Gadolinium pharmacokinetics of chronic myocardial infarcts: Implications for late gadolinium-enhanced infarct imaging.
OBJECTIVE
To monitor gadolinium pharmacokinetics in the hearts of patients with chronic myocardial infarcts and to determine the variability of contrast agent concentrations and accuracy of infarct detection over an hour time period.


METHODS
Twenty-five patients with chronic myocardial infarcts were examined. T1 measurements were performed every 2 minutes using an inversion recovery CINE balanced steady-state free precession technique. Paired differences in T1 values over time for the discrimination between the left ventricular (LV) bloodpool, viable, and infarct myocardium were statistically evaluated. The average change per 1, 5, and 10 minutes of the inversion time parameter for optimal nulling of viable myocardium was calculated. Receiver operator characteristic (ROC) curve analysis was performed to compare the performance of late gadolinium-enhanced infarct imaging at increasing delays after contrast agent administration.


RESULTS
Significantly different T1 values were reached after 10 minutes between the LV bloodpool, infarcted, and viable myocardium. The T1 difference between myocardial infarcts and the LV bloodpool increased over time, while the difference between viable myocardium and the LV bloodpool decreased. ROC curve analysis showed a decrease in performance of a fixed T1 value to discriminate between the LV bloodpool and viable myocardium over time, while there was a marked increase in the discrimination between the LV bloodpool and infarcted myocardium.


CONCLUSIONS
The ability to discriminate between infarcted myocardium and the LV bloodpool improves with an increasing delay after contrast agent administration while discrimination between viable myocardium and the LV bloodpool decreases.
Department of Research and Education, Saint Francis Hospital, Roslyn, New York 11576, USA. James.Goldfarb@chsli.org
James W
JW
Goldfarb
Sheeba
S
Arnold
Marguerite
M
Roth
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002908:Chronic Disease; D003287:Contrast Media / Q000493:pharmacokinetics*; D005260:Female; D019786:Gadolinium DTPA / Q000493:pharmacokinetics*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology*; D012372:ROC Curve
D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA