Vergleich der ödemsensitiven HASTE-TIRM-Sequenz mit der späten Kontrastmittelanreicherung bei akutem Myokardinfarkt

Zusammenfassung

Ziel: Vergleich der flüssigkeitssensitiven HASTE-TIRM-Sequenz mit der späten Kontrastmittel (KM)-Anreicherung in der MRT bei Patienten mit akutem Myokardinfarkt (AMI). Material und Methoden: 32 Patienten mit AMI wurden 7 ± 4 Tage post Infarkt mittels T₂-HASTE-TIRM und einer kontrastmittelverstärkten T₁- turbo-FLASH bei 1,5 Tesla untersucht. Mit der Schwellenwert-Methode (> 2 SD im Vergleich zu normalem Myokard) wurden die hyperintensen Areale in beiden Sequenzen vermessen sowie die Transmuralität auf segmentaler Ebene bestimmt. Ergebnisse: Die hyperintensen Flächen in der HASTE-TIRM (29,6 ± 13,2 % der linksventrikulären (LV)-Fläche) waren größer als die in der KM-MRT (19,2 ± 10 % der LV-Fläche; p < 0,0001). Die transmurale Ausdehnung der hyperintensen Regionen wurde in der HASTE-TIRM deutlich höher bemessen als in der KM-MRT (p < 0,0001). Während die KM-MRT mit dem maximalen Creatinkinasewert (CK max.) korrelierte (r = 0,59, p < 0,001), besteht keine Korrelation zwischen HASTE-TIRM und CK max. (r = 0,29, p = ns). Schlussfolgerungen: Mit der HASTE-TIRM kann zusätzlich zum avitalen Areal das periinfarzielle Ödem dargestellt werden. Die HASTE-TIRM zeigt eine größere Transmuralität der Infarkte im Vergleich zur KM-MRT an. Die zusätzlich mit der HATSE-TIRM dargestellte Fläche könnte funktionell gestörtes aber vitales Myokard darstellen.

Abstract

Goal: Comparison between a fluid-sensitive (HASTE-TIRM)-sequence and delayed contrast-enhancement in patients with acute myocardial infarct (AMI) in MRI. Material and Methods: 32 patients with AMI were imaged 7 ± 4 days after the time of infarction with a 1.5 T unit using a T₂ HASTE-TIRM and a contrast-enhanced (CE) T₁ turbo FLASH sequence. A threshold method (>2 SD in comparison with normal myocardium) was used to quantify the hyperintense zones in both sequences. The transmurality of the hyperintense regions was measured on a segmental basis. Results: The hyperintense areas were larger on the HASTE-TIRM sequence with 29.6 ± 13.2 % of the left ventricular (LV) area as compared to the CE-MRI with 19.2 ± 10 % of the LV area (p < 0.0001). The measured transmurality was higher with the HASTE-TIRM sequence than with the CE-MRI (p < 0.0001). While the correlation between CE-MRI and peak creatine kinase (CK max) was good (r = 0.59, p < 0.001), no correlation was found between the HASTE-TIRM sequence and CK max (r = 0.29, p = ns). Conclusions: The peri-infarct edema can be depicted with a HASTE-TIRM sequence in addition to the non-viable infarct zone. The HASTE-TIRM sequence shows a higher transmurality of the hyperintense regions than the CE-MRI. The additional area depicted by the HASTE-TIRM sequence could represent functionally impaired but viable myocardium).

Schlüsselwörter

MRT - Myokardinfarkt - Kontrastmittel - Ödem - HASTE-TIRM

Key words

MRI - myocardial infarct - contrast media - edema - HASTE-TIRM

Literatur

• 1 Krombach G A, Higgins C B, Günther R W, Kuhne T, Saeed M. MR contrast media for cardiovascular imaging.  Fortschr Röntgenstr. 2002;  174 (7) 819-829
• 2 van Dijkmann P R, van der Wall E E, de Roos A, Matheijssen N A, van Rossum A C, Doornbos J, van der Laarse A, van Voorthuisen A E, Bruschke A V. Acute, subacute, and chronic myocardial infarction: quantitative analysis of gadolinium-enhanced MR images.  Radiology. 1991;  180 (1) 147-151
• 3 Lima J A, Judd R M, Bazille A, Schulman S P, Atalar E, Zerhouni E A. Regional heterogeneity of human myocardial infarcts demonstrated by contrast-enhanced MRI. Potential mechanisms.  Circulation. 1995;  92 (5) 1117-1125
• 4 Rogers W J, Kramer C M, Geskin G, Hu Y L, Theobald T M, Vido D A, Petruolo S, Reichek N. Early contrast-enhanced MRI predicts late functional recovery after reperfused myocardial infarction.  Circulation. 1999;  99 (6) 744-750
• 5 Choi K M, Kim R J, Gubernikoff G, Vargas J D, Parker M, Judd R M. Transmural extent of acute myocardial infarction predicts long-term improvement in contractile function.  Circulation. 2001;  104 (10) 1101-1107
• 6 Wu C K, Zerhouni E A, Judd R M, Lugo-Olivieri C H, Barouch L A, Schulman S P, Blumenthal R S, Lima J A. Prognostic significance of microvascular obstruction by magnetic resonance imaging in patients with acute myocardial infarction.  Circulation. 1998;  97 (8) 765-772
• 7 Kim R J, Fieno D S, Parrish T B, Harris K, Chen E L, Simonetti O, Bundy J, Finn J P, Klocke F J, Judd R M. Relationship of MRI delayed contrast enhancement to irreversible injury, infarct age, and contractile function.  Circulation. 1999;  100 (19) 1992-2002
• 8 Gerber B L, Rochitte C E, Bluemke D A, Melin J A, Crosille P, Becker L C, Lima J A. Relation between Gd-DTPA contrast enhancement and regional inotropic response in the periphery and center of myocardial infarction.  Circulation. 2001;  104 (9) 998-1004
• 9 Saeed M, Lund G, Wendland M F, Bremerich J, Weinmann H, Higgins C B. magnetic resonance characterization of the peri-infarction zone of reperfused myocardial infarction with necrosis-specific and extracellular nonspecific contrast media.  Circulation. 2001;  103 (6) 871-876
• 10 Oshinski J N, Yang Z, Jones J R, Mata J F, French B A. Imaging time after Gd-DTPA injection is critical in using delayed enhancement to determine infarct size accurately with magnetic resonance imaging.  Circulation. 2001;  104 (23) 2838-2848
• 11 Rehwald W G, Fieno D S, Chen E L, Kim R J, Judd R M. Myocardial magnetic resonance imaging contrast agent concentrations after reversible and irreversible ischemic injury.  Circulation. 2002;  105 (2) 224-229
• 12 Hillenbrand H B, Kim R J, Parker M A, Fieno D S, Judd R M. Early assessment of myocardial salvage by contrast-enhanced magnetic resonance imaging.  Circulation. 2000;  102 (14) 1678-1683
• 13 Judd R M, Lugo-Olivieri C H, Arai M, Kondo T, Croisille P, Lima J A, Mohan V, Becker L C, Zerhouni E A. Physiological basis of myocardial contrast enhancement in fast magnetic resonance images of 2-day-old reperfused canine infarcts.  Circulation. 1995;  92 (7) 1902-1910
• 14 Kim R J, Chen E L, Lima J A, Judd R M. Myocardial Gd-DTPA kinetics determine MRI contrast enhancement and reflect the extent and severity of myocardial injury after acute reperfused infarction.  Circulation. 1996;  93 (12) 3318-3326
• 15 Jennings R B, Schaper J, Hill M L, Steenbergen C, Reimer K A. Effect of reperfusion late in the phase of reversible ischemic injury. Changes in cell volume, electrolytes, metabolites, and ultrastructure.  Circ Res. 1985;  56 (2) 262-278
• 16 Weitbrecht M, Schaper J, Zanker K, Blumel G, Mathes P. Morphology and mitochondrial function of the surviving myocardium following myocardial infarction in the cat.  Basic Res Cardiol. 1983;  78 (4) 423-434
• 17 Pislaru S V, Ni Y, Pislaru C, Bosmans H, Miao Y, Bogaert J, Dymarkowski S, Semmler W, Marchal G, Van de Werf F J. Noninvasive measurements of infarct size after thrombolysis with a necrosis-avid MRI contrast agent.  Circulation. 1999;  99 (5) 690-696
• 18 Bouchard A, Reeves R C, Cranney G, Bishop S P, Pohost G M. Assessment of myocardial infarct size by means of T₂-weighted 1H nuclear magnetic resonance imaging.  Am Heart J. 1989;  117 (2) 281-289
• 19 Dymarkowski S, Ni Y, Miao Y, Bogaert J, Rademakers F, Bosmans H, Marchal G. Value of T₂-weighted magnetic resonance imaging early after myocardial infarction in dogs: comparison with bis-gadolinium-mesoporphyrin enhanced T₁-weighted magnetic resonance imaging and functional data from cine magnetic resonance imaging.  Invest Radiol. 2002;  37 (2) 77-85
• 20 Smart S C, Sawada S, Ryan T, Segar D, Atherton L, Berkovitz K, Bourdillon P D, Feigenbaum H. Low-dose dobutamine echocardiography detects reversible dysfunction after thrombolytic therapy of acute myocardial infarction.  Circulation. 1993;  88 (2) 405-415
• 21 Gerber B L, Garot J, Bluemke D A, Wu K C, Lima J A. Accuracy of contrast-enhanced magnetic resonance imaging in predicting improvement of regional myocardial function in patients after acute myocardial infarction.  Circulation. 2002;  106 (9) 1083-1089
• 22 Whalen D A, Hamilton D G, Ganote C E, Jennings R B. Effect of a transient period of ischemia on myocardial cells. I. Effects on cell volume regulation.  Am J Pathol. 1974;  74 (3) 381-397
• 23 Fletcher J W, Rao P S, Witztum K F, Hamilton W P, Donati R M, Mueller H S. Clinical estimation of infarct size by 201thallium perfusion scintigraphy and by creatine kinase-KB in early myocardial infarction.  Clin Cardiol. 1980;  3 (2) 111-115
• 24 Norris R M, Whitlock R M, Barratt-Boyes C, Small C W. Clinical measurement of myocardial infarct size. Modification of a method for the estimation of total creatine phosphokinase release after myocardial infarction.  Circulation. 1975;  51 (4) 614-620