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(Circulation. 2008;118:795-796.)
© 2008 American Heart Association, Inc.

Editorial

Using Magnetic Resonance Imaging to Characterize Recent Myocardial Injury

Utility in Acute Coronary Syndrome and Other Clinical Scenarios

Andrew E. Arai, MD

From the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md.

Correspondence to Andrew E. Arai, MD, Senior Investigator, National Heart, Lung, and Blood Institute, National Institutes of Health, Bldg 10, Room B1D416, MSC 1061, 10 Center Dr, Bethesda, MD 20892–1061. E-mail araia@nih.gov

Key Words: Editorials • edema • fatty acids • magnetic resonance imaging • myocardial contraction • scintigraphy

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The work of Ricardo Cury et al¹ published this week in Circulation uses T2-weighted magnetic resonance imaging (MRI) to detect recent myocardial ischemia on the basis of subtle differences in myocardial water characteristics. They found that T2-weighted MRI improved diagnostic accuracy when characterizing patients with possible or probable acute coronary syndrome (ACS) who presented to the emergency department with chest pain.

Article p 837

This editorial will highlight recent developments in cardiac imaging that reliably allow differentiation of acute from chronic wall-motion abnormalities. The idea of imaging recent ischemia, either with T2-weighted MRI or with single-photon emission computed tomography (SPECT) agents such as ¹²³I beta-methyl-p-iodophenylpendadecanoic acid (BMIPP), represents a significant step in characterizing the metabolic condition of the myocardium beyond simple indices of regional strain or contractile function. T2-weighted MRI has generated significant interest over the last few years because it offers the ability to characterize or detect a recent reversible myocardial injury.

It is important to recognize that acute and chronic myocardial infarction (MI) can be difficult to differentiate with conventional imaging. Both will typically exhibit wall-motion abnormalities on echocardiography or MRI. Chronic MI is more likely to be associated with a thin wall, but this finding is not specific for nonviable myocardium. Both acute and chronic MI cause defects on conventional SPECT scans. Acute and chronic MI both enhance with gadolinium on MRI scans. Thus, individually these imaging methods cannot reliably differentiate acute from chronic MI.

A landmark study by Abdel-Aty et al documented that T2-weighted MRI can . . . [Full Text of this Article]

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