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Assessment of Myocardial Infarction in Humans with ²³Na MR Imaging: Comparison with Cine MR Imaging and Delayed Contrast Enhancement¹

¹ From the Departments of Radiology (J.J.W.S., T.P., M.B., C.L., K.B., F.B., W.K., D.H.) and Internal Medicine (K.H., W.V.), University of Würzburg, Klinikstrasse 8, D-97070 Würzburg, Germany; and Department of Cardiovascular Medicine, Oxford University, England (S.N.). Received September 21, 2000; revision requested November 22; revision received January 31, 2001; accepted February 26. Supported by a grant from the Bundesministerium für Bildung und Forschung, IZKF Würzburg (01 KS 9603). Address correspondence to J.J.W.S. (e-mail: joern.sandstede@mail.uni-wuerzburg.de).

PURPOSE: To demonstrate the feasibility of sodium 23 (²³Na) magnetic resonance (MR) imaging for assessment of subacute and chronic myocardial infarction and compare with cine, late enhancement, and T2-weighted imaging.

MATERIALS AND METHODS: Thirty patients underwent MR imaging 8 days ± 4 (subacute, n = 15) or more than 6 months (chronic, n = 15) after myocardial infarction by using a ²³Na surface coil with a double angulated electrocardiogram-triggered three-dimensional gradient-echo sequence at 1.5 T. In addition, cine, inversion-recovery gradient-echo, and, in the subacute group, T2-weighted images (n = 9) were obtained. Myocardial infarction mass was depicted as elevated signal intensity or wall motion abnormalities and expressed as a percentage of total left ventricular mass for all modalities. Correlations were tested with correlation coefficients.

RESULTS: All patients after subacute infarction and 12 of 15 patients with chronic infarction had an area of elevated ²³Na signal intensity that significantly correlated with wall motion abnormalities (subacute; r = 0.96, P < .001, and chronic; r = 0.9, P < .001); three patients had no wall motion abnormalities or elevated ²³Na signal intensity. Only 10 patients in the subacute and nine in the chronic group revealed late enhancement; significant correlation with ²³Na MR imaging occurred only in subacute group (r = 0.68, P < .05). Myocardial edema in subacute infarction correlated (r = 0.71, P < .05) with areas of elevated ²³Na signal intensity but was extensively larger.

CONCLUSION: ²³Na MR imaging demonstrates dysfunctional myocardium caused by subacute and chronic myocardial infarction.

Index terms: Myocardium, infarction, 511.771 • Myocardium, MR, 511.12147 • Magnetic resonance (MR), sodium studies, 511.121412, 511.12147

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