The utility of a macromolecular, intravascular contrast agent, albumin-gadolinium diethylenetriaminepentaacetic acid (DTPA), for the differentiation of acutely ischemic and reperfused myocardium on magnetic resonance (MR) images was investigated. Regional, reversible myocardial ischemia was produced in rats and confirmed. After reperfusion, flow to the compromised myocardial segment returned to baseline. Normal myocardium could not be differentiated from ischemic myocardium on nonenhanced MR images (n = 12). After 5 minutes of myocardial ischemia and after administration of albumin-Gd-DTPA, the ischemic zone involving the free wall of the left ventricle was characterized by the absence of significant enhancement. Normal myocardium appeared homogeneously enhanced (by 145%). This pattern persisted for up to 1 hour of myocardial ischemia. In six rats that underwent myocardial reperfusion after 5 minutes of ischemia, the normal and reperfused myocardium became isointense. Radiotracer studies with albumin-Gd-153-DTPA confirmed the decreased distribution of contrast agent to the ischemic myocardium, possibly due to decreased blood pool or a blocked primary delivery system in the ischemic myocardium.

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Changes in regional myocardial perfusion were measured using rapid sequence dynamic transmission tomography to detect differences in the initial distribution of contrast medium injected as an intravenous bolus. The experiments were carried out on 8 mongrel dogs instrumented with flow probes and vascular occluders around the coronary arteries. Flow reductions of 50 per cent or more were detected as regions of myocardium with less contrast enhancement than those with normal perfusion. Reactive hyperemia induced by transient ischemia was detected as areas of relatively increased contrast enhancement. These changes could be demonstrated on the images and quantitated using data depicting changes in HU (Hounsfield units) with time to develop an index of perfusion. The images obtained were of satisfactory quality and differences between the underperfused and normal myocardium were made more prominent by using dipyridamole infusions.