(Circulation. 1995;92:1902-1910.)
© 1995 American Heart Association, Inc.
Articles |
Physiological Basis of Myocardial Contrast Enhancement in Fast Magnetic Resonance Images of 2-Day-Old Reperfused Canine Infarcts
From the Departments of Radiology (R.M.J., C.H.L.-O., P.C., V.M., E.A.Z.) and Medicine (M.A., T.K., J.A.C.L., L.C.B.), Johns Hopkins University, Baltimore, Md.
Correspondence to Robert M. Judd, PhD, Johns Hopkins University, 143 MRI Bldg, 600 N Wolfe St, Baltimore, MD 21287. E-mail judd@mri.jhu.edu.
Background Contrast-enhanced fast magnetic resonance (MR) images of acute, reperfused human infarcts demonstrate regions of hypoenhancement and hyperenhancement. The relations between the spatial extent and time course of these enhancement patterns to myocardial risk, infarct, and no-reflow regions have not been well characterized.
Methods and Results The proximal left anterior descending coronary artery was occluded in 11 closed-chest dogs for 90 minutes followed by 2 days of reperfusion. Regional blood flow was determined by use of radioactive microspheres. The animals were studied at the 2-day time point with contrast-enhanced fast MRI (Signa 1.5 T, General Electric). Thioflavin-S was administered to demarcate no-reflow regions. The hearts were then excised, sectioned into five base-to-apex slices, stained with 2,3,5-triphenyltetrazolium chloride (TTC), and photographed under room light (for TTC) and ultraviolet light (for thioflavin). The spatial extents of thioflavin-negative, TTC-negative, and risk regions were compared planimetrically with MRI hypoenhanced and hyperenhanced regions. The spatial locations of subendocardial hypoenhancement in MR images correlated closely with those of thioflavin-negative regions. Microsphere blood flow in these regions was significantly reduced compared with remote regions (0.37±0.09 versus 0.88±0.10 mL/min per gram, respectively, P<.001) and with baseline (0.37±0.09 versus 0.87±0.15 mL/min per gram, P<.01). The spatial extent of hyperenhancement was smaller than the risk region (r=.64, slope=0.48, P<.001) but highly correlated with TTC-negative regions and were, on average, 12% larger (r=.93, slope=1.12, P=.035).
Conclusions In contrast-enhanced MR images of 2-day-old reperfused canine infarcts, myocardial regions of hypoenhancement are related to the no-reflow phenomenon. Approximately 90% of the myocardium within hyperenhanced regions is nonviable.
Key Words: perfusion • magnetic resonance imaging • contrast media • myocardial infarction • reperfusion
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D. S. Fieno, R. J. Kim, E.-L. Chen, J. W. Lomasney, F. J. Klocke, and R. M. Judd Contrast-enhanced magnetic resonance imaging of myocardium at risk: Distinction between reversible and irreversible injury throughout infarct healing J. Am. Coll. Cardiol., November 15, 2000; 36(6): 1985 - 1991. [Abstract] [Full Text] [PDF]
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C. E. Rochitte, R. J. Kim, H. B. Hillenbrand, E.-l. Chen, and J. A. C. Lima Microvascular Integrity and the Time Course of Myocardial Sodium Accumulation After Acute Infarction Circ. Res., October 13, 2000; 87(8): 648 - 655. [Abstract] [Full Text] [PDF]
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 K. Rajappan, N. G. Bellenger, L. Anderson, and D. J. Pennell The role of cardiovascular magnetic resonance in heart failure Eur J Heart Fail, September 1, 2000; 2(3): 241 - 252. [Abstract] [Full Text] [PDF]
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J. Bremerich, M. Saeed, H. Arheden, C. B. Higgins, and M. F. Wendland Normal and Infarcted Myocardium: Differentiation with Cellular Uptake of Manganese at MR Imaging in a Rat Model Radiology, August 1, 2000; 216(2): 524 - 530. [Abstract] [Full Text]
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S. I. Choi, S. H. Choi, S. T. Kim, K. H. Lim, C. H. Lim, G. Y. Gong, H. Y. Kim, H.-J. Weinmann, and T.-H. Lim Irreversibly Damaged Myocardium at MR Imaging with a Necrotic Tissue-Specific Contrast Agent in a Cat Model Radiology, June 1, 2000; 215(3): 863 - 868. [Abstract] [Full Text]
