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Detection of Intramyocardial Iron in Patients Following ST-Elevation Myocardial Infarction Using Cardiac Diffusion
Arka Das1, Christopher Kelly1, Irvin Teh1
1Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Insights
Cardiac diffusion tensor imaging (cDTI) effectively detects intramyocardial hemorrhage (IMH) post-ST-elevation myocardial infarction (STEMI). This technique shows high sensitivity and specificity, offering a new method for IMH assessment.
Area of Science:
- Cardiovascular Imaging
- Magnetic Resonance Imaging
- Myocardial Infarction Research
Background:
- Intramyocardial hemorrhage (IMH) after ST-elevation myocardial infarction (STEMI) is linked to poor patient outcomes.
- Cardiac magnetic resonance (MR) T2* mapping is the standard for IMH detection.
- The utility of cardiac diffusion tensor imaging (cDTI) for IMH detection remains unexplored.
Purpose of the Study:
- To evaluate the effectiveness of cardiac diffusion tensor imaging (cDTI) in detecting intramyocardial hemorrhage (IMH) following ST-elevation myocardial infarction (STEMI).
- To compare cDTI findings with the established T2* mapping technique for IMH assessment.
Main Methods:
- A prospective study involving 50 patients post-STEMI, scanned at 1 week and 3 months using 3.0T MR.
- Utilized T2* mapping for IMH detection and spin-echo cDTI to generate mean diffusivity (MD) and fractional anisotropy (FA) maps.
- Co-registered cDTI images with T2* maps, quantifying IMH using hypointense signal areas on averaged diffusion-weighted images (DWIs).
Main Results:
- cDTI successfully identified IMH in all patients with IMH detected by T2* mapping (100% sensitivity).
- Mean diffusivity (MD) was significantly reduced and fractional anisotropy (FA) significantly increased within IMH areas compared to surrounding infarcted myocardium.
- Overall sensitivity and specificity for IMH detection using averaged-DWI were 100% and 96%, respectively.
Conclusions:
- Cardiac diffusion tensor imaging (cDTI) parameters (MD and FA) are sensitive to the paramagnetic effects of iron, enabling IMH detection.
- cDTI provides a valuable tool for characterizing myocardial architecture and detecting IMH post-STEMI.
Background:
Intramyocardial hemorrhage (IMH) following ST-elevation myocardial infarction (STEMI) is associated with poor prognosis. In cardiac magnetic resonance (MR), T2* mapping is the reference standard for detecting IMH while cardiac diffusion tensor imaging (cDTI) can characterize myocardial architecture via fractional anisotropy (FA) and mean diffusivity (MD) of water molecules. The value of cDTI in the detection of IMH is not currently known.
Hypothesis:
cDTI can detect IMH post-STEMI.
Study Type:
Prospective.
Subjects:
A total of 50 patients (20% female) scanned at 1-week (V1) and 3-month (V2) post-STEMI.
Field Strength/Sequence:
A 3.0 T; inversion-recovery T1-weighted-imaging, multigradient-echo T2* mapping, spin-echo cDTI.
Assessment:
T2* maps were analyzed to detect IMH (defined as areas with T2* < 20 msec within areas of infarction). cDTI images were co-registered to produce averaged diffusion-weighted-images (DWIs), MD, and FA maps; hypointense areas were manually planimetered for IMH quantification.
Statistics:
On averaged DWI, the presence of hypointense signal in areas matching IMH on T2* maps constituted to true-positive detection of iron. Independent samples t-tests were used to compare regional cDTI values. Results were considered statistically significant at P ≤ 0.05.
Results:
At V1, 24 patients had IMH on T2*. On averaged DWI, all 24 patients had hypointense signal in matching areas. IMH size derived using averaged-DWI was nonsignificantly greater than from T2* (2.0 ± 1.0 cm2 vs 1.89 ± 0.96 cm2 , P = 0.69). Compared to surrounding infarcted myocardium, MD was significantly reduced (1.29 ± 0.20 × 10-3 mm2 /sec vs 1.75 ± 0.16 × 10-3 mm2 /sec) and FA was significantly increased (0.40 ± 0.07 vs 0.23 ± 0.03) within areas of IMH. By V2, all 24 patients with acute IMH continued to have hypointense signals on averaged-DWI in the affected area. T2* detected IMH in 96% of these patients. Overall, averaged-DWI had 100% sensitivity and 96% specificity for the detection of IMH.
Data Conclusion:
This study demonstrates that the parameters MD and FA are susceptible to the paramagnetic properties of iron, enabling cDTI to detect IMH.
Evidence Level:
1 TECHNICAL EFFICACY: Stage 2.
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