Top

Journal of Cardiovascular Magnetic Resonance

Published in:

Open Access 01-12-2017 | Research

Experimental validation of contrast-enhanced SSFP cine CMR for quantification of myocardium at risk in acute myocardial infarction

Authors: David Nordlund, Mikael Kanski, Robert Jablonowski, Sasha Koul, David Erlinge, Marcus Carlsson, Henrik Engblom, Anthony H. Aletras, Håkan Arheden

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2017

Abstract

Background

Accurate assessment of myocardium at risk (MaR) after acute myocardial infarction (AMI) is necessary when assessing myocardial salvage. Contrast-enhanced steady-state free precession (CE-SSFP) is a recently developed cardiovascular magnetic resonance (CMR) method for assessment of MaR up to 1 week after AMI. Our aim was to validate CE-SSFP for determination of MaR in an experimental porcine model using myocardial perfusion single-photon emission computed tomography (MPS) as a reference standard and to test the stability of MaR-quantification over time after injecting gadolinium-based contrast.

Methods

Eleven pigs were subjected to either 35 or 40 min occlusion of the left anterior descending artery followed by six hours of reperfusion. A technetium-based perfusion tracer was administered intravenously ten minutes before reperfusion. In-vivo and ex-vivo CE-SSFP CMR was performed followed by ex-vivo MPS imaging. MaR was expressed as % of left ventricular mass (LVM).

Results

There was good agreement between MaR by ex-vivo CMR and MaR by MPS (bias: 1 ± 3% LVM, r ² = 0.92, p < 0.001), between ex-vivo and in-vivo CMR (bias 0 ± 2% LVM, r ² = 0.94, p < 0.001) and between in-vivo CMR and MPS (bias -2 ± 3% LVM, r ² = 0.87, p < 0.001. No change in MaR was seen over the first 30 min after contrast injection (p = 0.95).

Conclusions

Contrast-enhanced SSFP cine CMR can be used to measure MaR, both in vivo and ex vivo, in a porcine model with good accuracy and precision over the first 30 min after contrast injection. This offers the option to use the less complex ex-vivo imaging when determining myocardial salvage in experimental studies.

Reimer KA, Jennings RB. The “wavefront phenomenon” of myocardial ischemic cell death. II. Transmural progression of necrosis within the framework of ischemic bed size (myocardium at risk) and collateral flow. Lab Invest. 1979;40:633–44.PubMed

Kim RJ, Wu E, Rafael A, Chen E-L, Parker MA, Simonetti O, Klocke FJ, Bonow RO, Judd RM. The Use of Contrast-Enhanced Magnetic Resonance Imaging to Identify Reversible Myocardial Dysfunction. N Engl J Med. 2000;343:1445–53.CrossRefPubMed

Simonetti OP, Kim RJ, Fieno DS, Hillenbrand HB, Wu E, Bundy JM, Finn JP, Judd RM. An improved MR imaging technique for the visualization of myocardial infarction. Radiology. 2001;218:215–23.CrossRefPubMed

Aletras AH, Tilak GS, Natanzon A, Hsu L-Y, Gonzalez FM, Hoyt RFJ, 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;113:1865–70.CrossRefPubMed

Carlsson M, Ubachs JFA, Hedström E, Heiberg E, Jovinge S, Arheden H. Myocardium at Risk After Acute Infarction in Humans on Cardiac Magnetic Resonance. JACC Cardiovasc Imaging. 2009;2:569–76.CrossRefPubMed

Nordlund D, Klug G, Heiberg E, Koul S, Larsen TH, Hoffmann P, Metzler B, Erlinge D, Atar D, Aletras AH, Carlsson M, Engblom H, Arheden H. Multi-vendor, multicentre comparison of contrast-enhanced SSFP and T2-STIR CMR for determining myocardium at risk in ST-elevation myocardial infarction. Eur Hear J – Cardiovasc Imaging. 2016;17:744–53.CrossRef

Keegan J, Gatehouse PD, Prasad SK, Firmin DN. Improved turbo spin-echo imaging of the heart with motion-tracking. J Magn Reson Imaging. 2006;24:563–70.CrossRefPubMed

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;57:891–7.CrossRefPubMedPubMedCentral

Sörensson P, Heiberg E, Saleh N, Bouvier F, Caidahl K, Tornvall P, Rydén L, Pernow J, Arheden H. Assessment of myocardium at risk with contrast enhanced steady-state free precession cine cardiovascular magnetic resonance compared to single-photon emission computed tomography. J Cardiovasc Magn Reson. 2010;12:25.CrossRefPubMedPubMedCentral

10.

