Diagnostic performance of T₁ and T₂ mapping to detect intramyocardial hemorrhage in reperfused ST‐segment elevation myocardial infarction (STEMI) patients

Abstract

PurposeTo investigate the performance of T 1 and T 2 mapping to detect intramyocardial hemorrhage (IMH) in ST‐segment elevation myocardial infarction (STEMI) patients treated by primary percutaneous coronary intervention (PPCI).Materials and MethodsFifty STEMI patients were prospectively recruited between August 2013 and July 2014 following informed consent. Forty‐eight patients completed a 1.5T cardiac magnetic resonance imaging (MRI) with native T 1, T 2, and T2* maps at 4 ± 2 days. Receiver operating characteristic (ROC) analyses were performed to assess the performance of T 1 and T 2 to detect IMH.ResultsThe mean age was 59 ± 13 years old and 88% (24/48) were male. In all, 39 patients had interpretable T2* maps and 26/39 (67%) of the patients had IMH ( T2* <20 msec on T2* maps). Both T 1 and T 2 values of the hypointense core within the area‐at‐risk (AAR) performed equally well to detect IMH (T 1 maps AUC 0.86 [95% confidence interval [CI] 0.72–0.99] versus T 2 maps AUC 0.86 [95% CI 0.74–0.99]; P = 0.94). Using the binary assessment of presence or absence of a hypointense core on the maps, the diagnostic performance of T 1 and T 2 remained equally good (T 1 AUC 0.87 [95% CI 0.73–1.00] versus T 2 AUC 0.85 [95% CI 0.71–0.99]; P = 0.90) with good sensitivity and specificity (T 1: 88% and 85% and T 2: 85% and 85%, respectively).ConclusionThe presence of a hypointense core on the T 1 and T 2 maps can detect IMH equally well and with good sensitivity and specificity in reperfused STEMI patients and could be used as an alternative when T2* images are not acquired or are not interpretable. Level of Evidence: 2 Technical Efficacy: Stage 2J. MAGN. RESON. IMAGING 2017;46:877–886

Cardiovascular magnetic resonance native T2 and T2* quantitative values for cardiomyopathies and heart transplantations: a systematic review and meta-analysis

“…The weighted mean T 2 * values at 1.5 T in myocardial infarction (MI) patients was 28.5 ± 6.8 ms and 34.7 ± 3.7 ms in controls [39][40][41][42][43][44][45][46][47][48][49] (Table 1, Fig. 2).…”

Cardiovascular Magnetic Resonance in Acute ST-Segment–Elevation Myocardial Infarction

“…A small study previously showed that the hypointense core on the T1 or T2 maps could provide an alternative method to detect intramyocardial hemorrhage in cases where T2* is not available or not interpretable (Figures 1 and 2) 39 and further studies are needed to confirm these findings.…”

“…14 The breakdown products of hemoglobin within the myocardium can be detected as a hypo-intense core 39 within the MI zone on T2*-imaging or T2*-mapping (Figures 1 and 2). Of the two approaches, T2*-mapping has been shown to have greater sensitivity for detecting intramyocardial hemorrhage following STEMI when compared to T2-mapping (Table 1).…”

Towards accurate and precise T 1 and extracellular volume mapping in the myocardium: a guide to current pitfalls and their solutions

“…This leads to a cascade of haemoglobin decay products in the no reflow region during the weeks following reperfusion, with various iron states affecting T 2 , estimated T 1 , and true T 1 [ 121 ]. Clearly this poses problems for T 1 mapping, and thus CMR studies should be timed appropriately after reperfusion therapy [ 122 ].…”