocardial salvage, infarct size, hypointense core in T2-weighted images, and late microvascular obstruction. Patients were categorized into 2 groups defined by the presence or absence of a hypointense core. The primary end point of the study was occurrence of major adverse cardiovascular events defined as death, reinfarction, and congestive heart failure within 6 months after infarction. A hypointense core was present in 122 (35%) patients and was associated with larger infarcts, greater amount of microvascular obstruction, less myocardial salvage, and impaired left ventricular function (PϽ0.001, respectively). The presence of a hypointense core was a strong univariable predictor of major adverse cardiovascular events (hazard ratio, 2.59; confidence interval, 1.27 to 5.27) and was significantly associated with an increased major adverse cardiovascular events rate (16.4% versus 7.0%, Pϭ0.006) 6 months after infarction. Conclusions-

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“…T2* CMR has been shown to identify myocardial hemorrhage in acute infarction. 58 Early gadolinium enhancement is also superior to echocardiography for the identification of ventricular thrombi, which appear as dark filling defects on the endocardial surface of enhanced infarcts. 59 Myocardial fiber microstructure remodeling after infarction can also be studied with diffusion tensor tractography.…”

Section: Myocardial Infarctionmentioning

confidence: 99%

Cardiovascular Magnetic Resonance

2010

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Reperfusion Hemorrhage Following Acute Myocardial Infarction: Assessment with T2* Mapping and Effect on Measuring the Area at Risk

Cited by 96 publications

References 35 publications

Detection of Acute Reperfusion Myocardial Hemorrhage with Cardiac MR Imaging: T2 versus T2*

Detection of Acute Reperfusion Myocardial Hemorrhage with Cardiac MR Imaging: T2 versus T2*

Prognostic Value and Determinants of a Hypointense Infarct Core in T2-Weighted Cardiac Magnetic Resonance in Acute Reperfused ST-Elevation–Myocardial Infarction

Cardiovascular Magnetic Resonance

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