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Diffusion-weighted imaging of reperfused acute myocardial infarction: effect of intravenous gadolinium-based contrast agent administration1Department of Radiology, The Afliated Hospital of Xuzhou Medical University, XUZHOU, China, 2Philips Healthcare, Shanghai, China, Shanghai, China
Synopsis
Keywords: Myocardium, Diffusion/other diffusion imaging techniques, acute myocardial infarction, reperfusion injury
Motivation: Cardiac diffusion-weighted(DW)imaging has proven to be an effective approach to explore ischemia reperfusion myocardium damage and inflammation induced by treatment after reperfusion.
Goal(s): The objective of this study was to investigate whether contrast agent (CA) administration significantly affects DWI in the evaluation of reperfused acute myocardial infarction.
Approach: The apparent diffusion coefficient (ADC) values,signal intensity(SI) and contrast-to-noise ratio(CNR) pre- and post-contrast were measured in the intramyocardial hemorrhage (IMH),edema area and remote regions, respectively.
Results: The ADC values in IMH and edema area were not significantly changed between pre- and post-contrast (P>0.05), while the SI of remote myocardium was inhibited and CNRs were reduced.
Impact: To better assess ischemia reperfusion myocardium damage, DWI is recommended to perform as much as possible before the gadolinium-based contrast agent administration.
Introduction
In patients with ST-elevation myocardial infarction, reperfusion perfusion therapy is the most effective strategy to inhibit myocardial ischemic injury1, which can significantly reduce the mortality after acute myocardial infarction2,3.Cardiac diffusion-weighted imaging(DWI) has proven to be an effective approach to explore ischemia reperfusion myocardium damage and inflammation induced by treatment after reperfusion4,5.We aimed to investigate whether gadolinium-based contrast agent (GBCA) administration significantly affects DWI at 3.0 T in the evaluation of reperfused acute myocardial infarction.Methods
Thirty-one participants with AMI after reperfusion underwent DWI at 3T before and after GBCA administration. Diffusion-encoding gradients using second-order gradient moment nulling were used to compensate for cardiac Motion6.The apparent diffusion coefficient (ADC) maps were developed from DWI data. The ADC values pre- and post-contrast were measured in the intramyocardial hemorrhage (IMH),edema area and remote regions, respectively. The signal intensity (SI) and contrast-to-noise ratio (CNR) were evaluated on pre- and post-contrast DWI.Results
The ADC values, SI and CNR of the IMH,edema and remote myocardium were significantly different with or without GBCA(P<0.05).In all regions,the ADC values were not significantly different between pre- and post-contrast (P>0.05), while the SI and CNR of remote myocardium were significantly different (P＜0.001 and 0.02, respectively).Between pre- and post-contrast, ADC values showed excellent agreement (intraclass correlation coefficient≥0.838) and variability of ≤3.3 %.Even if the direction of phase coding was changed, the septum and free wall of right ventricle still showed false“High signal” after 10 min of GBCA.Conclusion
In order to evaluate ischemia reperfusion myocardium damage more accurately, DWI is recommended to perform as much as possible before the gadolinium-based contrast agent administration.Acknowledgements
This study was supported by the National Natural Science Foundation of China (Grant No. 81771904). The funders played an important role in data collection, data analysis and the preparation of the manuscript.References
1. Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet 2003;361(9351):13–20.
2. Pedersen F, Butrymovich V, Kelbæk H, et al. Short- and long-term cause of death in patients treated with primary PCI for STEMI. J Am Coll Cardiol 2014;64(20):2101–2108.
3.Kristensen SD, Laut KG, Fajadet J, et al. Reperfusion therapy for ST elevation acute myocardial infarction 2010/2011: current status in 37 ESC countries. Eur Heart J 2014;35(29):1957–1970.
4.Moulin K, Viallon M, Romero W, et al. MRI of Reperfused Acute Myocardial Infarction Edema: ADC Quantification versus T1 and T2 Mapping. Radiology. 2020;295(3):542-549.
5.Das A, Kelly C, Teh I, et al. Pathophysiology of LV Remodeling Following STEMI: A Longitudinal Diffusion Tensor CMR Study. JACC Cardiovasc Imaging. 2023;16(2):159-171.
6.Welsh CL, DiBella EVR, Hsu EW. Higher-Order Motion-Compensation for In Vivo Cardiac Diffusion Tensor Imaging in Rats. IEEE Trans Med Imaging 2015;34(9):1843–1853.
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