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Performance of delayed-enhancement magnetic resonance imaging with gadoversetamide contrast for the detection and assessment of myocardial infarction: an international, multicenter, double-blinded, randomized trial.

AbstractBACKGROUND:
The identification and assessment of myocardial infarction (MI) are important for therapeutic and prognostic purposes, yet current recommended diagnostic strategies have significant limitations. We prospectively tested the performance of delayed-enhancement magnetic resonance imaging (MRI) with gadolinium-based contrast for the detection of MI in an international, multicenter trial.
METHODS AND RESULTS:
Patients with their first MI were enrolled in an acute (< or = 16 days after MI; n=282) or chronic (17 days to 6 months; n=284) arm and then randomized to 1 of 4 doses of gadoversetamide: 0.05, 0.1, 0.2, or 0.3 mmol/kg. Standard delayed-enhancement MRI was performed before contrast (control) and 10 and 30 minutes after gadoversetamide. For blinded analysis, precontrast and postcontrast MRIs were randomized and then scored for enhanced regions by 3 independent readers not associated with the study. The infarct-related artery perfusion territory was scored from x-ray angiograms separately. In total, 566 scans were performed in 26 centers using commercially available scanners from all major US/European vendors. All scans were included in the analysis. The sensitivity of MRI for detecting MI increased with rising dose of gadoversetamide (P<0.0001), reaching 99% (acute) and 94% (chronic) after contrast compared with 11% before contrast. Likewise, the accuracy of MRI for identifying MI location (compared with infarct-related artery perfusion territory) increased with rising dose of gadoversetamide (P<0.0001), reaching 99% (acute) and 91% (chronic) after contrast compared with 9% before contrast. For gadoversetamide doses > or = 0.2 mmol/kg, 10- and 30-minute images provided equal performance, and peak creatine kinase-MB levels correlated with MRI infarct size (P<0.0001).
CONCLUSIONS:
Gadoversetamide-enhanced MRI using doses of > or = 0.2 mmol/kg is effective in the detection and assessment of both acute and chronic MI. This study represents the first multicenter trial designed to evaluate an imaging approach for detecting MI.
AuthorsRaymond J Kim, Timothy S E Albert, James H Wible, Michael D Elliott, John C Allen, Jennifer C Lee, Michele Parker, Alicia Napoli, Robert M Judd, Gadoversetamide Myocardial Infarction Imaging Investigators
JournalCirculation (Circulation) Vol. 117 Issue 5 Pg. 629-37 (Feb 05 2008) ISSN: 1524-4539 [Electronic] United States
PMID18212288 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
Chemical References
  • Contrast Media
  • Organometallic Compounds
  • gadoversetamide
Topics
  • Acute Disease
  • Adult
  • Aged
  • Chronic Disease
  • Contrast Media
  • Double-Blind Method
  • Europe
  • Female
  • Humans
  • Image Enhancement (methods)
  • Magnetic Resonance Imaging (methods)
  • Male
  • Middle Aged
  • Myocardial Infarction (diagnosis)
  • Organometallic Compounds (therapeutic use)
  • Patient Selection
  • Sensitivity and Specificity
  • South America
  • United States

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