Magnetic resonance imaging of chronic myocardial infarcts in man

To evaluate the magnetic resonance imaging (MRI) features of chronic myocardial infarction (MI), 22 patients and several normal volunteers were studied with a 0.35-T cryogenic imaging system. The MIs were 9 months to 16 years old. The patients also had either left ventriculography (17 patients) or two-dimensional echocardiography (17 patients). At least one abnormality indicative of prior infarction was demonstrated on MRI in 20 of the 22 patients. Wall thinning was seen in 20 patients; in six of these, the thinning resulted in aneurysm formation. The other 14 patients had sufficient residual wall thickness to permit measurement of T2 relaxation times and MR signal intensity in the infarcted region. Ten of these 14 patients demonstrated low intensity and shortened T2 of the thinned segments (mean T2 = 28.7 msec) compared to adjacent normal myocardium (mean T2 = 45.4 msec) and to the myocardium of volunteers (mean T2 = 41.3 msec). The percentage of difference in intensity between thinned and normal myocardium was greater on 56-msec-TE images (98.2%) than on 28-msec-TE images (46.1%). In the other four patients, no difference in intensity of the myocardium was perceptible in the thinned region of the myocardial wall. Thus MRI shows regional wall thinning at the site of prior MI. In some patients, the chronic infarct is characterized as decreased spin-echo signal intensity and shortened T2 consistent with replacement of myocardium by fibrous scar.