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DOI: 10.1148/radiol.2493080340
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(Radiology 2009;250:50-60.)
© RSNA, 2009

Cardiac Imaging

Determination of Regional Ejection Fraction in Patients with Myocardial Infarction by Using Merged Late Gadolinium Enhancement and Cine MR: Feasibility Study1

Pier Giorgio Masci, MD, Steven Dymarkowski, MD, PhD, Frank E. Rademakers, MD, PhD, and Jan Bogaert, MD, PhD

1 From the Departments of Radiology (P.G.M., S.D., J.B.) and Cardiology (F.E.R.), University Hospitals of Leuven, Herestraat 49, B-3000 Leuven, Belgium. Received February 22, 2008; revision requested April 14; revision received June 11; accepted July 1; final version accepted July 15. Supported by FWO grant G. 0613.09N. Address correspondence to J.B. (e-mail: Jan.Bogaert{at}uz.kuleuven.ac.be).

Purpose: To quantify regional ejection fraction (EF) in patients with myocardial infarction (MI) by using merged late gadolinium enhancement (LGE) and cine magnetic resonance (MR) imaging, and compare this method with the standardized 17-segment American Heart Association approach.

Materials and Methods: After institutional review board approval and informed consent, 15 MI patients (14 men, one woman; mean age, 63 years ± 10 [standard deviation]) were studied at 1 week and at 4 months after MI. Short-axis LGE MR information was used to quantify infarct size, and to divide the left ventricle (LV) on short-axis cine MR images in infarct, periinfarct, and remote regions by using a fixed-center method, yielding information on regional volumes, regional EFs, systolic wall thickening (SWT), and systolic wall motion (SWM). This approach was compared with a floating-center approach and the 17-segment approach.

Results: Mean infarct size (normalized to LV mass) was 25% ± 14 at 1 week and 16% ± 8 at 4 months (P < .001). At 4 months, LV EF significantly improved (mean, 47.9% ± 5.9 vs 50.9% ± 6.6, P = .031), matching an improvement of regional EF (mean, 17.1% ± 11.5 vs 24.6% ± 13.1, P = .005) and SWM (mean, 3.2 mm ± 1.7 vs 3.9 mm ± 2.1, P = .027) in the infarcted myocardium. No significant changes in regional EF, SWT, or SWM occurred in the remote myocardium. Regional EF estimates correlated well with SWT and SWM (both r = 0.92, P < .001). The floating-center method invariably underestimated regional EF (mean, –20.8% ± 7.6; 95% confidence interval: –23.7%, –17.9%), especially with increasing infarct size. By using the 17-segment approach, no functional improvement was shown in the infarcted myocardium.

Conclusion: Assessment of regional ventricular performance (regional EF) in well-defined areas (eg, infarcted and remote myocardium) is feasible by using merged LGE and cine MR imaging.

© RSNA, 2009




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