Mechanisms for overestimating acute myocardial infarct size with gadolinium-enhanced cardiovascular magnetic resonance imaging in humans: A quantitative and kinetic study

Sophia Hammer-Hansen, W. Patricia Bandettini, Li Yueh Hsu, Steve W. Leung, Sujata Shanbhag, Christine Mancini, Anders M. Greve, Lars Køber, Jens Jakob Thune, Peter Kellman, Andrew E. Arai

Research output: Contribution to journalArticlepeer-review

30 Scopus citations

Abstract

Aims It remains controversial whether cardiovascular magnetic resonance imaging with gadolinium only enhances acutely infarcted or also salvaged myocardium. We hypothesized that enhancement of salvaged myocardium may be due to altered extracellular volume (ECV) and contrast kinetics compared with normal and infarcted myocardium. If so, these mechanisms could contribute to overestimation of acute myocardial infarction (AMI) size. Methods and results Imagingwas performed at 1.5T ≤7 days after AMI with serial T1 mapping and volumetric early (5 min post-contrast) and late (20 min post-contrast) gadolinium enhancement imaging. Infarcts were classified as transmural (.75% transmural extent) or non-transmural. Patients with non-transmural infarctions (n = 15) had shorter duration of symptoms before reperfusion (P = 0.02), lower peak troponin (P = 0.008), and less microvascular obstruction (P, 0.001) than patients with transmural infarcts (n = 22). The size of enhancement at 5 min was greater than at 20 min (18.7±12.7 vs. 12.1±7.0%, P = 0.003) in non-transmural infarctions, but similar in transmural infarctions (23.0±10.0 vs. 21.9±9.9%, P = 0.21). ECV of salvaged myocardium was greater than normal (39.5±5.8 vs. 24.1±3.1%) but less than infarcted myocardium (50.5±6.0%, both P ≤ 0.001). In kinetic studies of non-transmural infarctions, salvaged and infarcted myocardium had similar T1 at 4 min but different T1 at 8.20 min post-contrast. Conclusion Theextent of gadolinium enhancement inAMIis modulated byECVand contrast kinetics. Image acquisition too early after contrast administration resulted in overestimation of infarct size in non-transmural infarctions due to enhancement of salvaged myocardium.

Original languageEnglish
Pages (from-to)76-84
Number of pages9
JournalEuropean Heart Journal Cardiovascular Imaging
Volume17
Issue number1
DOIs
StatePublished - 2016

Bibliographical note

Publisher Copyright:
© 2015 The Author.

Keywords

  • Acute myocardial infarction
  • Cardiovascular magnetic resonance imaging
  • Extracellular volume
  • Gadolinium enhancement
  • Gadolinium kinetics

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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