Reperfusion hemorrhage following acute myocardial infarction: assessment with T2* mapping and effect on measuring the area at risk.

Research ethics committee approval and informed consent were obtained. The purpose of this study was to assess the feasibility of multiecho T2* mapping of the heart for detecting reperfusion hemorrhage following percutaneous primary coronary intervention (PPCI) for acute myocardial infarction, and to measure the effect of hemorrhage on quantifying the ischemic area at risk (IAR) on T2-weighted magnetic resonance images. Fifteen patients (mean age, 59 years; 13 men, two women) were imaged a mean of 3.2 days following PPCI. The mean area of hemorrhage, indicated by a T2* decay constant of less than 20 msec, was 5.0% +/- 4.9 (standard deviation) at the level of the infarct and this correlated with the infarct (r(2) = 0.76, P < .01) and microvascular obstruction (r(2) = 0.75, P < .01) volumes. When 5% or less hemorrhage was present, the IAR was underestimated by 50% at a standard deviation threshold level of five, compared with a boundary detection tool (21.8% vs 44.0%, P < .05). T2* mapping is feasible for quantifying post-reperfusion hemorrhage and boundary detection is required to accurately assess the IAR when hemorrhage is present.

[1]  P. Kellman,et al.  Quantitative myocardial infarction on delayed enhancement MRI. Part II: Clinical application of an automated feature analysis and combined thresholding infarct sizing algorithm , 2006, Journal of magnetic resonance imaging : JMRI.

[2]  G. Jensen,et al.  Sustained postinfarction myocardial oedema in humans visualised by magnetic resonance imaging , 2001, Heart.

[3]  P. Kellman,et al.  Quantitative myocardial infarction on delayed enhancement MRI. Part I: Animal validation of an automated feature analysis and combined thresholding infarct sizing algorithm , 2006, Journal of magnetic resonance imaging : JMRI.

[4]  B. Gersh.  Early Metoprolol Administration Before Coronary Reperfusion Results in Increased Myocardial Salvage: Analysis of Ischemic Myocardium at Risk Using Cardiac Magnetic Resonance , 2008 .

[5]  M. Fishbein,et al.  The Relationship of Vascular Injury and Myocardial Hemorrhage to Necrosis After Reperfusion , 1980, Circulation.

[6]  J. Schulz-Menger,et al.  The salvaged area at risk in reperfused acute myocardial infarction as visualized by cardiovascular magnetic resonance. , 2008, Journal of the American College of Cardiology.

[7]  落合 康一.  Hemorrhagic myocardial infarction after coronary reperfusion detected In vivo by magnetic resonance imaging in humans prevalence and clinical implications , 1999 .

[8]  T J Brady,et al.  Cardiac susceptibility artifacts arising from the heart‐lung interface , 2001, Magnetic resonance in medicine.

[9]  Piotr A Wielopolski,et al.  Magnetic resonance imaging of haemorrhage within reperfused myocardial infarcts: possible interference with iron oxide-labelled cell tracking? , 2006, European heart journal.

[10]  J. Lowe,et al.  The Wavefront Phenomenon of Ischemic Cell Death: 1. Myocardial Infarct Size vs Duration of Coronary Occlusion in Dogs , 1977, Circulation.

[11]  G. Pohost,et al.  The effect of postinfarction intramyocardial hemorrhage on transverse relaxation time , 1992, Magnetic resonance in medicine.

[12]  L. Boxt,et al.  Estimation of myocardial water content using transverse relaxation time from dual spin-echo magnetic resonance imaging. , 1993, Magnetic resonance imaging.

[13]  E. Braunwald,et al.  Studies of experimental coronary artery reperfusion. Effects on infarct size, myocardial function, biochemistry, ultrastructure and microvascular damage. , 1983, Circulation.

[14]  J. Schulz-Menger,et al.  Cardiovascular magnetic resonance of acute myocardial infarction at a very early stage. , 2003, Journal of the American College of Cardiology.

