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Updated: Aug 8, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Importance of perfusion in myocardial viability studies using delayed contrast-enhanced magnetic resonance imaging
Erik Hedström1, Håkan Arheden, Rolf Eriksson
1Department of Clinical Physiology, Lund University, Lund, Sweden. erik.hedstrom@med.iu.se
Insights
Gadolinium-based contrast agents (GBCAs) do not enter ischemic myocardium within one hour of administration during acute coronary occlusion. Nonperfused myocardium appears bright on inversion-recovery delayed contrast-enhanced MRI, even without contrast in the region.
Area of Science:
- Cardiovascular Imaging
- Magnetic Resonance Imaging
- Myocardial Perfusion
Background:
- Delayed contrast-enhanced MRI (DE-MRI) is crucial for assessing myocardial viability.
- Understanding contrast agent behavior in ischemic regions is vital for accurate interpretation.
Purpose of the Study:
- To determine if extracellular gadolinium-based contrast agents (GBCAs) penetrate nonperfused myocardium during acute coronary occlusion.
- To investigate if nonperfused myocardium appears hyperintense in DE-MRI without contrast presence.
Main Methods:
- Acute coronary occlusion was induced in pigs by occluding the left anterior descending coronary artery.
- Longitudinal relaxation rates (R(1)) were measured in blood, perfused, and nonperfused myocardium before and after GBCA administration.
- Look-Locker sequences were employed for R(1) measurements.
Main Results:
- Nonperfused myocardium showed no significant increase in R(1) after GBCA administration, unlike blood and perfused myocardium.
- R(1) in nonperfused myocardium remained significantly lower than in blood and perfused myocardium within the first hour.
- Hyperintense nonperfused myocardium was successfully demarcated by nulling the signal from perfused myocardium.
Conclusions:
- Extracellular GBCAs do not enter ischemic myocardium within one hour of administration during acute coronary occlusion.
- The ischemic region, devoid of contrast, appears bright on inversion-recovery DE-MRI when perfused myocardium signal is nulled.
- Findings enhance understanding of inversion-recovery viability imaging pathophysiology and acute coronary syndrome imaging.
Purpose:
To investigate whether an extracellular gadolinium-(Gd)-based contrast agent (CA) enters nonperfused myocardium during acute coronary occlusion, and whether nonperfused myocardium presents as hyperintense in delayed contrast-enhanced (DE) MR images in the absence of CA in that region.
Materials And Methods:
The left anterior descending coronary artery (LAD) was occluded for 200 minutes in six pigs. The longitudinal relaxation rate (R(1)) in blood, perfused myocardium, and nonperfused myocardium was repeatedly measured using a Look-Locker sequence before and during the first hour after administration of Gd-DTPA-BMA.
Results:
While blood and perfused myocardium showed a major increase in R(1) after CA administration, nonperfused myocardium did not. R(1) in nonperfused myocardium was significantly lower than in blood and perfused myocardium during the first hour after CA administration. When the signal from perfused myocardium was nulled, demarcation of the hyperintense nonperfused myocardium was achieved in all of the study animals.
Conclusion:
Gd-DTPA-BMA does not enter ischemic myocardium within one hour after administration during acute coronary occlusion. The ischemic region with complete absence of CA still appears bright when the signal from perfused myocardium is nulled using inversion-recovery DE-MRI. This finding is important for understanding the basic pathophysiology of inversion-recovery viability imaging, as well as for imaging of acute coronary syndromes.
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