1. Cardiac MRI to visualize myocardial damage after ST-segment elevation myocardial infarction
- Author
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Robin Nijveldt, Sebastiaan C.A.M. Bekkers, Henk Everaars, Lara S. F. Konijnenberg, Niels van Royen, Robert A. Kloner, Casper W. H. Beijnink, Saloua El Messaoudi, Raymond J. Kim, Albert C. van Rossum, and Nina W. van der Hoeven
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] ,PERCUTANEOUS CORONARY INTERVENTION ,SIGNAL INTENSITY ,Fibrosis ,Internal medicine ,Edema ,medicine ,Humans ,ST segment ,Late gadolinium enhancement ,Radiology, Nuclear Medicine and imaging ,Myocardial infarction ,cardiovascular diseases ,LATE GADOLINIUM-ENHANCEMENT ,INTRAMYOCARDIAL HEMORRHAGE ,QUANTITATIVE ASSESSMENT ,business.industry ,Myocardium ,Reproducibility of Results ,Percutaneous coronary intervention ,Vascular damage Radboud Institute for Molecular Life Sciences [Radboudumc 16] ,Heart ,Infarct size ,medicine.disease ,Magnetic Resonance Imaging ,PROGNOSTIC VALUE ,CARDIOVASCULAR MAGNETIC-RESONANCE ,MICROVASCULAR OBSTRUCTION ,PORCINE MODEL ,Cardiology ,CONTRAST ENHANCEMENT ,cardiovascular system ,ST Elevation Myocardial Infarction ,medicine.symptom ,business ,Reperfusion injury - Abstract
Item does not contain fulltext Cardiac MRI is a noninvasive diagnostic tool using nonionizing radiation that is widely used in patients with ST-segment elevation myocardial infarction (STEMI). Cardiac MRI depicts different prognosticating components of myocardial damage such as edema, intramyocardial hemorrhage (IMH), microvascular obstruction (MVO), and fibrosis. But how do cardiac MRI findings correlate to histologic findings? Shortly after STEMI, T2-weighted imaging and T2* mapping cardiac MRI depict, respectively, edema and IMH. The acute infarct size can be determined with late gadolinium enhancement (LGE) cardiac MRI. T2-weighted MRI should not be used for area-at-risk delineation because T2 values change dynamically over the first few days after STEMI and the severity of T2 abnormalities can be modulated with treatment. Furthermore, LGE cardiac MRI is the most accurate method to visualize MVO, which is characterized by hemorrhage, microvascular injury, and necrosis in histologic samples. In the chronic setting post-STEMI, LGE cardiac MRI is best used to detect replacement fibrosis (ie, final infarct size after injury healing). Finally, native T1 mapping has recently emerged as a contrast material-free method to measure infarct size that, however, remains inferior to LGE cardiac MRI. Especially LGE cardiac MRI-defined infarct size and the presence and extent of MVO may be used to monitor the effect of new therapeutic interventions in the treatment of reperfusion injury and infarct size reduction. © RSNA, 2021 Online supplemental material is available for this article.
- Published
- 2021