[15]  L. Schad,et al.  Susceptibility-sensitive magnetic resonance imaging detects human myocardium supplied by a stenotic coronary artery without a contrast agent. , 2003, Journal of the American College of Cardiology.

[16]  J. Gili,et al.  Analysis of myocardial oedema by magnetic resonance imaging early after coronary artery occlusion with or without reperfusion. , 1993, Cardiovascular research.

[17]  S. Dymarkowski,et al.  Determinants and impact of microvascular obstruction in successfully reperfused ST-segment elevation myocardial infarction. Assessment by magnetic resonance imaging , 2007, European Radiology.

[18]  Andrew E Arai,et al.  In Vivo T2-Weighted Magnetic Resonance Imaging Can Accurately Determine the Ischemic Area at Risk for 2-Day-Old Nonreperfused Myocardial Infarction , 2008, Investigative radiology.

[19]  S. Bishop,et al.  Assessment of Postreperfusion Myocardial Hemorrhage Using Proton NMR Imaging at 1.5 T , 1992, Circulation.

[20]  T. M. Sanders,et al.  Determinants of Myocardial Hemorrhage After Coronary Reperfusion in the Anesthetized Dog , 1982, Circulation.

[21]  D N Firmin,et al.  Cardiovascular T2-star (T2*) magnetic resonance for the early diagnosis of myocardial iron overload. , 2001, European heart journal.

[22]  D. Larkman,et al.  Combination of signals from array coils using image‐based estimation of coil sensitivity profiles , 2002, Magnetic resonance in medicine.

[23]  S. Kaul,et al.  Post-ischaemic myocardial dysfunction (stunning) results from myofibrillar oedema , 2007, Heart.

[24]  E R McVeigh,et al.  Magnitude and time course of microvascular obstruction and tissue injury after acute myocardial infarction. , 1998, Circulation.

[25]  D. Look,et al.  Time Saving in Measurement of NMR and EPR Relaxation Times , 1970 .

[26]  K. Tanabe,et al.  Relationship between progressive microvascular damage and intramyocardial hemorrhage in patients with reperfused anterior myocardial infarction: myocardial contrast echocardiographic study. , 1997, Circulation.

[27]  W. J. Powell,et al.  Quantitative Correlation between Cell Swelling and Necrosis in Myocardial Ischemia in Dogs , 1980, Circulation research.

[28]  G. Adam,et al.  Characterization of the peri-infarction zone using T2-weighted MRI and delayed-enhancement MRI in patients with acute myocardial infarction , 2006, European Radiology.

[29]  S. Dymarkowski,et al.  Autologous bone marrow-derived stem-cell transfer in patients with ST-segment elevation myocardial infarction: double-blind, randomised controlled trial , 2006, The Lancet.

[30]  R. Jennings,et al.  Effect of Reperfusion Late in the Phase of Reversible Ischemic Injury: Changes in Cell Volume, Electrolytes, Metabolites, and infrastructure , 1985, Circulation research.

[31]  S. Iliceto,et al.  Morphologic validation of reperfused hemorrhagic myocardial infarction by cardiovascular magnetic resonance. , 2007, The American journal of cardiology.

[32]  James A. Sethian,et al.  Level Set Methods for Curvature Flow, Image Enchancement, and Shape Recovery in Medical Images , 1997, VisMath.

[33]  Gerhard Adam,et al.  Acute myocardial infarction: evaluation with first-pass enhancement and delayed enhancement MR imaging compared with 201Tl SPECT imaging. , 2004, Radiology.

[34]  R. F. Hoyt,et al.  Cardiac magnetic resonance imaging , 2004, Postgraduate Medical Journal.

[35]  W. Bradley.  MR appearance of hemorrhage in the brain. , 1993, Radiology.

[36]  L. Barrios,et al.  Infarct size, myocardial hemorrhage, and recovery of function after mechanical versus pharmacological reperfusion: effects of lytic state and occlusion time. , 1997, Circulation.

[37]  E R McVeigh,et al.  In vivo measurement of T*2 and field inhomogeneity maps in the human heart at 1.5 T , 1998, Magnetic resonance in medicine.