Rationale and Objectives
To measure and validate patchy and large myocardial infarction (MI) at 3 days and 5 weeks in beating and nonbeating hearts using contrast-enhanced three-dimensional (3D) inversion-recovery gradient echo (IR-GRE) magnetic resonance imaging (MRI) and microscopy.
Materials and Methods
Pigs ( n = 28) were subjected to 1) patchy MI (group I), 2) large MI (group II), or 3) combined (patchy and large) MI (groups III and IV) using microemboli and/or 90-minute left anterior descending (LAD) occlusion and imaged at 3 days and 5 weeks after interventions. Gadolinium diethylenetriamine penta-acetic acid (Gd-DTPA)–enhanced 3D and two-dimensional (2D) IR-GRE were performed for comparison in beating and nonbeating hearts. Macroscopic histochemical and microscopic histopathologic measurements were used for validation.
Results
Three-dimensional images demonstrated hyperenhanced patchy microinfarction, large MI, hypoenhanced/hyperenhanced microvascular obstruction, and infarct resorption. Acute and chronic combined MI on 3D was underestimated compared to microscopy (bias: −1.8 ± 3.8%) but overestimated acute large infarction. In beating and nonbeating hearts, close correlations/agreements were found between 3D/2D acquisitions in all groups (beating hearts: r = 0.70–0.99; bias: group I 0.47 ± 2.0%, II 0.33 ± 1.2%, III 0.54 ± 1.5%, and IV 0.28 ± 1.0%).
Conclusions
The 3D IR-GRE underestimated the extent of acute and chronic combined MI compared to microscopic measurements. This sequence may have the potential to differentiate patchy from large MI and demonstrate MI healing after coronary interventions.
Coronary artery disease remains the main cause of death in developed countries . Obstruction of major and minor coronary arteries results in the development of large and patchy myocardial infarction (MI), respectively. The extent and pattern of MI is a determinant factor for prognosis and patient survival . Accurate quantification of infarction provides important information to guide clinicians in deciding which patients are likely to receive benefit from a revascularization procedure .
Positron emission tomography, single-photon emission computed tomography, echocardiography, and magnetic resonance imaging (MRI) have been the clinical modalities for assessing myocardial viability. The reference standard for cardiac MRI is two-dimensional (2D) inversion-recovery gradient echo sequence (IR-GRE), but the main limitation of this sequence is the long acquisition time . The recently developed contrast-enhanced three-dimensional (3D) IR-GRE or turbo FLASH has been validated against 2D IR-GRE in patients and swine using different field strengths but not in nonbeating hearts on 2D, 3D IR-GRE or microscopy. The purpose of this MRI study was to 1) determine the diagnostic value of delayed contrast-enhanced 3D IR-GRE for measuring acute and chronic patchy and large MI in a beating and nonbeating swine heart model and 2) validate the extent of acute and chronic MI measured on 3D IR-GRE against 2D IR-GRE, macroscopic histochemical, and microscopic histopathologic techniques.
Materials and methods
Animal Preparation
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Magnetic Resonance Imaging
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Microscopy
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Image Analysis
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Statistical Analysis
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Results
MRI of Patchy and Large MI
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Table 1
Comparison of the MI/remote Myocardium Signal Intensity (SI) Ratio in Patchy and Large Infarction on 3D and 2D IR-GRE Acquisitions (Note the Significant Effect of Motion on SI Ratio)
Group 3D IR-GRE 2D IR-GRE Beating heart Group I 1.8 ± 0.1 † 1.8 ± 0.1 † Group II 2.5 ± 0.1 2.5 ± 0.1 Group III 2.5 ± 0.1 2.6 ± 0.1 Group IV 2.6 ± 0.1 2.6 ± 0.1 Nonbeating heart Group I 2.2 ± 0.1 ∗ † 2.1 ± 0.1 ∗ † Group I 2.2 ± 0.1 ∗ † 2.1 ± 0.1 ∗ † Group II 3.3 ± 0.1 ∗ 3.2 ± 0.1 ∗ Group III 3.0 ± 0.1 ∗ 3.0 ± 0.1 ∗ Group IV 3.2 ± 0.1 ∗ 3.3 ± 0.1 ∗
IR-GRE, inversion-recovery gradient echo; MI, myocardial infarction; 2D, two-dimensional; 3D, three-dimensional.
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Microscopic Validation
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Table 2
Comparison of the Extent of MI on 3D, 2D IR-GRE Acquisitions, Histochemical Staining (TTC), and Microscopic Histopathology
Group 3D IR-GRE 2D IR-GRE TTC Microscopy Beating heart Group I 8.2 ± 0.5 7.7 ± 0.5 Group II 12.5 ± 0.6 ∗ § 12.1 ± 0.4 ∗ Group III 14.3 ± 1.6 ∗ 13.7 ± 1.5 ∗ Group IV 10.6 ± 0.3 ‖ 10.4 ± 0.5 ‖ Nonbeating heart Group I 7.7 ± 0.4 7.9 ± 0.6 7.4 ± 0.4 Group II 12.7 ± 0.5 ∗ 12.4 ± 0.4 ∗ 13.0 ± 1.6 ∗ 11.6 ± 0.5 Group III 14.1 ± 1.7 ∗ § 14.1 ± 1.9 ∗ § 13.6 ± 1.4 ∗ § 15.6 ± 1.7 † ‡ Group IV 10.3 ± 0.4 § ‖ 10.4 ± 0.3 § ‖ 10.5 ± 1.2 § ‖ 12.4 ± 0.7 ‖
IR-GRE, inversion-recovery gradient echo; MI, myocardial infarction; TTC, triphenyltetrazolium chloride; 2D, two-dimensional; 3D, three-dimensional.
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Beating Versus Nonbeating Hearts
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Discussion
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