Quantification of Myocardial Area at Risk With T2-Weighted CMRComparison With Contrast-Enhanced CMR and Coronary Angiography
Jeremy Wright, MBBS*, ,
Tom Adriaenssens, MD ,
Steven Dymarkowski, MD, PhD*,
Walter Desmet, MD, PhD,
Jan Bogaert, MD, PhD*,*
* Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium
Department of Cardiology, Gasthuisberg University Hospital, Leuven, Belgium
Greenslopes Private Hospital, Brisbane, Australia
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Figure 1 Hemorrhagic Myocardial Infarction in a 69-Year-Old Man
Coronary angiography before (A) and after (B) percutaneous coronary intervention, T2-weighted (T2W) cardiac magnetic resonance (CMR) (C). Left anterior oblique cranial view shows a proximal left anterior descending coronary artery (LAD) occlusion with thrombotic appearance (A). Presence of 60% stenosis on mid left circumflex coronary artery and 40% stenosis on the fourth inferolateral branch. Successful reperfusion of LAD (B). The T2W CMR shows area of increased signal intensity in anteroseptal left ventricular wall with hypointense core consistent with post-reperfusion intramyocardial hemorrhage (C). The BARI (Bypass Angioplasty Revascularization Investigation) risk score is 43.5%, T2W area at risk 48.7%.
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Figure 2 T2-Weighted and Contrast-Enhanced CMR Images
The T2W CMR (A) and contrast-enhanced CMR (B) in a 77-year-old male patient with an extensive anteroseptal acute myocardial infarction. On short-axis T2W CMR the area at risk is visible as a hyperintense (i.e., bright gray) area and is slightly larger than the infarct area as visible on contrast-enhanced CMR (i.e., 29.7% vs. 26.2%, respectively). The BARI risk score is 21.7%, and the infarct endocardial surface length is 24%. Abbreviations as in Figure 1.
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Figure 3 Myocardium at Risk and Infarct Size
The percentage of myocardium at risk during acute myocardial infarction was consistently greater than the irreversibly injured myocardium. The volume of myocardium at risk was measured with T2W CMR, and irreversibly injured myocardium was measured with contrast-enhanced CMR. The dashed line indicates the line of identity. AAR = area at risk; LV = left ventricular; other abbreviations as in Figure 1.
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Figure 4 T2W AAR and Infarct ESL
The AAR measured with T2W CMR correlates strongly with the infarct endocardial surface length (ESL) (r = 0.77). The solid line is the regression line, whereas the dotted line is the line of identity. Abbreviations as in Figures 1 and 3.
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Figure 5 Bland-Altman Plots of T2W AAR With Infarct ESL and BARI Risk Score With Infarct ESL
Both T2W AAR (7.8 ± 10.0%) (A) and BARI risk score (7.3 ± 11.2%) (B) show a positive bias compared with infarct ESL. The solid lines are the mean difference, whereas the dashed lines represent ± 2 SD from the mean. Abbreviations as in Figures 1 and 3.
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