Diagnostic Accuracy of 3.0-T Magnetic Resonance T1 and T2 Mapping and T2-Weighted Dark-Blood Imaging for the Infarct-Related Coronary Artery in Non-ST-Segment Elevation Myocardial Infarction

Jamie Layland, Samuli Rauhalammi, Matthew M Y Lee, Nadeem Ahmed, Jaclyn Carberry, Vannesa Teng Yue May, Stuart Watkins, Christie McComb, Kenneth Mangion, John D McClure, David Carrick, Anna O'Donnell, Arvind Sood, Margaret McEntegart, Keith G Oldroyd, Aleksandra Radjenovic, Colin Berry, Jamie Layland, Samuli Rauhalammi, Matthew M Y Lee, Nadeem Ahmed, Jaclyn Carberry, Vannesa Teng Yue May, Stuart Watkins, Christie McComb, Kenneth Mangion, John D McClure, David Carrick, Anna O'Donnell, Arvind Sood, Margaret McEntegart, Keith G Oldroyd, Aleksandra Radjenovic, Colin Berry

Abstract

Background: Patients with recent non-ST-segment elevation myocardial infarction commonly have heterogeneous characteristics that may be challenging to assess clinically.

Methods and results: We prospectively studied the diagnostic accuracy of 2 novel (T1, T2 mapping) and 1 established (T2-weighted short tau inversion recovery [T2W-STIR]) magnetic resonance imaging methods for imaging the ischemic area at risk and myocardial salvage in 73 patients with non-ST-segment elevation myocardial infarction (mean age 57±10 years, 78% male) at 3.0-T magnetic resonance imaging within 6.5±3.5 days of invasive management. The infarct-related territory was identified independently using a combination of angiographic, ECG, and clinical findings. The presence and extent of infarction was assessed with late gadolinium enhancement imaging (gadobutrol, 0.1 mmol/kg). The extent of acutely injured myocardium was independently assessed with native T1, T2, and T2W-STIR methods. The mean infarct size was 5.9±8.0% of left ventricular mass. The infarct zone T1 and T2 times were 1323±68 and 57±5 ms, respectively. The diagnostic accuracies of T1 and T2 mapping for identification of the infarct-related artery were similar (P=0.125), and both were superior to T2W-STIR (P<0.001). The extent of myocardial injury (percentage of left ventricular volume) estimated with T1 (15.8±10.6%) and T2 maps (16.0±11.8%) was similar (P=0.838) and moderately well correlated (r=0.82, P<0.001). Mean extent of acute injury estimated with T2W-STIR (7.8±11.6%) was lower than that estimated with T1 (P<0.001) or T2 maps (P<0.001).

Conclusions: In patients with non-ST-segment elevation myocardial infarction, T1 and T2 magnetic resonance imaging mapping have higher diagnostic performance than T2W-STIR for identifying the infarct-related artery. Compared with conventional STIR, T1 and T2 maps have superior value to inform diagnosis and revascularization planning in non-ST-segment elevation myocardial infarction.

Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02073422.

Keywords: acute coronary syndrome; area at risk; edema; mapping; noninvasive imaging; non–ST‐segment elevation acute coronary syndrome.

© 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Figures

Figure 1
Figure 1
Magnetic resonance imaging findings in a 62‐year‐old male patient 4 days after hospitalization because of an acute non–ST‐segment elevation myocardial infarction: (A) T2 map, (B) T2‐weighted short tau inversion recovery (T2W‐STIR), (C) T1 map, (D) late gadolinium enhancement (LGE). Inferior subendocardial infarction, as revealed by LGE, corresponds with the transmural extent of myocardial injury revealed with T1 and T2 maps, but this is not seen with T2W‐STIR. Conversely, the anterior wall is hyperintense with T2W‐STIR.
Figure 2
Figure 2
T1 and T2 values (m/s) in remote territory and in the injury zone (IZ).
Figure 3
Figure 3
Correlation between the extent of myocardial injury estimated with T1 and T2 mapping and dark‐blood T2W‐STIR imaging. LV indicates left ventricular; T2W‐STIR, T2‐weighted short tau inversion recovery.
Figure 4
Figure 4
Bland–Altman plot comparing the extent of myocardial injury using T1 vs T2 mapping sequences.

References

    1. Friedrich MG, Kim HW, Kim RJ. T2‐weighted imaging to assess post‐infarct myocardium at risk. JACC Cardiovasc Imaging. 2011;4:1014–1021.
    1. Payne AR, Casey M, McClure J, McGeoch R, Murphy A, Woodward R, Saul A, Bi X, Zuehlsdorff S, Oldroyd KG, Tzemos N, Berry C. Bright‐blood T2‐weighted MRI has higher diagnostic accuracy than dark‐blood short tau inversion recovery MRI for detection of acute myocardial infarction and for assessment of the ischemic area at risk and myocardial salvage. Circ Cardiovasc Imaging. 2011;4:210–219.
    1. Dall'Armellina E, Piechnik SK, Ferreira VM, Si QL, Robson MD, Francis JM, Cuculi F, Kharbanda RK, Banning AP, Choudhury RP, Karamitsos TD, Neubauer S. Cardiovascular magnetic resonance by non contrast T1‐mapping allows assessment of severity of injury in acute myocardial infarction. J Cardiovasc Magn Reson. 2012;14:15.
    1. Simonetti OP, Finn JP, White RD, Laub G, Henry DA. “Black blood” T2‐weighted inversion‐recovery MR imaging of the heart. Radiology. 1996;199:49–57.
    1. Raman SV, Simonetti OP, Winner MW III, Dickerson JA, He X, Mazzaferri EL Jr, Ambrosio G. Cardiac magnetic resonance with edema imaging identifies myocardium at risk and predicts worse outcome in patients with non‐ST‐segment elevation acute coronary syndrome. J Am Coll Cardiol. 2010;55:2480–2488.
    1. Eitel I, Desch S, Fuernau G, Hildebrand L, Gutberlet M, Schuler G, Thiele H. Prognostic significance and determinants of myocardial salvage assessed by cardiovascular magnetic resonance in acute reperfused myocardial infarction. J Am Coll Cardiol. 2010;55:2470–2479.
    1. Thiele H, Hildebrand L, Schirdewahn C, Eitel I, Adams V, Fuernau G, Erbs S, Linke A, Diederich KW, Nowak M, Desch S, Gutberlet M, Schuler G. Impact of high‐dose N‐acetylcysteine versus placebo on contrast‐induced nephropathy and myocardial reperfusion injury in unselected patients with ST‐segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. The LIPSIA‐N‐ACC (Prospective, Single‐Blind, Placebo‐Controlled, Randomized Leipzig Immediate PercutaneouS Coronary Intervention Acute Myocardial Infarction N‐ACC) Trial. J Am Coll Cardiol. 2010;55:2201–2209.
    1. Keegan J, Gatehouse PD, Prasad SK, Firmin DN. Improved turbo spin‐echo imaging of the heart with motion‐tracking. J Magn Reson Imaging. 2006;24:563–570.
    1. Kellman P, Aletras AH, Mancini C, McVeigh ER, Arai AE. T2‐prepared SSFP improves diagnostic confidence in edema imaging in acute myocardial infarction compared to turbo spin echo. Magn Reson Med. 2007;57:891–897.
    1. Verhaert D, Thavendiranathan P, Giri S, Mihai G, Rajagopalan S, Simonetti OP, Raman SV. Direct T2 quantification of myocardial edema in acute ischemic injury. JACC Cardiovasc Imaging. 2011;4:269–278.
    1. Carrick D, Behan M, Foo F, Christie J, Hillis WS, Norrie J, Oldroyd KG, Berry C. Usefulness of fractional flow reserve to improve diagnostic efficiency in patients with non‐ST elevation myocardial infarction. Am J Cardiol. 2013;111:45–50.
    1. Thygesen K, Alpert JS, White HD; Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction , Jaffe AS, Apple FS, Galvani M, Katus HA, Newby LK, Ravkilde J, Chaitman B, Clemmensen PM, Dellborg M, Hod H, Porela P, Underwood R, Bax JJ, Beller GA, Bonow R, Van der Wall EE, Bassand JP, Wijns W, Ferguson TB, Steg PG, Uretsky BF, Williams DO, Armstrong PW, Antman EM, Fox KA, Hamm CW, Ohman EM, Simoons ML, Poole‐Wilson PA, Gurfinkel EP, Lopez‐Sendon JL, Pais P, Mendis S, Zhu JR, Wallentin LC, Fernández‐Avilés F, Fox KM, Parkhomenko AN, Priori SG, Tendera M, Voipio‐Pulkki LM, Vahanian A, Camm AJ, De Caterina R, Dean V, Dickstein K, Filippatos G, Funck‐Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL, Morais J, Brener S, Harrington R, Morrow D, Lim M, Martinez‐Rios MA, Steinhubl S, Levine GN, Gibler WB, Goff D, Tubaro M, Dudek D, Al‐Attar N. Universal definition of myocardial infarction. Circulation. 2007;116:2634–2653.
    1. Hamm CW, Bassand JP, Agewall S, Bax J, Boersma E, Bueno H, Caso P, Dudek D, Gielen S, Huber K, Ohman M, Petrie MC, Sonntag F, Uva MS, Storey RF, Wijns W, Zahger D; ESC Committee for Practice Guidelines . ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST‐segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST‐segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2011;32:2999–3054.
    1. Messroghli DR, Radjenovic A, Kozerke S, Higgins DM, Sivananthan MU, Ridgway JP. Modified Look‐Locker inversion recovery (MOLLI) for high‐resolution T1 mapping of the heart. Magn Reson Med. 2004;52:141–146.
    1. Messroghli DR, Walters K, Plein S, Sparrow P, Friedrich MG, Ridgway JP, Sivananthan MU. Myocardial T1 mapping: application to patients with acute and chronic myocardial infarction. Magn Reson Med. 2007;58:34–40.
    1. Giri S, Chung YC, Merchant A, Mihai G, Rajagopalan S, Raman SV, Simonetti OP. T2 quantification for improved detection of myocardial edema. J Cardiovasc Magn Reson. 2009;11:56.
    1. Hermosillo G, Chefd'Hotel C, Faugeras O. International Journal of Computer Vision 2002;50:329.
    1. Berry C, Kellman P, Mancini C, Chen MY, Bandettini WP, Lowrey T, Hsu LY, Aletras AH, Arai AE. Magnetic resonance imaging delineates the ischemic area at risk and myocardial salvage in patients with acute myocardial infarction. Circ Cardiovasc Imaging. 2010;3:527–535.
    1. Kim RJ, Fieno DS, Parrish TB, Harris K, Chen EL, Simonetti O, Bundy J, Finn JP, Klocke FJ, Judd RM. Relationship of MRI delayed contrast enhancement to irreversible injury, infarct age, and contractile function. Circulation. 1999;100:1992–2002.
    1. Carrick D, Oldroyd KG, McEntegart M, Haig C, Petrie MC, Eteiba H, Hood S, Owens C, Watkins S, Layland J, Lindsay M, Peat E, Rae A, Behan M, Sood A, Hillis WS, Mordi I, Mahrous A, Ahmed N, Wilson R, Lasalle L, Genereux P, Ford I, Berry C. A randomized trial of deferred stenting versus immediate stenting to prevent no‐or slow reflow in acute ST‐elevation myocardial infarction (DEFER‐STEMI). J Am Coll Cardiol. 2014;63:2088–2098.
    1. Moon JC, Messroghli DR, Kellman P, Piechnik SK, Robson MD, Ugander M, Gatehouse PD, Arai AE, Friedrich MG, Neubauer S, Schulz‐Menger J, Schelbert EB. Myocardial T1 mapping and extracellular volume quantification: a Society for Cardiovascular Magnetic Resonance (SCMR) and CMR Working Group of the European Society of Cardiology consensus statement. J Cardiovasc Magn Reson. 2013;15:92.
