title: Bright-blood T(2)-weighted MRI has high diagnostic accuracy for myocardial hemorrhage in myocardial infarction: a preclinical validation study in swine.
abstract: BACKGROUND
  Myocardial hemorrhage after myocardial infarction (MI) usually goes undetected. We investigated the diagnostic accuracy of bright-blood T(2)-weighted cardiac MRI for myocardial hemorrhage in experimental MI.
  
  
  RESULTS
  MI was created in swine by occluding the left anterior descending (n=10) or circumflex (n=5) coronary arteries for 90 minutes followed by reperfusion for ≤3 days (n=2), 10 days (n=7), or 60 days (n=6). MRI was performed at 1.5 T, using bright-blood T(2)-prepared steady-state free-precession, T(2)* and early (1 minute) and late (10-15 minutes) gadolinium enhancement (EGE, LGE, respectively) MRI. Left ventricular sections and histology were assessed for hemorrhage by an experienced cardiac pathologist blinded to the MRI data. Hypointense regions on T(2)-weighted and contrast-enhanced MRI were independently determined by 3 cardiologists experienced in MRI who were also blinded to the pathology results. Eighty ventricular pathological sections were matched with MRI (n=68 for EGE MRI). All sections with evidence of MI (n=63, 79%) also exhibited hyperintense zones consistent with edema on T(2)-weighted MRI and infarct on LGE MRI. Myocardial hemorrhage occurred in 49 left ventricular sections (61%) and corresponded with signal voids on 48 T(2)-weighted (98%) and 26 LGE-MRI (53%). Alternatively, signal voids occurred in the absence of hemorrhage in 3 T(2)-weighted (90% specificity) and 5 LGE MRI (84% specificity). On EGE MRI, 27 of 43 cases of early microvascular obstruction corresponded with hemorrhage (63% sensitivity), whereas 5 of 25 defects occurred in the absence of hemorrhage (80% specificity). The positive and negative predictive values for pathological evidence of hemorrhage were 94% and 96% for T(2)-weighted, 84% and 55% for LGE MRI, and 85% and 56% for EGE MRI.
  
  
  CONCLUSIONS
  Bright-blood T(2)-weighted MRI has high diagnostic accuracy for myocardial hemorrhage.
authors.affiliation: National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, MD 20892-1061, USA.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Payne
authors.forename: Colin
authors.initials: C
authors.lastname: Berry
authors.forename: Peter
authors.initials: P
authors.lastname: Kellman
authors.forename: Rachel
authors.initials: R
authors.lastname: Anderson
authors.forename: Li-Yueh
authors.initials: LY
authors.lastname: Hsu
authors.forename: Marcus Y
authors.initials: MY
authors.lastname: Chen
authors.forename: Allan R
authors.initials: AR
authors.lastname: McPhaden
authors.forename: Stuart
authors.initials: S
authors.lastname: Watkins
authors.forename: William
authors.initials: W
authors.lastname: Schenke
authors.forename: Victor
authors.initials: V
authors.lastname: Wright
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lederman
authors.forename: Anthony H
authors.initials: AH
authors.lastname: Aletras
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Arai
mesh_terms: D000818:Animals; D001707:Biopsy, Needle; D003287:Contrast Media; D004195:Disease Models, Animal; D006331:Heart Diseases / Q000175:diagnosis* / Q000209:etiology; D006470:Hemorrhage / Q000175:diagnosis* / Q000209:etiology; D007089:Image Enhancement / Q000379:methods; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009203:Myocardial Infarction / Q000150:complications*; D009206:Myocardium / Q000473:pathology*; D011897:Random Allocation; D012680:Sensitivity and Specificity; D013552:Swine
chemical_list: D003287:Contrast Media