title: Gadomer-enhanced MR imaging in the detection of microvascular obstruction: alleviation with nicorandil therapy.
abstract: OBJECTIVE
  To evaluate Gadomer-enhanced magnetic resonance (MR) imaging in the quantification of small microvascular obstruction regions and determine if nicroandil alleviates the formation of microvascular obstruction.
  
  
  METHODS
  Approval of the institutional committee on animal research was obtained, and this study complied with guidelines for care and use of animals. Rats underwent coronary artery occlusion and reperfusion. After 24 hours, Gadomer-enhanced T1-weighted spin-echo MR imaging was used to define microvascular obstruction in animals in control and nicorandil groups. Sequential MR images obtained at two midventricular levels were acquired to measure microvascular obstruction and ischemically injured regions and monitor diffusive and/or convective transport of Gadomer in microvascular obstruction regions. Two investigators working in consensus and using threshold signal intensity measured differentially enhanced regions. Left-ventricular (LV) end-systolic and end-diastolic MR images obtained at the same two midventricular levels were used to measure regional wall thickening and systolic reduction in LV relative volumes. Agreement and correlation between MR imaging and postmortem data were determined with Bland-Altman and linear regression analyses. Animals were sacrificed 3 minutes after intravenous injection of blue dye.
  
  
  RESULTS
  On Gadomer-enhanced MR images, two differentially enhanced regions were observed in ischemically injured myocardium, namely, the hypoenhanced region and the surrounding hyperenhanced region. Hypoenhanced regions at MR imaging and unstained regions at blue dye administration were identical 3 minutes after administration (17% +/- 1 and 17% +/- 2; P = .6; r = 0.98). In the control group, Gadomer provided a prolonged imaging window (eg, 6 minutes) for accurately quantifying small microvascular obstruction regions. Microvascular obstruction was observed in all animals in the control group and 27% of animals in the nicorandil group. Microvascular obstruction regions were smaller in the nicorandil group (eg, 3% +/- 1) than in the control group (eg, 17% +/- 2) (P < .001). Hyper- and hypoenhanced regions were also smaller (eg, 20% +/- 2) in rats in the nicorandil group than in those in the control group (37% +/- 4, P < .001). Improvement in LV function in the nicorandil group is likely related to alleviation and reduction in infarct size.
  
  
  CONCLUSIONS
  Gadomer-enhanced MR imaging can be used to quantify small microvascular obstruction regions 24 hours after reperfusion. Intravenous therapy with nicorandil reduces formation of microvascular obstruction regions.
authors.affiliation: Department of Radiology, University of California, San Francisco, 505 Parnassus Ave, HSW 207B, San Francisco, CA 94143-0628, USA.
authors.forename: Gabriele A
authors.initials: GA
authors.lastname: Krombach
authors.forename: Charles B
authors.initials: CB
authors.lastname: Higgins
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Chujo
authors.forename: Maythem
authors.initials: M
authors.lastname: Saeed
mesh_terms: D000818:Animals; D003287:Contrast Media; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000188:drug therapy*; D003331:Coronary Vessels / Q000187:drug effects; D005682:Gadolinium; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008833:Microcirculation; D020108:Nicorandil / Q000627:therapeutic use*; D051381:Rats; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D003287:Contrast Media; D014665:Vasodilator Agents; C402765:gadomer 17; D020108:Nicorandil; D005682:Gadolinium