Reperfusion Hemorrhage Following Acute Myocardial Infarction: Assessment with T2* Mapping and Effect on Measuring the Area at Risk

Published Online:Mar 1 2009https://doi.org/10.1148/radiol.2503081154

Abstract

Research ethics committee approval and informed consent were obtained. The purpose of this study was to assess the feasibility of multiecho T2* mapping of the heart for detecting reperfusion hemorrhage following percutaneous primary coronary intervention (PPCI) for acute myocardial infarction, and to measure the effect of hemorrhage on quantifying the ischemic area at risk (IAR) on T2-weighted magnetic resonance images. Fifteen patients (mean age, 59 years; 13 men, two women) were imaged a mean of 3.2 days following PPCI. The mean area of hemorrhage, indicated by a T2* decay constant of less than 20 msec, was 5.0% ± 4.9 (standard deviation) at the level of the infarct and this correlated with the infarct (r² = 0.76, P < .01) and microvascular obstruction (r² = 0.75, P < .01) volumes. When 5% or less hemorrhage was present, the IAR was underestimated by 50% at a standard deviation threshold level of five, compared with a boundary detection tool (21.8% vs 44.0%, P < .05). T2* mapping is feasible for quantifying post-reperfusion hemorrhage and boundary detection is required to accurately assess the IAR when hemorrhage is present.

