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Published online before print June 26, 2006, 10.1148/radiol.2402051086
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MR Guidance of Targeted Injections into Border and Core of Scarred Myocardium in Pigs1

Maythem Saeed, DVM, PhD, Alastair J. Martin, PhD, Randall J. Lee, MD, PhD, Oliver Weber, PhD, Didier Revel, MD, David Saloner, PhD and Charles B. Higgins, MD

1 From the Departments of Radiology (M.S., A.J.M., O.W., D.R., D.S., C.B.H.) and Medicine and Cardiology (R.J.L.), University of California San Francisco, 513 Parnassus Ave, Room HSW 207 B, San Francisco, CA 94143-0628. Received June 28, 2005; revision requested August 23; revision received August 29; accepted September 22; final version accepted November 16. Address correspondence to M.S. (e-mail: maythem.saeed{at}radiology.ucsf.edu).


Figure 1
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  		Figure 1a: Long-axis MR images (4.0/2.0, 70° flip angle, 240-mm field of view, 160 x 160 matrix, 8-mm section thickness, 2 frames per second) acquired in water bath containing nitinol catheter and different active coil elements. (a) Only the external coil elements were active. (b) Only the catheter coil was active. (c) Only the catheter tip microcoil was active. (d) Field of view when all coil elements are contributing to the image. H = head, P = posterior.

 

Figure 1
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  		Figure 1b: Long-axis MR images (4.0/2.0, 70° flip angle, 240-mm field of view, 160 x 160 matrix, 8-mm section thickness, 2 frames per second) acquired in water bath containing nitinol catheter and different active coil elements. (a) Only the external coil elements were active. (b) Only the catheter coil was active. (c) Only the catheter tip microcoil was active. (d) Field of view when all coil elements are contributing to the image. H = head, P = posterior.

 

Figure 1
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  		Figure 1c: Long-axis MR images (4.0/2.0, 70° flip angle, 240-mm field of view, 160 x 160 matrix, 8-mm section thickness, 2 frames per second) acquired in water bath containing nitinol catheter and different active coil elements. (a) Only the external coil elements were active. (b) Only the catheter coil was active. (c) Only the catheter tip microcoil was active. (d) Field of view when all coil elements are contributing to the image. H = head, P = posterior.

 

Figure 1
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  		Figure 1d: Long-axis MR images (4.0/2.0, 70° flip angle, 240-mm field of view, 160 x 160 matrix, 8-mm section thickness, 2 frames per second) acquired in water bath containing nitinol catheter and different active coil elements. (a) Only the external coil elements were active. (b) Only the catheter coil was active. (c) Only the catheter tip microcoil was active. (d) Field of view when all coil elements are contributing to the image. H = head, P = posterior.

 

Figure 2
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  		Figure 2: A–F, MR images demonstrate injection of sprodiamide into border and core of scarred myocardium. Delayed contrast-enhanced long-axis (A) and short-axis (D) views depict the scar (arrow). B, Injection catheter (arrow) is introduced into the LV and is manipulated with MR fluoroscopy until it is aimed at the desired target. The injection catheter contains two MR coils, one encompassing the catheter shaft and another depicting the tip of the catheter. C, Image resulting when external radiofrequency coils used in B are turned off and the catheter coil elements are used to create the MR image; area of high signal intensity (arrow) demarcates the catheter tip. Injection of sprodiamide can be monitored with MR fluoroscopy (arrow in E) and assessed after injection at cine MR imaging (arrow in F).

 

Figure 3
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  		Figure 3a: Long-axis MR fluoroscopic images of the heart show tip of the active catheter (arrow) at (a) proximal portion, (b) core, and (c) distal portion of scarred thin wall of myocardium. Catheter illuminates the LV chamber and reaches different targets.

 

Figure 3
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  		Figure 3b: Long-axis MR fluoroscopic images of the heart show tip of the active catheter (arrow) at (a) proximal portion, (b) core, and (c) distal portion of scarred thin wall of myocardium. Catheter illuminates the LV chamber and reaches different targets.

 

Figure 3
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  		Figure 3c: Long-axis MR fluoroscopic images of the heart show tip of the active catheter (arrow) at (a) proximal portion, (b) core, and (c) distal portion of scarred thin wall of myocardium. Catheter illuminates the LV chamber and reaches different targets.

 

Figure 4
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  		Figure 4a: (a) Short- and (b–d) long-axis MR images of the heart. Scarred myocardium is seen as hyperenhanced region (arrow) after administration of 0.1 mmol/kg gadoterate meglumine. (c, d) MR images show the tip of the endovascular active catheter in the (c) distal and (d) proximal borders of the infarcted region. The sites of sprodiamide injections appear as small hypoenhanced regions (arrowhead).

 

Figure 4
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  		Figure 4b: (a) Short- and (b–d) long-axis MR images of the heart. Scarred myocardium is seen as hyperenhanced region (arrow) after administration of 0.1 mmol/kg gadoterate meglumine. (c, d) MR images show the tip of the endovascular active catheter in the (c) distal and (d) proximal borders of the infarcted region. The sites of sprodiamide injections appear as small hypoenhanced regions (arrowhead).

 

Figure 4
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  		Figure 4c: (a) Short- and (b–d) long-axis MR images of the heart. Scarred myocardium is seen as hyperenhanced region (arrow) after administration of 0.1 mmol/kg gadoterate meglumine. (c, d) MR images show the tip of the endovascular active catheter in the (c) distal and (d) proximal borders of the infarcted region. The sites of sprodiamide injections appear as small hypoenhanced regions (arrowhead).

 

Figure 4
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  		Figure 4d: (a) Short- and (b–d) long-axis MR images of the heart. Scarred myocardium is seen as hyperenhanced region (arrow) after administration of 0.1 mmol/kg gadoterate meglumine. (c, d) MR images show the tip of the endovascular active catheter in the (c) distal and (d) proximal borders of the infarcted region. The sites of sprodiamide injections appear as small hypoenhanced regions (arrowhead).

 

Figure 5
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  		Figure 5a: Oblique long-axis cine MR images show (a) endocardial and (b) transmural distribution of 0.6 mL of sprodiamide (arrows) in border region at posterior wall of the LV (in a case of obtuse coronary artery occlusion). At postmortem examination, there was no evidence of intramyocardial hemorrhage or any aortic valve or vascular damage.

 

Figure 5
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  		Figure 5b: Oblique long-axis cine MR images show (a) endocardial and (b) transmural distribution of 0.6 mL of sprodiamide (arrows) in border region at posterior wall of the LV (in a case of obtuse coronary artery occlusion). At postmortem examination, there was no evidence of intramyocardial hemorrhage or any aortic valve or vascular damage.

 

Figure 6
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  		Figure 6: Histopathologic specimen of core and border of scar tissue. Top: Transmural collagen fibers. (Hematoxylin-eosin stain; original magnification, x25.) Bottom: Islands of degenerated myocytes (arrows) at border of scarred myocardium of an 8-week-old myocardial infarction. (Masson trichrome stain; original magnification, x400.) Note invasion of scar tissue into viable myocardium at the border. Scar tissue is light red with hematoxylin-eosin stain and blue gray with Masson trichrome stain.

 




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