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R. J. Kim, D. S. Fieno, T. B. Parrish, K. Harris, E.-L. Chen, O. Simonetti, J. Bundy, J. P. Finn, F. J. Klocke, and R. M. Judd Relationship of MRI Delayed Contrast Enhancement to Irreversible Injury, Infarct Age, and Contractile Function Circulation, November 9, 1999; 100(19): 1992 - 2002. [Abstract] [Full Text] [PDF]
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M. Saeed, J. Bremerich, M. F. Wendland, R. Wyttenbach, H.-J. Weinmann, and C. B. Higgins Reperfused Myocardial Infarction as Seen with Use of Necrosis-specific versus Standard Extracellular MR Contrast Media in Rats Radiology, October 1, 1999; 213(1): 247 - 257. [Abstract] [Full Text]
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L. J. M. Kroft, J. Doornbos, R. J. van der Geest, S. Benderbous, and A. de Roos Infarcted Myocardium in Pigs: MR Imaging Enhanced with Slow-Interstitial-Diffusion Gadolinium Compound P760 Radiology, August 1, 1999; 212(2): 467 - 473. [Abstract] [Full Text]
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R. J. Kim, R. M. Judd, E.-L. Chen, D. S. Fieno, T. B. Parrish, and J. A. C. Lima Relationship of Elevated 23Na Magnetic Resonance Image Intensity to Infarct Size After Acute Reperfused Myocardial Infarction Circulation, July 13, 1999; 100(2): 185 - 192. [Abstract] [Full Text] [PDF]
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W. J. Rogers Jr, C. M. Kramer, G. Geskin, Y.-L. Hu, T. M. Theobald, D. A. Vido, S. Petruolo, and N. Reichek Early Contrast-Enhanced MRI Predicts Late Functional Recovery After Reperfused Myocardial Infarction Circulation, February 16, 1999; 99(6): 744 - 750. [Abstract] [Full Text] [PDF]
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P. Croisille, C. C. Moore, R. M. Judd, J. A. C. Lima, M. Arai, E. R. McVeigh, L. C. Becker, and E. A. Zerhouni Differentiation of Viable and Nonviable Myocardium by the Use of Three-Dimensional Tagged MRI in 2-Day-Old Reperfused Canine Infarcts Circulation, January 19, 1999; 99(2): 284 - 291. [Abstract] [Full Text] [PDF]
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K. Ramani, R. M. Judd, T. A. Holly, T. B. Parrish, V. H. Rigolin, M. A. Parker, C. Callahan, S. W. Fitzgerald, R. O. Bonow, and F. J. Klocke Contrast Magnetic Resonance Imaging in the Assessment of Myocardial Viability in Patients With Stable Coronary Artery Disease and Left Ventricular Dysfunction Circulation, December 15, 1998; 98(24): 2687 - 2694. [Abstract] [Full Text] [PDF]
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K. C. Wu, R. J. Kim, D. A. Bluemke, C. E. Rochitte, E. A. Zerhouni, L. C. Becker, and J. A. C. Lima Quantification and time course of microvascular obstruction by contrast-enhanced echocardiography and magnetic resonance imaging following acute myocardial infarction and reperfusion J. Am. Coll. Cardiol., November 15, 1998; 32(6): 1756 - 1764. [Abstract] [Full Text] [PDF]
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C. E. Rochitte, J. A. C. Lima, D. A. Bluemke, S. B. Reeder, E. R. McVeigh, T. Furuta, L. C. Becker, and J. A. Melin Magnitude and Time Course of Microvascular Obstruction and Tissue Injury After Acute Myocardial Infarction Circulation, September 8, 1998; 98(10): 1006 - 1014. [Abstract] [Full Text] [PDF]
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K. C. Wu, E. A. Zerhouni, R. M. Judd, C. H. Lugo-Olivieri, L. A. Barouch, S. P. Schulman, R. S. Blumenthal, and J. A. C. Lima Prognostic Significance of Microvascular Obstruction by Magnetic Resonance Imaging in Patients With Acute Myocardial Infarction Circulation, March 3, 1998; 97(8): 765 - 772. [Abstract] [Full Text] [PDF]
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R. J. Kim, J. A. C. Lima, E.-L. Chen, S. B. Reeder, F. J. Klocke, E. A. Zerhouni, and R. M. Judd Fast 23Na Magnetic Resonance Imaging of Acute Reperfused Myocardial Infarction : Potential to Assess Myocardial Viability Circulation, April 1, 1997; 95(7): 1877 - 1885. [Abstract] [Full Text]
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R. J. Kim, E.-L. Chen, J. A.C. Lima, and R. M. Judd Myocardial Gd-DTPA Kinetics Determine MRI Contrast Enhancement and Reflect the Extent and Severity of Myocardial Injury After Acute Reperfused Infarction Circulation, December 15, 1996; 94(12): 3318 - 3326. [Abstract] [Full Text]
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