Cardiac MRI in the diagnosis of complications of myocardial infarction

Abstract

The improvement in revascularization techniques and medicine treatment during infarction has substantially reduced mortality during the acute phase of this condition. Since the advent of kinetic sequences and the concomitant development of gadolinium chelates and delayed enhancement sequences, cardiac MRI has become the second-line reference examination for ischemic heart disease. The technique of delayed enhancement with the inversion recovery sequence performed after injection has been validated for numerous indications in ischemic disease. Delayed enhancement sequences make it possible in particular to look for "no-reflow" areas (microvascular obstructions), to quantify the infarction area, and to assess prognosis. MRI also allows us to define the area at risk, that is, the area with edema, and to look for and assess the mechanical complications of the infarction. The aim of this review is to summarize current knowledge about: the pharmacokinetic principles that regulate myocardial enhancement; the different sequences available to acquire delayed enhancement images, and; the value of cardiac MRI in the diagnosis of complications of myocardial infarction.

Combination of magnetic resonance imaging and targeted contrast agent for the diagnosis of myocardial infarction

“…A previous study summarized the current knowledge of the pharmacokinetic principles of gadolinium chelates for enhancing the diagnostic value of cardiac MRI in the diagnosis of complications of myocardial infarction ( 25 ). In addition, delayed-enhancement 3.0T MRI with 0.15 mmol/kg of contrast agent superparamagnetic iron oxide provides more accuracy in the assessment of chronic myocardial infarction ( 26 ).…”

Role of cardiovascular magnetic resonance in acute and chronic ischemic heart disease

“…2 b). With its superior spatial resolution and feasibility soon after the acute event, CMR is a promising tool for the identification of early and late MI complications [ 20 ]. Post MI ventricular septal defect (VSD) is associated with 80–90% mortality within few months after acute event; not only is CMR useful to make the diagnosis, but also tissue characterization to look for fibrosis of VSD edges helps identifying the most appropriate time for surgery [ 20 ].…”

“…With its superior spatial resolution and feasibility soon after the acute event, CMR is a promising tool for the identification of early and late MI complications [ 20 ]. Post MI ventricular septal defect (VSD) is associated with 80–90% mortality within few months after acute event; not only is CMR useful to make the diagnosis, but also tissue characterization to look for fibrosis of VSD edges helps identifying the most appropriate time for surgery [ 20 ]. Myocardial tissue characterization by CMR also allows to distinguish a true aneurysm, which is characterised by a large neck and typically enhanced aneurysm wall, from pseudo-aneurysm, which usually has a small neck, with non-enhanced wall, and represents a contained rupture [ 20 ].…”

“…Post MI ventricular septal defect (VSD) is associated with 80–90% mortality within few months after acute event; not only is CMR useful to make the diagnosis, but also tissue characterization to look for fibrosis of VSD edges helps identifying the most appropriate time for surgery [ 20 ]. Myocardial tissue characterization by CMR also allows to distinguish a true aneurysm, which is characterised by a large neck and typically enhanced aneurysm wall, from pseudo-aneurysm, which usually has a small neck, with non-enhanced wall, and represents a contained rupture [ 20 ]. A lipomatous metaplasia seen as a high signal intensity area in the cine and post-contrast sequences, is also commonly seen in patients with old MI who underwent surgical myocardial revascularization [ 20 ].…”

“…Myocardial tissue characterization by CMR also allows to distinguish a true aneurysm, which is characterised by a large neck and typically enhanced aneurysm wall, from pseudo-aneurysm, which usually has a small neck, with non-enhanced wall, and represents a contained rupture [ 20 ]. A lipomatous metaplasia seen as a high signal intensity area in the cine and post-contrast sequences, is also commonly seen in patients with old MI who underwent surgical myocardial revascularization [ 20 ]. The right ventricle (RV) is involved in a non-negligible proportion of acute MI, mainly involving the inferior wall (incidence 24–50%) [ 29 ], is haemodinamically relevant in up to 25–50% of cases and is usually associated with poorer prognosis [ 30 , 31 ] (Fig.…”