Ubachs JFA, Sorensson P, Engblom H, Carlsson M, Jovinge S, Pernow J, Arheden H. Myocardium at risk by magnetic resonance imaging: head-to-head comparison of T2-weighted imaging and contrast-enhanced steady-state free precession. Eur Hear J - Cardiovasc Imaging. 2012;13:1008–15.CrossRef

11.

Erlinge D, Götberg M, Lang I, Holzer M, Noc M, Clemmensen P, Jensen U, Metzler B, James S, Bötker HE, Omerovic E, Engblom H, Carlsson M, Arheden H, Östlund O, Wallentin L, Harnek J, Olivecrona GK. Rapid Endovascular Catheter Core Cooling Combined With Cold Saline as an Adjunct to Percutaneous Coronary Intervention for the Treatment of Acute Myocardial Infarction. J Am Coll Cardiol. 2014;63:1857–65.CrossRefPubMed

12.

Atar D, Arheden H, Berdeaux A, Bonnet J-L, Carlsson M, Clemmensen P, Cuvier V, Danchin N, Dubois-Rande J-L, Engblom H, Erlinge D, Firat H, Halvorsen S, Hansen HS, Hauke W, Heiberg E, Koul S, Larsen A-I, Le Corvoisier P, Nordrehaug JE, Paganelli F, Pruss RM, Rousseau H, Schaller S, Sonou G, Tuseth V, Veys J, Vicaut E, Jensen SE. Effect of intravenous TRO40303 as an adjunct to primary percutaneous coronary intervention for acute ST-elevation myocardial infarction: MITOCARE study results. Eur Heart J. 2014;36:1–8.

13.

Heiberg E, Sjögren J, Ugander M, Carlsson M, Engblom H, Arheden H. Design and validation of Segment--freely available software for cardiovascular image analysis. BMC Med Imaging. 2010;10:1.CrossRefPubMedPubMedCentral

14.

Engblom H, Tufvesson J, Jablonowski R, Carlsson M, Aletras AH, Hoffmann P, Jacquier A, Kober F, Metzler B, Erlinge D, Atar D, Arheden H, Heiberg E. A new automatic algorithm for quantification of myocardial infarction imaged by late gadolinium enhancement cardiovascular magnetic resonance: experimental validation and comparison to expert delineations in multi-center, multi-vendor patient data. J Cardiovasc Magn Reson. 2016;18:27.CrossRefPubMedPubMedCentral

15.

Kloner RA, Ganote CE, Jennings RB. The “No-Reflow” Phenomenon after Temporary Coronary Occlusion in the Dog. J Clin Invest. 1974;54:1496–508.CrossRefPubMedPubMedCentral

16.

Heiberg E, Ugander M, Engblom H, Götberg M, Olivecrona GK, Erlinge D, Arheden H. Automated quantification of myocardial infarction from MR images by accounting for partial volume effects: animal, phantom, and human study. Radiology. 2008;246:581–8.CrossRefPubMed

17.

Ugander M, Soneson H, Engblom H, van der Pals J, Erlinge D, Heiberg E, Arheden H. Quantification of myocardium at risk in myocardial perfusion SPECT by co-registration and fusion with delayed contrast-enhanced magnetic resonance imaging--an experimental ex vivo study. Clin Physiol Funct Imaging. 2012;32:33–8.CrossRefPubMed

18.

Altman DG, Bland JM. Measurement in Medicine: The Analysis of Method Comparison Studies. Stat. 1983;32:307.

19.

Bieri O, Scheffler K. Fundamentals of balanced steady state free precession MRI. J Magn Res Imaging. 2013:38(1):2–11.

20.

Ugander M, Bagi PS, Oki AJ, Chen B, Hsu L-Y, 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.CrossRefPubMedPubMedCentral

21.

Arheden H, Saeed M, Higgins CB, Gao DW, Bremerich J, Wyttenbach R, Dae MW, Wendland MF. Measurement of the distribution volume of gadopentetate dimeglumine at echo-planar MR imaging to quantify myocardial infarction: comparison with 99mTc-DTPA autoradiography in rats. Radiology. 1999;211:698–708.CrossRefPubMed

22.

Arheden H, Saeed M, Higgins CB, Gao DW, Ursell PC, Bremerich J, Wyttenbach R, Dae MW, Wendland MF. Reperfused rat myocardium subjected to various durations of ischemia: estimation of the distribution volume of contrast material with echo-planar MR imaging. Radiology. 2000;215:520–8.CrossRefPubMed

23.

