Cardiovascular magnetic resonance imaging of myocardial oedema following acute myocardial infarction: Is whole heart coverage necessary?

Abstract

BACKGROUND:

AAR measurement is useful when assessing the efficacy of reperfusion therapy and novel cardioprotective agents after myocardial infarction. Multi-slice (Typically 10-12) T2-STIR has been used widely for its measurement, typically with a short axis stack (SAX) covering the entire left ventricle, which can result in long acquisition times and multiple breath holds. This study sought to compare 3-slice T2-short-tau inversion recovery (T2- STIR) technique against conventional multi-slice T2-STIR technique for the assessment of area at risk (AAR).

METHODS:

CMR imaging was performed on 167 patients after successful primary percutaneous coronary intervention. 82 patients underwent a novel 3-slice SAX protocol and 85 patients underwent standard 10-slice SAX protocol. AAR was obtained by manual endocardial and epicardial contour mapping followed by a semi- automated selection of normal myocardium; the volume was expressed as mass (%) by two independent observers.

RESULTS:

85 patients underwent both 10-slice and 3-slice imaging assessment showing a significant and strong correlation (intraclass correlation coefficient = 0.92;p < 0.0001) and a low Bland-Altman limit (mean difference -0.03 ± 3.21%, 95% limit of agreement,- 6.3 to 6.3) between the 2 analysis techniques. A further 82 patients underwent 3-slice imaging alone, both the 3-slice and the 10-slice techniques showed statistically significant correlations with angiographic risk scores (3-slice to BARI r = 0.36, 3-slice to APPROACH r = 0.42, 10-slice to BARI r = 0.27, 10-slice to APPROACH r = 0.46). There was low inter-observer variability demonstrated in the 3-slice technique, which was comparable to the 10-slice method (z = 1.035, p = 0.15). Acquisition and analysis times were quicker in the 3-slice compared to the 10-slice method (3-slice median time: 100 seconds (IQR: 65-171 s) vs. (10-slice time: 355 seconds (IQR: 275-603 s); p < 0.0001.

CONCLUSIONS:

AAR measured using 3-slice T2-STIR technique correlates well with standard 10-slice techniques, with no significant bias demonstrated in assessing the AAR. The 3-slice technique requires less time to perform and analyse and is therefore advantageous for both patients and clinicians.

• Authors: Stephen Hamshere, Daniel A Jones, Cyril Pellaton, Danielle Longchamp, Tom Burchell, Saidi Mohiddin, James C Moon, Jens Kastrup, Didier Locca, Steffen E Petersen, Mark Westwood, Anthony Mathur
• Journal: Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance (J Cardiovasc Magn Reson) Vol. 18 Pg. 7 (Jan 23 2016) ISSN: 1532-429X [Electronic] England
• PMID: 26803468 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Contrast Media
• Organometallic Compounds
• Meglumine
• gadoterate meglumine

Topics

• Aged
• Clinical Trials as Topic
• Contrast Media
• Edema, Cardiac (etiology, pathology)
• Europe
• Female
• Humans
• Magnetic Resonance Imaging, Cine (methods)
• Male
• Meglumine
• Middle Aged
• Myocardial Infarction (complications, pathology, therapy)
• Myocardium (pathology)
• Observer Variation
• Organometallic Compounds
• Percutaneous Coronary Intervention
• Predictive Value of Tests
• Reproducibility of Results