References

1 Bragadeesh T, Jayaweera AR, Pascotto M, et al. Post-ischaemic myocardial dysfunction (stunning) results from myofibrillar oedema. Heart 2008; 94: 166–171. Crossref, Medline, Google Scholar
2 DiBona DR, Powell WJ Jr. Quantitative correlation between cell swelling and necrosis in myocardial ischemia in dogs. Circ Res 1980;47:653–665. Crossref, Medline, Google Scholar
3 Jennings RB, Schaper J, Hill ML, Steenbergen C Jr, Reimer KA. Effect of reperfusion late in the phase of reversible ischemic injury: changes in cell volume, electrolytes, metabolites, and ultrastructure. Circ Res 1985;56:262–278. Crossref, Medline, Google Scholar
4 Schulz-Menger J, Gross M, Messroghli D, Uhlich F, Dietz R, Friedrich MG. Cardiovascular magnetic resonance of acute myocardial infarction at a very early stage. J Am Coll Cardiol 2003;42:513–518. Crossref, Medline, Google Scholar
5 Nilsson JC, Nielsen G, Groenning BA, et al. Sustained postinfarction myocardial oedema in humans visualised by magnetic resonance imaging. Heart 2001;85:639–642. Crossref, Medline, Google Scholar
6 Garcia-Dorado D, Oliveras J, Gili J, et al. Analysis of myocardial oedema by magnetic resonance imaging early after coronary artery occlusion with or without reperfusion. Cardiovasc Res 1993;27:1462–1469. Crossref, Medline, Google Scholar
7 Boxt LM, Hsu D, Katz J, et al. Estimation of myocardial water content using transverse relaxation time from dual spin-echo magnetic resonance imaging. Magn Reson Imaging 1993;11:375–383. Crossref, Medline, Google Scholar
8 Aletras AH, Tilak GS, Natanzon A, et al. Retrospective determination of the area at risk for reperfused acute myocardial infarction with T2-weighted cardiac magnetic resonance imaging: histopathological and displacement encoding with stimulated echoes (DENSE) functional validations. Circulation 2006;113:1865–1870. Crossref, Medline, Google Scholar
9 Stork A, Lund GK, Muellerleile K, et al. Characterization of the peri-infarction zone using T2-weighted MRI and delayed-enhancement MRI in patients with acute myocardial infarction. Eur Radiol 2006;16:2350–2357. Crossref, Medline, Google Scholar
10 Tilak GS, Hsu LY, Hoyt RF, Arai AE, Aletras AH. In vivo T2-weighted magnetic resonance imaging can accurately determine the ischemic area at risk for 2-day-old nonreperfused myocardial infarction. Invest Radiol 2008;43:7–15. Crossref, Medline, Google Scholar
11 Basso C, Corbetti F, Silva C, et al. Morphologic validation of reperfused hemorrhagic myocardial infarction by cardiovascular magnetic resonance. Am J Cardiol 2007;100:1322–1327. Crossref, Medline, Google Scholar
12 Higginson LA, White F, Heggtveit HA, Sanders TM, Bloor CM, Covell JW. Determinants of myocardial hemorrhage after coronary reperfusion in the anesthetized dog. Circulation 1982;65:62–69. Crossref, Medline, Google Scholar
13 Reimer KA, Lowe JE, Rasmussen MM, Jennings RB. The wavefront phenomenon of ischemic cell death. I. Myocardial infarct size vs duration of coronary occlusion in dogs. Circulation 1977;56:786–794. Google Scholar
14 Lotan CS, Miller SK, Cranney GB, Pohost GM, Elgavish GA. The effect of postinfarction intramyocardial hemorrhage on transverse relaxation time. Magn Reson Med 1992;23:346–355. Crossref, Medline, Google Scholar
15 van den Bos EJ, Baks T, Moelker AD, et al. Magnetic resonance imaging of haemorrhage within reperfused myocardial infarcts: possible interference with iron oxide-labelled cell tracking? Eur Heart J 2006;27:1620–1626. Crossref, Medline, Google Scholar
16 Bydder M, Larkman DJ, Hajnal JV. Combination of signals from array coils using image-based estimation of coil sensitivity profiles. Magn Reson Med 2002;47:539–548. Crossref, Medline, Google Scholar
17 Look DC, Locker DR. Time saving in measurement of NMR and EPR relaxation times. Rev Sci Instrum 1970;41:250–251. Crossref, Google Scholar
18 Cancer for Information Technology. Medical image processing, analysis, and visualization. National Institutes of Health. http://mipav.cit.nih.gov/. Accessed April 8, 2008. Google Scholar
19 Malladi R, Sethian JA. Level set methods for curvature flow, image enhancement, and shape recovery in medical images. In: Proceedings of Conference on Visualization and Mathematics. Berlin, Germany: Springer-Verlag, 1995; 329–345. Google Scholar
20 Anderson LJ, Holden S, Davis B, et al. Cardiovascular T2-star (T2*) magnetic resonance for the early diagnosis of myocardial iron overload. Eur Heart J 2001;22:2171–2179. Crossref, Medline, Google Scholar
21 Reeder SB, Faranesh AZ, Boxerman JL, McVeigh ER. In vivo measurement of T*2 and field inhomogeneity maps in the human heart at 1.5 T. Magn Reson Med 1998;39:988–998. Crossref, Medline, Google Scholar
22 Atalay MK, Poncelet BP, Kantor HL, Brady TJ, Weisskoff RM. Cardiac susceptibility artifacts arising from the heart-lung interface. Magn Reson Med 2001;45:341–345. Crossref, Medline, Google Scholar
23 Bradley WG. MR appearance of hemorrhage in the brain. Radiology 1993;189:15–26. Link, Google Scholar
24 Asanuma T, Tanabe K, Ochiai K, et al. Relationship between progressive microvascular damage and intramyocardial hemorrhage in patients with reperfused anterior myocardial infarction: myocardial contrast echocardiographic study. Circulation 1997;96:448–453. Crossref, Medline, Google Scholar
25 Ochiai K, Shimada T, Murakami Y, et al. Hemorrhagic myocardial infarction after coronary reperfusion detected in vivo by magnetic resonance imaging in humans: prevalence and clinical implications. J Cardiovasc Magn Reson 1999;1:247–256. Crossref, Medline, Google Scholar
26 Pislaru SV, Barrios L, Stassen T, Jun L, Pislaru C, Van de Werf F. Infarct size, myocardial hemorrhage, and recovery of function after mechanical versus pharmacological reperfusion: effects of lytic state and occlusion time. Circulation 1997;96:659–666. Crossref, Medline, Google Scholar
27 Kloner RA, Ellis SG, Lange R, Braunwald E. Studies of experimental coronary artery reperfusion: effects on infarct size, myocardial function, biochemistry, ultrastructure and microvascular damage. Circulation 1983;68:8–15. Google Scholar
28 Fishbein MC, Y-Rit J, Lando U, Kanmatsuse K, Mercier JC, Ganz W. The relationship of vascular injury and myocardial hemorrhage to necrosis after reperfusion. Circulation 1980;62:1274–1279. Crossref, Medline, Google Scholar
29 Bogaert J, Kalantzi M, Rademakers FE, Dymarkowski S, Janssens S. Determinants and impact of microvascular obstruction in successfully reperfused ST-segment elevation myocardial infarction: assessment by magnetic resonance imaging. Eur Radiol 2007;17:2572–2580. Crossref, Medline, Google Scholar
30 Janssens S, Dubois C, Bogaert J, et al. Autologous bone marrow-derived stem-cell transfer in patients with ST-segment elevation myocardial infarction: double-blind, randomised controlled trial. Lancet 2006;367:113–121. Crossref, Medline, Google Scholar
31 Friedrich MG, Abdel-Aty H, Taylor A, Schulz-Menger J, Messroghli D, Dietz R. The salvaged area at risk in reperfused acute myocardial infarction as visualized by cardiovascular magnetic resonance. J Am Coll Cardiol 2008;51:1581–1587. Crossref, Medline, Google Scholar
32 Ibanez B, Prat-Gonzalez S, Speidl WS, et al. Early metoprolol administration before coronary reperfusion results in increased myocardial salvage: analysis of ischemic myocardium at risk using cardiac magnetic resonance. Circulation 2007;115:2909–2916. Crossref, Medline, Google Scholar
33 Hsu LY, Ingkanisorn WP, Kellman P, Aletras AH, Arai AE. Quantitative myocardial infarction on delayed enhancement MRI. II. Clinical application of an automated feature analysis and combined thresholding infarct sizing algorithm. J Magn Reson Imaging 2006;23:309–314. Google Scholar
34 Lotan CS, Bouchard A, Cranney GB, Bishop SP, Pohost GM. Assessment of postreperfusion myocardial hemorrhage using proton NMR imaging at 1.5 T. Circulation 1992;86:1018–1025. Crossref, Medline, Google Scholar
35 Wacker CM, Hartlep AW, Pfleger S, Schad LR, Ertl G, Bauer WR. Susceptibility-sensitive magnetic resonance imaging detects human myocardium supplied by a stenotic coronary artery without a contrast agent. J Am Coll Cardiol 2003;41:834–840. Crossref, Medline, Google Scholar
36 Rochitte CE, Lima JA, Bluemke DA, et al. Magnitude and time course of microvascular obstruction and tissue injury after acute myocardial infarction. Circulation 1998;98:1006–1014. Crossref, Medline, Google Scholar
37 Lund GK, Stork A, Saeed M, et al. Acute myocardial infarction: evaluation with first-pass enhancement and delayed enhancement MR imaging compared with 201Tl SPECT imaging. Radiology 2004;232:49–57. Link, Google Scholar

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Published in print: 2009

Vol. 250, No. 3

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