Relationship of T2-Weighted MRI Myocardial Hyperintensity and the Ischemic Area-At-Risk.
Journal Article
RATIONALE: After acute myocardial infarction (MI), delineating the area-at-risk (AAR) is crucial for measuring how much, if any, ischemic myocardium has been salvaged. T2-weighted MRI is promoted as an excellent method to delineate the AAR. However, the evidence supporting the validity of this method to measure the AAR is indirect, and it has never been validated with direct anatomic measurements. OBJECTIVE: To determine whether T2-weighted MRI delineates the AAR. METHODS AND RESULTS: Twenty-one canines and 24 patients with acute MI were studied. We compared bright-blood and black-blood T2-weighted MRI with images of the AAR and MI by histopathology in canines and with MI by in vivo delayed-enhancement MRI in canines and patients. Abnormal regions on MRI and pathology were compared by (a) quantitative measurement of the transmural-extent of the abnormality and (b) picture matching of contours. We found no relationship between the transmural-extent of T2-hyperintense regions and that of the AAR (bright-blood-T2: r=0.06, P=0.69; black-blood-T2: r=0.01, P=0.97). Instead, there was a strong correlation with that of infarction (bright-blood-T2: r=0.94, P<0.0001; black-blood-T2: r=0.95, P<0.0001). Additionally, contour analysis demonstrated a fingerprint match of T2-hyperintense regions with the intricate contour of infarcted regions by delayed-enhancement MRI. Similarly, in patients there was a close correspondence between contours of T2-hyperintense and infarcted regions, and the transmural-extent of these regions were highly correlated (bright-blood-T2: r=0.82, P<0.0001; black-blood-T2: r=0.83, P<0.0001). CONCLUSION: T2-weighted MRI does not depict the AAR. Accordingly, T2-weighted MRI should not be used to measure myocardial salvage, either to inform patient management decisions or to evaluate novel therapies for acute MI.
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Duke Authors
- Chen, Enn-Ling
- Crowley, Anna Lisa Chamis
- Jenista, Elizabeth
- Judd, Robert Martin
- Kim, Han Woong
- Kim, Raymond J.
- Klem, Igor
Cited Authors
- Kim, HW; Van Assche, L; Jennings, RB; Wince, WB; Jensen, CJ; Rehwald, WG; Wendell, DC; Bhatti, L; Spatz, DM; Parker, MA; Jenista, ER; Klem, I; Crowley, ALC; Chen, E-L; Judd, RM; Kim, RJ
Published Date
- July 17, 2015
Published In
Volume / Issue
- 117 / 3
Start / End Page
- 254 - 265
PubMed ID
- 25972514
Pubmed Central ID
- 25972514
Electronic International Standard Serial Number (EISSN)
- 1524-4571
Digital Object Identifier (DOI)
- 10.1161/CIRCRESAHA.117.305771
Language
- eng
Conference Location
- United States