Determining Microvascular Obstruction and Infarct Size with Steady-State Free Precession Imaging Cardiac MRI

Abstract

PurposeIn cardiac MRI (cMRI) injection of contrast medium may be performed prior to the acquisition of cine steady-state free precession (SSFP) imaging to speed up the protocol and avoid delay before late Gadolinium enhancement (LGE) imaging. Aim of this study was to evaluate whether a condensed clinical protocol with contrast cine SSFP imaging is able to detect early microvascular obstruction (MO) and determine the infarct size compared to the findings of LGE inversion recovery sequences.Materials and MethodsThe study complies with the Declaration of Helsinki and was performed following approval by the ethic committee of the University of Erlangen-Nuremberg. Written informed consent was obtained from every patient. 68 consecutive patients (14 females/54 males) with acute ST-elevation myocardial infarction (STEMI) treated by percutaneous coronary revascularization were included in this study. CMRI was performed 6.6±2 days after symptom onset and MO and infarct size in early contrast SSFP cine imaging were compared to LGE imaging.ResultsMO was detected in 47/68 (69%) patients on cine SSFP and in 41/68 (60%) patients on LGE imaging. In 6 patients MO was found on cine SSFP imaging but was not detectable on LGE imaging. Infarct size on cine SSFP showed a strong agreement to LGE imaging (intraclass correlation coefficient [ICC] of 0.96 for enddiastolic, p<0.001 and 0.96 for endsystolic, p<0.001 respectively). Significant interobserver agreement was found measuring enddiastolic and endsystolic infarct size on cine SSFP imaging (p<0.01).ConclusionsIn patients after STEMI infarct size and presence of MO can be detected with contrast cine SSFP imaging. This could be an option in patients who are limited in their ability to comply with the demands of a cMRI protocol.

Value of Fast MVO Identification From Contrast-Enhanced Cine (CE-SSFP) Combined With Myocardial Strain in Predicting Adverse Events in Patients After ST-Elevation Myocardial Infarction

“…It is challenging to accurately quantify the heterogeneity of small low-signal areas on LGE images, which requires experienced radiologists and much analysis time and is not conducive to widespread clinical application, especially in some non-highly specialized centers. However, MVO can be detected with contrast cine SSFP imaging ( 11 ). In our study, MVO was identified in 109 (51%) patients using CE-cine SSFP imaging and 107 (50%) in LGE imaging, comparable to LGE, CE-cine can serve as a backup when LGE imaging is unavailable ( 10 , 11 ) and can shorten scanning time.…”

“…However, MVO can be detected with contrast cine SSFP imaging ( 11 ). In our study, MVO was identified in 109 (51%) patients using CE-cine SSFP imaging and 107 (50%) in LGE imaging, comparable to LGE, CE-cine can serve as a backup when LGE imaging is unavailable ( 10 , 11 ) and can shorten scanning time. Therefore, MVO identification from CE-SSFP can be sufficient for clinical application, and it has a high degree of completion and accuracy, can be an option in patients who are limited in their ability to comply with the demands of a CMR protocol.…”

“…MVO was defined as middle or subendocardial dark areas within AAR. To eliminate low signal artifacts similar to MVO areas, a “true MVO” was defined as a dark area surrounded by the constantly visible hyperintensity zone and located at the same position within the cardiac wall on each SSFP image during the complete cardiac cycle ( 11 ) ( Figure 1 ). IS was expressed as a percentage of LV myocardial mass (LVMM), measured from short-axis LGE images (signal intensity > 5 SD of unenhanced remote myocardium) ( 12 ), and included MVO.…”

Desenvolvimento de métodos de análise de imagens para avaliação da viabilidade miocárdica, contratilidade ventricular, inervação autonômica e disfunção microvascular na Cardiomiopatia Chagásica Crônica

“…A Figura 5.16 reforça a separação das classes a partir dos valores expressos em todos os atributos analisados entre os padrões de fibrose para CINE-RMC e RT-RMC. O padrão de fibrose focal é representado na figura como o destaque na distinção com os demais padrões, embora seja mais evidente sua diferença na análise por RT-RMC quando comparada com a análise por CINE-RMC.No estudo realizado por Wuest[89], foi avaliada a aplicação do contraste gadolínio antes da aquisição de imagens CINE em pacientes com infarto miocárdico. Heatmap referente aos valores obtidos para cada atributo em relação ao miocárdio segmentado em imagens CINE-RMC de 60 pacientes com CCC para as porções apical, médio cavitário e basal.Figura 5.15: Heatmap referente a matriz de auto correlação e correlações cruzadas entre os valores dos 96 atributos analisados em CINE-RMC.…”