    1. Ortiz‐Perez JT, Meyers SN, Lee DC, Kansal P, Klocke FJ, Holly TA, Davidson CJ, Bonow RO, Wu E. Angiographic estimates of myocardium at risk during acute myocardial infarction: validation study using cardiac magnetic resonance imaging. Eur Heart J. 2007;28:1750–1758.
    1. Reiser B, Faraggi D. Confidence Intervals for the Overlapping Coefficient: the Normal Equal Variance Case. J R Stat Soc Ser. 1999;48:413–418.
    1. Cortell A, Sanchis J, Bodi V, Nunez J, Mainar L, Pellicer M, Minana G, Santas E, Dominguez E, Palau P, Llacer A. Non‐ST‐elevation acute myocardial infarction with normal coronary arteries: predictors and prognosis. Rev Esp Cardiol. 2009;62:1260–1266.
    1. Abdel‐Aty H, Cocker M, Meek C, Tyberg JV, Friedrich MG. Edema as a very early marker for acute myocardial ischemia: a cardiovascular magnetic resonance study. J Am Coll Cardiol. 2009;53:1194–1201.
    1. Aletras AH, Tilak GS, Natanzon A, Hsu LY, Gonzalez FM, Hoyt RF Jr, Arai AE. 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.
    1. Cury RC, Shash K, Nagurney JT, Rosito G, Shapiro MD, Nomura CH, Abbara S, Bamberg F, Ferencik M, Schmidt EJ, Brown DF, Hoffmann U, Brady TJ. Cardiac magnetic resonance with T2‐weighted imaging improves detection of patients with acute coronary syndrome in the emergency department. Circulation. 2008;118:837–844.
    1. Arai AE. Using magnetic resonance imaging to characterize recent myocardial injury: utility in acute coronary syndrome and other clinical scenarios. Circulation. 2008;118:795–796.
    1. Pennell D. Myocardial salvage: retrospection, resolution, and radio waves. Circulation. 2006;113:1821–1823.
    1. Ugander M, Bagi PS, Oki AJ, Chen B, Hsu LY, Aletras AH, Shah S, Greiser A, Kellman P, Arai AE. Myocardial edema as detected by pre‐contrast T1 and T2 CMR delineates area at risk associated with acute myocardial infarction. JACC Cardiovasc Imaging. 2012;5:596–603.
    1. Messroghli DR, Greiser A, Frohlich M, Dietz R, Schulz‐Menger J. Optimization and validation of a fully‐integrated pulse sequence for modified look‐locker inversion‐recovery (MOLLI) T1 mapping of the heart. J Magn Reson Imaging. 2007;26:1081–1086.
    1. Ferreira VM, Piechnik SK, Dall'Armellina E, Karamitsos TD, Francis JM, Choudhury RP, Friedrich MG, Robson MD, Neubauer S. Non‐contrast T1‐mapping detects acute myocardial edema with high diagnostic accuracy: a comparison to T2‐weighted cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2012;14:42.
    1. McAlindon E, Pufulete M, Lawton C, Angelini GD, Bucciarelli‐Ducci C. Quantification of infarct size and myocardium at risk: evaluation of different techniques and its implications. Eur Heart J Cardiovasc Imaging. 2015;16:738–746.
    1. Payne AR, Berry C, Kellman P, Anderson R, Hsu LY, Chen MY, McPhaden AR, Watkins S, Schenke W, Wright V, Lederman RJ, Aletras AH, Arai AE. Bright‐blood T(2)‐weighted MRI has high diagnostic accuracy for myocardial hemorrhage in myocardial infarction: a preclinical validation study in swine. Circ Cardiovasc Imaging. 2011;4:738–745.

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