The contributory role of interstitial water in Gd‐DTPA‐enhanced MRI in myocardial infarction

Inoue, Shinichi; Murakami, Yo; Ochiai, Koichi; Kitamura, Jun; Ishibashi, Yutaka; Kawamitsu, Hideaki; Sugimura, Kazuro; Shimada, Toshio

doi:10.1002/(sici)1522-2586(199902)9:2<215::aid-jmri10>3.0.co;2-#

Cited by 24 publications

(8 citation statements)

References 29 publications

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“…Myocardial edema resolves in 2–3 months without any myocardial scarring and with complete functional recovery [ 49 ••]. A few studies have shown the presence of subtle late gadolinium enhancement in TCM [ 50 •], but experimental data shows that delayed washout of gadolinium may be caused by increased interstitial water content such that associated with transient myocardial edema [ 51 ]. The subtle changes are called myocardial edema-related LGE and they do not represent myocardial necrosis.…”

Section: Role Of Cmr In Diagnosismentioning

confidence: 99%

The Role of Cardiac MRI in Patients with Troponin-Positive Chest Pain and Unobstructed Coronary Arteries

Dastidar

Rodrigues

Ahmed

et al. 2015

Curr Cardiovasc Imaging Rep

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Acute coronary syndrome (ACS) still remains one of the leading causes of mortality and morbidity worldwide. Seven to fifteen percent of patients presenting with ACS have unobstructed coronary artery disease (CAD) on urgent angiography. Patients with ACS and unobstructed coronary arteries represent a clinical dilemma and their diagnosis and management is quite variable in current practice. Cardiovascular magnetic resonance imaging with its unique non-invasive myocardial tissue characterization property has the potential to identify underlying etiologies and reach a final diagnosis. These include acute and chronic myocarditis, embolic/spontaneous recanalization myocardial infarction, and Tako-Tsubo cardiomyopathy, and other conditions. Establishing a final diagnosis has a direct implication on patient’s management and prognosis. In this article, we have reviewed the current evidence on the diagnostic role of cardiac magnetic resonance (CMR) in patients with ACS and unobstructed coronary arteries. We have also highlighted the potential role of CMR as a risk stratification or prognostication tool for this patient population.

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Section: Role Of Cmr In Diagnosismentioning

confidence: 99%

The Role of Cardiac MRI in Patients with Troponin-Positive Chest Pain and Unobstructed Coronary Arteries

Dastidar

Rodrigues

Ahmed

et al. 2015

Curr Cardiovasc Imaging Rep

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“…Greater gadolinium concentration and water content in ischemically injured versus normal myocardium have been reported previously in rats and pigs. 30,31 Further studies are needed to explore the difference in Gd-DTPA concentration between viable and nonviable portions within the ischemically injured myocardium. The distribution of 99m Tc-DTPA has been used recently as a surrogate agent for Gd-DTPA to study viable and nonviable portions within the ischemically injured myocardium by autoradiography.…”

Section: Characterization Of Ischemically Injured Myocardiummentioning

confidence: 99%

Magnetic Resonance Characterization of the Peri-Infarction Zone of Reperfused Myocardial Infarction With Necrosis-Specific and Extracellular Nonspecific Contrast Media

et al. 2001

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Background-Because ischemically injured myocardium is frequently composed of viable and nonviable portions, a method to discriminate the two is useful for clinical management. Methods and Results-Ischemically injured myocardium was characterized with extracellular nonspecific (Gd-DTPA) and necrosis-specific (mesoporphyrin) MR contrast media in rats. Relaxation rates (R1) were measured on day 1 and day 2 by inversion-recovery echoplanar imaging. Spin-echo imaging was used to define contrast-enhanced regions and regional wall thickening. Gadolinium concentration, area at risk, and infarct size were measured at postmortem examination. ⌬R1 ratio (⌬R1 myocardium /⌬R1 blood ) after administration of Gd-DTPA was greater in ischemically injured myocardium (1.20Ϯ0.15) than in normal myocardium (0.47Ϯ0.05, PϽ0.05), which was attributed to differences in gadolinium concentration and water content. The Gd-DTPA-enhanced region on day 2 was larger (32.8Ϯ0.9%) than true infarction as demonstrated by triphenyltetrazolium chloride (TTC) (24.6Ϯ1.4%, PϽ0.001, rϭ0.21). Bland-Altman analysis revealed that the Gd-DTPA-enhanced region overestimated true infarct size by 7.8Ϯ5.9%. On the other hand, the mesoporphyrin-enhanced region (26.9Ϯ1.8%, PϭNS, rϭ0.87) and true infarct size were identical. The difference in the areas demarcated by the 2 agents is the peri-infarction. Systolic and diastolic MR images revealed no wall thickening in the mesoporphyrin-enhanced region (0.3Ϯ3.3%) but reduced thickening in the Gd-DTPA-enhanced rim (8.5Ϯ5.5%, PϽ0.05). Conclusions-The Gd-DTPA-enhanced region encompasses both viable and nonviable portions of the ischemically injured myocardium. The Gd-DTPA-enhanced area overestimated infarct size, but the mesoporphyrin-enhanced area matched true infarct size. The salvageable peri-infarction zone can be characterized with double-contrast-enhanced and functional MR imaging; the mismatched area of enhancement between the 2 agents shows residual wall thickening.

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“…In earlier studies (22), the size of the hyperintense region was larger than the infarction size assessed with control methods. It has been suggested that the tissue surrounding infarction may be edematous and may, therefore, consist of larger extracellular spaces and an increased distribution volume for the contrast agent (23).…”

Section: Anatomic Distribution Of False-positive and False-negative Smentioning

confidence: 99%

Multimodality MR Imaging Assessment of Myocardial Viability: Combination of First-Pass and Late Contrast Enhancement to Wall Motion Dynamics and Comparison with FDG PET—Initial Experience

Lauerma¹,

Niemi²,

Hänninen³

et al. 2000

Radiology

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The contributory role of interstitial water in Gd‐DTPA‐enhanced MRI in myocardial infarction

Cited by 24 publications

References 29 publications

The Role of Cardiac MRI in Patients with Troponin-Positive Chest Pain and Unobstructed Coronary Arteries

The Role of Cardiac MRI in Patients with Troponin-Positive Chest Pain and Unobstructed Coronary Arteries

Magnetic Resonance Characterization of the Peri-Infarction Zone of Reperfused Myocardial Infarction With Necrosis-Specific and Extracellular Nonspecific Contrast Media

Multimodality MR Imaging Assessment of Myocardial Viability: Combination of First-Pass and Late Contrast Enhancement to Wall Motion Dynamics and Comparison with FDG PET—Initial Experience

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