title: Bright-blood T2-weighted MRI has higher diagnostic accuracy than dark-blood short tau inversion recovery MRI for detection of acute myocardial infarction and for assessment of the ischemic area at risk and myocardial salvage.
abstract: BACKGROUND
  T2-Weighted MRI reveals myocardial edema and enables estimation of the ischemic area at risk and myocardial salvage in patients with acute myocardial infarction (MI). We compared the diagnostic accuracy of a new bright-blood T2-weighted with a standard black blood T2-weighted MRI in patients with acute MI.
  
  
  RESULTS
  A breath-hold, bright-blood T2-weighted, Acquisition for Cardiac Unified T2 Edema pulse sequence with normalization for coil sensitivity and a breath-hold T2 dark-blood short tau inversion recovery sequence were used to depict the area at risk in 54 consecutive acute MI patients. Infarct size was measured on gadolinium late contrast enhancement images. Compared with dark-blood T2-weighted MRI, consensus agreements between independent observers for identification of myocardial edema were higher with bright-blood T2-weighted MRI when evaluated per patient (P<0.001) and per segment of left ventricle (P<0.001). Compared with bright-blood T2-weighted MRI, dark-blood T2-weighted MRI underestimated the area at risk compared with infarct size (P<0.001). The 95% limits of agreement for interobserver agreements for the ischemic area at risk and myocardial salvage were wider with dark-blood T2-weighted MRI than with bright-blood T2-weighted MRI. Bright blood enabled more accurate identification of the culprit coronary artery with correct identification in 94% of cases compared with 61% for dark blood (P<0.001).
  
  
  CONCLUSIONS
  Bright-blood T2-weighted MRI has higher diagnostic accuracy than dark-blood T2-weighted MRI. Additionally, dark-blood T2-weighted MRI may underestimate area at risk and myocardial salvage.
authors.affiliation: West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, Scotland, United Kingdom.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Payne
authors.forename: Matthew
authors.initials: M
authors.lastname: Casey
authors.forename: John
authors.initials: J
authors.lastname: McClure
authors.forename: Ross
authors.initials: R
authors.lastname: McGeoch
authors.forename: Aengus
authors.initials: A
authors.lastname: Murphy
authors.forename: Rosemary
authors.initials: R
authors.lastname: Woodward
authors.forename: Andrew
authors.initials: A
authors.lastname: Saul
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Bi
authors.forename: Sven
authors.initials: S
authors.lastname: Zuehlsdorff
authors.forename: Keith G
authors.initials: KG
authors.lastname: Oldroyd
authors.forename: Niko
authors.initials: N
authors.lastname: Tzemos
authors.forename: Colin
authors.initials: C
authors.lastname: Berry
mesh_terms: D001769:Blood; D017023:Coronary Angiography; D004489:Edema, Cardiac / Q000175:diagnosis; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D017202:Myocardial Ischemia / Q000175:diagnosis*; D009206:Myocardium / Q000473:pathology; D015588:Observer Variation