Determination of location, size, and transmurality of chronic myocardial infarction without exogenous contrast media by using cardiac magnetic resonance imaging at 3 T.
Determination of location, size, and transmurality of chronic myocardial infarction without exogenous contrast media by using cardiac magnetic resonance imaging at 3 T.
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DOI：
10.1161/circimaging.113.001541
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发表时间：
2014-05
期刊：
影响因子：
--
通讯作者：
Dharmakumar R
中科院分区：
文献类型：
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作者：
Kali A;Cokic I;Tang RL;Yang HJ;Sharif B;Marbán E;Li D;Berman DS;Dharmakumar R
LGE CMR是诊断MI的有效方法，但由于终末期慢性肾脏疾病，估计有近20%的MI患者禁忌输注必要的Gd。本研究的目的是探讨在3T不加造影剂的情况下，T1期心血管磁共振成像(CMR)是否可以替代晚期Gd增强(LGE)的CMR，用于在犬MI模型上确定慢性心肌梗死(MIS)的特征。29只犬分别于心肌梗死后7d(急性心肌梗死)和4个月(慢性心肌梗死)行CMR检查。比较1.5T和3T自然T1图和LGE图像测量的梗塞部位、范围和透壁性。T2MAP检测急性心肌梗死和脑梗塞患者的脑水肿消退情况。在3T时，T1图相对于LGE图像高估了急性心肌梗死的梗塞范围和跨壁性(p=0.016和p=0.007)，而cmI则不能观察到这种情况。T1图在1.5T时，相对于急性心肌梗死和心肌梗死(P<；0.001)的LGE图像，低估了梗死范围和跨壁性。心肌梗死组和急性心肌梗死组梗死心肌的T1较远端增加(p<；0.001)，而心肌梗死组的T2增加(p<；0.20)，而心肌梗死组(p>；0.20)无明显变化。组织学显示CMI区域内广泛的替代性纤维化。3T时T1CMR检测CMI的敏感性为95%，特异性为97%。3T自然T1图可确定CMI的位置、大小和透过性，具有较高的诊断准确性。患者研究对于临床翻译是必要的。
LGE CMR is a powerful method for characterizing MI, but the requisite gadolinium infusion is estimated to be contraindicated in nearly 20% of MI patients due to end-stage chronic kidney disease. The purpose of this study is to investigate whether T1 Cardiovascular-Magnetic-Resonance Imaging (CMR) obtained without contrast agents at 3T could be an alternative to Late-Gadolinium-Enhanced (LGE) CMR for characterizing chronic myocardial infarctions (MIs) using a canine model of MI. Canines (n=29) underwent CMR at 7 days (acute, AMI) and 4 months (chronic, CMI) post-MI. Infarct location, size and transmurality measured using native T1 maps and LGE images at 1.5T and 3T were compared. Resolution of edema between AMI and CMI was examined with T2 maps. T1 maps overestimated infarct size and transmurality relative to LGE images in AMI (p=0.016 and p=0.007, respectively), which was not observed in CMI (p=0.49 and p=0.81, respectively), at 3T. T1 maps underestimated infarct size and transmurality relative to LGE images in AMI and CMI (p<0.001), at 1.5T. Relative to the remote territories, T1 of the infarcted myocardium was increased in CMI and AMI (p<0.05); and T2 of the infarcted myocardium was increased in AMI (p<0.001), but not in CMI (p >0.20) at both field strengths. Histology showed extensive replacement fibrosis within the CMI territories. CMI detection sensitivity and specificity of T1 CMR at 3T were 95% and 97%, respectively. Native T1 maps at 3T can determine the location, size and transmurality of CMI with high diagnostic accuracy. Patient studies are necessary for clinical translation.