3D and 2D delayed-enhancement magnetic resonance imaging for detection of myocardial infarction: preclinical and clinical results.
OBJECTIVE
The purpose was to verify whether myocardial viability can be detected by a delayed enhancement magnetic resonance imaging (MRI) approach using a rapid three-dimensional inversion-recovery fast low-angle shot (3D IR-FLASH) sequence in a preclinical and clinical setting.


METHODS
Nonreperfused myocardial infarctions were induced in eight minipigs. Both the pigs and 15 patients with suspected myocardial infarction underwent MRI using a rapid 3D IR-FLASH sequence and a two-dimensional IR-FLASH sequence as the reference standard.


RESULTS
In the pigs, a total of 52 segments with myocardial infarction were identified with both sequences and there was good agreement in transmurality of 99.5%. The infarction volume determined with the 3D IR-FLASH in the animal study (2.4 +/- 1.5 cm(3)) showed a good correlation with the histomorphometrically determined volume using triphenyltetrazolium chloride (2.3 +/- 1.2 cm(3), r = 0.98, P < .001) and the two-dimensional IR-FLASH sequence (2.3 +/- 1.4 cm(3), r = 0.99, P < .001). Eleven of 15 patients were found to have myocardial infarction in 37 myocardial segments with both sequences and there was a good agreement in transmurality of 98.8%. There was also a good correlation in the clinical study between the 3D and 2D sequences (6.9 +/- 6.7 cm(3) vs. 6.8 +/- 6.5 cm(3), r = 0.98, P < .001). In Bland-Altman analysis there was no significant under- or overestimation of the myocardial infarction volume using the 3D IR-FLASH sequence in comparison to the two-dimensional reference standard in both the preclinical and clinical study. The contrast-to-noise ratios were not significantly different between 3D and 2D sequences in the animal (34.7 +/- 1.5 vs. 33.8 +/- 2.6; P = .51) and clinical study (31.4 +/- 12.5 vs. 36.7 +/- 11.5; P = .31). The breathhold time for the 3D IR-FLASH sequence in the clinical study (20.4 +/- 2.2 s) was significantly shorter than that of the 2D IR-FLASH sequence (190.1 +/- 20.8 s, P < .001).


CONCLUSIONS
The rapid 3D IR-FLASH sequence detects myocardial infarction with high accuracy and allows a relevant reduction in acquisition time.
Peukert
Daniel
D
Department of Radiology, Charité, Humboldt Universität zu Berlin, Institut für Radiologie, Charitéplatz 1, 10117 Berlin, Germany.
Laule
Michael
M
Taupitz
Matthias
M
Kaufels
Nicola
N
Hamm
Bernd
B
Dewey
Marc
M
D000368:Aged; D000818:Animals; D002908:Chronic Disease; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D019786:Gadolinium DTPA; D006571:Heterocyclic Compounds; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis*; D009942:Organometallic Compounds; D011237:Predictive Value of Tests; D012015:Reference Standards; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013552:Swine; D013556:Swine, Miniature; D013997:Time Factors
D003287:Contrast Media; D006571:Heterocyclic Compounds; D009942:Organometallic Compounds; C050823:gadolinium 1,4,7,10-tetraazacyclododecane-N,N',N'',N'''-tetraacetate; D019786:Gadolinium DTPA