Published online before print December 19, 2003, 10.1148/radiol.2302021120
Myocardial Viability: Rapid Assessment with Delayed Contrast-enhanced MR Imaging with Three-dimensional Inversion-Recovery Prepared Pulse Sequence1
Harald P. Kühl, MD,
Theano S. Papavasiliu, MD,
Aernout M. Beek, MD,
Mark B. M. Hofman, PhD,
Nicole S. Heusen, MSc and
Albert C. van Rossum, MD, PhD
1 From Medical Clinic I (H.P.K.) and the Dept of Medical Statistics (N.S.H.), University Hospital Aachen, Pauwelstrasse 30, 52057 Aachen, Germany; and Depts of Cardiology (T.S.P., A.M.B., A.C.v.R.) and Clinical Physics and Informatics (M.B.M.H.), Vrÿe University Medical Center, Amsterdam, the Netherlands. Supported by Netherlands Heart Foundation grant 2001.158. H.P.K. supported in part by grants from the Faculty of Medicine of the Rheinisch-Westfälische Technische Hochschule, Aachen, Germany, and by the Grimmke-Stiftung, Düsseldorf, Germany. Received Sept 11, 2002; revision requested Nov 7; final revision received May 12, 2003; accepted June 16. Address correspondence to H.P.K. (e-mail: hkuehl@ukaachen.de).
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Figure 1a. (a) Corresponding short-axis MR images in a 65-year-old male patient. Top row: Two-dimensional images (repetition time msec/echo time msec/inversion time msec, 9.8/4.4/300.0; flip angle, 25°). Bottom row: Three-dimensional images (3.8/1.2/210.0; flip angle, 25°). Leftmost images demonstrate the overlay that was used for segmental data analysis. (b) Magnified images. Left: Two-dimensional image. Right: Three-dimensional image. Information concerning the presence and localization of hyperenhancement is similar with both sequences.
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Figure 1b. (a) Corresponding short-axis MR images in a 65-year-old male patient. Top row: Two-dimensional images (repetition time msec/echo time msec/inversion time msec, 9.8/4.4/300.0; flip angle, 25°). Bottom row: Three-dimensional images (3.8/1.2/210.0; flip angle, 25°). Leftmost images demonstrate the overlay that was used for segmental data analysis. (b) Magnified images. Left: Two-dimensional image. Right: Three-dimensional image. Information concerning the presence and localization of hyperenhancement is similar with both sequences.
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Figure 2. Schematic shows segmental model and qualitative data analysis. Presence of hyperenhancement was scored in each segment (positive scores in segments 1-3). Next, distribution of hyperenhancement throughout myocardial wall (transmural extent [white arrow]) and width of segments (segmental width of hyperenhancement [black arrow]) were scored in those segments with hyperenhancement. Score for segment 1 is 1 (no transmural extent or partial segmental width of hyperenhancement). Score for segments 2 and 3 is 2 (full transmural extent or full segmental width of hyperenhancement).
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Figure 3. A-D, Corresponding short-axis MR images acquired with the 2D sequence (9.8/4.4/250.0 [A] or 3,00.0 [C]; flip angle, 25°) and with the 3D sequence (3.8/1.3/200.0; flip angle, 25° [B, D]) in a 71-year-old male patient with a posterolateral infarction (arrowheads in A and B) and in a 56-year-old male patient with an anterior myocardial infarction (arrowheads in C and D). Small areas of delayed contrast enhancement (arrows) are equally well visualized with the 2D and 3D sequences. Nontransmural distribution of infarction can be appreciated in both patients with both acquisition approaches.
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Figure 4. Bland-Altman plots. Left: Individual differences for total myocardial area per MR image. Right: Delayed contrast-enhanced (DCE) areas on MR images obtained with the 2D and 3D MR sequences. Findings reveal no relevant bias, with acceptable limits of agreement between the two sequences for the quantification of myocardial and hyperenhancement areas.
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Copyright © 2004 by the Radiological Society of North America.
