title: Relationship of T2-Weighted MRI Myocardial Hyperintensity and the Ischemic Area-At-Risk.
abstract: BACKGROUND
  After acute myocardial infarction (MI), delineating the area-at-risk (AAR) is crucial for measuring how much, if any, ischemic myocardium has been salvaged. T2-weighted MRI is promoted as an excellent method to delineate the AAR. However, the evidence supporting the validity of this method to measure the AAR is indirect, and it has never been validated with direct anatomic measurements.
  
  
  OBJECTIVE
  To determine whether T2-weighted MRI delineates the AAR.
  
  
  RESULTS
  Twenty-one canines and 24 patients with acute MI were studied. We compared bright-blood and black-blood T2-weighted MRI with images of the AAR and MI by histopathology in canines and with MI by in vivo delayed-enhancement MRI in canines and patients. Abnormal regions on MRI and pathology were compared by (a) quantitative measurement of the transmural-extent of the abnormality and (b) picture matching of contours. We found no relationship between the transmural-extent of T2-hyperintense regions and that of the AAR (bright-blood-T2: r=0.06, P=0.69; black-blood-T2: r=0.01, P=0.97). Instead, there was a strong correlation with that of infarction (bright-blood-T2: r=0.94, P<0.0001; black-blood-T2: r=0.95, P<0.0001). Additionally, contour analysis demonstrated a fingerprint match of T2-hyperintense regions with the intricate contour of infarcted regions by delayed-enhancement MRI. Similarly, in patients there was a close correspondence between contours of T2-hyperintense and infarcted regions, and the transmural-extent of these regions were highly correlated (bright-blood-T2: r=0.82, P<0.0001; black-blood-T2: r=0.83, P<0.0001).
  
  
  CONCLUSIONS
  T2-weighted MRI does not depict the AAR. Accordingly, T2-weighted MRI should not be used to measure myocardial salvage, either to inform patient management decisions or to evaluate novel therapies for acute MI.
authors.affiliation: From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.).
authors.forename: Han W
authors.initials: HW
authors.lastname: Kim
authors.affiliation: From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.).
authors.forename: Lowie
authors.initials: L
authors.lastname: Van Assche
authors.affiliation: From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.).
authors.forename: Robert B
authors.initials: RB
authors.lastname: Jennings
authors.affiliation: From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.).
authors.forename: W Benjamin
authors.initials: WB
authors.lastname: Wince
authors.affiliation: From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.).
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Jensen
authors.affiliation: From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.).
authors.forename: Wolfgang G
authors.initials: WG
authors.lastname: Rehwald
authors.affiliation: From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.).
authors.forename: David C
authors.initials: DC
authors.lastname: Wendell
authors.affiliation: From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.).
authors.forename: Lubna
authors.initials: L
authors.lastname: Bhatti
authors.affiliation: From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.).
authors.forename: Deneen M
authors.initials: DM
authors.lastname: Spatz
authors.affiliation: From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.).
authors.forename: Michele A
authors.initials: MA
authors.lastname: Parker
authors.affiliation: From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.).
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Jenista
authors.affiliation: From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.).
authors.forename: Igor
authors.initials: I
authors.lastname: Klem
authors.affiliation: From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.).
authors.forename: Anna Lisa C
authors.initials: AL
authors.lastname: Crowley
authors.affiliation: From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.).
authors.forename: Enn-Ling
authors.initials: EL
authors.lastname: Chen
authors.affiliation: From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.).
authors.forename: Robert M
authors.initials: RM
authors.lastname: Judd
authors.affiliation: From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.). raymond.kim@duke.edu.
authors.forename: Raymond J
authors.initials: RJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D003326:Coronary Circulation; D003937:Diagnosis, Differential; D004285:Dogs; D004487:Edema / Q000473:pathology; D023381:Endpoint Determination; D005260:Female; D005456:Fluorescent Dyes; D006321:Heart / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000139:chemically induced / Q000473:pathology* / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology*; D009929:Organ Size; D009942:Organometallic Compounds; D011446:Prospective Studies; D012306:Risk; D020107:Troponin T / Q000097:blood
chemical_list: D005456:Fluorescent Dyes; D009942:Organometallic Compounds; D020107:Troponin T; C112666:gadoversetamide
keywords: MRI; magnetic resonance; myocardial infarction