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MR imaging of acute myocardial infarction: value of Gd-DTPA
A de Roos1, J Doornbos, E E van der Wall
1Department of Diagnostic Radiology, University Hospital Leiden, the Netherlands.
Abstract:
The potential of gadolinium (Gd)-DTPA to improve the detection of acute myocardial infarction by MR has been shown in experimental canine studies. To determine its value in humans, we studied five patients 2-17 days after myocardial infarction by using ECG-gated MR before and after administration of 0.1 mmol/kg Gd-DTPA. One patient had a rupture of the interventricular septum, complicating an acute inferior-wall infarction. Spin-echo images were obtained before and immediately after injection of Gd-DTPA and were repeated every 10 min for up to 40 min. In four patients, intensity-vs-time curves revealed increasing signal intensity in the infarcted area in the first 20 min after injection of gadolinium. Contrast between normal and infarcted myocardium was greatest 20-30 min after Gd-DTPA injection. In one patient, increasing signal intensity of the infarcted myocardium was observed up to 40 min after Gd-DTPA injection. The precontrast intensity ratio between infarcted and normal myocardium was 1.1 at echo time (TE) = 30 msec and was 1.4 at TE = 60 msec (p less than .05). The postcontrast intensity ratio was 1.6, which was not statistically different from the ratio at TE = 60 msec but which was significantly higher than the ratio at TE = 30 msec (p less than .01). Infarct definition was substantially improved on postcontrast images. The septal rupture was clearly seen, and the infarcted myocardium surrounding the septal rupture showed enhancement on postcontrast images. These results suggest that Gd-DTPA can improve MR visualization and detection of acute myocardial infarction.
Insights
Gadolinium (Gd)-DTPA enhances magnetic resonance (MR) imaging for detecting acute myocardial infarction in humans. This contrast agent significantly improves visualization of infarcted heart muscle and related complications like septal rupture.
Area of Science:
- Cardiovascular Imaging
- Medical Diagnostics
- Radiology
Background:
- Acute myocardial infarction (AMI) detection is crucial for timely intervention.
- Magnetic resonance (MR) imaging shows potential for diagnosing AMI.
- Gadolinium (Gd)-DTPA is a contrast agent with potential to enhance MR imaging of myocardial infarction.
Purpose of the Study:
- To evaluate the effectiveness of Gd-DTPA in improving the detection and visualization of acute myocardial infarction in human patients using MR imaging.
- To assess the timing and degree of contrast enhancement in infarcted myocardium after Gd-DTPA administration.
Main Methods:
- Five patients with acute myocardial infarction (2-17 days post-event) underwent ECG-gated MR imaging.
- Spin-echo images were acquired before and after intravenous administration of 0.1 mmol/kg Gd-DTPA.
- Image acquisition was repeated every 10 minutes for up to 40 minutes post-injection to analyze signal intensity changes over time.
Main Results:
- Gd-DTPA administration led to increased signal intensity in infarcted areas within 20-40 minutes post-injection in most patients.
- Optimal contrast between normal and infarcted myocardium was observed 20-30 minutes after Gd-DTPA injection.
- Post-contrast imaging significantly improved infarct definition and clearly visualized a complex case of septal rupture with associated myocardial enhancement.
Conclusions:
- Gd-DTPA significantly enhances MR imaging for the detection and definition of acute myocardial infarction in humans.
- The contrast agent improves visualization of infarcted myocardium and associated complications.
- Gd-DTPA is a valuable tool for improving MR-based diagnosis of acute myocardial infarction.