Jablonowski R, Engblom H, Kanski M, Nordlund D, Koul S, van der Pals J, Englund E, Heiberg E, Erlinge D, Carlsson M, Arheden H. Contrast-Enhanced CMR Overestimates Early Myocardial Infarct Size: Mechanistic Insights Using ECV Measurements on Day 1 and Day 7. JACC Cardiovasc Imaging. 2015;8:1379–89.CrossRefPubMed

24.

Wendland MF, Saeed M, Lauerma K, Derugin N, Mintorovitch J, Cavagna FM, Higgins CB. Alterations inT1 of normal and reperfused infarcted myocardium after Gd-BOPTA versus GD-DTPA on inversion recovery EPI. Magn Reson Med. 1997;37:448–56.CrossRefPubMed

25.

Ugander M, Oki AJ, Hsu LY, Kellman P, Greiser A, Aletras AH, Sibley CT, Chen MY, Patricia Bandettini W, Arai AE. Extracellular volume imaging by magnetic resonance imaging provides insights into overt and sub-clinical myocardial pathology. Eur Heart J. 2012;33:1268–78.CrossRefPubMedPubMedCentral

26.

Khoshnood A, Carlsson M, Akbarzadeh M, Bhiladvala P, Roijer A, Bodetoft S, Höglund P, Zughaft D, Todorova L, Erlinge DEU. The Effects of Oxygen Therapy on Myocardial Salvage in ST Elevation Myocardial Infarction Treated with Acute Percutaneous Coronary Intervention: The Supplemental Oxygen in Catheterized Coronary Emergency Reperfusion (SOCCER) Study. Cardiology. 2015;132:16–21.CrossRefPubMed

27.

De Coster PM, Wijns W, Cauwe F, Robert A, Beckers C, Melin JA. Area-at-risk determination by technetium-99 m-hexakis-2-methoxyisobutyl isonitrile in experimental reperfused myocardial infarction. Circulation. 1990;82:2152–62.CrossRefPubMed

28.

Garcia-Dorado D, Théroux P, Duran JM, Solares J, Alonso J, Sanz E, Munoz R, Elizaga J, Botas J, Fernandez-Avilés F. Selective inhibition of the contractile apparatus. A new approach to modification of infarct size, infarct composition, and infarct geometry during coronary artery occlusion and reperfusion. Circulation. 1992;85:1160–74.CrossRefPubMed

29.

Engblom H, Heiberg E, Erlinge D, Jensen SE, Nordrehaug JE, Dubois-Randé J-L, Halvorsen S, Hoffmann P, Koul S, Carlsson M, Atar D, Arheden H. Sample Size in Clinical Cardioprotection Trials Using Myocardial Salvage Index, Infarct Size, or Biochemical Markers as Endpoint. J Am Heart Assoc. 2016;5:e002708.CrossRefPubMedPubMedCentral

30.

Bulluck H, White SK, Rosmini S, Bhuva A, Treibel TA, Fontana M, Abdel-Gadir A, Herrey A, Manisty C, Wan SMY, Groves A, Menezes L, Moon JC, Hausenloy DJ. T1 mapping and T2 mapping at 3 T for quantifying the area-at-risk in reperfused STEMI patients. J Cardiovasc Magn Reson. 2015;17:73.CrossRefPubMedPubMedCentral

Title: Experimental validation of contrast-enhanced SSFP cine CMR for quantification of myocardium at risk in acute myocardial infarction
Authors: David Nordlund
Mikael Kanski
Robert Jablonowski
Sasha Koul
David Erlinge
Marcus Carlsson
Henrik Engblom
Anthony H. Aletras
Håkan Arheden
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: Journal of Cardiovascular Magnetic Resonance / Issue 1/2017
Electronic ISSN: 1532-429X
DOI: https://doi.org/10.1186/s12968-017-0325-y

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Experimental validation of contrast-enhanced SSFP cine CMR for quantification of myocardium at risk in acute myocardial infarction

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2017

Synthetic hematocrit derived from the longitudinal relaxation of blood can lead to clinically significant errors in measurement of extracellular volume fraction in pediatric and young adult patients

Altered aortic 3D hemodynamics and geometry in pediatric Marfan syndrome patients

Diagnostic performance of semi-quantitative and quantitative stress CMR perfusion analysis: a meta-analysis

Impact of bileaflet mitral valve prolapse on quantification of mitral regurgitation with cardiac magnetic resonance: a single-center study

Non-contrast MR angiography at 1.5 Tesla for aortic monitoring in Marfan patients after aortic root surgery

Representation of cardiovascular magnetic resonance in the AHA / ACC guidelines