Bright-blood T2-weighted MRI has high diagnostic accuracy for myocardial hemorrhage in myocardial infarction: a preclinical validation study in swine

Payne, A.R. et al. (2011) Bright-blood T2-weighted MRI has high diagnostic accuracy for myocardial hemorrhage in myocardial infarction: a preclinical validation study in swine. Circulation: Cardiovascular Imaging, 4(6), pp. 738-745. (doi:10.1161/​CIRCIMAGING.111.965095)

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Abstract

Background: Myocardial hemorrhage after myocardial infarction (MI) usually goes undetected. We investigated the diagnostic accuracy of bright-blood T2-weighted cardiac MRI for myocardial hemorrhage in experimental MI.

Methods and Results: MI was created in swine by occluding the left anterior descending (n=10) or circumflex (n=5) coronary arteries for 90 minutes followed by reperfusion for ≤3 days (n=2), 10 days (n=7), or 60 days (n=6). MRI was performed at 1.5 T, using bright-blood T2-prepared steady-state free-precession, T2* and early (1 minute) and late (10–15 minutes) gadolinium enhancement (EGE, LGE, respectively) MRI. Left ventricular sections and histology were assessed for hemorrhage by an experienced cardiac pathologist blinded to the MRI data. Hypointense regions on T2-weighted and contrast-enhanced MRI were independently determined by 3 cardiologists experienced in MRI who were also blinded to the pathology results. Eighty ventricular pathological sections were matched with MRI (n=68 for EGE MRI). All sections with evidence of MI (n=63, 79%) also exhibited hyperintense zones consistent with edema on T2-weighted MRI and infarct on LGE MRI. Myocardial hemorrhage occurred in 49 left ventricular sections (61%) and corresponded with signal voids on 48 T2-weighted (98%) and 26 LGE-MRI (53%). Alternatively, signal voids occurred in the absence of hemorrhage in 3 T2-weighted (90% specificity) and 5 LGE MRI (84% specificity). On EGE MRI, 27 of 43 cases of early microvascular obstruction corresponded with hemorrhage (63% sensitivity), whereas 5 of 25 defects occurred in the absence of hemorrhage (80% specificity). The positive and negative predictive values for pathological evidence of hemorrhage were 94% and 96% for T2-weighted, 84% and 55% for LGE MRI, and 85% and 56% for EGE MRI.

Conclusions: Bright-blood T2-weighted MRI has high diagnostic accuracy for myocardial hemorrhage.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and McPhaden, Dr Allan and Payne, Dr Alexander
Authors: Payne, A.R., Berry, C., Kellman, P., Anderson, R., Hsu, L.-Y., Chen, M.Y., McPhaden, A.R., Watkins, S., Schenke, W., Wright, V., Lederman, R.J., Aletras, A.H., and Arai, A.E.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Circulation: Cardiovascular Imaging
ISSN:1941-9651
Published Online:19 September 2011

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