Accurate and objective infarct sizing by contrast-enhanced magnetic resonance imaging in a canine myocardial infarction model.
OBJECTIVE
To identify an accurate and reproducible method to define myocardial infarct (MI) size, we conducted a study in a closed-chest canine model of acute myocardial infarction, in which MI size was measured using different thresholding techniques and by imaging at different delay times after contrast administration.


BACKGROUND
The MI size by contrast-enhanced magnetic resonance imaging (CE-MRI) is directly related to long-term prognosis. However, previous measurements were done using nonuniform methods and tended to overestimate nonviable areas.


METHODS
Thirteen animals underwent 90 min of coronary artery occlusion, followed by reperfusion. The CE-MRI data were acquired within 24 h after reperfusion and compared with triphenyltetrazolium chloride pathology. In the first nine animals, images were obtained approximately 15 min after gadolinium diethylene triamine penta-acetic acid (Gd-DTPA) using an inversion-recovery gradient-echo pulse sequence. To identify the most accurate method, MI size by CE-MRI was measured visually and by semi-automatic thresholding techniques, using different criteria. In four additional animals, images were acquired every 6 min until 30 min after Gd-DTPA.


RESULTS
Postmortem MI size was 13.5 +/- 2.6% of left ventricular volume. Semi-automatic techniques, using full-width at half-maximum (FWHM) criterion, correlated best with postmortem data (r(2) = 0.94, p < 0.001; results confirmed by Bland-Altman plots). Using FWHM, there was no difference in MI size between different delay times after contrast (15.2 +/- 2.9% to 14.5 +/- 4.2% at 6 and 30 min, respectively; p = NS).


CONCLUSIONS
When an objective technique is used to define MI size by CE-MRI, accurate infarct size measurements can be obtained from images obtained up to 30 min after contrast administration.
Amado
Luciano C
LC
Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 2187, USA.
Gerber
Bernhard L
BL
Gupta
Sandeep N
SN
Rettmann
Dan W
DW
Szarf
Gilberto
G
Schock
Robert
R
Nasir
Khurram
K
Kraitchman
Dara L
DL
Lima
João A C
JA
D000818:Animals; D004396:Coloring Agents; D003287:Contrast Media; D004285:Dogs; D017352:Echo-Planar Imaging; D019786:Gadolinium DTPA; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000473:pathology; D013778:Tetrazolium Salts; D013997:Time Factors
D004396:Coloring Agents; D003287:Contrast Media; D013778:Tetrazolium Salts; C009591:triphenyltetrazolium; D019786:Gadolinium DTPA